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Early Signs (early + sign)
Selected AbstractsEarly signs of lethal effects in Daphnia magna (Branchiopoda, Cladocera) exposed to the insecticide cypermethrin and the fungicide azoxystrobinENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 10 2010Ursula Friberg-Jensen Abstract This study presents the effects of sublethal concentrations of pesticides cypermethrin and azoxystrobin on the activity of several physiological parameters of egg-carrying Daphnia magna studied using a video-image technique. Single tethered daphnids were continuously recorded for 24,h of pesticide exposure, and the activity of the heart, the filtering limbs, the mandibles, and the focal spine were subsequently analyzed. Acute toxicity tests based on the criteria of immobilization were performed on egg-carrying D. magna, and sublethal concentrations of 0.1, 1.0, and 10,µg/L cypermethrin and 0.5, 1.0, and 2.0,mg/L azoxystrobin were established. At a concentration as low as 0.1,µg/L cypermethrin, the 5% effective concentration after 24,h of exposure (EC5,24h), the activity of the focal spine increased and the filtering limb activity decreased. The activity of the mandibles was reduced by exposure to 1.0 (EC18,24,h) and 10,µg/L (EC41,24,h) cypermethrin, whereas heart activity increased at a concentration of 10,µg/L (EC41,24,h). With regard to azoxystrobin, the activity of all response parameters except the focal spine decreased by exposure to 0.5,mg/L (EC4,24h) azoxystrobin. The focal spine was not affected by azoxystrobin. The results show that physiological mechanisms important for ingestion of food in D. magna may be impaired by low concentrations of commonly used pesticides. Environ. Toxicol. Chem. 2010;29:2371,2378. © 2010 SETAC [source] Influence of environmental stress on skin tone, color and melanogenesis in Japanese skinINTERNATIONAL JOURNAL OF COSMETIC SCIENCE, Issue 1 2005K. Kikuchi Introduction It is needless to say that one of the most potent environmental stress for melanogenesis of the human skin is the effect of ultraviolet (UV) light from the sunlight. Characteristic skin aging as a result of this UV light is recognized as photoaging. Clinical features in photoaging are wrinkles, skin laxity, coarseness, leathery, yellowing, lentigenes, mottled pigmentation, telangiectasia, sebaceous hypertrophy and purpura. There is an apparent difference in clinical features in photoaging among different races, i.e. between Caucasians, African American and Asians that include Japanese. Not only photo skin type but also environmental factors, such as climate, latitude, altitude and their habit of sunbathing, smoking and skin care influence the characteristic development of their photoaging. Racial difference in photoaging Caucasians tend to develop skin laxity and fine wrinkles more than Asians [1]. Asians tend to produce coarser wrinkles than the Caucasians although their development is rather late in life. There is also a difference in the skin color. Pigmentation is an earliest and prominent skin changes in Asians [1] and it increases with age [2]. In contrast, pigmentation is not apparent in the Caucasians although redness probably because of an increase in cutaneous vascularization becomes prominent in middle aged Caucasians [2]. Chung reported that seborrheic keratosis is a major pigmentary lesion in men, whereas hyperpigmented macules are prominent features in women in Koreans [3]. Melanogenesis pigmentation disorders in Japanese Ephelides (freckles) are commonly found in those with photo skin type I who have fair skin and red eyes and blond hair. They are also found in the Japanese. Clinical feature reveals that multiple small pigmentary macules on sun-exposed areas mainly on the mid-portion of the face. These lesions seem to be familial, becoming apparent even in early childhood after sun exposure. Melasma is an acquired pigmentary disorder commonly found in middle aged Japanese women characterized by irregular brown macules and patches on the sun-exposed areas on the face typically as bilaterally present macules on the cheeks. An increase in sex hormones as a result of pregnancy and intake of contraceptive pills is one of the etiological factors to develop melasma. Sun exposure also worsens it. Nevus of Ota is also a common pigmentary disorder found in the Japanese. It is usually unilateral, blue-brown to slate-gray pigmentary macules on the eyelid and cheek that appear in early childhood or in puberty. Acquired dermal melanocytosis is also a pigmentary disorder, in which dermal melanocytes are found as shown in nevus of Ota, characterized by bilateral brown to blue-gray macules on the forehead, temple, eyelid and malar areas in middle aged Japanese women. This tends to be misdiagnosed as melasma. Solar lentigo is an acquired pigmented macule induced by sun exposure. Solar lentigines are usually multiple, circumscribed brown macules. There are two types of solar lentigo. One is a small macular type, characterized by multiple, small brown macules whose diameter is less than 5 mm, being similar to ephelides (freckles). The other type is a large macular type, characterized by a few round to oval, brown macules whose diameter is beyond 1 cm. Some of their surface are hyperkeratotic and become elevated to produce seborrheic keratosis. Again, the early sign of photoaging in Japanese is pigmentated spots and these pigmentation disorders increase with age. Among the pigmentary changes, nevus of Ota, acquired dermal melanocytosis, melasma and large macular type of solar lentigo are characteristic skin changes found in the Japanese in addition to ephelides and small macular type of solar lentigo. Seasonal changes of the various functional properties of the skin including skin color assessed by non-invasive bioengineering techniques [4]. When we consider skin tone, color and melanogenesis, UV light from the sunlight is the most potent environmental stress, although we cannot forget also the important influence of environmental relative humidity affects our skin functions as well as its appearance. We investigated seasonal influences on the various properties of the skin in 39 healthy Japanese females consisting of different age groups. Their skin is thought to be affected by the UV light in summer, and by the exposure to the dry and cold air in winter. Materials and methods Biophysical, non-invasive measurements, including transepidermal water loss (TEWL) as a parameter for the barrier function of the stratum corneum (SC), high frequency conductance as a parameter for the