AMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2008
C. B. Drachenberg
Accurate diagnosis and grading of rejection and other pathological processes are of paramount importance to guide therapeutic interventions in patients with pancreas allograft dysfunction. A multi-disciplinary panel of pathologists, surgeons and nephrologists was convened for the purpose of developing a consensus document delineating the histopathological features for diagnosis and grading of rejection in pancreas transplant biopsies. Based on the available published data and the collective experience, criteria for the diagnosis of acute cell-mediated allograft rejection (ACMR) were established. Three severity grades (I/mild, II/moderate and III/severe) were defined based on lesions known to be more or less responsive to treatment and associated with better- or worse-graft outcomes, respectively. The features of chronic rejection/graft sclerosis were reassessed, and three histological stages were established. Tentative criteria for the diagnosis of antibody-mediated rejection were also characterized, in anticipation of future studies that ought to provide more information on this process. Criteria for needle core biopsy adequacy and guidelines for pathology reporting were also defined. The availability of a simple, reproducible, clinically relevant and internationally accepted schema for grading rejection should improve the level of diagnostic accuracy and facilitate communication between all parties involved in the care of pancreas transplant recipients. [source]

New Traversability Indices and Traversability Grid for Integrated Sensor/Map-Based Navigation

JOURNAL OF FIELD ROBOTICS (FORMERLY JOURNAL OF ROBOTIC SYSTEMS), Issue 3 2003
Homayoun Seraji
This paper presents new measures of terrain traversability at short range and long range of a mobile robot; namely, local and global traversability indices. The sensor-based local traversability index is related by a set of linguistic rules to large obstacles and surface softness within a short range of the robot measured by on-board sensors. The map-based global traversability index is obtained from the terrain topographic map, and is based on major surface features such as hills and lakes within a long range of the robot. These traversability indices complement the mid-range sensor-based regional traversability index introduced earlier. Each traversability index is represented by four fuzzy sets with the linguistic labels {POOR, LOW, MODERATE, HIGH}, corresponding to surfaces that are unsafe, moderately-unsafe, moderately-safe, and safe for traversal, respectively. The global terrain analysis also leads to the new concepts of traversability map and traversability grid for representation of terrain quality based on the global map information. The traversability indices are used in two sensor-based traverse-local and traverse-regional behaviors and one map-based traverse-global behavior. These behaviors are integrated with a map-based seek-goal behavior to ensure that the mobile robot reaches its goal safely while avoiding both sensed and mapped terrain hazards. This provides a unified system in which the two independent sources of terrain quality information, i.e., prior maps and on-board sensors, are integrated together for reactive robot navigation. The paper is concluded by a graphical simulation study. © 2003 Wiley Periodicals, Inc. [source]

CONTROLLED-RELEASE OXYCODONE RELIEVES MODERATE TO SEVERE PAIN IN A 3-MONTH STUDY OF PERSISTENT MODERATE TO SEVERE BACK PAIN

PAIN MEDICINE, Issue 2 2002
Article first published online: 4 JUL 200
Patricia Richards, MD, PhD; Pinggao Zhang, PhD; Michael Friedman, PhD; Rahul Dhanda, PhD. (Purdue Pharma L.P.) Introduction: Opioids are frequently prescribed for management of persistent low back pain, however, efficacy has not been well documented, and concerns are that opioids may impair physical functioning. Objective: To compare controlled-release oxycodone (CRO) with placebo in controlling pain and to observe the effect of CRO on quality of life and functionality. Methods: A double-blind, randomized, placebo-controlled, parallel-group study of 3 months duration was conducted in 110 subjects (49 males, 61 females), mean age 48 years (19,80 years). Subjects had a 3- to 12-month history of moderate to severe persistent low back pain and were previously unresponsive to therapeutic doses of NSAIDs, and/or low dose combination opioid analgesics. At baseline 4% of subjects were on opioids, 39% on NSAIDs, and 57% both NSAIDs and opioids. Subjects were treated with 10 mg CRO tablet or 10 mg oral placebo q12h, titrated to stable pain control. Existing treatment regimens of acetaminophen, NSAIDs, or oral steroids were allowed to continue. The Brief Pain Inventory (BPI), the Roland Morris Functionality Questionnaire, and the MOS 36-Item Short-Form Health Survey (SF-36) were the measures of pain intensity, functionality, and quality of life. Treatments were compared using repeated measures ANCOVA with baseline value as covariate. Results: CRO treatment was significantly superior to placebo on the BPI average pain intensity and average percent pain relief scores overall (4.6 vs 5.4, P = .03, and 47.2 vs 36.3, P = .05, respectively). Fewer CRO subjects discontinued because of inadequate pain control (P < .001). No significant differences between treatments were observed in either Roland Morris or SF-36 scores. Common adverse events for CRO were nausea, constipation, somnolence, headache, and pruritus, consistent with opioid use. Conclusions: Three-month treatment with CRO provides significant pain relief for subjects with persistent moderate to severe back pain, without significantly impairing functionality and quality of life. The support of Purdue Pharma L.P. for this research project is gratefully acknowledged. [source]

COMPARISON OF THE EFFECTS OF TULOBUTEROL PATCH AND SALMETEROL IN MODERATE TO SEVERE ASTHMA

CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 11 2006
Osamu Nishiyama
SUMMARY 1Although the clinical effects of the tulobuterol patch have been reported to include an increase in morning peak expiratory flow (PEF) values and a decrease of symptoms and the frequency of the rescue use of inhaled short-acting b2 -adrenoceptor agonists, no trials comparing the efficacy of the tulobuterol patch to other standard inhaled long-acting b2 -adrenoceptor agonists have yet been conducted. The aim of the present study was to compare the clinical effects of the patch formulation of tulobuterol with those of inhaled salmeterol in moderate to severe asthma. 2Fifty-four patients with moderate to severe asthma, whose conditions were suboptimally controlled despite receiving inhaled corticosteroids, were recruited. The study was a prospective, randomized trial of cross-over design comparing the effects of 4 weeks treatment with tulobuterol patch, 2 mg once daily, and salmeterol, 50 mg twice daily. The mean prebronchodilator morning PEF during the last 14 days of each treatment period and health-related quality of life (HRQoL) were the primary outcome variables. The HRQoL was assessed using the St George's Respiratory Questionnaire. 3Forty-four patients (81.5%) completed the trial and were included in the analysis. The mean morning PEF and HRQoL score were significantly improved in both the salmeterol (P < 0.0001 and P < 0.05, respectively) and the tulobuterol patch (P < 0.01 and P < 0.05, respectively) treatment periods compared with the run-in period. Although the mean morning PEF was significantly higher in the salmeterol-treated group than in the tulobuterol-treated group (P < 0.001), the HRQoL scores were comparable. 4The tulobuterol patch may be useful as a controller medication in addition to inhaled corticosteroids in moderate to severe asthma. [source]

