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Selected AbstractsEph/ephrin expression in the adult rat visual system following localized retinal lesions: localized and transneuronal up-regulation in the retina and superior colliculusEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 8 2005J. Rodger Abstract Following unilateral optic nerve section in adult PVG hooded rat, the axon guidance cue ephrin-A2 is up-regulated in caudal but not rostral superior colliculus (SC) and the EphA5 receptor is down-regulated in axotomised retinal ganglion cells (RGCs). Changes occur bilaterally despite the retino-collicular projection being mostly crossed. Here we investigate the dynamics of Eph/ephrin expression using in situ hybridization and semi-quantitative immunohistochemistry after localized retinal lesions. Unilateral krypton laser lesions to dorso-nasal retina ablated contralaterally projecting RGCs (DN group); ventro-temporal lesions ablated contralaterally and ipsilaterally projecting RGCs (VT group). Lesions of the entire retina served as controls (Total group). Results are compared to normal animals in which tectal ephrin-A2 and retinal EphA5 are expressed, respectively, as shallow ascending rostro-caudal and naso-temporal gradients. In both SCs of DN and Total groups, tectal ephrin-A2 was up-regulated caudally; in the VT group, expression remained normal bilaterally. Unilateral collicular ablation indicated that bilateral changes in ephrin-A2 expression are mediated via intercollicular pathways. EphA5 expression in the VT group was elevated in the intact nasal region of experimental retinae. For each experimental group, EphA5 expression was also elevated in nasal retina of the opposite eye, resulting in uniform expression across the naso-temporal axis. Up-regulation of ephrin-A2 in caudal, but not rostral, SC suggests the enhancement of developmental positional information as a result of injury. Bilateral increases in retinal EphA5 expression demonstrate that signals for up-regulation operate interocularly. The study demonstrates that signals regulating guidance cue expression are both localized and relayed transneuronally. [source] The relation between the localization of foot dermatitis and the causative allergens in shoes: a 13-year retrospective studyCONTACT DERMATITIS, Issue 4 2005A. Nardelli The purpose of this retrospective study was to test whether the initial pattern of clinical presentation of shoe dermatitis could indicate the causative allergen(s) and to estimate the odds on foot dermatitis in patients with a positive patch test versus those with a negative patch-test result. Between 1990 and 2002, 8543 patients were patch tested with the standard series (and additional allergens, if appropriate). Of them, 1168 (14%) had been referred because of foot dermatitis and 474 of these patients (5.5% of the total group) presented a positive reaction to one or more substances related to shoes. We found that 6 standard allergens in the male group and 8 standard allergens in the female group were statistically significant for the shoe dermatitis group. The data showed a relationship between the distribution pattern of the foot lesions and most of the allergens. These results have clinical applications since the gender of the patients and the localization of the foot eruptions can, indeed, indicate what allergen is involved. [source] Neuropsychiatric movement disorders following streptococcal infectionDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 11 2005K G Walker MB BS The aim of this study was to describe post-streptococcal movement disorders that form part of the acute rheumatic fever complex. The clinical records of patients diagnosed with Sydenham's chorea were analyzed retrospectively to investigate epidemiology, the significance of socioeconomic deprivation, clinical manifestations, treatments, outcomes, long-term morbidity, and disease evolution. Forty-two patients (21 males, 21 females) were diagnosed with Sydenham's chorea. The median presentation age was 9 years 8 months (range 3y 5mo to 13y 2mo). Nineteen patients were of indigenous African ancestry; 23 were of mixed ancestry. All patients lived in poverty and had poor access to medical care. Twelve of the total group had disabling symptoms for longer than 2 years; six of these patients developed paediatric autoimmune neuropsychiatric disorder associated with Streptococcus (Paediatric autoimmune neuropsychiatric disorder associated with Streptococcus [PANDAS]), five Tourette syndrome (TS), and one learning difficulties. Poor outcome was significantly more prevalent in patients of mixed ancestry, in those with a positive family history, previous behavioural problems, or a failure to complete 10 days of penicillin and ,bed-rest'/hospitalization. Sydenham's chorea is one manifestation of post-streptococcal neuropsychiatric movement disorders. This study demonstrates that patients can present with one diagnosis and evolve other neuropsychiatric conditions such as TS and PANDAS. In the South African context, it is important to delineate neuropsychiatric movement disorders associated with streptococcal infections. The potential genetic susceptibility should be explored. [source] Circulating mononuclear cells nuclear factor-kappa B activity, plasma xanthine oxidase, and low grade inflammatory markers in adult patients with familial hypercholesterolaemiaEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2 2010J. T. Real Eur J Clin Invest 2010; 40 (2): 89,94 Abstract Background, Few data are available on circulating mononuclear cells nuclear factor-kappa B (NF-kB) activity and plasma xanthine oxidase (XO) activity in heterozygous familial hypercholesterolaemia (FH). The goal of the study was to analyse circulating mononuclear cells NF-kB and plasma XO activities in FH patients. Materials and methods, Thirty FH index patients and 30 normoglycaemic normocholesterolaemic controls matched by age, gender, body mass index, abdominal circumference and homeostasis model assessment index were studied. Plasma XO and inflammatory markers were measured by standard methods. NF-kB was assayed in circulating mononuclear cells. Results, Familial hypercholesterolaemia patients showed a significantly higher NF-kB (75·0 ± 20·7 vs. 42·7 ± 16·8 relative luminiscence units) and