hydration state of the SC, skin color and casual surface lipid levels, were conducted during late summer and winter months. Skin color was determined with a chromameter according to the L*a*b* CIE 1976 system, where L* is an attribute on the luminance scale, a* that on the red versus green scale and b* that on the yellow versus blue scale. All the measurements were conducted in an environment controlled-chamber (21 ± 1 °C room temperature, and 50 ± 3% relative humidity). Results The barrier function of the SC was found to be significantly impaired in winter on the cheek as compared with that measured in summer, whereas no such seasonal change was apparent both in the hydration state of the SC and sebum levels on the cheek. In the assessment of the skin color on the cheek, a significant increase in a* (redness) and a decrease in b* (yellowness) were observed in winter. In contrast, on the flexor forearm, the values of L* (luminescence) increased in winter, but no seasonal change was noted in the values of a* and b*. In this study, skin changes with aging were also found by the non-invasive bioengineering methods. The value of TEWL on the cheek tended to increase with age, whereas no significant change was observed in the value of TEWL on the forearm. In the assessment of skin color, b* value on the cheek significantly increased with age whereas a* and L* values on the cheek did not show any significant change with age. Summary of this study We think that such an increase in yellowness with aging of the cheek skin is a phenomenon unique to the Japanese (Asians) since an increase in b* value was not observed in Caucasians [2]. The facial skin that is always exposed shows barrier impairment in a dry and cold winter environment and demonstrates increased yellowness in skin color because of a prolonged exposure to the UV light from the sun in the summer season. The non-invasive bioengineering methods are useful to demonstrate even invisible seasonal changes occurring in the same individuals and changes with age occurring in the skin. References 1.,Goh, S.H. The treatment of visible signs of senescence: the Asian experience. Br. J. Dermatol.122, 105,109 (1990). 2.,LeFur, I., Numagami, K., Guinot, C. et al. Age-related reference values of skin color in Caucasian and Japanese healthy women according to skin site. Pigment Cell Res. 7, 67 (1999). 3.,Chung, J.H., Lee, S.H., Youn, C.S. et al. Cutaneous photodamage in Koreans: influence of sex, sun exposure, smoking, and skin color. Arch. Dermatol. 137, 1043,1051 (2001). 4.,Kikuchi, K., Kobayashi, H., Le Fur, I. et al. Winter season affects more severely the facial skin than the forearm skin: comparative biophysical studies conducted in the same Japanese females in later summer and winter. Exog. Dermatol. 1, 32,38 (2002). [source] Unifocal Langerhans cell histiocytosis of the oral mucosaJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 7 2009Susanna Fistarol Summary A 24-year-old man was admitted for a painful gingival ulcer. Histology and immunohistochemistry of a lesional biopsy revealed the diagnosis of Langerhans cell histiocytosis (LCH). To rule out multifocal disease, a complete staging was performed. There was no evidence of bony lesions or any other organ involvement. The diagnosis of LCH restricted to the oral mucosa was established. The complete oral lesion was ablated by CO2 laser and subsequently treated topically with triamcinolone acetonide. The patient is still in remission after one year of follow-up. LCH confined to the oral mucosa is rare. It presents usually as an inflammatory or ulcerative lesion, easily leading to misinterpretation and delayed diagnosis. Patients with limited unifocal mucocutaneous disease, as in the present case, usually have an excellent prognosis. However, the oral lesion may represent an early sign of LCH, predating and progressing to an aggressive life-threatening multiorgan disease. [source] A novel approach to assessing percutaneous VX poisoning in the conscious guinea-pig,JOURNAL OF APPLIED TOXICOLOGY, Issue 5 2008Helen Mumford Abstract Nerve agents like VX (S-2-diisopropylaminoethyl-O-ethyl-methylphosphonothiolate) are potent irreversible acetylcholinesterase (AChE) inhibitors. Following percutaneous nerve agent exposure there is a slower rate of absorption, later onset and longer duration of signs of poisoning. Relatively little is known about the physiological effects of percutaneously applied nerve agent in unanaesthetised laboratory animals. Heart rate (ECG), brain electrical activity (EEG), body temperature, locomotor activity and clinical signs were monitored following percutaneous application of VX to conscious guinea-pigs. A fall in heart rate (bradycardia) preceded incapacitation following the highest VX dose, and occurred in the absence of incapacitation at the lower doses. Following the highest dose of VX (0.592 mg kg,1) three out of four animals died within 24 h. The lower two doses of VX (0.296 and 0.148 mg kg,1), produced extended periods of bradycardia in the absence of observable signs of poisoning. Bradycardia preceded, or occurred in the absence of, a temperature decrease; seizure-like EEG changes were not observed at any of the VX doses tested. Acetylcholinesterase activity was significantly inhibited in the blood and most brain areas at 48 h. There were significant dose-related decreases in body weight at 24 and 48 h following VX. This preliminary study suggests that decreased heart rate may be an early sign of the toxic effects of VX, whereas temperature and observable clinical signs are not good early indicators of percutaneous VX poisoning in this animal model. Future studies will use this model to assess the benefit of administering medical countermeasures in response to a defined decrease in heart rate. © Crown Copyright 2007. Reproduced with the permission of the Controller of HMSO. Published by John Wiley & Sons, Ltd. This article was published online on 5 December 2007. An error was subsequently identified. This notice is included in the online and print versions to indicate that both have been corrected [30 May 2008]. [source] Index of myocardial performance in patients with type 2 diabetes without hypertension and its relationship with clinical and echocardiographic parametersJOURNAL OF DIABETES, Issue 1 2009Hayrettin SAGLAM Abstract Background:, Diabetes mellitus affects the systolic and diastolic function of the left ventricle (LV). The aim of the present study was to evaluate the index of myocardial performance (IMP), a new Doppler index, in asymptomatic, normotensive patients with