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Terms modified by Additional Risk Selected AbstractsImpaired glucose regulation and type 2 diabetes in children and adolescentsDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 6 2008Kerstin Kempf Abstract Diabetes mellitus in paediatric patients used to be almost exclusively type 1, but in recent years, case series as well as hospital-based and population-based studies indicated that the number of children and adolescents with type 2 diabetes (T2DM) has been increasing. This development is alarming since T2DM in youth is usually not an isolated condition, but accompanied by other cardiovascular risk factors such as obesity, dyslipidaemia, hypertension and low-grade inflammation. In adults, numerous studies provided detailed data on prevalence, incidence and risk factors for the development of T2DM, but for children and adolescents clinical and experimental data are still rather limited. This review provides an overview about the epidemiology and pathogenesis of T2DM in youth and about impaired glucose regulation as major risk factor for diabetes development with a special focus on the recent literature on clinical and lifestyle-related risk factors. Differences in incidence and prevalence across different populations indicate that ethnic background and genetic pre-disposition may be important risk determinants. In addition, epigenetic factors and foetal programming appear to confer additional risk before birth. Among the environmental and lifestyle-related risk factors there is evidence that obesity, hypercaloric diet, physical inactivity, socio-economic position (SEP), smoking, low-grade inflammation, psychosocial stress and sleeping patterns contribute to the risk for T2DM. However, the assessment of the relevance of risk factors and of incidence or prevalence estimates in youth is complicated by methodological issues that are also discussed. Copyright © 2008 John Wiley & Sons, Ltd. [source] Mydriasis and glaucoma: exploding the myth.DIABETIC MEDICINE, Issue 10 2000A systematic review SUMMARY Aims To investigate the risk of inducing acute glaucoma following mydriasis. Methods Systematic review of published research 1933,1999. Results The risk of inducing acute glaucoma following mydriasis with tropicamide alone is close to zero, no case being identified. The risk with long-acting or combined agents is between 1 in 3380 and 1 in 20 000. The presence of chronic glaucoma constitutes no additional risk. Conclusions Mydriasis with tropicamide alone is safe even in people with chronic glaucoma. It should be advised in all patients when thorough retinal examination is indicated. [source] Prospects for therapeutic vaccination with glatiramer acetate for neurodegenerative diseases such as Alzheimer's diseaseDRUG DEVELOPMENT RESEARCH, Issue 2 2002Michal Schwartz Abstract Neurodegenerative diseases, whatever their primary causes, are characterized by certain common features, one of which is their self-perpetuating nature. The ongoing progression of the disorder is due to the effects of destructive self-compounds, whose presence in the tissues is an outcome of the early phase of the disease and which gradually destroy remaining functional neurons. Studies in our laboratory have led to the recent formulation of a novel concept of protective autoimmunity as the body's mechanism of defense against these destructive self-compounds. This autoimmune response to central nervous system (CNS) insults is mediated by T-cells and presumably operates by activating and regulating local microglia and infiltrating macrophages (inflammatory response) to carry out their function of clearing destructive material from the tissue at risk. We suggest that a well-controlled autoimmunity counteracts and overcomes the destructive effects of the potentially harmful self-compounds, at the cost of some loss of tissue. An additional risk to the individual is the induction of an autoimmune disease, which is likely to occur if the autoimmune response is malfunctioning. An optimal balance of the various factors will lead to an outcome of maximal benefit at minimal cost to the tissue. A procedure for safely boosting the autoimmune response, by vaccination with a weak self-crossreactive antigen such as glatiramer acetate (also known as Cop-1) was found to protect rats from glutamate toxicity, a major mediator of the spread of damage and a well-known causative factor in neurodegenerative disorders. Cop-1, when administered according to a different regimen, is an FDA-approved drug for the treatment of multiple sclerosis. Different formulations of the same drug can therefore be used to treat two extreme manifestations of chronic degenerative diseases of the CNS. Drug Dev. Res. 56:143,149, 2002. © 2002 Wiley-Liss, Inc. [source] Cholestasis enhances liver ischemia/reperfusion-induced coagulation activation in ratsHEPATOLOGY RESEARCH, Issue 2 2010Jaap J. Kloek Aim:, Cholestasis is associated with increased morbidity and mortality in patients undergoing major liver surgery. An additional risk is induced when vascular inflow occlusion is applied giving rise to liver ischemia/reperfusion (I/R) injury. The role of the coagulation system in this type of injury is elusive. The aim of the current study was to assess activation of coagulation following hepatic I/R injury in cholestatic rats. Methods:, Male Wistar rats were randomized into two groups and subjected to bile