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Biomedical subjects

Amy L Weaver

Publications and source records attributed to Amy L Weaver.

At least 37 records · Page 2Linked to original sources
PubMed2005

Diet and functional gastrointestinal disorders: a population-based case-control study.

BACKGROUND: Diet has been implicated to play a role in functional gastrointestinal disorders (FGID) in clinic-based studies. No population-based data comparing food and nutrient consumption between individuals with FGID and without gastrointestinal symptoms are available. OBJECTIVES: The purpose of this study was to compare the dietary consumption of specific food items and nutrients between individuals with FGID and without symptoms in a population-based sample. METHODS: A validated self-report Bowel Disease Questionnaire was mailed to an age- and gender-stratified random sample of participants aged 20-50 yr from Olmsted County, Minnesota. All patients who reported either FGID symptoms (irritable bowel or dyspepsia) or no gastrointestinal symptoms were invited to undergo a blinded physician interview and physical exam and to complete a validated Harvard Food Frequency Questionnaire. Wilcoxon rank sum tests and logistic regression were used for statistical analysis. RESULTS: In total, 222 of the 260 eligible (85%) subjects participated and 218 provided diet data: 99 were FGID cases and 119 were healthy controls. Cases and controls consumed similar number of servings per week of wheat-containing foods, lactose-containing foods, caffeinated drinks, and fructose-sweetened beverages. Cases were slightly more likely to consume >or=7 servings per week of norepinephrine- and epinephrine-containing foods (57%vs 45%, p= 0.10), but not serotonin- or tryptophan-containing foods. No differences were observed for amount of intake of calories, fiber, protein, iron, calcium, niacin, and vitamins C, D, E, niacin, B(1), B(2), B(6), and B(12). Cases reported consuming more fat (median, 33%vs 31%) and less carbohydrates (median, 49%vs 52%) than controls. CONCLUSIONS: No differences were seen in the consumption of frequently suspected "culprit" foods between community residents with and without FGID symptoms. While symptoms may be due to food sensitivity rather than altered diet composition, the role of fat and perhaps norepinephrine and epinephrine in foods in gut symptoms needs to be studied further.

Adult↗
PubMed2005

Influence of platelet-rich plasma added to xenogeneic bone grafts in periimplant defects: a vital fluorescence study in dogs.

BACKGROUND: The use of platelet-rich plasma (PRP) has been suggested in order to increase the rate of bone deposition when sites are augmented prior to or in conjunction with dental implant placement. PURPOSE: The goal of this study was to investigate whether the addition of PRP to xenogeneic bone grafts would increase the rate of bone formation in dogs. MATERIALS AND METHODS: Ninety endosseous dental implants were inserted in the mandibles of nine hound dogs. Subsequently, mesial and distal three-wall periimplant defects were surgically created. Defects were randomly assigned to three groups: demineralized freeze-dried bone graft plus platelet-rich plasma (DFDBG plus PRP), demineralized freeze-dried bone graft alone (DFDBG), and no treatment. Postsurgically each dog received a series of three fluorescent labels for estimation of bone cell activity at baseline and during different stages of healing, with particular attention to the bone formation rate per tissue volume (BFR/TV). Animals were sacrificed at 1 month, 2 months, and 3 months, and specimens were subjected to analysis by fluorescence microscopy. Treatment effects were evaluated with analysis of variance models. RESULTS: Overall, the average BFR/TV differed by treatment although this difference approached only minimal statistical significance (p = .057). The largest difference occurred between periimplant defects treated with DFDBG only and defects that were not treated (mean percentage BFR/TV, 0.0720% vs 0.0994%). There was no evidence of an overall treatment effect (p = .27) for the mineral apposition rate (MAR) values. The data also suggest a consistent variability in the bone formation parameters among the three groups at different healing points. CONCLUSION: In this animal model the addition of PRP to xenogeneic bone grafts did not demonstrate evidence of faster bone formation during healing. However, limitations of the histologic technique possibly played a negative role in the assessment of bone formation parameters.

Alveolar Ridge Augmentation↗
PubMed2005

Regenerative potential of platelet-rich plasma added to xenogenic bone grafts in peri-implant defects: a histomorphometric analysis in dogs.