XO (0·44 ± 0·13 vs. 0·32 ± 0·09 mU mL,1) activities than controls. In addition, interleukin-1, interleukin-6, high sensitivity C reactive protein (hsCRP) and oxidized LDL (LDL-ox) were also significantly higher in FH patients. In the total group (FH and controls), XO was significantly associated with LDL-cholesterol (LDL-C), apolipoprotein B (apoB), NF-kB and hsCPR, and NF-kB activity was significantly associated with XO, hsCPR, LDL-ox, LDL-C and apoB plasma values. Using multiple regression analysis, XO was independently associated with hsCPR and NF-kB, and NF-kB activity in circulating mononuclear cells was independently associated with apoB and LDL-ox plasma values. Conclusion, Familial hypercholesterolaemia patients show increased activities of NF-kB and XO, and higher values of low grade inflammatory markers related to atherosclerosis. NF-kB activity was independently associated with apoB plasma values. These data could explain in part the high cardiovascular disease risk present in these patients. [source] Burnout intervention among Dutch dentists: long-term effectsEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 6 2001Hans Te Brake The aim of the present study was to determine the long-term effects of a burnout-intervention program among Dutch dentists using a longitudinal design. Using the Maslach Burnout Inventory (Dutch version: MBI-NL), at the initial measurement in 1997 a ,burnout risk group' (n=171) was identified. This group received feedback on their scores and was invited to participate in an intervention program. Of the total group, 19 dentists participated in an intervention program. After the end of the intervention program, 92 dentists (the 19 participants and a control group) responded to a post-intervention survey in 1998. These dentists were approached once more 1 yr later, and this time 78 dentists (84.8%) returned a questionnaire. While demonstrating an improvement on all subscales of the MBI-NL at the first post-test, results show that the program participants showed a relapse at the second post-test. Controls who took action on their own initiative, on the other hand, reported a beneficial effect in the long run. Finally, controls that did not take any preventive action showed little or no progress. Possible causes for these findings are discussed, including the influence of coping style, perceived control, confounding factors, demand characteristics, and the necessity of post-intervention follow-up. [source] Mutations and polymorphisms in the human methyl CpG-binding protein MECP2,,HUMAN MUTATION, Issue 2 2003Gabriel Miltenberger-Miltenyi Abstract Rett syndrome (RTT or RS) is a neurodevelopmental disorder and one of the most frequent genetic diseases in girls. Mutations of the MECP2 gene have been found in a variety of different RTT phenotypes. The MECP2 gene (Xq28) has been described in 1992. Up to now, 218 different mutations have been reported in a total group, of more than 2,100 patients. Mutations in the MECP2 gene are responsible for up to 75% of the classical RTT cases. The mutations, are distributed along the whole gene and are comprised of all types of mutations. Several polymorphisms and benign genetic variants have also been described. Apart from spared reported familial cases, almost all cases are sporadic. RTT syndrome has been considered to be a lethal trait in males. Studying the parental origin of the mutations, however, we and others have found a very high prevalence of de novo mutations on the paternal chromosome. In this work we summarize the mutational reports published until now. One of our aims was to check the mutations' descriptions for consistency and particularly to rename them according to the recommended mutation nomenclature. The increasing number of investigations on the functions of the MeCP2 can help to gain more information about the neuropathogenetic mechanisms causing RTT. Hum Mutat 22:107,115, 2003. © 2003 Wiley-Liss, Inc. [source] The Relationship between Behavioral Inhibition and Time Perception in ChildrenJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 4 2005Julie B. Meaux PhD PURPOSE:,To test one component of Barkley's (1997) model of executive functions by examining the relationship between behavioral inhibition and time perception in children. METHOD:,Correlation analysis was used to determine the relationships between measures of behavioral inhibition and time perception for the entire sample, and for boys (n = 34) and girls (n = 26) separately. FINDINGS:,For both parent and child measures, behavioral inhibition and time perception scores were correlated for the total group and for girls. Child measure of behavioral inhibition and time perception were not correlated for boys. CONCLUSIONS:,The findings of this study support Barkley's theory and indicate a relationship between poor behavioral inhibition and poor time perception in children. [source] A study on associations between antiprothrombin antibodies, antiplasminogen antibodies and thrombosisJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 4 2003M. J. A. Simmelink Summary., Anti-prothrombin antibodies are a frequent cause of lupus anticoagulant (LAC), a thrombotic risk factor. Prothrombin shares structural homology with plasminogen, a kringle protein with an important role in fibrinolysis. Cross-reactivity between antiprothrombin antibodies and plasminogen has been described. To study associations between LAC, IgG and IgM class antiprothrombin and antiplasminogen antibodies, plasminogen activity levels and thrombosis in selected patients with systemic autoimmune diseases. Patients included forty-six consecutive LAC-positive patients (29 with systemic lupus erythematosus (SLE); 33 with a thrombotic history), 38 patients without LAC (36 with SLE; seven with a history of thrombosis) and 40 healthy controls. In the total group of 84 patient samples, the prevalence of antiprothrombin and antiplasminogen antibodies was 30 and 38%, respectively. There was no significant relationship between the presence of these antibodies. In contrast to presence of antiplasminogen antibodies, presence of antiprothrombin antibodies was statistically significant related to thrombosis. Thirteen samples had antiprothrombin and antiplasminogen antibodies of similar isotype (IgG, n= 4; IgM, n= 9). Of these, all