duct ligation (BDL) or sham laparotomy. After 7 days, both groups underwent 30 min partial liver ischemia. Animals were sacrificed before ischemia or after 6 h, 24 h, and 48 h reperfusion. Results:, Plasma AST and ALT levels were higher after I/R in cholestatic rats (P < 0.05). Hepatic necrosis, liver wet/dry ratio and neutrophil influx were increased in the BDL group up to 48 h reperfusion (P < 0.05). Liver synthetic function was decreased in the BDL group as reflected by prolonged prothrombin time after 6 h and 24 h reperfusion (P < 0.05). I/R in cholestatic rats resulted in a 12-fold vs. 7-fold (P < 0.01) increase in markers for thrombin generation and a 6-fold vs. 2-fold (P < 0.01) increase in fibrin degradation products (BDL vs. control, respectively). In addition, the cholestatic rats exhibited significantly decreased levels of antithrombin (AT) III and increased levels of the fibrinolytic inhibitor plasminogen activator inhibitor (PAI-1) during reperfusion. Conclusions:, Cholestasis significantly enhances I/R-induced hepatic damage and inflammation that concurs with an increased activation of coagulation and fibrinolysis. [source] A modified Mini Nutritional Assessment without BMI can effectively assess the nutritional status of neuropsychiatric patientsJOURNAL OF CLINICAL NURSING, Issue 13 2009Alan C Tsai Aim and objectives., To determine whether a modified version of the Mini Nutritional Assessment (MNA) without body mass index (BMI) can effectively identify individuals at risk of malnutrition among patients with neuropsychiatric disorders. Background., Neuropsychiatric patients have an additional risk of nutritional disorder due to functional impairments and drug effects. However, their nutritional status is generally neglected. It is important to find a tool that is simple, easy to use and non-invasive. Design., The study involved 105 patients in the acute phase of confirmed neuropsychiatric disorders in an area hospital. All subjects were cognitively able to have effective verbal communication. Method., The study included serum biochemical and anthropometric measurements and an on-site, in-person interview using a structured questionnaire to elicit personal data, health condition and answers to questions in the MNA. Subjects' nutritional statuses were graded with a MNA that adopted population-specific anthropometric cut-off points or one further with the BMI question removed and its assigned score redistributed to other anthropometric questions. Results., Both versions of the modified MNA effectively graded the nutritional status of neuropsychiatric patients and showed good correlations with the major nutritional indicators such as BMI, calf circumference and the length of hospital stay. Conclusions., The MNA can effectively assess the nutritional status of neuropsychiatric patients and enhance timely detection and intervention of their nutritional disorders. A modified MNA without the BMI question can maintain the full functionality of the tool. The version does not require weight and height measurements and thus will enhance the usefulness of the instrument. Relevance to clinical practice., Neuropsychiatric patients are a high-risk group of nutritional disorders. The MNA, especially the one without BMI, has the potential to improve professional efficiency of the primary care workers. [source] A systematic review of prophylactic antimicrobials in PEG placementJOURNAL OF CLINICAL NURSING, Issue 7 2009Allyson Lipp Aim., To establish whether prophylactic systemic antimicrobials reduce the risk of peristomal infection in placement of percutaneous endoscopic gastrostomies. Background., Percutaneous endoscopic gastrostomies, placed surgically through the anterior abdominal wall, maintain nutrition in the short or long term. Those undergoing percutaneous endoscopic gastrostomy placement are often vulnerable to infection. The increasing incidence of methicillin-resistant Staphylococcus aureus contributes an additional risk to the debate surrounding antibiotic prophylaxis. The aim of antimicrobial prophylaxis is to establish a bactericidal concentration of an antimicrobial drug in the patient, during placement. Design., Systematic review. Methods., We searched the Cochrane Wounds Group Specialised Register (July 2006); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2); handsearched wound care journals, relevant conference proceedings and bibliographies of publications identified, and contacted manufacturers and distributors of percutaneous endoscopic gastrostomy products. Randomised controlled trials were selected evaluating the use of prophylactic antimicrobials for percutaneous endoscopic gastrostomy placement, with no restrictions for language, date or publication status. Both authors performed data extraction and assessment of study quality. Meta-analysis was performed where appropriate. Results., Ten eligible randomised controlled trials were identified evaluating prophylactic antimicrobials in 1100 patients. All trials reported peristomal infection as an outcome and a pooled analysis resulted in a statistically significant reduction in the incidence of peristomal infection with prophylactic antibiotics (pooled OR 0·31, 95% CI 0·22,0·44). The relative reduction in risk of infection for those given antibiotics was 19% with the need to treat 5·8 patients to prevent one infection , NNT. Conclusions., Administration of systemic prophylactic antibiotics for