Correlations among Extinction Risks Assessed by Different Systems of Threatened Species Categorization

CONSERVATION BIOLOGY, Issue 6 2004
JULIAN J. O'GRADY
análisis de viabilidad poblacional; categorías de amenaza; especies en peligro; riesgo de extinción Abstract:,Many different systems are used to assess levels of threat faced by species. Prominent ones are those used by the World Conservation Union, NatureServe, and the Florida Game and Freshwater Fish Commission (now the Florida Fish and Wildlife Conservation Commission). These systems assign taxa a threat ranking by assessing their demographic and ecological characteristics. These threat rankings support the legislative protection of species and guide the placement of conservation programs in order of priority. It is not known, however, whether these assessment systems rank species in a similar order. To resolve this issue, we assessed 55 mainly vertebrate taxa with widely differing life histories under each of these systems and determined the rank correlations among them. Moderate, significant positive correlations were seen among the threat rankings provided by the three systems (correlations 0.58,0.69). Further, the threat rankings for taxa obtained using these systems were significantly correlated to their rankings based on predicted probability of extinction within 100 years as determined by population viability analysis (correlations 0.28,0.37). The different categorization systems, then, yield related but not identical threat rankings, and these rankings are associated with predicted extinction risk. Resumen:,Se utilizan muchos sistemas diferentes para evaluar los niveles de amenaza que enfrentan las especies. Son prominentes los utilizados por World Conservation Union, NatureServe Heritage y Florida Game and Freshwater Fish Commission (ahora Florida Fish and Wildlife Conservation Commission). Estos sistemas asignan una categoría de amenaza a los taxa mediante la evaluación de sus características demográficas y ecológicas. Estas categorías de amenaza sustentan a la protección legislativa de especies y guían la definición de prioridades en programas de conservación. Sin embargo, se desconoce si estos sistemas de evaluación categorizan a las especies en orden similar. Para resolver este tema, evaluamos 55 taxa, principalmente de vertebrados, con historias de vidas muy diferentes con cada uno de estos sistemas y determinamos las correlaciones entre las categorías. Hubo correlaciones positivas moderadas entre las categorías de amenaza proporcionadas por los tres sistemas (correlaciones 0.58-0.69). Más aun, las categorías de amenaza proporcionados por estos sistemas estuvieron correlacionadas significativamente con las categorías definidas con base en la probabilidad de extinción pronosticada en 100 años determinada por análisis de viabilidad poblacional (correlaciones 0.28-0.37). Por lo tanto, los diferentes sistemas de categorización están proporcionando categorías de amenazas relacionadas pero no idénticas, y estas categorías están relacionadas con el riesgo de extinción pronosticado. [source]

Islam In Our Times: A Determined Moslem Moderate Emerges from the Shadows

CROSSCURRENTS, Issue 2 2008
Zeina M. Barakat
[source]

Investigating moderate to severe paediatric trauma in the Auckland region

EMERGENCY MEDICINE AUSTRALASIA, Issue 2 2010
Louise Couch
Abstract Objective: To investigate differences between paediatric patients with moderate to severe trauma admitted from two paediatric ED, with respect to: demographics, patterns of presentation, mechanism of injury, injury severity scores (ISS), interventions and outcome. Method: Retrospective cohort study. Moderate to severe trauma was defined as ISS >9. Paediatric patients admitted to hospital via Starship Children's Emergency or KidzFirst ED, with trauma from 1 May 2003 to 30 April 2004, with ISS >9 were identified using multiple databases. The charts were reviewed and data collected included: demographics, hospital of first presentation, diagnoses, ISS, Paediatric trauma score (PTS), Glasgow coma score (GCS), ventilator hours, length of admission, survival and discharge destination. Descriptive statistics with 95% confidence intervals, Mann,Whitney U -test, ,2 -test and Fisher's exact test were used as appropriate. Results: A total of 393 children with moderate to severe trauma were identified using initial search strategies. Of these, 82 children met the inclusion and exclusion criteria for the study; 42 children were admitted via KidzFirst ED and 40 via Starship Children's ED. There was no statistically significant difference in ISS (P= 0.86), PTS (P= 0.11), GCS (P= 0.62), hours on a ventilator (P= 0.28) and length of stay (P= 0.87) between children admitted from Starship or KidzFirst ED. Conclusion: This study suggests that there are no differences in the numbers or severity of paediatric trauma patients admitted from the Starship and KidzFirst ED. This indicates triage is to the closest ED despite having a tertiary referral centre for paediatric trauma available in Auckland City. [source]

Association of self-reported alcohol use and hospitalization for an alcohol-related cause in Scotland: a record-linkage study of 23 183 individuals