type 2 diabetes mellitus (T2DM). Methods:, The study population consisted of 40 asymptomatic normotensive patients with T2DM (22 women, 18 men; mean [±SD] age 49,±,7 years) and 20 healthy controls (13 women, seven men; mean age 45,±,4 years). M-Mode and two-dimensional Doppler echocardiography was performed in all subjects to calculate IMP. Venous blood samples were collected for analysis and body mass index (BMI) was calculated. Results:, In normotensive T2DM patients, the mitral E wave was decreased, whereas mitral A wave, mitral E/A ratio, and septal wall thickening were increased compared with values obtained for the control group. The IMP was higher in normotensive T2DM patients than in the control group (P = 0.004). There was a significant correlation between IMP and triglyceride (TG) levels (P,<,0.001), mitral E wave (P,<,0.001), mitral E/A ratio (P,<,0.001), ejection fraction (P = 0.001), fasting blood glucose (P =0.007), LV systolic dimension (P,<,0.001), duration of diabetes (P = 0.017), and BMI (P = 0.029). Stepwise multiple regression analysis demonstrated that only TG levels (, = 0.355, t = 2.487, P = 0.017) and the mitral E/A ratio (, = ,0.384, t = ,2.690, P = 0.011) had an independent effect on IMP. Conclusion:, The results of the present study indicate that IMP is increased in normotensive T2DM patients. The findings suggest that increased IMP may be an early sign of diabetic cardiomyopathy in normotensive diabetic patients with preserved LV function. [source] Gonad development and evidence of protogyny in the red-throat emperor on the Great Barrier ReefJOURNAL OF FISH BIOLOGY, Issue 2 2003K. Bean The gonad development in the red-throat emperor Lethrinus miniatus is described and the first detailed evidence for protogyny in this species provided. The identification of transitional individuals, bimodal sex-specific size-frequency distributions and female biased sex ratios suggest that L. miniatus is most likely a protogynous hermaphrodite. Transitional L. miniatus gonads were characterized by the concurrent degeneration of all oocytes and the proliferation of spermatocysts near the edge of the lamellae, an increase in blood vessels along strands of stromal tissue within the lamellae and the formation of multiple sperm sinuses. The sites of oocyte degeneration and proliferation of spermatocysts were spatially segregated. An increase in blood vessels along strands of stromal tissue within the lamellae of transitional phase gonads is likely to assist in the breakdown of oocytes and the proliferation of spermatocysts. Most mature resting females containing spermatocysts occurred within the transitional size-frequency distribution, suggesting that the presence of spermatocysts in these females may be an early sign of sex change. Oocytes within female gonads were interrupted by filamentous strands of stromal tissue within the lamellae. The testis contained a remanent ovarian lumen but no residual oocytes. Three characteristics of transitional L. miniatus gonads were found to be unusual and described for few other species of coral reef fishes. These included the absence of oocytes within testes, increased numbers of blood vessels, and the presence of strands of stromal tissue within the lamellae. [source] Tissue Doppler and Strain Imaging in Dogs with Myxomatous Mitral Valve Disease in Different Stages of Congestive Heart FailureJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 6 2009A. Tidholm Background: Tissue Doppler imaging (TDI) including strain and strain rate (SR) assess systolic and diastolic myocardial function. Hypothesis: TDI, strain, and SR variables of the left ventricle (LV) and the interventricular septum (IVS) differ significantly between dogs with myxomatous mitral valve disease (MMVD) with and without congestive heart failure (CHF). Animals: Sixty-one dogs with MMVD with and without CHF. Ten healthy control dogs. Methods: Prospective observational study. Results: Radial motion: None of the systolic variables were altered and 3 of the diastolic velocities were significantly increased in dogs with CHF compared with dogs without CHF and control dogs. Longitudinal motion: 2 systolic velocities and 3 diastolic velocities were significantly increased in dogs with CHF compared with dogs without CHF and control dogs. Difference in systolic velocity time-to-peak between LV and IVS was significantly increased in dogs with MMVD with and without CHF compared with control dogs. In total, 11 (23%) of 48 TDI and strain variables differed significantly between groups. Left atrial to aortic ratio was positively correlated to early diastolic velocities, percentage increase in left ventricular internal diameter in systole was positively correlated to systolic and diastolic velocities, and mitral E wave to peak early diastolic velocity in the LV basal segment (E/Em) was positively correlated to radial strain and SR. Conclusions and Clinical Importance: Few TDI and strain variables were changed in dogs with MMVD with and without CHF. Intraventricular dyssynchrony may be an early sign of MMVD or may be an age-related finding. [source] Microcirculatory Dysfunction in Chronic Venous Insufficiency (CVI)MICROCIRCULATION, Issue S1 2000MICHAEL JÜNGER ABSTRACT The elevated ambulatory pressure in the peripheral venous system of chronic venous insufficiency (CVI) patients manifests itself not only in the form of disturbed macrocirculation but also and particularly in microangiopathic changes. For this reason, it is closely correlated with trophic disorders of the skin and can ultimately lead to ulceration. Using microcirculation research techniques, we are able to provide clear evidence of a typical microangiopathy in chronic venous insufficiency. Fifty CVI patients in Widmer stages I, II, and III were examined with fluorescence video microscopy, intravital video capillaroscopy, transcutaneous oxygen partial pressure measurement, TcpO2 and laser Doppler flowmetry. The effects of compression therapy with individually fitted compression stockings on capillary morphology were studied over a period of 4 weeks in 20 CVI patients in Widmer stages I and II. The capillary pressure was measured during simulated muscle contraction using a servo-null micropressure system. We periodically drew blood from the dorsalis pedis vein and a brachial vein of 11 healthy test persons and 8 patients with stage III CVI during experimental venous hypertension in order to evaluate the expression pattern of leukocyte adhesion molecules involved in inflammation: LFA-1 (CD11a), Mac-1 (CD11b), p150,95 (CD11c), CD18, VLA-4 (CD49d), and