percutaneous endoscopic gastrostomy placement reduces peristomal infection. Relevance to clinical practice., The nurse's role in endoscopy is expanding rapidly and demands that practice is based on the best available evidence. This systematic review seeks to make a contribution to best practice in percutaneous endoscopic gastrostomy placement. [source] Time-resolved contrast-enhanced MR angiography of intracranial lesionsJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2008Zhitong Zou MD Abstract Purpose To determine if contrast-enhanced (CE) MRI of intracranial lesions benefits from time-resolved MR angiography (MRA) during contrast agent injection. Materials and Methods For 126 patients with suspected intracranial lesions undergoing routine CE MRI at 3.0T (N = 88) or 1.5T (N = 38), time-resolved CE MRA (three-dimensional [3D] time-resolved imaging of contrast kinetics [TRICKS]) was performed during injection of the routine gadolinium (Gd) dose of 0.1 mmol/kg. Time to peak (TTP) enhancement of lesions as well as time to internal carotid artery (ICA), middle cerebral artery (MCA), superior sagittal sinus (SSS), and jugular vein enhancement were measured. Source and maximum intensity projection (MIP) images were reviewed to delineate the spatial relationship of lesions and the vasculature. Results In 61 patients (48%), additional important findings were detected on time-resolved MRA that were not seen on the routine CE protocol, including aneurysms (N = 6), arteriovenous malformations (N = 7), ICA stenoses (N = 2), vascular anomalies (N = 18), and relationships between lesions and vessels (N = 28). In addition, tumor TTP correlated with glioma grade (r = 0.87) and discriminated epithelial from nonepithelial meningiomas (P = 2.6 × 10,5). MRA added eight minutes to the total exam time. Conclusion Time-resolved MRA performed during contrast agent injection adds information to the routine brain CE MRI examination of intracranial lesions with only a small time penalty and no additional risk to the patient. J. Magn. Reson. Imaging 2008. © 2008 Wiley-Liss, Inc. [source] Timing of Thyroid Hormone Action in the Developing Brain: Clinical Observations and Experimental FindingsJOURNAL OF NEUROENDOCRINOLOGY, Issue 10 2004R. T. Zoeller Abstract The original concept of the critical period of thyroid hormone (TH) action on brain development was proposed to identify the postnatal period during which TH supplement must be provided to a child with congenital hypothyroidism to prevent mental retardation. As neuropsychological tools have become more sensitive, it has become apparent that even mild TH insufficiency in humans can produce measurable deficits in very specific neuropsychological functions, and that the specific consequences of TH deficiency depends on the precise developmental timing of the deficiency. Models of maternal hypothyroidism, hypothyroxinaemia and congential hyperthyroidism have provided these insights. If the TH deficiency occurs early in pregnancy, the offspring display problems in visual attention, visual processing (i.e. acuity and strabismus) and gross motor skills. If it occurs later in pregnancy, children are at additional risk of subnormal visual (i.e. contrast sensitivity) and visuospatial skills, as well as slower response speeds and fine motor deficits. Finally, if TH insufficiency occurs after birth, language and memory skills are most predominantly affected. Although the experimental literature lags behind clinical studies in providing a mechanistic explanation for each of these observations, recent studies confirm that the specific action of TH on brain development depends upon developmental timing, and studies informing us about molecular mechanisms of TH action are generating hypotheses concerning possible mechanisms to account for these pleiotropic actions. [source] Lipoprotein(a) levels in girls with premature adrenarcheJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2008Nesibe Andiran Aim: Elevated lipoprotein(a) (Lp(a)) level is a risk factor for cardiovasculary disease (CVD). Women with polycystic ovary syndrome (PCOS) have higher Lp(a) and risk for CVD than controls. The girls with premature adrenarche (PA) were shown to share similar hormonal/metabolic properties with PCOS. We compared Lp(a) levels in PA, with healthy and PCOS girls. Methods: In total, 25 PA, 20 controls and 10 girls with PCOS were evaluated. Lp(a), lipid profiles and insulin, glucose, free testosterone, dehydroepiandrosterone sulfate (DHEAS) and androstenedione levels were measured. A family history about CVD was obtained. Results: The mean age of girls with PA, at time of the study, was 10.04 ± 1.53, control 9.83 ± 1.58 and PCOS was 16.58 ± 1.46 years. The median (range) of Lp(a) levels were 22.5 (3.50,99.90), 9.6 (3.33,32.40) and 21.2 (5.89,85.65) mg/dL in PA, control and PCOS groups, respectively (P > 0.05). The median Lp(a)'s were 14.5 (3.50,87.00) and 24.30 (6.20,99.90) mg/dL, in prepubertal (Tanner 1) and pubertal PA girls (Tanner 2,5), respectively (P > 0.05). The median Lp(a) of prepubertal peers was 8.7 (3.33,21.17), while that of pubertal ones was 15.4 (4.72,32.40) mg/dL (P > 0.05). There was no difference between Lp(a) levels of pre-pubertal PA girls and their peers; however, significant difference was found in Lp(a) levels in pubertal stages of PA and healthy peers (P < 0.05). The positive family history of CVD was 60% in PA; 55% and 80% in the control and