ADDICTION, Issue 4 2009
Scott A. McDonald
ABSTRACT Aims To investigate the extent to which self-reported alcohol consumption level in the Scottish population is associated with first-time hospital admission for an alcohol-related cause. Design Observational record-linkage study. Setting Scotland, 1995,2005. Participants A total of 23 183 respondents aged 16 and over who participated in the 1995, 1998 and 2003 Scottish Health Surveys, followed-up via record-linkage from interview date until 30 September 2005. Measurements Rate of first-time hospital admission with at least one alcohol-related diagnosis. Cox proportional hazards regression analysis was applied to estimate the relative risk of first-time hospitalization with an alcohol-related condition associated with usual alcohol consumption level (1,7, 8,14, 15,21, 22,35, 36,49, 50+ units/week and ex-drinker, compared with <1 unit per week). Findings Of the SHS participants, 527 were hospitalized for an alcohol-related cause during 135 313 person-years of follow-up [39 first admissions per 10 000 person-years, 95% confidence interval (CI) 36,42]. Alcohol-related hospitalization rates were considerably higher for males (61/10 000 person-years, 95% CI 54,67) than for females (22/10 000 person-years, 95% CI 18,26). Compared with the lowest alcohol consumption category (<1 unit per week), the relative risk of first-time alcohol-related admission increased with reported consumption: age-adjusted hazard ratios ranged from 3 (1,5) for 1,7 units/week to 19 (10,37) for 50+ units/week (males); and from 2 (1,3) for 1,7 units/week to 28 (14,56) for 50+ units/week (females). After adjusting for age and usual alcohol consumption, the relative risk of first-time alcohol-related admission remained significantly higher for males reporting binge drinking and for both males and females residing in the most deprived localities. Conclusions Moderate and higher levels of usual alcohol consumption and binge drinking are serious risk factors for alcohol-related hospitalization in the Scottish population. These findings contribute to our understanding of the relationship between alcohol intake and alcohol-related morbidity. [source]

Pregnancy outcome in congenital dyserythropoietic anemia type I

EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 4 2008
Hanna Shalev
Abstract Objectives:, Congenital dyserythropoietic anemia type I (CDA I) is a rare inherited disease characterized by moderate to severe macrocytic anemia and abnormal erythroid precursors with nuclear chromatin bridges and spongy heterochromatin. Moderate to severe maternal anemia is a recognized independent risk factor for low birth weight (LBW) and complicated delivery. The aim of the study was to review the outcome of pregnancies in women with CDA I. Methods:, The clinical and laboratory records of 28 spontaneous pregnancies in six Bedouin women with CDA I were reviewed. The results were compared with findings from a retrospective review of a large population-based registry including all pregnancies in Bedouin women during the same 15-yr period. Results:, Eighteen pregnancies in women with CDA I (64%) were complicated. One pregnancy was aborted spontaneously in the first trimester and one resulted in a non-viable fetus (stillborn at 26 wk). Cesarean section (CS) was performed in 10 pregnancies (36%). Eleven of the 26 newborns (42%) had a LBW: six were born prematurely and five were small for gestational age. The odds ratio for CS in women with CDA I compared with healthy Bedouin women was 4.5 [95% confidence interval (CI) 1.2,10.3], and for a LBW infant, 5.5 (95% CI 2.4,12.3). Careful follow-up was associated with significantly better fetal outcome (P = 0.05). Conclusions:, Pregnancies in women with CDA I are at high risk for delivery-related and outcome complications. To improve fetal outcome, women with CDA I should be carefully monitored during pregnancy. [source]

Oral lichen planus has a high rate of TP53 mutations.

EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 3 2002
A study of oral mucosa in Iceland
Oral squamous cell carcinoma (OSCC) is a world-wide health problem. In addition to external exposure (smoking and alcohol), certain oral lesions may increase the risk of oral cancer (e.g. leukoplakia, erythroplakia, and oral lichen planus). TP53 has been implicated in OSCC, but there are limited studies of mutations in premalignant oral lesions. In this study, 55 samples from OSCC, 47 from hyperkeratotic (HK) oral mucosa, clinically diagnosed as white patches, 48 samples from oral lichen planus (OLP), and 12 biopsies from normal oral mucosa were studied immunohistochemically for expression of TP53 protein. From all the carcinoma samples and selected non-malignant samples showing moderate or strong TP53 protein expression, malignant cells or TP53-positive nuclei were microdissected and screened for mutations in exons 5,8 by constant denaturation gel electrophoresis. Moderate to strong TP53 protein staining was seen in 56% of OSCC, 32% of OLP but only in 13% of HK. All OLP samples showed a characteristic pattern of positive nuclei confined to the basal layer, whereas TP53 staining was seen in suprabasal nuclei in HK. Mutation rate was 11 out of 52 for OSCC, three out of 20 tested for HK and, remarkably, nine out 27 tested for OLP. There was no correlation between TP53 protein staining and TP53 mutations. No associations were found with anatomical sites or disease progression. The unexpectedly high mutation rate of OLP might explain the premalignant potential of this lesion. [source]

Infant colic and maternal depression

INFANT MENTAL HEALTH JOURNAL, Issue 1 2005
Aimee E. Maxted
The combined impact of infant colic and maternal depression on infant, parent, and family difficulties was examined. The sample included 93 consecutive patients seen at an outpatient Colic Clinic. Most mothers had private insurance and completed high school. Infants were approximately 2 months of age. Questionnaires completed by the mother prior to treatment onset were used to measure depressive symptoms in the mothers, infant cry, sleep and temperament, characteristics, parenting stress, maternal self-esteem, social support, and family function. Moderate to severe depressive symptoms were reported by 45.2% of the mothers. More severe depressive symptoms in the mothers were related to fussy/difficult infant temperament, more parenting stress, lower parental self-esteem, and more family-functioning problems. Pediatric health care providers need to be aware that the combined effects of colic and maternal depression can be problematic for the family. ©2005 Michigan Association for Infant Mental Health. [source]

A Bifunctional Cinchona Alkaloid-Squaramide Catalyst for the Highly Enantioselective Conjugate Addition of Thiols to trans -Chalcones

ADVANCED SYNTHESIS & CATALYSIS (PREVIOUSLY: JOURNAL FUER PRAKTISCHE CHEMIE), Issue 13 2010
Le Dai
Abstract A chiral squaramide catalysts-promoted asymmetric sulfa-Michael conjugated addition of thiols to trans -chalcones is presented. Moderate to excellent yields and high enantioselectivities (up to 99% ee) were achieved under mild conditions. [source]

Stent-protected angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy: SPACE2 , a three-arm randomised-controlled clinical trial