L-selectin (CD62L). In the same patients, we used immunohistochemical methods to examine clinically unaffected skin and the skin near an ulcer, focusing on the adhesion molecules ICAM-1, VCAM-1, and E-selectin. The microangiopathic changes observed with worsening clinical symptoms include a decrease in the number of capillaries, glomerulus-like changes in capillary morphology, a drop in the oxygen content (tcpO2) of the skin, increased permeability of the capillaries to low-molecular-weight substances, increased laser Doppler flux reflecting elevated subcutaneous flow, and diminished vascular reserve. These microangiopathic changes worsen in linear proportion to the clinical severity of chronic venous insufficiency. In patients with venous ulcerations, the baseline expression of LFA-1 and VLA-4 on lymphocytes, Mac-1 expression on the myeloid cell line, and L-selectin expression on all three cell lines was not significantly different from that in healthy controls. During orthostatic stress, there was a significant reduction in the expression of L-selectin in blood cells collected at foot level in the controls (p = 0.002), but not in the patients. Clinical improvement by compression therapy was accompanied by an increase in the number of nutritive capillaries, while the diameter of the capillaries and the dermal papillae was reduced. When ulcers healed in a short period (<6 weeks), we observed a concomitant increase in the number of capillaries (p < 0.05). Microangiopathy appears before trophic disorders of the skin develop. Even trophically normal skin areas may have dilated nutritive capillaries, an early sign of disturbed skin perfusion. These changes represent a plausible explanation for the development and to recurrency tendency of venous ulcers. The reduced expression of lymphocytic L-selectin in healthy controls during the orthostatic stress test may be an indication that the cells are activated by venous stasis. Clinically effective therapeutic measures improve the impaired microcirculation of the skin in the ankle area. [source] Olfactory loss may be a first sign of idiopathic Parkinson's diseaseMOVEMENT DISORDERS, Issue 6 2007Antje Haehner MD Abstract Recent studies support the idea of olfactory dysfunction as a very early sign of idiopathic Parkinson's disease (IPD). Aim of the present study was to clinically follow-up patients with idiopathic hyposmia to find out the percentage of patients developing IPD after 4 years time. At baseline, olfactory tests had been combined with transcranial sonography of the substantia nigra and 123I-FP-CIT SPECT imaging. At the present neurological examination, 7% of the individuals with idiopathic hyposmia had developed clinical IPD. Altogether, 13% presented with abnormalities of the motor system. Our data suggest that a combination of olfactory testing and other tests may constitute a screening tool for the risk to develop IPD. © 2007 Movement Disorder Society [source] Detecting early structural lung damage in cystic fibrosis,,PEDIATRIC PULMONOLOGY, Issue 3 2002Harm A.W.M. Tiddens MD In cystic fibrosis (CF) patients, both severe lung inflammation and severe lung damage occur early and persist throughout life. High-resolution computed tomography (HRCT), a more sensitive method of detecting structural abnormalities than chest X-ray, shows that airways undergo substantial thickening in early CF lung disease. Lung function tests, which are an indirect measure of structural integrity, are insensitive to localized or early damage. Thickening of the peripheral airways causes a reduction in maximal expiratory flow at 25% of forced vital capacity (MEF25) or other measurements of peripheral air flow. Reduced peripheral flows, even in the presence of normal forced expired volume in 1 sec (FEV1) and forced vital capacity (FVC), should be considered an early sign of substantial lung damage and should stimulate aggressive treatment to prevent further deterioration. Pediatr Pulmonol. 2002; 34:228,231. © 2002 Wiley-Liss, Inc. [source] Prostaglandin F2, Stimulates Endothelial Nitric Oxide Synthase Depending on the Existence of Bovine Granulosa Cells: Analysis by Co-culture System of Endothelial Cells, Smooth Muscle Cells and Granulosa CellsREPRODUCTION IN DOMESTIC ANIMALS, Issue 5 2008K Shirasuna Contents Prostaglandin F2, (PGF2,) induces luteolysis in the mid but not in the early luteal phase; despite this, both the early and the mid corpus luteum (CL) have PGF2, receptor (FPr). We previously indicated that the luteal blood flow surrounding the CL drastically increases prior to a decrease of progesterone (P) in the cows, suggesting that an acute increase of luteal blood flow may be an early sign of luteolysis in response to PGF2, and that this may be induced by a vasorelaxant nitric oxide (NO). The aim of this study was to investigate the luteal stage-dependent and the site-restricted effect of PGF2, and NO on the mRNA expressions and P secretion. To mimic the local luteal region both of peripheral and central areas of the CL, we utilized co-cultures using bovine aorta endothelial cells (EC), smooth muscle cells (SMC) and luteinizing granulosa cells (GC) or fully-luteinized GC. PGF2, stimulated the expression of endothelial NO synthase (eNOS) mRNA at 0.5 h in mix-cultures of EC and SMC with fully-luteinized GC but not with luteinizing GC. The expression of eNOS mRNA in EC was increased by PGF2, at 1 h only when EC was cultured together with fully-luteinized GC but not with luteinizing GC. In all co-cultures, PGF2, did not affect the mRNA expression of FPr. Treatment of NO donor inhibited P secretion at 0.5 h. In conclusion, the present study suggests that the coexistence of the mature luteal cells (fully-luteinized GC) with EC/SMC may be crucial for acquiring functional NO synthesis induced by PGF2,. [source] Leukemia cutis is an early sign of blast transformation that may mimic a common skin disease: Sycosis-like eruptions in chronic myelomonocytic leukemiaTHE JOURNAL OF DERMATOLOGY, Issue 10 2010Sonoko TAKEUCHI No abstract is available for this article. [source] Scalp dermoscopy of androgenetic alopecia in Asian peopleTHE JOURNAL OF DERMATOLOGY, Issue 2 2009Shigeki INUI ABSTRACT Although dermoscopy is used mainly for diagnosing pigmented skin lesions, this device has been reported to be useful in observing alopecia areata and frontal fibrosing alopecia. Herein, we investigated the dermoscopic features and their incidence of androgenetic alopecia (AGA; n = 50 men) and female AGA (FAGA; n = 10 women) in Asian people. More than 20% hair diameter diversity (HDD), which