PCOS groups, respectively, with no statistical difference. Lp(a) level was correlated with DHEAS (r = 0.386, P = 0.008) and free testosterone (r = 0.337, P = 0.022) levels positively. There was no significant correlation between Lp(a) and body mass index, fasting insulin and fasting glucose/insulin ratio. Conclusions: Lipoprotein(a) levels in pubertal girls with PA differ significantly from healthy peers. However, to clarify whether the girls with PA have an additional risk for CVD with respect to Lp(a), further follow-up studies with larger number of patients are necessary. [source] Influence of anti-HBc seropositivity on the risk of hepatocellular carcinoma in HCV-infected patients after adjusting for confounding factorsJOURNAL OF VIRAL HEPATITIS, Issue 2 2010T. Ohki Summary., It is controversial whether past hepatitis B virus infection constitutes an additional risk of hepatocellular carcinoma (HCC) among patients with hepatitis C virus (HCV). The incidence of HCC between 1994 and 2004 was analysed among 1262 patients who were only positive for HCV. The cumulative incidence of HCC was assessed by Kaplan,Meier analysis and the difference between two groups was assessed by the log-rank test. The effect of anti-HBc positivity on the risk of HCC was assessed with multivariate Cox proportional analysis. Anti-HBc was positive in 522 (41.4%) patients. The proportion of male patients (56.7 vs 46.8%, P < 0.001) and mean age (60.8 vs 56.9 years, P < 0.001) were significantly higher in the anti-HBc positive group. HCC developed in 339 patients (mean follow-up 7.0 years), with cumulative incidence rates at 3, 5 and 10 years of 12.7, 24.5 and 41.9% in the anti-HBc positive group and 10.6, 17.7 and 33.4% in the negative group, respectively (P = 0.005). However, anti-HBc seropositivity did not reach statistical significance in multivariate analysis including age and gender (hazard ratio, 1.06; 95% CI, 0.85,1.31; P = 0.63). Anti-HBc positivity and HCC incidence were confounded by male gender and older age. [source] The profitability-risk tradeoff of just-in-time manufacturing technologiesMANAGERIAL AND DECISION ECONOMICS, Issue 5 2003Jeffrey L. Callen Qualitative survey studies and a recent quantitative study by Callen et al. (2000) indicate that JIT manufacturing is more profitable than conventional non-JIT manufacturing. This study tests the hypothesis that the excess profitability of JIT manufacturing just compensates for the additional operational risks of JIT technology relative to conventional manufacturing. An often-suggested alternative hypothesis is that JIT manufacturing dominates conventional manufacturing in reducing costs and increasing revenues and that risk is not an issue. The multivariate results unambiguously reject the hypothesis that excess JIT profits are compensation for additional risk. We find that profitability is inversely related to risk, especially for JIT plants. We also find that the JIT plants in our sample are more profitable than non-JIT plants even after adjusting for risk, consistent with the dominance argument. Copyright © 2003 John Wiley & Sons, Ltd. [source] IgE sensitization, respiratory allergy symptoms, and heritability independently increase the risk of otitis media with effusionALLERGY, Issue 3 2006F. M. Chantzi Background and aims:, Epidemiological evidence examining the role of atopy and/or allergy in the pathogenesis of otitis media with effusion (OME) is inconclusive. The aim of this study was to assess any increased risk for OME attributable to allergy-related factors, in a well-characterized population using a case-control design and multivariate analysis. Subjects and methods:, Eighty-eight 1,7-year-old children with OME, diagnosed by clinical and tympanometric evaluation and 80 matched controls were enrolled. A standardized questionnaire was completed, in order to assess factors related to OME and allergy-related symptoms and diagnoses using strict clinical definitions. Specific IgE was measured by skin-prick tests and/or CAP-FEIA. Results:, The patient and control groups were well matched. Factors conferring increased risk for OME in the univariate analysis included IgE sensitization, dyspnea, wheezing, asthma, paroxysmal sneezing, rhinitis, eczema, ,any allergic disease,' family history of otitis media, and family history of allergy. After multivariate analysis IgE sensitization, wheezing, nasal obstruction, family history of otitis, and child-care attendance remained as independent risk factors for development of OME. Conclusion:, IgE sensitization and respiratory allergy symptoms are independent risk factors for the development of OME, suggesting that both immunological and mechanical pathways may contribute to the development of the disease. Otitis heritability provides additional risk, as well as frequent exposure to viral upper respiratory tract infections in children attending daycare. Treatment and/or prevention of OME using anti-allergic medications should be further examined. [source] TRADING-VOLUME SHOCKS AND STOCK RETURNS: AN EMPIRICAL ANALYSISTHE JOURNAL OF FINANCIAL RESEARCH, Issue 2 2010Zhaodan Huang Abstract We examine high-volume premiums based on weekly risk-adjusted returns. Significant average weekly abnormal high-volume premiums up to 0.50% per week are documented for 1962,2005. Most premiums are generated in the first two weeks and monotonically decline as holding periods are extended. Evidence of reversal is