BACKGROUND: The purpose of this investigation was to evaluate the regenerative influence of platelet-rich plasma (PRP) added to xenogenic bone grafts on bone histomorphometric parameters in a dog model. METHODS: Ninety endosseous dental implants were inserted in the mandibles of nine hound dogs. Mesial and distal 3-wall peri-implant defects were surgically created adjacent to the implants. Defects were randomly assigned to three groups: demineralized freeze dried bone with platelet-rich plasma (DFDB + PRP), DFDB alone, and no treatment (NT). Animals were sacrificed at 1, 2, and 3 months according to a previously established randomization schedule, and specimens were subjected to histomorphometric analysis. Percentages of bone area inside the implant threads (BiIT), bone-to-implant contact (BIC), and bone area outside implant threads (BoIT) were recorded. Treatment effects were evaluated using analysis of variance models. RESULTS: The effect of the three treatments on the outcome measures did not differ significantly by healing time (P > 0.05 for the healing time by treatment interaction). However, the average (standard deviation) percentage of BIC and BoIT was significantly different between the treatment groups. In particular, the average percentage of BIC differed between peri-implant defects treated with DFDB + PRP (33.8% [11.0]) and those treated with DFDB alone (28.5% [10.8]; P = 0.042), as well as those in the NT group (27.9% [11.0]; P = 0.024). Furthermore, the average percentage of BoIT differed significantly between defects treated with DFDB + PRP compared to defects in the NT group (51.6% [12.2] versus 43.3% [10.3]; P = 0.005). There was borderline evidence to suggest that the average percentage of BiIT and BIC was significantly different depending on the length of the healing time (P = 0.054 and P = 0.085, respectively). CONCLUSION: This study found that the addition of PRP to xenogenic bone grafts demonstrated a low regenerative potential in this animal model.

Alveolar Bone Loss↗
PubMed2004

Prognostic value of p53 and MIB-1 in transitional cell carcinoma of the urinary bladder with regional lymph node involvement.

BACKGROUND: The effect of p53 protein expression and MIB-1 proliferative activity on survival and chemotherapeutic response in patients with lymph node (LN)-positive transitional cell carcinoma (TCC) of the urinary bladder remains unclear. The objective of this study was to assess the ability of these markers to predict disease-associated outcomes and response to chemotherapy in a cohort of patients with LN-positive TCC. METHODS: The authors examined the expression of p53 and MIB-1 in the LN metastases from 139 patients who underwent cystectomy for TCC at their institution. P53 and MIB-1 nuclear staining were quantified using an image-analysis system. Cox proportional hazards regression models were used to test associations of these markers with death from TCC, distant metastases, and local recurrence for all patients and in the subset of patients who were treated with adjuvant chemotherapy. RESULTS: The median p53 and MIB-1 indices were 45.2% and 30.3%, respectively. The median follow-up was 4.5 years (range, 0.1-10 years). There were no statistically significant associations noted between the p53 and MIB-1 indices and the outcomes studied. When the analysis was limited to patients who were treated with adjuvant chemotherapy (n = 37 patients), the p53 index was found to have no prognostic value; however, there was a significant association between MIB-1 and distant metastases (P = 0.049). When disease-specific survival rates were stratified according to p53 index and chemotherapy, patients exhibited a response to chemotherapy regardless of p53 index. CONCLUSIONS: p53 and MIB-1 were not found to be associated significantly with disease-related outcomes in patients with LN-positive TCC. Adjuvant chemotherapy appeared to be effective regardless of p53 status. MIB-1 may prove useful in predicting response to chemotherapy.

Biomarkers, Tumor↗
PubMed2004

Efficacy of adenoidectomy in the treatment of nasal and middle ear symptoms in children with Down syndrome.