INTERNATIONAL JOURNAL OF STROKE, Issue 4 2009
T. Reiff
Moderate to severe (,70%) asymptomatic stenosis of the extracranial carotid artery leads to an increased rate of stroke of approximately 11% in 5 years. Patients with asymptomatic carotid stenosis, however, are also at a higher risk of nonstroke vascular events. The estimated annual risks of such events in patients with asymptomatic stenosis are 7% for a coronary ischaemic event and 4,7% for overall mortality. The superiority of carotid endarterectomy compared with medical treatment in symptomatic carotid disease is established, provided that the surgical procedure can be performed with a perioperative morbidity and mortality of <6%. The advantage of carotid endarterectomy for asymptomatic patients is less established. An alternative treatment, carotid artery stenting, has been developed. This treatment is used frequently in both symptomatic and asymptomatic patients. In the last decade, major advantages in medical primary prevention of cerebrovascular and cardiovascular disease have been accomplished. The control groups in the large trials for asymptomatic carotid artery disease (ACAS and ACST) originate from more than a decade ago and, for the most part, have not received a medical primary prevention strategy that would now be considered the standard according to current national and international guidelines. For this reason, a three-arm trial (SPACE2; http://www.space-2.de) with a hierarchical design and a recruitment target of 3640 patients is chosen. Firstly, a superior trial of intervention (carotid artery stenting or carotid endarterectomy) vs. state-of-the-art conservative treatment is designed. In case of superiority of the interventions, a noninferiority end-point will be tested between carotid artery stenting and carotid endarterectomy. This trial is registered at Current Controlled Trials ISRCTN 78592017. [source]

Cardiovascular Exercise Training Extends Influenza Vaccine Seroprotection in Sedentary Older Adults: The Immune Function Intervention Trial

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2009
Jeffrey A. Woods PhD
OBJECTIVES: To determine whether cardiovascular exercise training resulted in improved antibody responses to influenza vaccination in sedentary elderly people who exhibited poor vaccine responses. DESIGN: Single-site randomized parallel-arm 10-month controlled trial. SETTING: University of Illinois at Urbana-Champaign. PARTICIPANTS: One hundred forty-four sedentary, healthy older (69.9 ± 0.4) adults. INTERVENTIONS: Moderate (60,70% maximal oxygen uptake) cardiovascular exercise was compared with flexibility and balance training. MEASUREMENTS: The primary outcome was influenza vaccine response, as measured according to hemagglutination inhibition (HI) anti-influenza antibody titer and seroprotective responses (HI titer ,40). Secondary measures included cardiovascular fitness and body composition. RESULTS: Of the 160 participants enrolled, 144 (90%) completed the 10-month intervention with excellent compliance (,83%). Cardiovascular, but not flexibility, exercise intervention resulted in improvements in indices of cardiovascular fitness, including maximal oxygen uptake. Although not affecting peak (e.g., 3 and 6 weeks) postvaccine anti-influenza HI titers, cardiovascular exercise resulted in a significant increase in seroprotection 24 weeks after vaccination (30,100% dependent on vaccine variant), whereas flexibility training did not. CONCLUSION: Participants randomized to cardiovascular exercise experienced improvements in influenza seroprotection throughout the entire influenza season, whereas those in the balance and flexibility intervention did not. Although there were no differences in reported respiratory tract infections, the exercise group exhibited reduced overall illness severity and sleep disturbance. These data support the hypothesis that regular endurance exercise improves influenza vaccine responses. [source]

Musculoskeletal Pain and Risk for Falls in Older Disabled Women Living in the Community

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2002
Suzanne G. Leveille PhD
OBJECTIVES: To determine whether musculoskeletal pain increased risk for falls in older women with disabilities. DESIGN: Prospective population-based cohort study. SETTING: The city and county of the eastern area of Baltimore. PARTICIPANTS: One thousand two women aged 65 and older, participants in the Women's Health and Aging Study, representing the one-third of older women who were living at home with disabilities, followed semiannually for 3 years beginning in 1991. MEASUREMENTS: Pain was categorized into four groups according to severity and location. Widespread pain was defined as pain in the upper and lower extremities and in the axial skeletal region, with moderate to severe pain in at least one region (, 4 on a 10-point numeric rating scale, 10 = excruciating pain). Moderate to severe lower extremity pain that did not meet criteria for widespread pain was the next category. The reference category was no pain or mild pain in one site. The additional category of "other pain" was pain that did not fit into the other three groups. The occurrence of falls and fall-related injuries were assessed at each interview. RESULTS: Of the 940 women who participated in at least one follow-up examination, 39% fell in first year; of the survivors, 36% fell in Year 2, and 39% in Year 3. After adjusting for several major risk factors for falls, women with widespread pain had an increased likelihood of falling during follow-up (adjusted odds ratio (AOR) = 1.66, 95% confidence interval (CI) = 1.25,2.21) compared with those with no or mild pain in only one musculoskeletal site. Women who had other musculoskeletal pain but not widespread pain or lower extremity pain also had an increased risk of falls (AOR = 1.36, 95% CI = 1.02,1.82). Among women with musculoskeletal pain, risk for falls was lower in those who used daily analgesic medication. Risk for recurrent falls and self-reported fractures due to falls was also elevated in women with musculoskeletal pain, most consistently in women with widespread pain. CONCLUSIONS: Musculoskeletal pain, particularly widespread pain, is a substantial risk factor for falls in older women with disabilities. These findings add an important dimension to our understanding of the multifactorial processes leading to falls in older persons. J Am Geriatr Soc 50:671,678, 2002. [source]