found as the holding periods are extended. Premiums depend on realized turnover in the holding period. The last finding supports the theories of Miller and Merton. Finally, we test whether premiums are compensation for taking additional risk. Negative skewness, idiosyncratic risk, and liquidity risk do not explain the high-volume premiums. [source] Quality of Diets Consumed by Older Rural AdultsTHE JOURNAL OF RURAL HEALTH, Issue 1 2002Mara Z. Vitolins Dr.P.H.R.D Older adults residing in rural communities are at risk for low dietary quality because of a variety of social, physical and environmental circumstances. Minority elders are at additional risk because of poorer health status and lower socioeconomic status. This study evaluated the food group intake of 130 older (>70 years) African American (34%), European American (36%), and Native American (30%) residents of two rural communities in central North Carolina. An interviewer-administered food frequency questionnaire was used to measure dietary intake. Food items were classified into food groups similar to the United States Department of Agriculture (USDA) Food Guide Pyramid and the National Cancer Institutés 5 A Day for Better Health program. None of the survey participants met minimum intake recommendations and most over-consumed fats, oils, sweets and snacks. African Americans and Native Americans consumed fewer servings of meats, fruits and vegetables, and fats, oils, sweets and snacks than European Americans. African American men consumed the fewest servings of fruits and vegetables of all gender/ethnic groups. Consumption of fats, oils and sweets was greatest among those 85 years and older and was more common among denture users. National strategies to educate the public about the importance of consuming a varied diet based on the recommendations presented in national nutrition education campaigns may not be reaching older adults in rural communities, particularly minority group members. [source] The Impact of Preexisting or Acquired Kaposi Sarcoma Herpesvirus Infection in Kidney Transplant Recipients on Morbidity and SurvivalAMERICAN JOURNAL OF TRANSPLANTATION, Issue 11 2009C. Francès The impact of preexisting or acquired Kaposi sarcoma herpesvirus (KSHV) infection in kidney transplant recipients was evaluated in a prospective study. Serum collected from kidney donors and recipients before transplantation were tested for antibodies against KSHV latent nuclear antigen. Three groups of recipients were defined: group A (KSHV+), group B (KSHV,, KSHV+ donor) and group C (donor and recipient KSHV,). Blood was collected from recipients, every 3 months for 3 years, for KSHV viremia (groups A and B), quantitative (group A) and qualitative serology (group B). Data of group C recipients were extracted from a French database. The prevalence of KSHV antibodies was 1.1% in donors and 3.2% in recipients. There were respectively 161, 64 and 4744 recipients in groups A, B and C. In group A, 13% developed Kaposi's sarcoma (KS). Age >53.5 years (p = 0.025) and black skin (p = 0.0054) were associated with KS development. In group B, three recipients developed clinical manifestations related to KSHV infection. There was no difference in terms of survival and graft loss between the three groups. In conclusion, although kidney recipients should be aware of the additional risk of KSHV morbidity, KSHV+ recipients should not be systematically excluded from kidney transplantation. [source] Elective Surgical Patients as Living Organ Donors: A Clinical and Ethical InnovationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2009G. Testa We propose a new model for living organ donation that would invite elective laparoscopic cholecystectomy patients to become volunteer, unrelated living kidney donors. Such donors would be surgical patients first and living donors second, in contrast to the current system, which ,creates' a surgical patient by operating on a healthy individual. Elective surgery patients have accepted the risks of anesthesia and surgery for their own surgical needs but would face additional surgical risks when a donor nephrectomy is combined with their cholecystectomy procedure. Because these two procedures have never been performed together, the precise level of additional risk entailed in such a combined approach is unknown and will require further study. However, considering the large number of elective cholecystectomies performed each year in the United States, if as few as 5% of elective cholecystectomy patients agreed to also serve as living kidney donors, the number of living kidney donors would increase substantially. If this proposal is accepted by a minority of patients and surgeons, and proves safe and effective in a protocol study, it could be applied to other elective abdominal surgery procedures and used to obtain other abdominal donor organs (e.g. liver and intestinal segments) for transplantation. [source] Marijuana Use in Potential Liver Transplant CandidatesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2009D. N. Ranney Concern exists that liver transplant center substance abuse policies may have an inappropriate and disproportionate impact on marijuana users. Our hypothesis is that patients with chronic liver disease who were marijuana users will have inferior survival. This is a retrospective (1999,2007) cohort study. The primary outcome measure is time-dependent, adjusted patient survival from the