OBJECTIVE: To compare the efficacy of adenoidectomy in children with Down syndrome and control patients. METHODS: Medical records were reviewed for preoperative symptoms, ear complaints, date and reason for adenoidectomy, and postoperative symptoms in 27 children (mean age, 6.0 years; range, 1.6-14.5 years) with Down syndrome and 53 age- and sex-matched controls who had adenoidectomy between January 1978 and September 1997. Long-term follow-up was aided by telephone interviews. Improvement in nasal and middle ear symptoms after adenoidectomy was calculated as the percentage of patients symptom-free postoperatively among those with symptoms preoperatively. RESULTS: After adenoidectomy, more controls than patients with Down syndrome had improvement in symptoms, including nasal obstruction (86.7% versus 50.0%; P=0.005); snoring (73.2% versus 40.9%; P=0.01); mouth breathing (84.1% versus 40.9%; P<0.001); and middle ear disease (68.0% versus 23.1%; P<0.001). Patients with Down syndrome were 7.7 times (95% confidence interval, 2.3-25.3) more likely to have chronic ear drainage after adenoidectomy. CONCLUSIONS: The results of the study suggest that the efficacy of adenoidectomy in children with Down syndrome is significantly less than that in controls and should influence surgical decision making in these children.

Adenoidectomy↗
PubMed2004

Outcome of patients with a final diagnosis of chest pain of undetermined origin admitted under the suspicion of acute coronary syndrome: a report from the Rochester Epidemiology Project.

STUDY OBJECTIVES: Patients presenting to the emergency department (ED) with chest pain after a recent negative inpatient evaluation for cardiac pathology represent a dilemma for the emergency physician. The purposes of this study were to assess the outcome of patients discharged with a diagnosis of chest pain of undetermined origin and to identify predisposing factors for further cardiac events. METHODS: The resources of the Rochester Epidemiology Project were used to identify all admitted ED patients with chest pain with suspected acute coronary syndrome who received a discharge diagnosis of chest pain of undetermined origin from 1985 through 1992. Patient records were reviewed for the occurrence of adverse cardiac events and subsequent ED visits for recurrent chest pain within 12 months of discharge. Associations between patient characteristics and an adverse cardiac event were evaluated univariately and summarized by using odds ratios (ORs). Long-term mortality was also determined. RESULTS: Among 1,973 admitted ED patients with chest pain, 230 were given a diagnosis of chest pain of undetermined origin. Ten (4.4%) of 230 patients experienced an adverse cardiac event. Factors significantly associated with an adverse cardiac event included an abnormal ECG on admission (OR 9.5; 95% confidence interval [CI] 2.0 to 45.8), preexisting diabetes mellitus (OR 7.1; 95% CI 1.8 to 27.2), and preexisting coronary artery disease (OR 28.4; 95% CI 3.5 to 229.0). Thirty-three (14%) patients returned to the ED within 12 months of discharge; 5 patients were given a diagnosis of a cardiac condition, and 5 were given a diagnosis of a gastrointestinal condition. In long-term follow-up, 46 patients died, with a mean time from hospital discharge to death of any cause of 6.1 years and an estimated 5-year survival of 91.4%. CONCLUSION: Among patients discharged from the hospital with a diagnosis of chest pain of undetermined origin, those with an initial abnormal ECG, preexisting diabetes, or preexisting coronary artery disease are at higher risk of a subsequent adverse cardiac event. In the absence of such factors, cardiac outcome is excellent.

Acute Disease↗
PubMed2004

Sarcomatoid renal cell carcinoma: an examination of underlying histologic subtype and an analysis of associations with patient outcome.

A sarcomatoid component can occur in all histologic subtypes of renal cell carcinoma (RCC) and indicates an aggressive tumor. We studied 2381 patients treated with radical nephrectomy for RCC between 1970 and 2000. A urologic pathologist reviewed the microscopic slides from all tumor specimens for the presence of a sarcomatoid component, defined as a RCC with any malignant spindle cell component. All tumors with a sarcomatoid component were classified as nuclear grade 4. A total of 120 (5.0%) patients had RCC with a sarcomatoid component, including 94 who died of RCC at a mean of 1.4 years following nephrectomy (median 8 months; range 44 days to 10 years). Cancer-specific survival rates at 2 and 5 years following nephrectomy were 33.3% and 14.5%, respectively. The presence of distant metastases at the radical nephrectomy and histologic tumor necrosis were significantly associated with death from RCC among patients with sarcomatoid RCC. Patients with clear cell (conventional) RCC and chromophobe RCC were more likely to have tumors with a sarcomatoid component (5.2% and 8.7%, respectively) compared with patients with papillary RCC (1.9%). The presence of a sarcomatoid component was significantly associated with death from RCC for all three subtypes (P < 0.001). Even among patients with grade 4 clear cell RCC, the presence of a sarcomatoid component was significantly associated with outcome, both univariately (risk ratio 1.59; P = 0.010) and after adjusting for TNM stage, tumor size, and histologic tumor necrosis (risk ratio 1.46; P = 0.037).

