Objective Our study had 3 aims: (1) to evaluate the functioning of the Symptom Burden Index (SBI) in patients with systemic sclerosis (SSc); (2) to determine the amount of burden per problem experienced by patients as well as the number of patients experiencing each measured problem area, and the number of SSc problems per patient; and (3) to characterize the burden profiles of problem area-specific subgroups of patients. Methods We developed the SBI to determine the effect of problems in 8 major symptomatic areas of importance to patients (skin, hand mobility, calcinosis, shortness of breath, eating, bowel, sleep, and pain). Results Sixty-two patients with SSc completed questionnaires on current disease-related problems, physical functioning, and health status. On average, patients were 53.4 years old and had had SSc for 8 years. Patients were mainly women (87%), English-speaking (87%), with diffuse SSc (63%), white (69%), married (61%), and lived with 1 or more additional household members (84%). Only 26% were employed full-time. The 3 most widely reported problem areas were pain, hand, and skin, experienced by 92%, 89%, and 88%, respectively. About one-third reported experiencing 0–5 problems and one-third 7–8 problems; individual patients experienced, on average, 5.7 problems. Conclusion Psychometric evaluation determined that (1) summarizing SBI problem area item sets to report burden scores per problem measured is justified; (2) the 8 proposed problem areas are independent and deserve separate evaluation; and (3) burden scores correlate as expected with the Health Assessment Questionnaire-Disability Index and the Medical Outcomes Study Short-Form 36 questionnaire. The number of problems experienced and the degree of problem-associated burden that patients with SSc bear are substantial. Use of the SBI's patient-focused measurements may aid physicians in resolving problems most directly affecting patients' quality of life. This approach to measuring symptomatic burden in patients with chronic disease could be extended to other conditions.

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Background: Analytical methods for measuring the calcium isotope distribution in enriched human serum samples that use low blood volumes, simple preparation methods, and rapid analysis are important in clinical studies of calcium kinetics. Previously, sample preparation by oxalate precipitation typically required 500 L of serum. This method was time-consuming, and the blood volume required was limiting in circumstances when only a small amount of serum could be obtained. Methods: Serum was collected from humans who were administered 42 Ca, and 20 L of serum was mixed with 2 mL of 0.22-0.67 mol/L HNO 3 at room temperature for between 1 min and 16 h. The 42 Ca/ 43 Ca ratio in the supernatant was measured by a magnetic sector inductively coupled plasma mass spectrometer (ICP-MS). Calcium isotope ratios from these equilibration solutions were compared with data from oxalate-precipitated serum samples to determine the optimum equilibrium time and the effect of acid concentration on equilibrium. Results: Various amounts of aggregated particles developed in different acid-serum mixtures. These affected the time required for isotope equilibration in the mixture. The shortest equilibrium time needed for the calcium isotopes varied from 1 to 6 h for samples acidified with 0.22-0.45 mol/L HNO 3 . Data obtained from these solutions were consistent with data from oxalate-precipitated calcium. The precision of 42 Ca/ 43 Ca ratio measurements was better than 0.5%.

A 67-year-old right-handed man was referred to a tertiary care center for headaches, changes in cognition, and gait imbalance. His symptoms began 3 months prior when he developed an unremitting, left-sided, parietal headache. The headache was unusual for him and was not associated with nausea, photophobia, or phonophobia. He had a history of prior headaches that began after minor head trauma in a skiing accident. However, those headaches were infrequent and invariably resolved after 1 day.Shortly after the onset of headache, he began experiencing intermittent scotomas and scintillations in the right visual field. The visual phenomenon would resolve after several minutes. Around the same time, he began having word-finding difficulties and deficits in his short-term memory. There were no clear deficits in long-term memory or changes in mood, behavior, or emotional stability.Within a few weeks, he began to feel unstable when walking. He had several falls due to what he described as a feeling of ''being stuck to the floor'' and then falling forward when he was finally able to move. His family noted a shuffling gait but no listing to either side. He had to start using a walker.Two months after the onset of symptoms, his visual phenomenon resolved without any intervention. However, he then developed stereotyped, olfactory hallucinations consisting of 20-second episodes of smelling a foul odor. His gait also continued to decline with increased bradykinesia and shuffling. The headaches were still persistent.He was seen at a local hospital 2 weeks after the onset of symptoms, where he underwent a lumbar puncture as part of his workup. Following the lumbar puncture, his gait temporarily improved.His past medical history was significant for diabetes, hyperlipidemia, and hypertension. There was no significant family history. He had smoked 1 pack per day for 37 years, but quit 5 months prior to presentation. There were no systemic symptoms including fevers, night sweats, or rashes. Neurologic ExaminationOn general examination, the patient was well appearing. He was afebrile. Blood pressure was 130/75 mm Hg. Heart rate was 68 beats/min and respiratory rate was 12 breaths/min. On mental status testing, he was fully oriented and attentive with a digit span of 7 forward and 5 backward. Naming and repetition were intact. He could name only 3 D-words and 13 animals in 1 minute (normal ¼ !16 D-words and !23 animals). There was no neglect. He scored 30 of 30 on the Mini-Mental Status Examination. The cranial nerve examination was normal including visual acuity, visual fields, and fundoscopy. On motor examination, there was mild spasticity in the bilateral upper extremities. He had a subtle right pronator drift. Power was full on confrontational testing in all the 4 limbs. Sensation was intact to all modalities with a negative Romberg. Reflexes were symmetrical and 2þ in the biceps, triceps, brachioradialis, and patellas. Ankle jerks were absent bilaterally. Plantar responses were flexor. He had a shuffling, wide-based gait, and coul...