time of liver transplant evaluation. The primary exposure variable is a positive cannabinoid toxicology screen during the liver transplant evaluation period. Overall, 155 patients qualified as marijuana users while 1334 patients were marijuana non-users. Marijuana users were significantly (p < 0.05) younger (48.3 vs. 52.1), more likely to be male (78.1% vs. 63.0%), have hepatitis C (63.9% vs. 40.6%) and were less likely to receive a transplant (21.8% vs. 14.8%). Marijuana users were more likely to use tobacco, narcotics, benzodiazepines, amphetamines, cocaine or barbiturates (p < 0.05). Unadjusted survival rates were similar between cohorts. Upon multivariate analysis, MELD score, hepatitis C and transplantation were significantly associated with survival, while marijuana use was not (HR 1.09, 95% CI 0.78,1.54). We conclude that patients who did and did not use marijuana had similar survival rates. Current substance abuse policies do not seen to systematically expose marijuana users to additional risk of mortality. [source] Early Presence of Calcium Oxalate Deposition in Kidney Graft Biopsies is Associated with Poor Long-Term Graft SurvivalAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2005Hélady Sanders Pinheiro Accumulated oxalate will be excreted after renal transplantation, creating an increased risk of tubular precipitation, especially in the presence of allograft dysfunction. We evaluated calcium oxalate (CaOx) deposition in renal allograft biopsies with early dysfunction, its association with acute tubular necrosis (ATN) and graft survival. We studied 97 renal transplant patients, submitted to a graft biopsy within 3 months post-transplant, and reanalyzed them after 10 years. We analyzed renal tissue under polarized light and quantified CaOx deposits. CaOx deposits were detected in 52.6% of the patients; 26.8% were of mild and 25.8% of moderate intensity. The deposits were more frequent in biopsies performed within 3 weeks post-transplant (82.4 vs. 63.0%, p < 0.05) and in allografts with more severe renal dysfunction (creatinine 5.6 mg/dL vs. 3.4 mg/dL, p < 0.001). ATN incidence was also higher in patients with CaOx deposits (47% vs. 24%, p < 0.001). Twelve-year graft survival was strikingly worse in patients with CaOx deposits compared to those free of deposits (49.7 vs. 74.1%, p = 0.013). Our study shows a high incidence of CaOx deposits in kidney allografts with early dysfunction, implying an additional risk for acute tubular injury, with a negative impact on graft survival. [source] Are common symptoms in childhood associated with chronic widespread body pain in adulthood?: Results from the 1958 british birth cohort studyARTHRITIS & RHEUMATISM, Issue 5 2007Gareth T. Jones Objective Studies have shown that common symptoms in childhood predict the onset of chronic widespread pain in the short term. However, it is unknown whether this association persists into adulthood. The aim of the current study was to examine, prospectively, whether children with common symptoms experience an increased risk of chronic widespread pain as adults. Methods Information on vomiting/bilious attacks, abdominal pain, and headaches/migraine was collected on 10,453 7-year-old children, by maternal report. Similar data were gathered when the children were ages 11 years and 16 years. Body pain at age 45 years was assessed by postal questionnaire. Poisson regression was used to examine chronic widespread pain in relation to childhood symptom reporting. Results Of the 10,453 subjects on whom data were obtained when they were children, 7,470 participated at age 45 years (71.5%). Children with multiple symptoms at age 7 years experienced a 50% increased risk of chronic widespread pain (relative risk 1.5 [95% confidence interval 1.03, 2.3]). This relationship persisted after adjustment for sex, recent psychological distress, and childhood and current socioeconomic status, and after excluding children with major illnesses that might have explained early symptom reporting. A similar relationship with symptoms at ages 11 and 16 years was observed, although this was not associated with additional risk compared with that found with the presence of symptoms at age 7 years. However, despite a modest increase in risk, the presence of multiple symptoms at early ages was uncommon (<1.5%), and therefore, the associated population attributable risk was low (<1%). Conclusion Multiple common symptoms in childhood are associated with an increased risk of chronic widespread pain in adulthood. However, the magnitude of this increased risk is modest, and reports of multiple symptoms in childhood are uncommon. Thus the "early pain pathway" phenomenon is applicable only to a small proportion of individuals with chronic widespread pain. [source] Risk Assessment for Quantitative Responses Using a Mixture ModelBIOMETRICS, Issue 2 2000Mehdi Razzaghi Summary. A problem that frequently occurs in biological experiments with laboratory animals is that some subjects are less susceptible to the treatment than others. A mixture model has traditionally been proposed to describe the distribution of responses in treatment groups for such experiments. Using a mixture dose-response model, we derive an upper confidence limit on additional risk, defined as the excess risk over the background risk due to an added dose. Our focus will be on experiments with continuous responses for which risk is the probability of an adverse