Adult↗
PubMed2004

Pertussis vaccination and the risk of respiratory syncytial virus-associated hospitalization.

BACKGROUND: Animal data suggest an association between recent vaccination with a pertussis-containing vaccine and increased severity of respiratory syncytial virus (RSV) infection. We sought to determine whether such an association exists in humans by studying a population-based cohort of young children. PATIENTS AND METHODS: We performed a nested case-control study of 280 children younger than 24 months of age hospitalized with RSV infection in Olmsted County, MN from January 1990 to December 1999. Controls (2 per case) consisted of nonhospitalized residents of Olmsted County matched to cases by date of birth and sex. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for the odds of hospitalization for RSV infection among subjects with a recent pertussis-containing vaccination in proximity to the cases' date of hospitalization relative to the odds among subjects with no vaccination. RESULTS: The OR for receipt of a pertussis-containing vaccine within 0 to 6 days of a case's hospitalization for RSV disease was 0.8 (95% CI 0.4-1.8). For the time intervals 7-13, 14-20 and > or =21 days, the OR were 1.3 (95% CI 0.5-3.0), 1.3 (95% CI 0.5-3.2) and 0.7 (95% CI 0.3-1.5), respectively. Adjusting for vaccine delay and for risk status did not alter the findings. The median interval between the most recent pertussis-containing vaccine and the case's date of hospitalization was 40 days for cases and 42.5 days for controls (P = 0.69). Among the RSV cases, pertussis vaccination in the month preceding hospitalization was not a risk factor for oxygen requirement (P = 0.82), intensive care unit admission (P = 0.46) or need for mechanical ventilation (P = 0.28). CONCLUSION: In our study, recent immunization with a pertussis-containing vaccine was not a risk factor for hospitalization for RSV infection. In addition, among children hospitalized with RSV infection, recent pertussis immunization was not associated with a more severe clinical course.

Case-Control Studies↗
PubMed2004

Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy.

PURPOSE: We compared outcomes between patients treated with nephron sparing surgery (NSS) without imperative indications for renal preservation and radical nephrectomy (RN) for 4 to 7 cm renal cell carcinoma (RCC). MATERIALS AND METHODS: We identified 91 patients treated with NSS and 841 patients treated with RN for 4 to 7 cm RCC between 1970 and 2000. Cancer specific, distant metastases-free and recurrence-free survivals were estimated using the Kaplan-Meier method. RESULTS: Cancer specific survival rates at 5 years for patients treated with NSS and RN for 4 to 7 cm RCC were 98% and 86%, respectively. On univariate analysis patients treated with RN for 4 to 7 cm RCC were more likely to die of RCC compared to patients treated with NSS. However, after adjusting for features associated with death from RCC including stage, grade, histological tumor necrosis and histological subtype, this difference was no longer statistically significant (risk ratio 1.60, 95% CI 0.50-5.12, p = 0.430). Distant metastases-free survival rates at 5 years for patients treated with NSS and RN were 94% and 83%, respectively. On univariate analysis patients treated with RN were more likely to have tumors that metastasized compared to patients treated with NSS, although this difference was no longer significant after adjusting for the features listed previously (risk ratio 1.76, 95% CI 0.64-4.83, p = 0.273). Recurrence-free survival rates at 5 years for patients treated with NSS and RN were 94% and 98%, respectively. On univariate analysis patients treated with RN were less likely to have recurrence compared to patients treated with NSS (risk ratio 0.32, 95% CI 0.12-0.85, p = 0.022). CONCLUSIONS: There were no statistically significant differences in cancer specific survival and distant metastases-free survival between patients treated with NSS and RN for 4 to 7 cm RCC after adjusting for important pathological features. NSS for 4 to 7 cm RCC results in excellent outcome in appropriately selected patients.

Adult↗
PubMed2004

Psychosocial factors are linked to functional gastrointestinal disorders: a population based nested case-control study.

