The cellular and reaginic immune responses to ragweed were examined in six strains of inbred rats. Three differentiable patterns of primary reaginic responses were observed: (a) Lewis rats--good uniform responders--produced high titers of IgE antibody for a short (less than 2 weeks) time; (b) Brown Norway rats--good uniform responders--produced high titers of IgE antibody for a long time (more than 1 month), and (c) intermediate responders--Buffalo, ACI, Fischer 344 and Wistar-Furth rats--produced poor-to-moderate titers of IgE for an intermediate time. There were no secondary reaginic immune responses to ragweed AgE in these six strains of rats. Furthermore, extensive study of Lewis rats indicated that IgE antibody production in primary immunization could be suppressed by passive transfer of either AgE-primed spleen lymphocytes, AgE-primed blood lymphocytes, or Con-A stimulated lymphocytes. Cellular responses to AgE and PHA stimulation were suppressed in rats receiving AgE-primed lymphocytes or Con-A stimulated lymphocytes.
The findings of a retrospective analysis of the charts of 426 children admitted on 484 occasions with diagnoses of esophageal foreign bodies that were managed at the Hospital for Sick Children for 15 years to the end of 1989 are reported. In the majority of cases, ingestion of the foreign body was either witnessed or suspected. Removal was completed with the use of general anesthesia with endotracheal intubation in 90% of cases. The postcricoid area was the commonest site for impaction. Coins were the commonest foreign body. Approximately 5% of children had more than one foreign body. Fifty-nine children had esophageal anomalies. Thoracotomy or laparotomy for the retrieval of foreign bodies was necessary in less than 1% of patients. Complications occurred in 13% of patients; there were no deaths.
From Massachusetts General Hospital, Boston, MA (A.J.Y., Z.A.C., O.A.B., R.G.G.); Medical College of Wisconsin, Milwaukee, WI (O.O.Z.); University of Calgary, Calgary, AB, Canada (M.G., A.M.D., B.K.M.); Penumbra Inc, Alameda, CA (E.M., D.U., H.B., S.P.S., A.B.).
The efficacy of intra-arterial treatment remains uncertain. Because most centers performing IAT use noncontrast CT (NCCT) imaging, it is critical to understand the impact of NCCT findings on treatment outcomes. This study aimed to compare functional independence and safety among patients undergoing intra-arterial treatment stratified by the extent of ischemic change on pretreatment NCCT.
The study cohort was derived from multicenter trials of the Penumbra System. Inclusion criteria were anterior circulation proximal occlusion, evaluable pretreatment NCCT, and known time to reperfusion. Ischemic change was quantified using the Alberta Stroke Program Early CT Score (ASPECTS) and stratified into 3 prespecified groups for comparison: 0 to 4 (most ischemic change) versus 5 to 7 versus 8 to 10 (least ischemic change).
A total of 249 patients were analyzed: 40 with ASPECTS 0 to 4, 83 with ASPECTS 5 to 7, and 126 with ASPECTS 8 to 10. For ASPECTS 0 to 4, 5 to 7, and 8 to 10, respectively, good outcome (modified Rankin Scale score, 0-2) rates were 5%, 38.6%, and 46% (P
Early ischemic changes on pretreatment NCCT quantified using ASPECTS have been demonstrated to predict outcomes after IAT. We sought to determine the interobserver reliability of ASPECTS for patients with AIS with PAO and to determine whether pretreatment ASPECTS dichotomized at 7 would demonstrate at least substantial ? agreement.
From our prospective IAT data base, we identified consecutive patients with anterior circulation PAO who underwent IAT over a 6-year period. Only those with an evaluable pretreatment NCCT were included. ASPECTS was graded independently by 2 experienced readers. Interrater agreement was assessed for total ASPECTS, dichotomized ASPECTS (= 7 versus >7), and each ASPECTS region. Statistical analysis included determination of Cohen ? coefficients and concordance correlation coefficients. PABAK coefficients were also calculated.
One hundred fifty-five patients met our study criteria. Median pretreatment ASPECTS was 8 (interquartile range 7-9). Interrater agreement for total ASPECTS was substantial (concordance correlation coefficient = 0.77). The mean ASPECTS difference between readers was 0.2 (95% confidence interval, -2.8 to 2.4). For dichotomized ASPECTS, there was a 76.8% (119/155) observed rate of agreement, with a moderate ? = 0.53 (PABAK = 0.54). By region, agreement was worst in the internal capsule and the cortical areas, ranging from fair to moderate. After adjusting for prevalence and bias, agreement improved to substantial or near perfect in most regions.
Interobserver reliability is substantial for total ASPECTS but is only moderate for ASPECTS dichotomized at 7. This may limit the utility of dichotomized ASPECTS for IAT selection.
A retrospective analysis was completed of the charts of the 1,727 patients with the diagnosis of croup seen during two years (1985 and 1986) in the Emergency Department of The Hospital for Sick Children in Toronto. Cough (91.4%) was the most common presenting symptom. Other presenting signs and symptoms included stridor (57.5%), chest wall retraction (38%), coryza and wheezing (18.5%) and tracheal tug (15%). The majority of patients were treated on an ambulatory basis while 377 (21.7%) were admitted for further management. Inpatient treatment included racemic epinephrine (120 patients) and parenteral steroids (17). Twelve (12) patients required airway support (endotracheal intubation). No tracheotomy for tracheitis was performed during this two year period. No deaths occurred in this patient population.
A central issue in genome-wide association (GWA) studies is assessing statistical significance while adjusting for multiple hypothesis testing. An equally important question is the statistical efficiency of the GWA design as compared to the traditional sequential approach in which genome-wide linkage analysis is followed by region-wise association mapping. Nevertheless, GWA is becoming more popular due in part to cost efficiency: commercially available 1M chips are nearly as inexpensive as a custom-designed 10 K chip. It is becoming apparent, however, that most of the on-going GWA studies with 2,000-5,000 samples are in fact underpowered. As a means to improve power, we emphasize the importance of utilizing prior information such as results of previous linkage studies via a stratified false discovery rate (FDR) control. The essence of the stratified FDR control is to prioritize the genome and maintain power to interrogate candidate regions within the GWA study. These candidate regions can be defined as, but are by no means limited to, linkage-peak regions. Furthermore, we theoretically unify the stratified FDR approach and the weighted P-value method, and we show that stratified FDR can be formulated as a robust version of weighted FDR. Finally, we demonstrate the utility of the methods in two GWA datasets: Type 2 diabetes (FUSION) and an on-going study of long-term diabetic complications (DCCT/EDIC). The methods are implemented as a user-friendly software package, SFDR. The same stratification framework can be readily applied to other type of studies, for example, using GWA results to improve the power of sequencing data analyses.
Notes
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