Bone Fragility Contributes to the Risk of Fracture in Children, Even After Moderate and Severe Trauma,,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 2 2008
Emma M Clark
Abstract We prospectively examined whether the relationship between skeletal fragility and fracture risk in children 9.9 ± 0.3 (SD) yr is affected by trauma level. Bone size relative to body size and humeral vBMD showed similar inverse relationships with fracture risk, irrespective of whether fractures followed slight or moderate/severe trauma. Introduction: Fracture risk in childhood is related to underlying skeletal fragility. However, whether this relationship is confined to low-trauma fractures or whether skeletal fragility also contributes to the risk of fracture caused by higher levels of trauma is currently unknown. Materials and Methods: Total body DXA scan results obtained at 9.9 yr of age were linked to reported fractures over the following 2 yr in children from the Avon Longitudinal Study of Parents and Children. DXA scan results that were subsequently derived included total body less head (TBLH) bone size relative to body size (calculated from TBLH area adjusted for height and weight) and humeral volumetric BMD (vBMD; derived from subregional analysis at this site). Trauma level was assigned using the Landin classification based on a questionnaire asking about precipitating causes. Results: Of the 6204 children with available data, 549 (8.9%) reported at least one fracture over the follow-up period, and trauma level was assigned in 280 as follows: slight trauma, 56.1%; moderate trauma, 41.0%; severe trauma, 2.9%. Compared with children without fractures, after adjustment for age, sex, socioeconomic status, and ethnicity, children with fractures from both slight and moderate/severe trauma had a reduced bone size relative to body size (1133 cm2 in nonfractured children versus 1112 cm2 for slight trauma fractures, p < 0.001; 1112 cm2 for moderate/severe trauma fractures, p = 0.001) and reduced humeral vBMD (0.494 g/cm3 in nonfractured children versus 0.484 g/cm3 for slight trauma fractures, p = 0.036; and 0.482g/cm3 for moderate/severe trauma fractures, p = 0.016). Conclusions: Skeletal fragility contributes to fracture risk in children, not only in fractures caused by slight trauma but also in those that result from moderate or severe trauma. [source]

Occurrence and risk indicators of increased probing depth in an adult Brazilian population

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2005
Cristiano Susin
Abstract Background/Aims: There is little information about the occurrence and risk indicators for periodontal diseases in Latin America. The present study describes the prevalence, extent and severity of periodontal probing depth (PPD) and assesses the association between demographic, behavioural and environmental risk indicators and the extent and severity of PPD in this population. Materials and Methods: The target population was urban adults aged 30 years in Rio Grande do Sul state in South Brazil. A representative sample was selected using a multi-stage, probability, cluster sampling strategy and included 853 dentate subjects 30,103 years of age. A full-mouth clinical examination was carried out at six sites per tooth on all permanent teeth, excluding third molars, and was conducted in a mobile examination centre. Results: Approximately 65% and 25% of the subjects and 19% and 5% teeth per subject had PPD 5 and 7 mm, respectively. 31.6%, 33.7% and 34.7% subjects had generalized, localized or no PPD 5 mm, respectively. Probing depth increased in prevalence with increasing age, and leveled off at around 50 years of age and beyond. PPD 5 mm was significantly higher in males than in females, and in non-Whites than in Whites. Cigarette smokers had a significantly higher occurrence of PPD 5 mm than non-smokers, and this relationship was dose dependent. A multivariate model showed that generalized PPD 5 mm was associated with subjects aged 40 years, males, non-Whites and moderate or heavy cigarette smokers (relative risk ratios: 2.0, 2.0, 2.2, 2.4 and 6.8, respectively). Conclusion: Moderate and deep probing depth was a common finding in this urban adult Brazilian population. Older age, male gender, non-White race and moderate and heavy cigarette smoking were significant risk indicators of increased PPD, and these may be useful indicators of periodontal disease high-risk groups. [source]

Testing the developmental distinctiveness of male proactive and reactive aggression with a nested longitudinal experimental intervention

AGGRESSIVE BEHAVIOR, Issue 2 2010
Edward D. Barker
Abstract An experimental preventive intervention nested into a longitudinal study was used to test the developmental distinctiveness of proactive and reactive aggression. The randomized multimodal preventive intervention targeted a subsample of boys rated disruptive by their teachers. These boys were initially part of a sample of 895 boys, followed from kindergarten to 17 years of age. Semiparametric analyses of developmental trajectories for self-reported proactive and reactive aggression (between 13 and 17 years of age) indicated three trajectories for each type of aggression that varied in size and shape (Low, Moderate, and High Peaking). Intent-to-treat comparisons between the boys in the prevention group and the control group confirmed that the preventive intervention between 7 and 9 years of age, which included parenting skills and social skills training, could impact the development of reactive more than proactive aggression. The intervention effect identified in reactive aggression was related to a reduction in self-reported coercive parenting. The importance of these results for the distinction between subtypes of aggressive behaviors and the value of longitudinal-experimental studies from early childhood onward is discussed. Aggr. Behav. 36:127,140, 2010. © 2010 Wiley-Liss, Inc. [source]

Effect of a lifestyle intervention in patients with abnormal liver enzymes and metabolic risk factors

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2009
Alexis St. George
Abstract Background and Aim:, Non-alcoholic fatty liver disease associated with insulin resistance is the most common cause of abnormal liver tests in clinical practice. To date, practical and effective strategies to improve the metabolic profile of this large group of patients have not been well characterised. We sought to assess the effect at 3 months of a behavior change-based lifestyle intervention on the metabolic profile of patients characterised by elevated liver enzymes. Methods:, A total of 152 patients with elevated liver enzymes, central obesity and a range of metabolic risk factors were randomised to either a moderate- (6 sessions/10 weeks) or low-intensity (3 sessions/4 weeks) lifestyle counselling intervention or control group. Results:, There was improvement in all metabolic risk factors in the moderate-intensity group, versus a smaller number of changes in the low-intensity intervention group and no change in any metabolic risk factors in control subjects. Reduction in liver enzymes was greatest in the moderate-intensity intervention group and least in the control group. The likelihood of elevated alanine aminotransferase (ALT) levels in both the moderate and low-intensity groups was reduced by over 70% compared to controls. The proportion of subjects achieving weight loss (, 2%) was significantly higher in the moderate-intensity intervention group (66%) versus the low-intensity intervention group (39%; P < 0.05) and controls (29%; P < 0.001). Conclusions:, Moderate and even low-intensity lifestyle counselling interventions targeting improvement in physical activity and nutritional behaviors and modest weight loss are a practical and effective method for improving the health of patients with elevated liver enzymes and a range of metabolic risk factors. [source]

Microstructural tectonometamorphic processes and the development of gneissic layering: a mechanism for metamorphic segregation