BACKGROUND: It is widely accepted based on volunteer studies that levels of psychological distress are similar in those with functional gastrointestinal (GI) disorders and health in the community, while increased psychological distress in outpatients is largely explained by health-care seeking. AIMS: To determine if psychological distress, life event stress, or social support is associated with functional GI disorders in a population-based study. METHODS: A nested case-control study was performed by first mailing a self-report bowel disease questionnaire to a random sample of Olmsted County, Minnesota, aged 20-50 yr. All persons who reported symptoms of nonulcer dyspepsia (NUD) or irritable bowel syndrome (IBS) (cases), or an absence of GI symptoms (controls), were invited to complete a series of validated questionnaires designed to measure psychological distress, life event stress, social support, current symptoms, and physician visits. RESULTS: 103 subjects with functional GI disorders and 119 controls participated (85% of eligible). Functional GI disorders were more likely to be reported by those with higher scores on each of the nine SCL-90-R scales used to measure psychological distress (except phobic anxiety), and those with more negative and total life event stress. In a multiple logistic regression model (including age and gender), somatization, interpersonal sensitivity, and total life event stress were independently associated with functional GI disorders. Findings were similar when subjects with the IBS and NUD were analyzed separately compared to controls. CONCLUSIONS: Contrary to current dogma, psychosocial factors were significantly associated with functional GI disorders in this community sample. This suggests that these factors may be involved in the etiopathogenesis rather than just driving health-care utilization.

Adult↗
PubMed2004

Use of vasopressin in a canine model of severe verapamil poisoning: a preliminary descriptive study.

OBJECTIVES: The purpose of this preliminary study was to evaluate the effect of arginine vasopressin (AVP) administration in a model of shock induced by calcium channel antagonist overdose and to determine endogenous serum AVP concentrations in calcium channel antagonist-induced shock. METHODS: This was a controlled, randomized laboratory investigation based on a previously described canine model of verapamil toxicity. After induction of verapamil toxicity, animals in both the control and the experimental groups (n = 6 each) received a continuous infusion of verapamil. Experimental animals received an escalating dose of AVP, while control animals received an equal volume of 0.9% saline infusion. The hemodynamic end point was return of mean arterial pressure (MAP) to within 20% of baseline. Surviving animals were killed after 60 minutes. RESULTS: In the treatment group, administration of low-dose AVP (4 mU/kg/min) resulted in further declines in cardiac index and heart rate. No significant change was noted in MAP with low-dose AVP. A slight increase in MAP was noted with both escalating doses of AVP and equivalent volumes of normal saline. By the end of the 60-minute antidote/saline phase, the MAPs of the saline control group and the AVP experimental group were similar. The primary hemodynamic end point was not achieved in either the AVP or the saline control arm. Mean baseline serum AVP concentration in control animals was 5.8 pg/mL, increasing to 225 pg/mL during the toxicity phase. CONCLUSIONS: In an animal model of verapamil-induced shock, endogenous AVP levels increased nearly 40-fold compared with baseline levels. Escalating doses of exogenous AVP worsened cardiac index and failed to return MAP to within 20% of baseline.

Animals↗
PubMed2004

Functional gastrointestinal disorders among people with sleep disturbances: a population-based study.

OBJECTIVE: To determine whether unexplained gastrointestinal (GI) symptoms are more common in people with self-reported sleep disturbance. PARTICIPANTS AND METHODS: From November 1988 to June 1994, valid self-report questionnaires were mailed to age- and sex-stratified random samples of Olmsted County, Minnesota, residents aged 20 to 95 years. RESULTS: Of 2269 study participants (74% response rate), 52% were women (mean age, 45.0 years). The overall age- and sex-adjusted prevalence of sleep disturbance per 100 population was 13.5% (95% confidence interval [CI], 11.7%-15.3%). Among study participants with sleep disturbance, the prevalence of irritable bowel syndrome (IBS) was 33.3% (95% CI, 26.0%-40.5%) and the prevalence of frequent dyspepsia (FD) was 21.3% (95% CI, 14.4%-28.2%). After adjusting for age, sex, and somatization score, IBS was significantly more common in those with sleep disturbance (odds ratio, 1.6; 95% CI, 1.1-2.2), but the univariate association with FD was no longer statistically significant (odds ratio, 1.3; 95% CI, 0.9-1.9). CONCLUSIONS: Both IBS and FD are prevalent in those with self-reported sleep disturbance. Sleep disturbance was independently associated with IBS but not FD in the general population.