but one had LAC and 11/13 came from patients with a history of thrombosis. Simultaneous presence of IgM-class antiprothrombin and antiplasminogen antibodies had a significant association with thrombosis. Levels of plasminogen activity were similar in samples from healthy controls and patients (with or without antiplasminogen antibodies or thrombosis). Anti-prothrombin antibodies and antiplasminogen antibodies occur frequently in patients with systemic autoimmune disease. Anti-prothrombin antibodies, but not antiplasminogen antibodies are a risk factor for thrombosis. Anti-plasminogen are in most cases unrelated to antiprothrombin antibodies. [source] Systematic review: the role of different types of fibre in the treatment of irritable bowel syndromeALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2004C. J. Bijkerk Summary Background :,Both high-fibre dietary advice and the prescription of fibre as a bulking agent are very common in primary and secondary care management of irritable bowel syndrome. Irritable bowel syndrome patients with constipation may have delayed intestinal transit. Therefore, fibres that accelerate intestinal transit may be beneficial in these patients. The uncertain benefits reported in several clinical studies, however, have led us to reappraise the value of fibre in irritable bowel syndrome management. Aim :,To quantify the effect of different types of fibre on global and symptom relief from irritable bowel syndrome. Methods :,Using a structured literature search in MEDLINE (1966,2002), we selected randomized controlled trials involving irritable bowel syndrome patients treated with fibre. Analyses were performed for the total group and for trials using soluble and insoluble fibre separately. Results :,Seventeen studies were included in the analysis. None investigated primary care irritable bowel syndrome patients. Fibre, in general, was effective in the relief of global irritable bowel syndrome symptoms [relative risk, 1.33; 95% confidence interval (CI), 1.19,1.50]. Irritable bowel syndrome patients with constipation may receive benefit from fibre treatment (relative risk, 1.56; 95% CI, 1.21,2.02), but there was no evidence that fibre was effective in the relief of abdominal pain in irritable bowel syndrome. Soluble and insoluble fibre, separately, had different effects on global irritable bowel syndrome symptoms. Soluble fibre (psyllium, ispaghula, calcium polycarbophil) showed significant improvement (relative risk, 1.55; 95% CI, 1.35,1.78), whereas insoluble fibre (corn, wheat bran), in some cases, worsened the clinical outcome, but there was no significant difference compared with placebo (relative risk, 0.89; 95% CI, 0.72,1.11). Conclusions :,The benefits of fibre in the treatment of irritable bowel syndrome are marginal for global irritable bowel syndrome symptom improvement and irritable bowel syndrome-related constipation. Soluble and insoluble fibres have different effects on global irritable bowel syndrome symptoms. Indeed, in some cases, insoluble fibres may worsen the clinical outcome. Future clinical studies evaluating the effect and tolerability of fibre therapy are needed in primary care. [source] Is a one-week course of triple anti- Helicobacter pylori therapy sufficient to control active duodenal ulcer?ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2001B. Tepe Background: Triple therapy currently forms the cornerstone of the treatment of patients with Helicobacter pylori -positive duodenal ulcer. Aim: To establish whether prolonged antisecretory therapy is necessary in patients with active duodenal ulcer. Methods: A total of 77 patients with H. pylori -positive duodenal ulcer were included in a prospective, controlled, double-blind study. All patients received a 7-day treatment with omeprazole 20 mg b.d., clarithromycin 500 mg b.d. and amoxicillin 1000 mg b.d. Patients in the omeprazole group underwent an additional 14-day therapy with omeprazole 20 mg; patients in placebo group received placebo. Endoscopy was performed upon inclusion in the study and after 3 and 8 weeks. Results: Seventy-four patients were eligible for a per protocol analysis after 3 weeks, and 65 after 8 weeks. After 3 weeks, the healing rate was 89% in the omeprazole group and 81% in the placebo group (P=0.51). After 8 weeks, the ulcer healed in 97% of the patients in the total group (95% CI: 92.7,100%). H. pylori was eradicated in 88% of patients in the omeprazole group and in 91% in the placebo group (P=1.0). No statistically significant differences between the groups were found in ulcer-related symptoms or in ulcer healing. Conclusion: In patients with H. pylori -positive duodenal ulcer, a 7-day triple therapy alone is sufficient to control the disease. [source] Assessment of professional behaviour in undergraduate medical education: peer assessment enhances performanceMEDICAL EDUCATION, Issue 9 2007Johanna Schönrock-Adema Objectives, To examine whether peer assessment can enhance scores on professional behaviour, with the expectation that students who assess peers score more highly on professional behaviour than students who do not assess peers. Methods, Undergraduate medical students in their first and second trimesters were randomly assigned to conditions with or without peer assessment. Of the total group of 336 students, 278 students participated in the first trimester, distributed over 31 tutorial groups, 17 of which assessed peers. The second trimester involved 272 students distributed over 32 groups, 15 of which assessed peers. Professional behaviour was rated by tutors on 3 dimensions: Task Performance; Aspects of Communication, and Personal Performance. The rating scale ranged from 1 (poor) to 10 (excellent). Data were analysed using multivariate repeated measures multilevel analysis. Results, Assessment scores were found to have generally increased in the second trimester, especially the personal performance scores of students who assessed peers. In addition, female students were found to have significantly higher scores than male students. Conclusions, In undergraduate medical education, peer assessment has a positive influence on professional behaviour. However, the results imply that peer assessment is only effective after students have become adjusted to the complex learning