JOURNAL OF METAMORPHIC GEOLOGY, Issue 1 2000
Williams
The Mary granite, in the East Athabasca mylonite triangle, northern Saskatchewan, provides an example and a model for the development of non-migmatitic gneissic texture. Gneissic compositional layering developed through the simultaneous evolution of three microdomains corresponding to original plagioclase, orthopyroxene and matrix in the igneous rocks. Plagioclase phenocrysts were progressively deformed and recrystallized, first into core and mantle structures, and ultimately into plagioclase-rich layers or ribbons. Garnet preferentially developed in the outer portions of recrystallized mantles, and, with further deformation, produced garnet-rich sub-layers within the plagioclase-rich gneissic domains. Orthopyroxene was replaced by clinopyroxene and garnet (and hornblende if sufficient water was present), which were, in turn, drawn into layers with new garnet growth along the boundaries. The igneous matrix evolved through a number of transient fabric stages involving S-C fabrics, S-C-C, fabrics, and ultramylonitic domains. In addition, quartz veins were emplaced and subsequently deformed into quartz-rich gneissic layers. Moderate to highly strained samples display extreme mineralogical (compositional) segregation, yet most domains can be directly related to the original igneous precursors. The Mary granite was emplaced at approximately 900 °C and 1.0 GPa and was metamorphosed at approximately 750 °C and 1.0 GPa. The igneous rocks crystallized in the medium-pressure granulite field (Opx,Pl) but were metamorphosed on cooling into the high-pressure (Grt,Cpx,Pl) granulite field. The compositional segregation resulted from a dynamic, mutually reinforcing interaction between deformation, metamorphic and igneous processes in the deep crust. The production of gneissic texture by processes such as these may be the inevitable result of isobaric cooling of igneous rocks within a tectonically active deep crust. [source]

The Effect of Moderate to Heavy Alcohol Consumption on Neuropsychological Performance as Measured by the Repeatable Battery for the Assessment of Neuropsychological Status

ALCOHOLISM, Issue 3 2010
Alisa Green
Background:, Excessive alcohol use is associated with damage to the structure and function of the brain and impairment of cognition and behavior. Traditional test batteries used to assess cognitive performance in alcoholics are extensive and costly, limiting their use across various clinical and research settings. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a relatively new instrument that attempts to overcome some of these limitations. As yet the individual effect of moderate to heavy alcohol consumption on RBANS performance has not been examined. The primary aim of this study was to explore and quantify differences in performance between controls and drinkers on the RBANS and to examine the influence of age, gender, and alcohol use patterns on test performance. Methods:, Data from a subset of "Using Our Brains" (UoB) donors (n = 28) still actively drinking and meeting criteria for moderate to heavy alcohol use (30 to 80 g of ethanol per day) (Harper, 1988) and 28 matched controls (age, education, and premorbid Intelligence Quotient) were compared. Results:, Participants in the alcohol group performed below the healthy control group on the visuospatial and immediate memory index, and also on the RBANS total score p < 0.001 and showed a greater decline in RBANS scores from estimated cross-sectional premorbid levels. There was a positive association between alcohol ingestion in the preceding 12 months and the language index p < 0.03 and the semantic fluency subtest (p < 0.03). Age was negatively associated with story memory (p < 0.02), coding (p < 0.001), list recognition (p < 0.01), story recall (p < 0.03), and figure recall (p < 0.02). Conclusion:, Our results suggest that the RBANS is able to detect and characterize differences in verbal fluency, visuospatial skills, components of declarative memory, and psychomotor speed between healthy controls and moderate to heavy active alcohol users. Executive functions, commonly affected by alcoholism and not included in the RBANS, require assessment with additional measures. [source]

Acute Effects of Low Doses of Red Wine on Cardiac Conduction and Repolarization in Young Healthy Subjects

ALCOHOLISM, Issue 12 2009
Matteo Cameli
Background:, Moderate to high blood concentrations of ethanol have been shown to yield acute changes in cardiac electrophysiological properties, but the effect of low concentrations have never been assessed. The role of concomitant changes in clinical variables or cardiac dimensions is also still unknown. This study aimed at exploring the acute effects of low doses of ethanol, administered as Italian red wine, on conduction, depolarization, and repolarization electrocardiographic (ECG) intervals in a population of healthy subjects. Methods:, Forty healthy young volunteers drank a low quantity of red wine (5 ml/kg), and an equal volume of fruit juice in separate experiments. Heart rate, P-wave duration, PR interval, QRS duration, QT interval, corrected QT interval, QT dispersion, and corrected QT dispersion were assessed at baseline and after 60 minutes from challenge. Results:, Mean blood ethanol concentration after drinking was 0.48 ± 0.06 g/l. Compared to the control challenge, significant changes after red wine intake were observed in P-wave duration (from 101 ± 11 to 108 ± 14 milliseconds, p = 0.0006), PR interval (from 153 ± 15 to 167 ± 17 milliseconds, p < 0.0001), QT interval (from 346 ± 28 to 361 ± 24 milliseconds, p < 0.0001), and corrected QT interval (from 388 ± 24 to 402 ± 30 milliseconds, p = 0.0006). None of these changes showed correlations with modifications in clinical or echocardiographic variables. In multivariate analyses aimed at exploring predictors of ECG changes, none of the variables entered the final models. Conclusions:, Low doses of red wine acutely slow cardiac conduction and prolong repolarization in normal individuals. These changes are poorly predictable. The potential arrhythmogenic impact of these effects is worthy of exploration. [source]

Use of aminoglutethimide in the treatment of pituitary-dependent hyperadrenocorticism in the dog

JOURNAL OF SMALL ANIMAL PRACTICE, Issue 3 2002
M. D. Pérez Alenza
The aim of this study was to evaluate the efficacy and safety of aminoglutethimide in the treatment of dogs with pituitary-dependent hyperadrenocorticism (PDH). Ten dogs were diagnosed with PDH based on clinical and laboratory data, adrenal function tests (adrenocorticotropic hormone [ACTH] stimulation test and urinary cortisol/creatinine ratio [UCCR] combined with a high dose oral dexamethasone suppression test) and ultrasonographic evaluation of the adrenal glands. Aminoglutethimide was administered daily at a dose of 15 mg/kg bodyweight for one month. Median basal cortisol concentration and post-ACTH cortisol concentration one month after treatment were significantly lower than pretreatment values. Complete response was achieved in one dog, and partial response was obtained in three dogs. Severe side effects of anorexia, vomiting and weakness occurred in one dog and medication was withdrawn. Two further dogs developed decompensations of concurrent diseases and medication was stopped in these animals as well. Mild toxicity occurred in four dogs. Moderate to severe elevations in liver enzymes occurred in all dogs. The efficacy of this drug is lower than that observed using mitotane and ketoconazole, and adverse effects limit its use. Aminoglutethimide, using the protocol described, cannot be recommended for long-term management of PDH in the dog. [source]