effect defined as an event that is extremely rare in controls. The asymptotic distribution of the likelihood ratio statistic is used to obtain the upper confidence limit on additional risk. The method can also be used to derive a benchmark dose corresponding to a specified level of increased risk. The EM algorithm is utilized to find the maximum likelihood estimates of model parameters and an extension of the algorithm is proposed to derive the estimates when the model is subject to a specified level of added risk. An example is used to demonstrate the results, and it is shown that by using the mixture model a more accurate measure of added risk is obtained. [source] Bronze baby syndrome and the risk of kernicterusACTA PAEDIATRICA, Issue 7 2005Giovanna Bertini Abstract Aim: The problem of kernicterus in infants with bronze baby syndrome (BBS) has been reviewed on the basis of cases reported in the literature. In addition, a new case concerning an infant with severe Rh haemolytic disease, who presented with BBS and who has developed neurological manifestations of kernicterus with magnetic resonance images showing basal ganglia abnormalities, is presented. In this patient, the total serum bilirubin (TSB) concentration ranged from 18.0 to 22.8 mg/dl (306 to 388 ,mol/l) and the bilirubin/albumin (B/A) ratio was 6.0 (mg/g) (6.8 is the value at which an exchange transfusion should be considered). The case presented is important due to the fact that kernicterus appeared after an exchange transfusion was performed when the TSB level reached 22.8 mg/dl (388 ,mol/l) on 6th day of life while the haematocrit was 30%. From this case and from other cases reported in the literature, we must stress that, even if the level at which hyperbilirubinemia poses a threat remains undefined, BBS may constitute an additional risk of developing kernicterus. Conclusion: The possible strategies for implementing an approach to the management of hyperbilirubinemia (especially the haemolytic kind) in the presence of BBS may include an exchange transfusion carried out at lower TSB concentration than previously recommended or an early administration of Sn-mesoporphyrin. [source] The impacts of climate change on the risk of natural disastersDISASTERS, Issue 1 2006Maarten K. Van Aalst Abstract Human emissions of greenhouse gases are already changing our climate. This paper provides an overview of the relation between climate change and weather extremes, and examines three specific cases where recent acute events have stimulated debate on the potential role of climate change: the European heatwave of 2003; the risk of inland flooding, such as recently in Central Europe and Great Britain; and the harsh Atlantic hurricane seasons of 2004 and 2005. Furthermore, it briefly assesses the relation between climate change and El Niño, and the potential of abrupt climate change. Several trends in weather extremes are sufficiently clear to inform risk reduction efforts. In many instances, however, the potential increases in extreme events due to climate change come on top of alarming rises in vulnerability. Hence, the additional risks due to climate change should not be analysed or treated in isolation, but instead integrated into broader efforts to reduce the risk of natural disasters. [source] Home management of haemophiliaHAEMOPHILIA, Issue 2 2004J. M. Teitel Summary., The demonstrated benefits of home care for haemophilia include improved quality of life, less pain and disability, fewer hospitalizations, and less time lost from work or school. Although reduced mortality has not been demonstrated, the substantial increase in longevity since the early 1980s correlates with the introduction of home treatment and prophylaxis programmes. These programmes must be designed and monitored by haemophilia treatment centres (HTC), which are staffed with professionals with broad and complementary expertise in the disease and its complications. In return, patients and their families must be willing to accept the reciprocal responsibilities that come from administering blood products or their recombinant equivalents at home. Patients with inhibitors to factors VIII or IX pose special challenges, but these complications do not obviate participation in home care programmes. Home care was an essential prerequisite to the introduction of effective prophylactic factor replacement therapy. Prophylaxis offers significant improvements in quality of life, but requires a substantial commitment. The use of implantable venous access devices can eliminate some of the difficulty and discomfort of peripheral venous access in small children, but brings additional risks. The future holds the promise of factor concentrates for home use that have longer half-lives, or can be administered by alternate routes. Knowledge of patient genotypes may allow treatments tailored to avoid complications such as inhibitor development. Gene therapy trials, which are currently ongoing, will ultimately lead to gene-based treatments as a complement to traditional protein-based therapy. [source] Does Aortic Root Enlargement Impair the Outcome of Patients With Small Aortic Root?JOURNAL OF CARDIAC SURGERY, Issue 5 2006Hasan Ardal The aim of this study was to evaluate long-term results of the posterior root enlargement. Methods: Between 1985 and 2002, 124 patients underwent aortic valve replacement with a posterior root enlargement. The main indication was a small