Lifetime cost of stroke subtypes in Australia: findings from the North East Melbourne stroke incidence study (NEMESIS)

Background and Purpose-: Little is known about any variations in resource use and costs of care between stroke subtypes, especially nonhospital costs. The purpose of this study was to describe the patterns of resource use and to estimate the first-year and lifetime costs for stroke subtypes.

Methods-: A cost-of-illness model was used to estimate the total first-year costs and lifetime costs of stroke subtypes for all strokes (subarachnoid hemorrhages excluded) that occurred in Australia during 1997. For each subtype, average cost per case during the first year and the present value of average cost per case over a lifetime were calculated. Resource use data obtained in the North East Melbourne Stroke Incidence Study (NEMESIS) were used.

Results-: The present value of total lifetime costs for all strokes was Aus $1.3 billion (US $985 million). Total lifetime costs were greatest for ischemic stroke (72%; Aus $936.8 million; US $709.7 million), followed by intracerebral hemorrhage (26%; Aus $334.5 million; US $253.4 million) and unclassified stroke (2%; Aus $30 million; US $22.7 million). The average cost per case during the first year was greatest for total anterior circulation infarction (Aus $28 266). Over a lifetime, the present value of average costs was greatest for intracerebral hemorrhage (Aus $73 542), followed by total anterior circulation infarction (Aus $53 020), partial anterior circulation infarction (Aus $50 692), posterior circulation infarction (Aus $37 270), lacunar infarction (Aus $34 470), and unclassified stroke (Aus $12 031).

Conclusions-: First-year and lifetime costs vary considerably between stroke subtypes. Variation in average length of total hospital stay is the main explanation for differences in first-year costs.

Significance of histological subtypes of Kikuchi`s disease: comparative immunohistochemical and apoptotic studies

Kikuchi's disease (KD) is a self-limiting lymphadenitis mostly affecting the cervical lymph nodes of young individuals. It has been classified into three histological subtypes and postulated to progress from the proliferative type (PT) to the necrotizing type (NT) and finally resolve into the xanthomatous type (XT). Since KD has been shown to be an apoptotic disease, the apoptotic activity was studied by the TUNEL method on 6, 12, and 6 cases of PT, NT, and XT, respectively, to see if the apoptotic activity could be shown to decrease in the order of the postulated sequence of evoluation. Significant statistical difference among the three subtypes was found (P = 0.050). Further analysis revealed that PT versus NT was significant (P = 0.010), but NT versus XT (P = 0.385) or PT versus XT (P = 0.310) was not. Analysis of three stages of NT was also significant (P = 0.019). Immunohistochemical study showed that abundant CD8+ T cells and cytotoxic protein positive cells were present in PT and NT, but were relatively low in XT. Our results showed progression of PT to NT, but not from NT to XT. Xanthomatous type was not the resolving stage of KD, but seemed to be a distinctive histological variant of KD caused by either different etiology or an unusual host reaction.

Subtypes of psychopathy : proposed differences between narcissistic, borderline, sadistic and antisocial psychopaths

Atascadero State Hospital (ASH) is a maximum-security forensic hospital that houses male patients with a wide range of psychiatric diagnoses. Psychopaths at this institution appear to be a heterogeneous group of individuals who, while sharing core personality characteristics, manifest substantial variability in their behavior. Identifying subtypes within this clinical classification can have implications for patient treatment and management, as well as for the safety of the staff who work with them and for the communities to which they will eventually return. Several means of identifying subtypes have been proposed in the literature, and potential subgroups have been identified. Clinical observations at ASH have suggested 4 possible subtypes of psychopathy: narcissistic, borderline, sadistic, and antisocial. Issues related to the conceptualization of psychopathy are addressed, recognizing that additional data are needed to understand the observed variations in cases of psychopathy.

Hub-based reliable gene expression algorithm to classify ER+ and ER- breast cancer subtypes

Identifying gene signatures that are associatedwith the estrogen receptor based breast cancer samples is achallenging problem that has significant implications in breastcancer diagnosis and treatment. Various existing approaches foridentifying gene signatures have been developed but are not ableto achieve the satisfactory results because of their severallimitations. Subnetwork-based approaches have shown to be arobust classification method that uses interaction datasets suchas protein-protein interaction datasets. It has been reported thatthese interaction datasets contain many irrelevant interactionsthat have no biological meaning associated with them, and thusit is essential to filter out those interactions which can improvethe classification results. In this paper, we therefore, proposed ahub-based reliable gene expression algorithm (HRGE) thateffectively extracts the significant biologically-relevantinteractions and uses hub-gene topology to generate thesubnetwork based gene signatures for ER+ and ER- breastcancer subtypes. The proposed approach shows the superiorclassification accuracy amongst the other existing classifiers, inthe validation dataset.

Neuropsychological changes following cognitive-behavioral treatment of obsessive-compulsive disorder (OCD)

Previous research has suggested that individuals with OCD show compromised performance on tests assessing visuospatial and executive processes. This study aimed to further examine such findings by investigating the relationship between OCD symptom improvement following cognitive-behavioral therapy and changes in neuropsychological performance in individuals with OCD (n = 26), compared to test-retest control participants (n = 10). Successful treatment of OCD led to improvements relative to the control group on neuropsychological tasks measuring spatial working memory. Neuroscientific models of OCD consider such findings to be consistent with possible cortical dysfunction in OCD. However, a significant limitation of the study is in its inability to discount alternative explanations for this finding, such as the influence of changes in beliefs. Implications are discussed.

Expression of muscarinic receptor subtypes in tree shrew ocular tissues and their regulation during the development of myopia

Muscarinic receptors are known to regulate several important physiologic processes in the eye. Antagonists to these receptors such as atropine and pirenzepine are effective at stopping the excessive ocular growth that results in myopia. However, their site of action is unknown. This study details ocular muscarinic subtype expression within a well documented model of eye growth and investigates their expression during early stages of myopia induction. Total RNA was isolated from tree shrew corneal, iris/ciliary body, retinal, choroidal, and scleral tissue samples and was reverse transcribed. Using tree shrew-specific primers to the five muscarinic acetylcholine receptor subtypes (CHRM1-CHRM5), products were amplified using polymerase chain reaction (PCR) and their identity confirmed using automated sequencing. The expression of the receptor proteins (M1-M5) were also explored in the retina, choroid, and sclera using immunohistochemistry. Myopia was induced in the tree shrew for one or five days using monocular deprivation of pattern vision, and the expression of the receptor subtypes was assessed in the retina, choroid, and sclera using real-time PCR. All five muscarinic receptor subtypes were expressed in the iris/ciliary body, retina, choroid, and sclera while gene products corresponding to CHRM1, CHRM3, CHRM4, and CHRM5 were present in the corneal samples. The gene expression data were confirmed by immunohistochemistry with the M1-M5 proteins detected in the retina, choroid, and sclera. After one or five days of myopia development, muscarinic receptor gene expression remained unaltered in the retinal, choroidal, and scleral tissue samples. This study provides a comprehensive profile of muscarinic receptor gene and protein expression in tree shrew ocular tissues with all receptor subtypes found in tissues implicated in the control of eye growth. Despite the efficacy of muscarinic antagonists at inhibiting myopia development, the genes of the muscarinic receptor subtypes are neither regulated early in myopia (before measurable axial elongation) nor after significant structural change.