Enhanced B7 Costimulatory Molecule Expression In Inflammatory Human Sural Nerve Biopsies

JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2001
R Kiefer
Objectives-To define the role of the costimulatory molecules B7-1 and B7-2 in inflammatory disorders of the peripheral nervous system. B7 molecules are essential for effective antigen presentation and may determine the differentiation of T cells into a Th-1 or Th-2 phenotype, thus modulating immune response and disease course. Methods-Forty nine sural nerve biopsies from patients with neuroborreliosis, Guillain-Barre syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), CIDP variants and hereditary neuropathies, and those with no detectable abnormality were investigated. The expression of B7-1 and B7-2 mRNA and protein was investigated by polymerase chain reaction (PCR) and immunocytochemistry. Results-B7-1 mRNA was strongly upregulated in both cases of neuroborreliosis, in two cases of GBS and one case of variant CIDP. Moderate to low levels were detected in the remaining GBS and CIDP biopsies and were rarely found in a noninflammatory control group consisting of hereditary neuropathy and normal nerves. At the immunocytochemical level, strong expression of B7-1 protein was found in both neuroborreliosis cases, and moderate or low expression in six of eight GBS cases and seven of 17 CIDP cases investigated, whereas only one of five non-inflammatory control nerves showed staining, which was very weak. In neuroborreliosis, B7-1 protein was found very pronounced in epineurial infiltrates, whereas in CBS and CIDP, labelling was predominantly endoneurial and localised to putative macrophages. B7-2 mRNA and protein were expressed only at low levels in neuroborreliosis and selected autoimmune neuropathy cases, and were essentially absent from noninflammatory controls. Conclusions-B7 molecules are expressed in the peripheral nervous system and regulated during disease, and their presence in macrophages underlines the putative function of endoneurial macrophages as local antigen presenting cells in the immunopathology of peripheral nerve. B7-1 rather than B7-2 is preferentially upregulated, possibly promoting the induction of a Th-1-type T cell response within the nerve. [source]

Symptoms in patients on long-term proton pump inhibitors: prevalence and predictors

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009
A. S. RAGHUNATH
Summary Background, Symptom control in primary care patients on long-term proton pump inhibitor (PPI) treatment is poorly understood. Aim, To explore associations between symptom control and demographics, lifestyle, PPI use, diagnosis and Helicobacter pylori status. Methods, A cross-sectional survey (n = 726) using note reviews, questionnaires and carbon-13 urea breath testing. Determinants of symptom control [Leeds Dyspepsia Questionnaire (LDQ), Carlsson and Dent Reflux Questionnaire (CDRQ), health-related quality-of-life measures (EuroQoL: EQ-5D and EQ-VAS)] were explored using stepwise linear regression. Results, Moderate or severe dyspepsia symptoms occurred in 61% of subjects (LDQ) and reflux symptoms in 59% (CDRQ). Age, gender, smoking and body mass index had little or no influence upon symptom control or PPI use. Average symptom scores and PPI use were lower in patients with non-ulcer dyspepsia and gastro-protection than gastro-oesophageal reflux disease (GERD) and uninvestigated dyspepsia. H. pylori infection was associated with lower reflux symptom scores only in patients with GERD and uninvestigated dyspepsia. EQ-5D was not able to discriminate between diagnostic groups, although the EQ-VAS performed well. Conclusions, A majority of patients suffered ongoing moderate or severe symptoms. GERD and uninvestigated dyspepsia were associated with poorer long-term symptom control; H. pylori appeared to have a protective effect on reflux symptoms in these patients. [source]

Symptom overlap in patients with upper gastrointestinal complaints in the Canadian confirmatory acid suppression test (CAST) study: further psychometric validation of the reflux disease questionnaire

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2007
S. V. VAN ZANTEN
Summary Background The reflux disease questionnaire (RDQ) is a short, patient-completed instrument. Aims To investigate the psychometric characteristics of the RDQ in patients with heartburn-predominant (HB) and non-heartburn predominant (NHB) dyspepsia. Methods HB (n = 388) and NHB (n = 733) patients were randomized to esomeprazole 40 mg daily or twice daily for 1 week, followed by 3 weeks of esomeprazole 40 mg daily. Results High factor loadings (0.78,0.86) supported the ,regurgitation' dimension of the RDQ. Overlapping factor loadings in the ,heartburn' and ,dyspepsia' dimensions suggested symptom overlap. All dimensions demonstrated high internal consistency (Cronbach's alpha: 0.79,0.90). Intra-class correlation coefficients over 4 weeks were good (0.66,0.85). The RDQ showed good responsiveness over 4 weeks of treatment, with high effect sizes (,0.80). Moderate or large symptom improvements were reported by 90% and 77% of HB and NHB patients, respectively, following treatment. Patients who responded to acid suppression also experienced symptom benefits in all RDQ dimensions. Conclusions The RDQ is reliable, valid and responsive to change in HB and NHB patients. The symptom overlap is important but need not play a major role in determining treatment strategy as both patient groups benefited from proton pump inhibitor treatment. [source]