reportedly is an early sign of AGA and corresponds to hair follicle miniaturization, was observed in the affected area of all AGA and FAGA cases, suggesting that HDD is an essential feature to diagnose AGA and FAGA. Peripilar signs, corresponding to perifollicular pigmentation, were seen in 66% (33/50) of AGA and 20% (2/10) of FAGA women. This incidence in the present study was lower than previously reported in white subjects possibly because the Asian skin color conceals slight peripilar pigmentation. Yellow dots were observed in 26% (13/50) of AGA and 10% (1/10) of FAGA cases and the number of yellow dots in AGA and FAGA was limited to 10 on the overall hair loss area. Yellow dots possibly indicate the coincidence of AGA and enlargement of the sebaceous glands caused by common end-organ hypersensitivity to androgen. In conclusion, dermoscopy is useful to diagnose AGA and FAGA and provides insights into the pathogenesis of AGA. [source] Adenotonsillar Hypertrophy and Epstein-Barr Virus in Pediatric Organ Transplant Recipients,THE LARYNGOSCOPE, Issue 6 2001Nina L. Shapiro MD Abstract Objectives/Hypothesis Epstein-Barr virus,related (EBV-related) lymphoid hyperplasia of the tonsils and adenoids is a precursor to post-transplantation lymphoproliferative disorder (PTLD). The incidence of post-transplantation adenotonsillar hypertrophy, a potential early sign of PTLD or EBV-related lymphoid hyperplasia, is not known. We sought to identify potential risk factors for adenotonsillar hypertrophy manifested as EBV-related hyperplasia and early PTLD in the pediatric solid organ transplant population. Study Design Cross-sectional analysis. Methods We developed a 65-point questionnaire concerning obstructive sleep disorder and upper respiratory tract infections and an 8-point focused physical examination, to identify prevalence of and risk factors for adenotonsillar hypertrophy in the pediatric transplant population. We evaluated 120 pediatric solid organ transplant recipients by parental questionnaire and focused adenotonsillar physical examination. Results Of the 120 patients, 62 had undergone liver transplantation and 58 had undergone kidney transplantation. Overall, the mean questionnaire score was 8.36 (range, 0,40) and the mean physical examination score was 3.86 (range, 1,8). Patients whose EBV serological test result was negative at the time of transplant had higher scores for both the questionnaire (mean score, 10.24) and the physical examination (mean score, 4.56) than those whose EBV serological test result was positive at the time of transplantation (scores of 7.38 and 3.30 for questionnaire and physical examination, respectively). The difference in examination scores was statistically significant (P <.003). Conclusions Epstein-Barr virus seronegativity at the time of organ transplantation is a known risk factor for PTLD, with associated risk of developing EBV-related lymphoid hyperplasia. Our results indicate a higher incidence of symptoms and signs consistent with adenotonsillar hypertrophy in the EBV seronegative population. Adenotonsillar hypertrophy may be a precursor to EBV-related lymphoid hyperplasia and PTLD and must be identified in this patient population. [source] Changes in molecular forms of prostate-specific antigen during treatment with finasterideBJU INTERNATIONAL, Issue 7 2002F. Espańa Objective ,To study the influence of finasteride treatment on the molecular forms of prostate-specific antigen (PSA) in patients with benign prostatic hyperplasia (BPH). Patients and methods ,Total PSA, free PSA and PSA complexed to ,1 -antichymotrypsin (PSA-,1ACT) were measured in plasma and serum from 40 men with BPH and a total PSA of <,20 ng/mL, using in-house and commercial immunoassays, before and during treatment with finasteride (30 men) or placebo (10 men). Results ,The baseline values were not significantly different between the groups, with mean (sd) total plasma PSA levels of 3.6 (4.3) and 4.8 (5.9) ng/mL in the finasteride and placebo groups, respectively. Finasteride, but not placebo, induced a significant reduction in total PSA, free PSA and PSA-,1ACT levels in plasma and serum (P < 0.001). However, complexed-to-total (c/t) and free-to-total (f/t) PSA ratios remained constant in both groups, both in plasma and serum, during the follow-up. Conclusion ,The decrease in total PSA after finasteride treatment results from a proportional reduction in its two major molecular forms, free PSA and PSA-,1ACT, which explains why the c/t and f/tPSA ratios do not change significantly despite treatment. This suggests that routine analysis of molecular forms of PSA could improve the utility of the change in total PSA associated with finasteride for the early diagnosis of prostate cancer. It also suggests that any subsequent change in both ratios, particularly an increase in c/tPSA or a decrease in f/tPSA ratio, could be considered an early sign of neoplastic degeneration rather than a therapeutic consequence. [source] Intracranial germinoma: A rare but important differential diagnosis in children with growth retardationACTA PAEDIATRICA, Issue 3 2006Sven Gottschling Abstract Aim: Intracranial germinoma is a rare malignant tumour in childhood with an excellent prognosis under adequate therapy. Finding the right diagnosis at an early stage is difficult because of the slow-growing tumour and the resulting lack of clinical symptoms. Methods: Our patients with histologically secured germinoma were retrospectively assessed concerning growth retardation, pituitary hormone status, magnetic resonance imaging scan results and clinical symptoms to find out whether there is a leading parameter. Results: In all our patients, the leading symptom was growth retardation of at least 2 y before being diagnosed. Conclusion: Growth retardation seems to be a very early sign of germinoma in the suprasellar region. Therefore, early neuroradiological imaging combined with pituitary hormone status should be considered in every paediatric patient with a history of secondary growth retardation. [source] Impaired cardiac functional reserve in type 2 diabetic db/db mice is associated with metabolic, but not structural, remodellingACTA PHYSIOLOGICA, Issue 1 2010A. Daniels Abstract Aim:, To identify the initial alterations in myocardial tissue associated with the early signs of diabetic cardiac haemodynamic dysfunction, we monitored changes in cardiac function, structural remodelling and gene expression in hearts of type 2 diabetic db/db mice. Methods:, Cardiac dimensions and function were determined echocardiographically at 8, 12, 