aortic valve orifice area to patient body surface area (indexed valve area < 0.85 cm2/m2). Fifty-four (44%) patients were male, and 70 (56%) were female with a mean age 39.1 ± 14.3 years. Indications for operation were severe calcified aortic valve stenosis (37.1%), severe aortic insufficiency (25.8%), or combination (37.1%). Seventy-five (60%) patients received double-valve replacement. A pericardial patch was used in 100 patients (80.6%) and a Dacron patch was used in 24 patients. Results: Operative mortality was 6.4% (8 patients). The causes of hospital mortality were low cardiac output syndrome (LCOS) (in 6 patients), cerebrovascular events (in 1 patient) and multiple organ failure (in 1 patient). Multivariate analysis demonstrated concomitant coronary revascularization to be a significant (p = 0.03) predictor for early mortality. There were six (5.4%) late deaths. Cox proportional hazards regression analysis demonstrated LCOS (p = 0.013) and infective endocarditis (p = 0.003) to be significant predictors for late mortality. Atrioventricular block required a permanent pacemaker was observed in 4 patients (3.2%). Conclusions: Posterior aortic root enlargement techniques can be easily applied without additional risks. Long-term survival and freedoms from valve-related complications are satisfactory. [source] Unfavorable lipid profiles in mild obesity with excess body fat percentagePEDIATRICS INTERNATIONAL, Issue 1 2000Akiho Tamura Abstract Background: The aim of the present study was to investigate the usefulness of subclassifications of overweight children using the body fat percentage (Fat%) to predict the serum lipid profile. Methods: School children (431, 236 boys and 195 girls) aged 9,12 years were divided into three obesity groups (non-, mild and advanced obesity) and were further divided into two subgroups according to the Fat% measured by bioelectrical impedance analysis. The mean fasting serum lipid levels were also evaluated. Results: In the non-obesity and the advanced obesity groups, the Fat%-based subclassification demonstrated no essential differences in lipid profiles or in the prevalence of hyperlipidemia between the two subgroups. However, in the mild obesity group, the levels of low-density lipoprotein cholesterol and triglyceride and the atherogenic index were significantly higher and the high-density lipoprotein cholesterol level was significantly lower in the adipositic subgroup (Fat%, age/sex-specific cut-off value) than in the non-adipositic subgroup. Multiple comparison of lipid levels among all six categories of children indicated that the adipositic subgroup of mild obesity had no advantage over the advanced obesity group with respect to the atherogenic potential and that the non-adipositic subgroup of mild obesity showed no additional risks compared to the non-obesity group. Moreover, the prevalence of hyperlipidemia in the adipositic subgroup of mild obesity (50.0%) was significantly different from that in its non-adipositic counterpart (13.3%) and was equivalent to that in the advanced obesity group. Conclusions: These results suggest that Fat% evaluation is useful to divide mildly obese children into two distinct subtypes based on serum lipid profiles and that the excess Fat% in mildly obese school children is a predictor of atherogenesis. [source] Fatal case of bilateral internal jugular vein thrombosis following IVIg infusion in an adolescent girl treated for ITPAMERICAN JOURNAL OF HEMATOLOGY, Issue 4 2008Pui-Ying Iroh Tam Intravenous immunoglobulin (IVIg) is often used as therapy in immune-mediated diseases and is generally considered a safe therapeutic agent. However, thrombotic complications such as myocardial infarction and deep vein thrombosis have been reported, although primarily in older adults. We describe a 13-year-old girl who received one dose of IVIg for immune thrombocytopenic purpura and developed fatal bilateral jugular venous thromboses. This is the first known case of IVIg-associated thrombosis in an adolescent and alsothe first report describing internal jugular vein thrombosis associated with IVIg infusion. We identify additional risks that may potentiate the agent's thrombotic risk. Am. J. Hematol., 2008. © 2007 Wiley-Liss, Inc. [source] Tube thoracostomy during allogeneic stem cell transplantation does not carry an increased risk for infections or bleedingCLINICAL TRANSPLANTATION, Issue 1 2004D Barkan Abstract:, Background:, Candidates for stem cell transplantation may occasionally suffer from massive pleural effusions related to their disease and require tube thoracostomy. The additional risk of this procedure during allogeneic transplantation procedure is not known. Methods:, Four high-risk patients transplanted in our institution during a 2-yr period had chest drainage by tube thoracostomy. The characteristics of the fluid, the clinical course, and the outcome were assessed. Results:, A total of nine chest drains were inserted (range 1,5). No bleeding complications related to the procedure were noted. None of the patients developed any clinical signs of local infection at the tube insertion site or within the pleural fluid. All cultures taken from the drained fluid or from the insertion wound were negative. Conclusions:, Tube thoracostomy in itself does not seem to pose additional risks in the transplant procedure, despite all patients in this series being considered to be at high-risk for complications. [source] |