environment. [source] Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unitPEDIATRIC ANESTHESIA, Issue 9 2006ALEX VELDMAN MD Summary Background :,Unplanned extubation events (UEE) are a serious hazard to patient safety, especially on a neonatal intensive care unit (NICU), where reestablishing a secure airway can be difficult. The following study was undertaken to analyze characteristics of UEE and develop prevention strategies. Methods :,A retrospective cohort study on a level III single center NICU was undertaken. Patient records of a 12-month period from December 2003 to December 2004 were analyzed using a standardized evaluation form. Fischer's exact t -test and the Mann,Whitney U -Ranked Sum test were used for statistical analysis. Results :,One hundred and four neonates with a total ventilation time of 14 495 h were included in this study. Of these patients 12 UEE were observed (1 UEE/1208 h of ventilation time). Neither median birth weight [1445 g (range 460,4650) vs 1755 g (range 460,3570 g)] nor median gestational age [31.5 weeks (range 25.6,39.6 weeks) vs 32.7 weeks (range 23.9,41.5 weeks)] differed significantly between neonates with UEE compared with the total group. When the UEE occurred, the neonates were cared for by experienced nursing staff with a median of 10 years nursing experience. The workload for the individual nurse was high: during shifts when UEE happened, each nurse had to take care of 3.85 patients (range 1.8,5 patients). This workload was higher than the average of 3 (range 1.6,6) patients/nurse during the study period. The most frequently reported reason for UEE was difficult fixation of the tracheal tube (TT) (four patients), followed by handling of the infant by nursing staff or physiotherapy (two patients) or an active infant in whom dislocation of the TT occurred without external manipulations (three patients). In three instances, the reason for the UEE was not documented. Of the 12 UEE observed in 10 patients, three required immediate reintubation, five were managed with nasal continuous positive airway pressure and four did not require further respiratory support. Of those who required support, FiO2 increased by 14% over baseline compared with the FiO2 prior to UEE. Conclusions :,Inadequate TT fixation could be identified as the main contributor to UEE and should be targeted in prevention strategies. The reintubation rate after UEE was only 25%. Overall, UEE did not result in an adverse outcome in terms of mortality. Length of stay on NICU was significantly longer in UEE patients. [source] Prevalence of allergic symptoms among children with diabetes mellitus type 1 of different socioeconomic statusPEDIATRIC DIABETES, Issue 4pt2 2008Kyriaki Karavanaki Abstract:, The aim of the study was to assess the possible associations between allergies and type 1 diabetes mellitus (DM1), stratified by social class. We studied 127 children with DM1 with a median age of 10.8 yr and 150 controls of comparable age and sex distribution. The parents completed questionnaires on their education and occupation and on their children's history of allergic symptoms, breast-feeding, viral infections, and measles,mumps,rubella (MMR) vaccination. Lower family's social class was more frequently encountered among the DM1 families than in the controls (OR = 0.56, 95% CI: 0.35,0.92). The occurrence of any allergic symptoms among children with DM1 (35.45%) was not significantly different from the controls (38.78%), neither in the total group (OR = 0.87, 95% CI: 0.52,1.45) nor in the stratified analysis by social class. Similar findings were observed regarding the different types of allergic symptoms. In the univariate analysis, breast-feeding, the experience of viral infections, and MMR vaccination were found to be protective of DM1 presentation in both upper and lower social classes. In the multiple logistic regression analysis, the experience of more than 2 infections/yr (OR = 0.12, 95% CI: 0.04,0.34), the origin from middle and upper social classes (OR = 0.42, 95% CI: 0.22,0.80) and breast-feeding (OR = 0.58, 95% CI: 0.31,1.07) were protective of DM1 occurrence. In children with DM1, the presence of allergic symptoms was not associated with the development of DM1. Among the environmental factors, the origin from middle or upper social classes, breast-feeding, the experience of viral infections, and MMR vaccination were found to have a protective effect on DM1 presentation. [source] Evaluation of catch-up growth after liver transplantation in children with biliary atresiaPEDIATRIC TRANSPLANTATION, Issue 3 2004G. Alonso Abstract:, Orthotopic liver transplantation (Tx) has improved survival in infants with extrahepatic biliary atresia (BA) when portoenteroanastomosis fails. Symptoms leading to Tx include liver failure, poor quality of life and growth failure. The objective of the study was to determine catch-up growth in children with BA. Medical records and growth data of 36 patients (24 girls) who received a Tx due to BA were analyzed. Thirty-two patients completed 3 yr and 15 patients 7 yr of follow-up after Tx. At Tx, the median age was 2.7 yr (range 0.7,12.6) and mean height Z score (±s.d.) was ,1.56 (±1.3). Patients were divided in two groups according to age at Tx: group I (n = 10), younger than 1.0 yr, and group II (n = 26) older than 1.0 yr. Median age (range) at Tx in group I was 0.8 yr (0.7,1.0) and in group II it was 3.35 yr (1.25,12.6). Thirteen patients (nine in group I) were receptors of living related donors. We evaluated linear growth, liver and renal function, immunosuppressive regimen and allograft rejection episodes. We did not find any significant differences in allograft or renal function, immunosuppressive therapy and number of acute rejection episodes or height Z score at Tx, second and third year post-Tx between both groups. The mean height Z score at Tx in group I was ,1.61 and in group II ,1.54; at the second year, group I ,0.66 and group II ,1.08; at the third year, group I ,0.17 and group II ,0.85; and at the seventh year (total group) ,0.3. However, the height gain at the third year was better in group I than in group II (p < 0.01, t-test). Height Z score at the third year improved more than 1 SDS in seven out of eight patients in group I and in only nine out of 24 in group II (odds ratio 11.6). We also found