Adult↗
PubMed2004

Incidence of tuberculosis in Olmsted County, Minnesota, 1990-2001.

OBJECTIVE: To describe and compare the incidence and clinical characteristics of tuberculosis in Olmsted County, Minnesota, among US-born and foreign-born persons. PATIENTS AND METHODS: We performed a retrospective cohort study at the Mayo Clinic in Rochester, Minn, of all residents of Olmsted County (2000 population: 124,277) diagnosed as having tuberculosis between January 1, 1990, and December 31, 2001. Potential cases were identified with use of a computerized diagnostic coding database and microbiological laboratory data; all identified medical records were abstracted. Definite cases were those in which Mycobacterium tuberculosis was recovered in culture. Probable cases were those that met predefined clinical or radiographic evidence of tuberculosis and other criteria. Age-specific, sex-specific, and country of origin-specific incidence rates were calculated with use of Olmsted County census data. Variables were compared among risk groups using the Fisher exact test. RESULTS: During a 12-year period, 71 cases of tuberculosis (53 definite, 18 probable) were identified, for an incidence of 5.3 per 100,000 person-years. Of these cases, 54 (76%) occurred during the second half of the study (incidence: 7.7 per 100,000 person-years). The incidence among US-born persons was similar throughout the study period; however, the Incidence among foreign-born persons increased more than 3-fold during the second half of the study period. Twenty-five patients (35%) were former refugees. All isoniazid-resistant infections (12% of isolates) and multidrug-resistant infections (6% of isolates) occurred among foreign-born persons. CONCLUSION: The incidence of tuberculosis increased substantially in Olmsted County between 1990 and 2001, primarily because of an increase in the number of cases among foreign-born persons.

Adult↗
PubMed2004

Evaluation of the educational utility of patient follow-up.

OBJECTIVES: To date, no studies in emergency medicine (EM) have addressed the educational value of the Residency Review Committee for Emergency Medicine's (RRC-EM) requirement for patient follow-up (FU). The authors examined whether performance of patient FU improved EM resident education. METHODS: All EM resident FU encounters from September 25, 2001, through September 24, 2002, were documented and analyzed. All EM residents at a regional tertiary referral emergency department (ED) initiated patient FU encounters by entering information regarding patients' initial ED presentations into a Web-based follow-up system (WBFUS), subsequently entered FU information, and indicated whether they thought that the specific FU encounters improved their education (yes/no). Supervising faculty members then reviewed the residents' completed FU entries. Blinded to residents' responses regarding educational utility, faculty members evaluated whether they thought the specific FU encounters were educational for the residents (yes/no). Data entered into the WBFUS were then summarized as percentages. RESULTS: Eight hundred forty-seven FU encounters were completed by 18 EM residents and 29 EM faculty. Ninety-three percent of the FU entries were deemed by at least one evaluator (resident or faculty) to have educational value. Residents found the act of performing FU educational in 81.3% of cases, whereas faculty thought 80.4% were educational for the resident. Although the residents and faculty agreed on the educational value in 75.4% of cases, the overall strength of the agreement was slight to fair (kappa statistic = 0.21). CONCLUSIONS: This study indicates that EM residents and faculty believe that the act of performing patient FU has educational value for EM residents; however, the interobserver agreement between residents and faculty was low.

Adolescent↗
PubMed2004

Early life risk factors for attention-deficit/hyperactivity disorder: a population-based cohort study.