16 and 18 weeks of age. Left ventricular pressure characteristics were measured at 18 weeks under baseline conditions and upon dobutamine infusion. Results:, The db/db mice were severely diabetic already at 8 weeks after birth, showing elevated fasting blood glucose levels and albuminuria. Nevertheless, echocardiography revealed no significant changes in cardiac function up to 18 weeks of age. At 18 weeks of age, left ventricular pressure characteristics were not significantly different at baseline between diabetic and control mice. However, dobutamine stress test revealed significantly attenuated cardiac inotropic and lusitropic responses in db/db mice. Post-mortem cardiac tissue analyses showed minor structural remodelling and no significant changes in gene expression levels of the sarcoplasmic reticulum calcium ATPase (SERCA2a) or ,1-adrenoceptor (,1-AR). Moreover, the phosphorylation state of known contractile protein targets of protein kinase A (PKA) was not altered, indicating unaffected cardiac ,-adrenergic signalling activity in diabetic animals. By contrast, the substantially increased expression of uncoupling protein-3 (UCP3) and angiopoietin-like-4 (Angptl4), along with decreased phosphorylation of AMP-activated protein kinase (AMPK) in the diabetic heart, is indicative of marked changes in cardiac metabolism. Conclusion:, db/db mice show impaired cardiac functional reserve capacity during maximal ,-adrenergic stimulation which is associated with unfavourable changes in cardiac energy metabolism. [source] Severe personality disorder emerging in childhood: a proposal for a new developmental disorderCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2004Eileen Vizard Background The concept of ,severe personality disorder' is currently applied to adults with a history of serious antisocial and offending behaviour. There is, however, no similar classification that can be applied to the sub-group of children and adolescents who display persistent and serious offending from an early age. This omission from diagnostic nomenclature prevents the appropriate early identification, assessment and management of these young people. Method This paper therefore proposes a new developmental disorder: ,severe personality disorder emerging in childhood'. The existing evidence base strongly supports the presence of a developmental trajectory from childhood to adult life for the small number of children who show early signs of severe personality disorder (SPD). Based on a review of the literature and the experience of working in a specialist, forensic Child and Adolescent Mental Health Service (CAMHS), a multi-factorial model is proposed that outlines the developmental trajectory of SPD. This model includes neurobiological, psychosocial, environmental and systemic factors, within a developmental framework, and contributes to a more developmentally appropriate understanding of the genesis of severe personality disorder. Copyright © 2004 Whurr Publishers Ltd. [source] Brazil's Bolsa Família: A Double-Edged Sword?DEVELOPMENT AND CHANGE, Issue 5 2008Anthony Hall ABSTRACT In common with most Latin American countries, as governments embrace safety nets to attack poverty, conditional cash transfer (CCT) programmes have become part of mainstream social policy in Brazil. Under president Fernando Henrique Cardoso (1995,2002), and especially since Luiz Inácio Lula da Silva took office in 2003, targeted assistance in education, health and nutrition, now united under Bolsa Família, have expanded rapidly to benefit forty-four million (24 per cent of the total population), absorbing almost two-fifths of the social assistance budget earmarked for the poorest sectors. Despite its operational problems, Bolsa Família appears to have been effective in providing short-term relief to some of the most deprived groups in Brazil. Yet it could prove to be a double-edged sword. There is a risk that, due to its popularity among both the poor and Brazil's politicians, Bolsa Família could greatly increase patronage in the distribution of economic and social benefits and induce a strong dependence on government handouts. There are also early signs that it may be contributing to a reduction in social spending in key sectors such as education, housing and basic sanitation, possibly undermining the country's future social and economic development. [source] Size-related deterioration of semi-natural grassland fragments in SwedenDIVERSITY AND DISTRIBUTIONS, Issue 1 2002Katariina Kiviniemi Abstract. One of the most dramatic landscape changes during the 20th century in Sweden, like in most of Europe, has been the reduction and fragmentation of semi-natural grasslands. Using a set of remnant semi-natural grasslands, chosen to be as similar as possible, but differing in size, we have examined whether size of remnant fragments of traditionally managed semi-natural grasslands in Sweden is related to patterns of species richness and composition. We focused on edge-to-interior relationships, since we expected that a possible impact from invasive habitat generalists would be manifested in a gradient from the edge of fragments to their interior. We found no relationship between size of grassland fragments and (a) overall species richness, (b) species richness at different spatial scales, and (c) abundance of some typical invader species or species characteristic of semi-natural grasslands. However, the results indicated that larger grasslands have a comparatively larger number of species in the edges, whereas the opposite pattern was found in smaller grasslands. The similarity in species composition between the edge and the interior of the pastures also increased with grassland size. Thus, even though the overall species richness is still unaffected by reduction in grassland fragment size, the edges of smaller grasslands show signs of degradation, i.e. reduction in species richness and a decreased similarity to the grassland interior. We suggest that these kinds of effects may be early signs of fragmentation effects that in the future will result in species loss even if the present distribution of semi-natural grasslands is maintained. [source] Youth mental health reform and early intervention: encouraging early signsEARLY INTERVENTION IN PSYCHIATRY, Issue 3 2009Pat McGorry No abstract is available for this article. [source] Efficacy of skin self-examination for the early detection of melanomaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2010Reyhaneh Hamidi BA The National Cancer Institute's "Melanoma Action Plan" calls for reduction of melanoma