a correlation between height gain at the third year and age at Tx (r,0.65) and between height gain at the third year and height Z score at Tx (r,0.54) (Pearson, p < 0.05). Children with BA who are transplanted before 12 months of age presented better catch-up growth without change survival and morbidity. Orthotopic liver Tx improves survival and also enables height gain in these children. [source] Clinical interest: a study of the influence on general practitioners' prescribing,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2007Dorte Gilså Hansen MD Abstract Purpose To analyse the association between general practitioners' clinical interest and prescribing rates in four clinical areas: dyspepsia, depression, headache and diabetes. Methods Data concerning general practitioners' prescribing during 2004 were retrieved from a pharmacy database and linked with data from a physician questionnaire and the National Health Insurance Register. To counterbalance differences in practice populations all 1-year prevalences of prescribing were standardised according to age and gender. Participants were asked ,To what extent do you find the following areas interesting from a professional point-of- view?' Four rating categories were used. The association between clinical interest and standardised prescribing rates was investigated using logistic regression, the Kruskal-Wallis test and a trend test. Results A total of 68 (72%) single-handed general practitioners representative of the total group completed the questionnaire. We observed a two-fold ratio between the 90% and the 10% percentiles of the 1-year prevalences of antisecretory drugs, antidepressants, migraine drugs as well as anti-diabetics. The variation in prescribing of antidepressant and antisecretory drugs was far above chance level. No significant association with clinical interest could, however, be observed for any of the four clinical areas. Conclusion General practitioners' prescribing of the four classes of medical drugs varied considerably. However, only part of this variation was based on chance. This study did not confirm our hypothesis that general practitioners' level of clinical interest in one area corresponds with their prescribing of drugs used within that area. Copyright © 2007 John Wiley & Sons, Ltd. [source] Changes in Maltreated Children's Emotional,Behavioral Problems Following Typically Provided Mental Health ServicesAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 3 2010Julie S. McCrae Child welfare agencies serve as gate keepers for children's mental health services (MHS). Yet, the impact of offered services on behavioral outcomes has not been well studied. Data from the National Survey of Child and Adolescent Well-Being (NSCAW) were examined to measure caregivers' reported change in children's emotional,behavioral problems. Over 600 children in three age groups were matched and problem levels compared across 3 years. Although behavioral problems for the total group improved across time, scores for children who received MHS slightly worsened. Children who received MHS scored 1.4,3.7 points worse than children who did not receive MHS. Additionally, young Black, Hispanic, and other racially identified children had more problems than young White children, regardless of service. Higher behavior problem scores were noted for school-age children and adolescents. Although child welfare appears to rely on a cluster of MHS, including school-based counseling and private practitioner services, future service delivery should expand from improving access to achieving outcomes. [source] Endoscopic Vertical Partial Laryngectomy,THE LARYNGOSCOPE, Issue 2 2004R Kim Davis MD Abstract Objective: To explain the significant difference between microlaryngoscopy with cordectomy and endoscopic vertical partial laryngectomy (EVPL), to describe the efficacy of EVPL on T1b and T2 glottic squamous cell carcinoma, and to evaluate EVPL with postoperative irradiation in T2 glottic cancer with impaired true vocal cord mobility. Study Design: Retrospective review. Methods: Twenty-six patients seen at the University of Utah Health Science Center between 1987 and 2000 with bilateral T1 (T1b) or T2 squamous cell carcinoma of the glottic larynx underwent EVPL. T2 cancers were classified as follows: a = unilateral disease, b = bilateral disease; i = impaired mobility. T1b and T2a glottic cancer patients received surgery alone, whereas impaired mobility patients (T2ai + T2bi) patients received surgery followed by planned postoperative irradiation. Patients were assessed for primary site control, perioperative and long-term complications, and ultimate cancer control. Results: Survival in the total group was 88.5%, with local control at 92.3%. The two recurrent patients were salvaged by total laryngectomy. For the whole group, anterior commissure involvement was present in 57.7% (15 of 26). Thirteen T2 (5 T2ai + 8 T2bi) carcinoma patients underwent combined therapy, with 8 (61.5%) of these patients having anterior commissure involvement. Two of these patients were upstaged at surgery, one to T3 and one to T4. Local control was 84.5%. Thirteen patients were treated by surgery only, with five of these patients having failed previous irradiation. Survival was 92.3% and local control 100%. This group included two T2bi patients, two patients upstaged to T4 on the basis of extension beyond the subglottis to the anterior wall of the trachea, 3 T2b, and 6 T2a patients. Anterior commissure involvement was seen in 7 (53.8%) of these patients. Conclusions: EVPL alone controlled all T1b and T2a glottic cancer patients, even in the presence of greater than 50% anterior commissure involvement. The significant difference between EVPL and classical microlaryngoscopy with cordectomy was carefully described. EVPL with planned postoperative irradiation resulted in an 85% local control rate in clinically staged T2ai and T2bi cancer patients, including the three upstaged patients. [source] Consequences to Hearing During the Conservative Management of Vestibular Schwannomas,THE LARYNGOSCOPE, Issue 2 2000FRCS(ORL), Rory M. Walsh MA Abstract Objective: To estimate the risk of loss of serviceable hearing during the conservative management of vestibular schwannomas. Study Design: Retrospective case review. Methods: Twenty-five patients with a radiological diagnosis of unilateral vestibular schwannoma were managed conservatively for a mean duration of 43.8 months (range, 12,194 mo). The pure-tone average (PTA) (0.5, 1, 2, and 3 kHz) and speech discrimination scores (SDS) were measured at regular intervals throughout the entire duration of follow-up. Serviceable hearing was defined using two criteria: 70% SDS/30 dB PTA (the 70/30 rule) and 50% SDS/50 dB PTA (the 50/50 rule). The size and growth rate of tumors were determined according to the American Academy of Otolaryngology,Head and Neck Surgery guidelines (1995). Intervention was recommended if there was evidence of continuous or rapid radiological tumor growth, and/or increasing symptoms or signs suggestive of tumor growth. Results: The risk of loss of serviceable hearing for the total group was 43% using the 70/30 rule and 42% using the 50/50 rule. Tumor growth was considered significant (> 1 mm) in 8 tumors (32%) and nonsignificant in 17 (68%). The risk of loss of serviceable hearing for the tumor-growth group was 67% using the 70/30 rule and 80% using the 50/50 rule. In contrast, the risk of loss of serviceable hearing for the no tumor,growth group was 25% using the 70/30 rule and 14% using the 50/50 rule. No audiological factors predictive of tumor growth were identified. Conclusions: There is a significant risk of loss of serviceable hearing during the conservative management of vestibular schwannomas. This risk appears to be greater in tumors that demonstrate significant growth. [source] Liver Transplantation with Grafts from Controlled Donors after Cardiac Death: A 20-Year Follow-up at a Single CenterAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2010S. Yamamoto The first liver transplantation (LTx) in Sweden was performed in 1984, but brain death as a legal death criterion was not accepted until 1988. Between November 1984 and May 1988, we performed 40 consecutive LTxs in 32 patients. Twenty-four grafts were from donors after cardiac death (DCD) and 16 grafts from heart-beating donors (HBD). Significantly, more hepatic artery thrombosis and biliary complications occurred in the DCD group (p < 0.01 and p < 0.05, respectively). Graft and patient survival did not differ between the groups. In the total group, there was a significant difference in graft survival between first-time LTx grafts and grafts used for retransplantation. There was better graft survival in nonmalignant than malignant patients, although this did not reach statistical significance. Multivariate analysis revealed cold ischemia time and post-LTx peak ALT to be independent predictive factors for graft survival in the DCD group. In the 11 livers surviving 20 years or more, follow-up biopsies were performed 18,20 years post-LTx (n = 10) and 6 years post-LTx (n = 1). Signs of chronic rejection were seen in three cases, with no difference between DCD and HBD. Our analysis with a 20-year follow-up suggests that controlled DCD liver grafts might be a feasible option to increase the donor pool. [source] Elevated levels of leukotriene B4 and leukotriene E4 in bronchoalveolar lavage fluid from patients with scleroderma lung diseaseARTHRITIS & RHEUMATISM, Issue 6 2003Otylia Kowal-Bielecka Objective The leukotrienes are a family of arachidonic acid,derived lipid mediators with proinflammatory and profibrotic properties. The aim of this study was to analyze the role of leukotriene B4 (LTB4) and LTE4 in the pathogenesis of scleroderma lung disease (SLD). Methods Nineteen systemic sclerosis (SSc) patients with SLD, 11 SSc patients without SLD, and 10 healthy controls were studied. Bronchoalveolar lavage (BAL) fluid was obtained during routine bronchoscopy of the right middle lobe in all study subjects. Levels of LTB4 and LTE4 were measured using enzyme immunoassay kits. Results Levels of LTB4 and LTE4 were significantly higher in SSc patients with SLD (251 ± 170 pg/ml and 479 ± 301 pg/ml, respectively), than those in patients without SLD (114 ± 86 and 159 ± 149 pg/ml) and those in normal controls (86 ± 49 and 110 ± 67 pg/ml). In the total group of patients with SSc, levels of both leukotrienes correlated positively with the total number of cells in the BAL fluid and correlated negatively with the forced vital capacity. After intravenous pulse therapy with cyclophosphamide in 6 patients, there was a significant reduction in the concentration of LTB4 (from 380 ± 196 pg/ml to 155 ± 123 pg/ml) but no significant difference in the levels of LTE4 (from 697 ± 325 pg/ml to 418 ± 140 pg/ml). Conclusion Our findings show that LTB4 and LTE4 levels are elevated in SSc patients with SLD and correlate with parameters of inflammation in the lungs. These results indicate that leukotrienes may contribute to the pathogenesis of SLD and may represent a new therapeutic target. [source] Consumer acceptability, sensory properties and expert quality judgements of Australian Cabernet Sauvignon and Shiraz winesAUSTRALIAN JOURNAL OF GRAPE AND WINE RESEARCH, Issue 1 2010K.A. LATTEY Abstract Background and Aims:, This study aimed to determine what sensory attributes most drive consumer and expert acceptance for Cabernet Sauvignon and Shiraz wines. Methods and Results:, The sensory attributes of a set of commercial wines were quantified by a trained panel. A subset was assessed blind for liking by 203 consumers and for quality by 67 winemakers. For the total group of consumers, wines with low levels of ,bitterness', ,hotness', ,metallic', ,smoky' and ,pepper' were preferred. In addition, four consumer clusters were identified, each with different sensory drivers of preference, with the attributes ,red berry', ,floral', ,caramel' and ,vanilla' aroma, ,acidity', ,green' flavour and astringency being of importance in distinguishing the different clusters' acceptance scores. The winemakers' quality scores had little relationship with consumer response, although both groups gave low ratings to wines with Brettanomyces -related flavour. Conclusions:, A relatively small set of sensory attributes were of greatest importance to consumer liking, and these generally dominate varietal differences. Winemakers' quality concepts do not closely align with those of the consumers. Significance of the Study:, This study identifies sensory properties of red wines