OBJECTIVES: To Identify risk factors for attention-deficit/hyperactivity disorder (ADHD) and to determine whether these factors differ between boys and girls. SUBJECTS AND METHODS: We conducted a case-control study of all children born between January 1, 1976, and December 31, 1982, in Olmsted County, Minnesota (N=5701), and examined birth certificates for risk factors for ADHD. Using school and medical records, we identified 305 children with ADHD. All children not identified with ADHD served as controls (N=5326). Risk factors that were assessed included demographic characteristics of both children and parents, as well as pregnancy, labor, and delivery characteristics, including the effect of a multiple birth and presence of pregnancy and delivery complications. RESULTS: Pregnancy and labor characteristics, low birth weight, and presence of a twin birth were not associated with ADHD. Male sex (odds ratio [OR], 3.05; 95% confidence interval [CI], 2.34-3.98) was associated with an increased risk for ADHD, whereas high maternal and paternal education levels (high maternal education: OR, 0.57; 95% CI, 0.42-0.78; high paternal education: OR, 0.58; 95% CI, 0.49-0.78) were associated with a decreased risk for ADHD. In addition, low maternal and paternal education levels increased the risk for ADHD in boys more than in girls. CONCLUSION: Male sex and low parental education levels are significant risk factors for ADHD. In addition, boys born to parents with low maternal and paternal education levels appear to be at an increased risk for ADHD compared with girls born to parents with low education levels.

Adult↗
PubMed2003

Transitional cell carcinoma of the urinary bladder with regional lymph node involvement treated by cystectomy: clinicopathologic features associated with outcome.

BACKGROUND: Patients with transitional cell carcinoma (TCC) of the urinary bladder metastatic to regional lymph nodes (LN) typically have a poor prognosis. However, some patients are cured by radical cystectomy alone. The goal of this study was to identify predictors of survival in this cohort. METHODS: The authors identified 154 patients with TCC metastatic to regional LNs treated by cystectomy between 1970 and 1998. Clinical characteristics collected included age, gender, and preoperative computed tomographic or magnetic resonance image scan findings, as well as neoadjuvant and adjuvant therapy. Pathologic features evaluated included multifocality, size, pathologic stage, grade, and margin status of the primary tumor, as well as the number, location, and bilaterality of the positive LNs. Capsular penetration, greatest linear extent, and surface area of the largest metastatic LN deposit were also recorded. The Kaplan-Meier method was used to evaluate survival rates. Cox proportional hazards models were used to identify predictors of outcome. RESULTS: The mean follow-up was 4.5 years (range, 0.1-13.9 years). In a multivariate setting, only adjuvant chemotherapy and the number of positive LNs were associated significantly with death from TCC. Patients treated adjuvantly with chemotherapy were 2.1 times less likely to die of their disease (P = 0.005). Each increase in one positive LN increased the risk of death from TCC by 20% (P < 0.001). Recursive partitioning indicated that the optimal cutoff point to predict death from TCC was five or more positive LNs. CONCLUSIONS: Adjuvant chemotherapy and the number of positive LNs were associated significantly with death from TCC.

Adult↗
PubMed2003

Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials.

BACKGROUND: The objective of the current study was to develop an algorithm to predict progression to metastases after radical nephrectomy for patients with clinically localized renal cell carcinoma (RCC) to allow stratification of patients for potential adjuvant therapy trials. METHODS: The authors identified 1671 sporadic patients with clinically localized, unilateral clear cell RCC who underwent radical nephrectomy between 1970 and 2000. The clinical features examined included age, gender, smoking history, recent onset hypertension, performance status, and presenting symptoms. The pathologic features examined included surgical margins, tumor stage, regional lymph node status, tumor size, nuclear grade, histologic tumor necrosis, sarcomatoid component, cystic architecture, and multifocality. Metastases free survival was estimated using the Kaplan-Meier method. A multivariate Cox proportional hazards regression model was fit to determine associations between the clinical and pathologic features and distant metastases. RESULTS: The median follow-up was 5.4 years (range, 0-31 years). Metastases occurred in 479 patients at a median of 1.3 years (range, 0-25 years) after nephrectomy. The estimated metastases free survival rates were 86.9% at 1 year, 77.8% at 3 years, 74.1% at 5 years, 70.8% at 7 years, and 67.1% at 10 years. Multivariate analysis showed that the following features were associated with progression to metastases: tumor stage, regional lymph node status, tumor size, nuclear grade, and histologic tumor necrosis (P < 0.001 for all). CONCLUSIONS: In patients with clear cell RCC, tumor stage, regional lymph node status, tumor size, nuclear grade, and histologic tumor necrosis showed statistically significant associations with progression to metastatic RCC. The authors present a scoring algorithm based on these features that can be used to predict disease progression after patients undergo radical nephrectomy for clinically localized clear cell RCC. Cancer 2003;97:1663-71.

Adenocarcinoma, Clear Cell↗