mortality through early detection. Routine skin self-examination (SSE) has the potential to increase chances of early detection and treatment and may be the key to melanoma survival. We provide a focused review of the accuracy of SSE for detecting premalignant lesions and cutaneous risk factors for melanoma, with suggestions for future directions for enhancing measurement of SSE accuracy and ways in which to improve the public's perceptions of melanoma efficacy. We examined published data on the efficacy of skin self-examination for the early detection of melanoma. We searched the MEDLINE database for publications between January 1, 1987 and June 1, 2007 using search terms for "melanoma" and "self-examination." We found that sensitivity of skin self-examination is low, ranging from 25% to 93%, while specificity is generally higher (83% to 97%). Attempts to increase improve the lay public's perceptions of the early signs of melanoma have proved effective, while those aimed at increasing accuracy of SSE with targeted interventions have been moderately successful. SSE's insensitivity for detection of pigmented lesions should prompt further investigation of educational interventions to enhance its accuracy and lead to its adoption as a cheap, simple screening tool. Assessment of the accuracy and efficacy of SSE should proceed using standardized definitions and measurements such that it is easier to pool data on the overall value of SSE as a screening modality. [source] Consumer attitudes towards self-referral with early signs of cancer: implications for symptom awareness campaignsINTERNATIONAL JOURNAL OF NONPROFIT & VOLUNTARY SECTOR MARKETING, Issue 4 2007Douglas Eadie Traditionally, secondary prevention programmes have employed mass screening approaches to assess for asymptomatic signs of cancer. It has been suggested that early detection strategies, involving public education and self-referral may prove more cost-effective, with low-risk populations for cancers with symptomatic presentation. The success of public education approaches is dependent on careful consideration of the psycho-social factors of self-examination and referral. This paper presents the findings from an exploratory study, using qualitative methods with an at-risk population of older people living in deprived communities in west-central Scotland. The study examines consumer perceptions of the early detection of cancer and the cultural barriers to self-referral, as well as response to aspects of communication strategy. The implications for design of symptom awareness campaigns, including use of message appeals, specification of target symptoms, identification of target audience and selection of communication channels, are discussed. Copyright © 2007 John Wiley & Sons, Ltd. [source] Older patients with chronic heart failure within Swedish community health care: a record review of nursing assessments and interventionsJOURNAL OF CLINICAL NURSING, Issue 1 2004Anna Ehrenberg PhD Background., Older patients with chronic heart failure constitute a large group within community home care that is at high risk for re-hospitalization. However, hospital readmission can be prevented if early signs of deterioration are recognized and proper interventions applied. Aims and objectives., The aim of the study was to audit nursing care for older chronic heart failure patients within the Swedish community health care system. Design., The study adopted a retrospective descriptive design. Methods., In a Swedish urban municipality nursing documentation from 161 records on patients diagnosed with chronic heart failure was collected retrospectively from community nursing home care units. Patient records were reviewed for characteristics of nursing care and assessed for comprehensiveness in recording. Results., The main results showed that medical care of patients with chronic heart failure was poorly recorded, making it possible only to follow fragments of the care process. The nursing notes showed poor adherence to current clinical guidelines. Only 12% of the records contained notes on patients' body weight and only 4% noted patients' knowledge about chronic heart failure. When interventions did occur, they largely consisted of drug administration. Conclusions., The findings revealed flaws in the recording of specific assessment and interventions as well as poor adherence to current international clinical guidelines. Relevance to clinical practice., Supportive guidelines available at the point of care are needed to enhance proper community-based home health care for older patients with chronic heart failure. [source] Early detection of bone infection and differentiation from post-surgical inflammation using 2-deoxy-2-[18F]-fluoro- D -glucose positron emission tomography (FDG-PET) in an animal modelJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 6 2005Laurie Jones-Jackson Abstract Diagnosing bone infection in the context of post-surgical inflammation is problematic since many of the early signs of infection are similar to normal post-surgical changes. We used a rabbit osteomyelitis model to evaluate the use of 2-deoxy-2-[18F]-fluoro- D -glucose positron emission tomography (FDG-PET) as a means of detecting post-operative infection in the context of post-surgical inflammation. Comparisons were made between infected and non-infected rabbits in which infection with Staphylococcus aureus was initiated at the time of surgery. Weekly PET scans were obtained 30 and 60 min after the introduction of FDG and analyzed based on standardized uptake values (SUV) at the surgical site and visual assessment of the presence or absence of infection. Concurrent X-rays were taken immediately prior to scanning. At 4 weeks post-operatively, animals were sacrificed for histologic and bacteriologic confirmation of infection. Uptake of FDG was evident in the bone of all rabbits on day 1 post-surgery, however, SUV comparisons from the surgical site could not be used to distinguish between the infected and uninfected groups until day 15. Visual analysis of FDG-PET scans revealed a significant difference (p < 0.01) between the infected and uninfected groups as early as day 8. This was due in part to the ability to visualize regional lymph nodes by FDG-PET.