which could be maximised as well as those which should be reduced, allowing producers to better meet consumers' preferences. [source] Diagnosing bipolar disorder in trauma exposed primary care patientsBIPOLAR DISORDERS, Issue 4 2007Ruth Elaine Graves Objectives:, Bipolar disorder (BD) is often under-recognized in non-psychiatric settings, especially in African Americans. The Mood Disorder Questionnaire (MDQ) is a screening instrument proposed to show adequate sensitivity and specificity for bipolar spectrum disorders. The current study is an examination of the usefulness of this instrument in a trauma exposed subgroup of mainly African American patients attending primary care clinics. Methods:, The sample is a part of a larger study exploring traumatic stress exposure and psychopathology. Consenting patients in 3 academically affiliated primary care clinics were asked to complete the MDQ. Ninety percent of the participants were African American. Diagnostic performance was determined in a trauma exposed subgroup by employing the Structured Clinical Interview for DSM-IV (SCID) as a gold standard. Results:, Of the total group of 579 participants, 178 (30.7%) screened positive for BD along with 77 (33.7%) of the 228 trauma exposed subjects who were SCID interviewed. Only 13 (27%) of the MDQ positives met SCID criteria for BD and were true positives. The sensitivity was 61.9% and the specificity was 69%, with a positive predictive value of 16.8% and a negative predictive value of 94.7%. Conclusions:, The MDQ was found to have low specificity in a predominately African American group of trauma exposed patients attending primary care. [source] Bone metabolism markers and ghrelin in boys at different stages of sexual maturityACTA PAEDIATRICA, Issue 5 2009Jaak Jürimäe Abstract Aim: To examine the relationship of the markers of bone formation (procollagen type I N-terminal propeptide [PINP]) and bone resorption (type I carboxyterminal telopeptide [ICTP]) with bone mineral content (BMC), bone mineral density (BMD), ghrelin and testosterone in boys during puberty. Methods: Sixty boys were divided in three groups (20 boys in each) based on the pubertal stage (G1, I; G2,G3, II; G4,G5, III). Fasting PINP, ICTP, ghrelin and testosterone were measured. Total body BMD, lumbar BMD, lumbar apparent volumetric BMD (BMAD) and BMC were measured by DXA. Results: PINP and ICTP values peaked at the beginning of puberty (Group II). Ghrelin was lower in Groups II and III compared to less mature boys. PINP and ICTP correlated with each other and were associated with lumbar BMAD in total group of boys. Relationships of PINP and ICTP with total BMD, total BMC and lumbar spine BMD in Group I were observed. PINP and ICTP were also correlated with testosterone in Group II and with lumbar spine BMAD in Group III. Conclusion: These data suggest that testosterone stimulates PINP and ICTP in early puberty, while ghrelin has no direct influence on bone turnover markers in boys at different stages of puberty. [source] Obesity in looked after children: is foster care protective from the dangers of obesity?CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 6 2008S. C. Hadfield Abstract Background Obesity in all age groups of children has become an increasing concern in recent years. Children looked after by the Local Authority (LA) should be protected from health problems while being accommodated. These studies assess the effect on weight of looked after children (LAC) in the care of a Midlands County Council. They assess the frequency of obesity or overweight problems in looked after children following receipt into care and review changes in body mass index (BMI) while in the care of the LA. Method The height and weight measurements of all 106 children who had statutory health assessments while in the care of the LA between 1 January 2004 and 30 December 2004 were used to calculate their BMI. The data were plotted onto standard Growth Foundation charts and the International Obesity Task Force Paediatric cut-offs were determined to distinguish overweight and obese children and young people. The date that the child had come into the care system and the number of moves of placement was obtained for each child from the social care. This was related to the total group and the overweight group of looked after children. Result Looked after children are more likely to be overweight and obese compared with standard norms, and there are a number of children (35%) whose BMI increases once in care. Outcome Looked after care did not protect a child from the national problem of increasing weight gain and obesity. [source] Audit of local performance compared with standards recommended by the national guidelines for aetiologic investigation of permanent childhood hearing impairmentCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 6 2005S. Yoong Abstract Background National guidelines for aetiologic investigation of childhood deafness were developed as the Newborn Hearing Screening Program (NHSP) was being implemented in the United Kingdom. This guidance document was expected to be incorporated into the operational procedure of the NHSP. Method This criterion-based audit compared local care set against developed guidelines that can be used to assess the appropriateness of specific investigations, services and outcomes. Data on children diagnosed to have sensorineural deafness from March 2002,2004 were extracted from an established computerized database for analysis. Results Forty-seven children were included; 17 have bilateral severe to profound hearing loss, 25 have bilateral mild to moderate loss and 5 with unilateral loss. A high proportion of Pakistani children were from consanguineous marriages with a family history of deafness. Total 29.8% of children were diagnosed through newborn screening and 70.2% detected through hearing surveillance programmes. For children with bilateral severe to profound deafness, 53.0% accepted, 5.9% declined and 41.2% were not offered imaging of their inner ears. A total of 47.1% accepted and 52.9% declined electrocardiograph (ECG) evaluation. Total 70.6% accepted and 29.4% declined connexin mutations testing. Parental requests were required for those with lesser degree of hearing loss. Total 24% accepted, 28% declined and 48% were not offered