Outcome of liver transplantation for patients with pulmonary hypertension

LIVER TRANSPLANTATION, Issue 4 2002
Peter Starkel
It is generally believed that pulmonary hypertension (PHT) adversely affects outcome after liver transplantation (LT). Most transplant units consider severe PHT to be an absolute contraindication to LT. We examined the outcome of 145 patients who underwent LT between 1997 and 1999. Pulmonary artery pressures (PAPs) had been measured before surgery. Pre-LT workup included electrocardiography and echocardiography for the majority of patients. Also, the liver unit database was screened for patients with known PHT who had undergone LT before 1997. Based on pulmonary floatation catheter measurements made after the induction of anesthesia for LT, PHT was defined as mild or moderate to severe if the mean PAP (MPAP) exceeded 25 and 35 mm Hg, respectively. The incidence of PHT was 26% (38 of 145 patients); 31 of 38 patients had mild PHT. Kaplan-Meier survival analysis did not show a significant survival benefit for patients with normal PAPs compared with patients with PHT (all, mild, moderate to severe). For surviving patients, the duration of ventilation and intensive care unit stay was unaffected by PHT. Four of 5 patients (identified from the database 1982 to 1999) with MPAPs greater than 40 mm Hg survived LT by more than 1 year. PHT of this severity was usually associated with specific and suggestive abnormality of the echocardiogram. Mild PHT is common and does not affect patient outcome after LT. Moderate and severe PHT are uncommon. Our analysis suggests that when the cardiac index is preserved, the majority of patients with moderate and severe PHT can survive LT, and they will not die of PHT during long-term follow-up. Echocardiography detects most severe PHT, but not mild and moderate PHT. [source]

Cytokine production from sputum cells and blood leukocytes in asthmatics according to disease severity

ALLERGY, Issue 7 2010
M. Manise
To cite this article: Manise M, Schleich F, Gusbin N, Godinas L, Henket M, Antoine N, Corhay JL, Louis R. Cytokine production from sputum cells and blood leukocytes in asthmatics according to disease severity. Allergy 2010; 65: 889,896. Abstract Background:, Although mild to moderate asthma is known to be Th2 driven, cytokines produced in refractory asthma might not fit the classical Th2 pattern. Methods:, The aim of our study was to assess the cytokine production by sputum and blood cells from 15 refractory asthmatics (American Thoracic Society Criteria) compared to 15 mild untreated and 17 moderate treated asthmatics and 22 healthy subjects. Spontaneous production of interleukin (IL)-4, IL-6, IL-10, interferon-,, and tumor necrosis factor , was measured by immunotrapping after 24 h sputum or blood cell culture. Results:, Moderate and refractory asthmatics were both characterized by a lower production of IL-6 from their airway cells compared to healthy subjects. However, the difference was no longer significant when expressing the results per gram of sputum. No significant difference between the three groups was found regarding other cytokines. As for cytokine production from blood, the three groups of asthmatics exhibited raised production of IL-4 when compared to healthy subjects, and this was true when results were expressed per blood volume or after normalization for total leukocyte cell count. Moderate asthmatics exhibited greater production of IL-10 when compared to refractory asthmatics and healthy subjects when results were normalized for total leukocyte cell count. Conclusions:, Sputum cells from moderate and refractory asthmatics release less IL-6. While the systemic overproduction of IL-4 was observed through the all spectrum of asthma severity, moderate asthmatics exhibited greater systemic IL-10 production compared to refractory asthmatics. [source]

Putaminal magnetic resonance imaging features at various magnetic field strengths in multiple system atrophy,

MOVEMENT DISORDERS, Issue 12 2010
Hirohisa Watanabe MD
Abstract We delineated the effects of magnetic field strength on signal intensities to facilitate the specific findings of multiple system atrophy (MSA). Fifteen patients with probable MSA were imaged by 0.35T fast spin-echo (FSE), 1.5T FSE, and 3.0T FSE using a consistent protocol, testing all field strengths on the same day. Sixty patients with probable Parkinson's disease (PD) also underwent imaging. Moderate or marked hyperintensity at the dorsolateral outer putaminal margin, hyperintensity of the putaminal body, hypointensity relative to the globus pallidus at the dorsolateral putaminal margin, and infratentorial signal changes were evaluated as specific findings for MSA. As the field strength increased, the occurrence of hyperintensity both at the dorsolateral outer putaminal margin and of the putaminal body decreased, while the occurrence of hypointensity at the dorsolateral putaminal margin increased in MSA. The occurrence of uniform mild hyperintensity of the outer putaminal margin was evident in 7% at 0.35T, 40% at 1.5T, and 47% at 3.0T in MSA and in 5% at 0.35T, 60% at 1.5T, and 75% at 3.0T in PD. However, no PD patients showed hyperintensity at the dorsolateral outer putaminal margin and that of the putaminal body. Putaminal magnetic resonance imaging (MRI) findings in MSA were altered considerably by magnetic field strength. The severity and distribution of signal changes are important for assessing putaminal MRI findings in MSA. © 2010 Movement Disorders Society [source]

Titration with Oxymorphone Extended Release to Achieve Effective Long-Term Pain Relief and Improve Tolerability in Opioid-Naive Patients with Moderate to Severe Pain

PAIN MEDICINE, Issue 7 2008
Richard Rauck MD
ABSTRACT Objective., Assess the effectiveness and tolerability of a program of gradual dose titration with oxymorphone extended release (ER) for treatment of moderate to severe chronic pain in opioid-naive patients. Design., Open-label, nonrandomized 6-month study with a titration/stabilization period of ,1 month followed by a 5-month maintenance period. Setting., Multidisciplinary pain centers in the United States. Patients., Adult opioid-naive patients with moderate to severe chronic pain. Interventions., Patients were gradually titrated from a 5-mg dose of oxymorphone ER (taken every 12 hours) to a stabilized dose that provided effective pain relief and was well tolerated. Outcome Measures., Brief Pain Inventory Short Form questions 5 and 9, patient and physician global assessments of pain relief, adverse events (AEs), and discontinuations. Results., The majority (94/126; 75%) of patients were stabilized on a dose of oxymorphone ER that provided effective pain relief with tolerable AEs. Most (81/94; 86%) required <24 days to reach a stable dose. Sixteen percent of patients in the titration period and 17% of patients in the maintenance period discontinued because of AEs possibly or probably related to oxymorphone ER. Patients completing the entire 5-month maintenance period experienced effective pain relief with significant (>50%) reductions of pain interference with quality-of-life measures. There was minimal dose escalation over the 5 months and low use of rescue medication. Conclusions., Oxymorphone ER provided effective pain relief from moderate to severe chronic pain in opioid-naive patients. Gradual titration was well tolerated, with a low rate of discontinuations caused by AEs. [source]