© 2005 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Spinal degenerative disk disease (DDD) in female macaque monkeys: epidemiology and comparison with womenJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 3 2002Patricia Ann Kramer Spinal degenerative disk disease (DDD) in a radiographic, cross-sectional sample of 192 female macaque monkeys, approximately 5,30 years old, is described. The presence and extent of disk space narrowing (DSN) and anterior osteophytosis were assessed with reference to age, average lifetime body mass, and distribution within the thoracolumbar spine. Age was a strong correlate of disk narrowing and osteophytosis, with early signs appearing at equivalent ages in both species and increasing in prevalence thereafter. Macaques showed a far greater prevalence of DDD, especially in the oldest age group, than has been reported in the human data. Body mass was associated with disk narrowing in the macaque, but not with osteophytosis. The two species differed little in the pattern of distribution of DDD along the spine. Our results suggest that bipedality is not the singular, or even the most important, biomechanical factor in the development of human DDD. Rather, others shared postural regimes, e.g., sitting, may be responsible for the onset and progression of DDD in both species. The macaque model could substantially add to the under-standing and, potentially, treatment of this oftentimes debilitating condition. © 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source] Oral Cancer Knowledge and Opinions Among Maryland Nurse PractitionersJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2001Piya Siriphant DDS Abstract Objectives: As part of a Maryland statewide oral cancer needs assessment, a census of adult and family practice nurse practitioners was conducted to determine their knowledge of oral cancer risk factors, diagnostic procedures and related opinions. Methods: Information was obtained through a pretested, 40-item, self-administered mail questionnaire of 389 nurse practitioners. A second complete mailing was sent three weeks after the initial mailing; two postal card reminders were mailed at 10 and 17 days after the second mailing, which yielded a response rate of 56 percent. Results: Most nurse practitioners identified the use of tobacco, alcohol, and prior oral cancer lesions as real risk factors. But only 35 percent identified exposure to the sun as a risk for lip cancer. Respondents were not overly knowledgeable about the early signs of oral cancer, most common forms, or sites for oral cancer. Only 19 percent believed their knowledge of oral cancer was current. Nurse practitioners who reported having a continuing education course on oral cancer within the past two to five years were 3.1 times more likely to have a high score on knowledge of risk factors and 2.9 times more likely to have a high score on knowledge of both risk factors and of diagnostic procedures than were those who had never had a continuing education course. Conclusions: The reported knowledge of oral cancer, in conjunction with opinions about level of knowledge and training, point to a need for systematic educational updates in oral cancer prevention and early detection. [source] A case of fatal anaphylaxis in a dog associated with a dexamethasone suppression testJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2005DACVECC, DACVIM, Michael Schaer DVM Abstract Objective: To describe a case of fatal anaphylaxis in a dog associated with a ,routine' dexamethasone suppression test. Case summary: An 8-year-old, spayed female dog, was treated with parenteral dexamethasone for a diagnosis of immune-mediated thrombocytopenia. The dog had responded to treatment, but 9 months later was evaluated for endogenous hyperadrenocorticism, prior to surgery for a ruptured anterior cruciate ligament. A normal ACTH stimulation test was followed by a high-dose dexamethasone suppression test. Immediately following the intravenous injection of dexamethasone, the dog developed severe anaphylactic shock and died. The postmortem examination findings supported the diagnosis of anaphylaxis. New information provided: The anaphylaxis in this dog was fulminating and by-passed the usual early signs of drug hypersensitivity. This is the first case in the veterinary literature reporting on dexamethasone as the cause of this dog's catastrophic event. [source] Improving Dean's writing: or, what shall we tell the children?LITERACY, Issue 2 2004Graham Frater Abstract In this paper Graham Frater finds early signs of a revival of explicit instruction in English grammar to pupils of compulsory school age in England; this is accompanied by an expectation that such teaching might play an important part in closing the ,writing gap'. He suggests that, strengthened by the National Literacy Strategy, this early re-awakening invokes again some of the debates that accompanied the construction of the National Curriculum. Rooted in a case study of a text by a low-achieving Y7 writer, and in two surveys of effective practice with writing (covering Key Stages 2,4), this paper argues that purposeful text-level teaching, reading in particular, and the creation of real readerships offer more secure ways of promoting progress in writing. [source] Langerhans cell histiocytosis: oral/periodontal involvement in adult patientsORAL DISEASES, Issue 8 2009S Annibali Objective:, Langerhans cell histiocytosis (LCH) is a clonal proliferative multisystem disease. Although bone and mucosae have been classified as non-risk organs, their involvement may increase the risk of disease progression. Oral and periodontal lesions are burdened with a significant impairment of quality of life for associated signs, symptoms and loss of function. Most of information regards paediatric disease; the disease in adults has received limited attention. Subjects and Methods:, A total of 31 adult patients affected by immuno-histopathology confirmed LCH have been prospectively examined; attention was paid to the occurrence and characterization of oral lesions. Results:, Twelve patients developed oral lesions. Posterior regions of jawbones were always affected; the involvement of anterior regions was not constant. Unifocal oral involvement was significantly associated with multisystemic disease while multifocal lesions were associated with unisystemic disease. Oral disease presented with soft tissue ulcers (50% of cases), gingival bleeding (66.7%), pain (83.4%), periodontal damage (50%), tooth mobility (16.7%), non-healing extraction socket (8.3%); 41.6% of patients complained of negative outcomes on quality of life. Oral lesions were easily handled with local measures. Conclusions:, Posterior regions require attention; single oral lesions may be part of multisystemic disease; oral and periodontal lesions may be early signs of disease reactivation. [source] | ||||||||||||||||||||||||||||||||||