connexin testing. None were offered ECG and imaging. Testing for congenital infections was inappropriate for children over 1 year old. Ten subjects accepted and five declined this investigation. In the total group, 63.8% accepted, 17.0% declined and 19.1% were not offered referral to the ophthalmic service. Total 46.8% accepted, 44.7% declined and 8.5% were not offered referral to genetics service. Investigations resulted in two connexin-positive children with moderate loss. Conclusion Our study identified key areas where guidelines were not followed. These were related to lack of funding and parental choice. This sample has a higher connexin ,hit' rate for lesser degree deafness. [source] Thyroid hormone levels in children with Prader,Willi syndrome before and during growth hormone treatmentCLINICAL ENDOCRINOLOGY, Issue 3 2007D. A. M. Festen Summary Background, Prader,Willi syndrome (PWS) is a neurogenetic disorder characterized by muscular hypotonia, psychomotor delay, obesity and short stature. Several endocrine abnormalities have been described, including GH deficiency and hypogonadotrophic hypogonadism. Published data on thyroid hormone levels in PWS children are very limited. Objective, To evaluate thyroid function in children with PWS, before and during GH treatment. Design/patients, At baseline, serum levels of T4, free T4 (fT4), T3, reverse T3 (rT3) and TSH were assessed in 75 PWS children. After 1 year, assessments were repeated in 57 of the them. These children participated in a randomized study with two groups: group A (n = 34) treated with 1 mg GH/m2/day and group B (n = 23) as controls. Results, Median age (interquartile range, IQR) of the total group at baseline was 4·7 (2·7,7·6) years. Median (IQR) TSH level was ,0·1 SDS (,0·5 to 0·5), T4 level ,0·6 SDS (,1·7 to 0·0) and fT4 level ,0·8 SDS (,1·3 to ,0·3), the latter two being significantly lower than 0 SDS. T3 level, at 0·3 SDS (,0·3 to 0·9), was significantly higher than 0 SDS. After 1 year of GH treatment, fT4 decreased significantly from ,0·8 SDS (,1·5 to ,0·2) to ,1·4 SDS (,1·6 to ,0·7), compared to no change in untreated PWS children. However, T3 did not change, at 0·3 SDS (,0·1 to 0·8). Conclusions We found normal fT4 levels in most PWS children. During GH treatment, fT4 decreased significantly to low-normal levels. TSH levels remained normal. T3 levels were relatively high or normal, both before and during GH treatment, indicating that PWS children have increased T4 to T3 conversion. [source] The impact of acute elevation of non-esterified fatty acids on insulin sensitivity and secretion in women with former gestational diabetesCLINICAL ENDOCRINOLOGY, Issue 1 2005K. A. McLachlan Summary Objectives, Elevations in non-esterified fatty acids (NEFA) have been shown to decrease insulin action and secretion, and are a risk factor for the development of Type 2 diabetes. As women who have had gestational diabetes (GDM) are at increased risk of diabetes, we examined the effect of an acute elevation of NEFA on insulin secretion and action in these women. Patients and design, Nineteen women with recent former GDM and 19 age- and BMI-matched postpartum healthy control subjects underwent a 40-min intravenous glucose tolerance test, with and without a preceding 2-h infusion of 20% Intralipid. Insulin action was assessed by glucose disappearance (Kg) and insulin sensitivity (SI); insulin secretion by first phase insulin release (FPIR) and disposition index (DI). Results, NEFA levels were similarly elevated in both groups by the Intralipid infusion (up to 1·140 ± 0·03 mm). As expected, the lipid infusion significantly reduced Kg (2·15 ± 0·13 vs. 1·69 ± 0·09/min, P < 0·001) and SI (3·14 ± 0·28 vs. 2·13 ± 0·17/min/mUl/min, P < 0·001) in all subjects, and these were significant within the GDM and control subgroups. FPIR was elevated in the Intralipid study in the total group of women (4·50 ± 0·50 vs. 5·02 ± 0·53, P = 0·02), but DI was significantly reduced (12·13 ± 1·1 vs. 8·83 ± 0·7, P < 0·001). There was no significant difference, however, in the absolute or percentage change in Kg, SI or FPIR with lipid infusion between the GDM and control groups. GDM status was not a predictor of the response of Kg, SI or FPIR to lipid infusion, rather, adiposity (% fat), average fasting NEFA levels and basal disposition index were associated. Conclusion, These data suggest that women with former gestational diabetes, in contrast to other prediabetic states, are not more susceptible to the deleterious effects of an acute elevation in nonesterified fatty acids than matched control subjects. [source] Current clinical selection strategies for identification of hereditary non-polyposis colorectal cancer families are inadequate: a meta-analysisCLINICAL GENETICS, Issue 4 2004W Kievit Present guidelines to identify hereditary non-polyposis colorectal cancer (HNPCC) families are criticized for limitations in accuracy. The Amsterdam criteria I and II (AC I and AC II) are used to predict a germline mutation in one of the mismatch repair genes. In families not fulfilling the AC I and AC II criteria, individual indications to test cancer specimens for microsatellite instability (MSI) are guided by the Bethesda Guidelines (BG). Germline mutation testing is then performed in patients who conform to the BG and show MSI. We investigated the sensitivity and specificity of AC I, AC II, and BG. A meta-analysis of studies on the value of the AC I and AC II criteria for predicting germline mutation, as well as a meta-analysis of BG for the detection of MSI was performed. For the AC I, sensitivity varied from 54 to 91% and specificity varied from 62 to 84%. For the AC II, the pooled sensitivity was 78% and specificity ranged between 46 and 68%. Post-test probabilities of a positive test result were 0.61 and 0.46 for the AC I and AC II, respectively. Post-test probabilities of a negative test result were 0.17 and 0.21 for the AC I and AC II, respectively. For the BG, the pooled sensitivity was 89% and pooled specificity was 53%. Post-test probability of a positive test result was 41%, and post-test probability of a negative test result was 9%. The sensitivity and specificity of the Amsterdam criteria for predicting a germline mutation that causes HNPCC is not sufficient. The BG are useful for the detection of MSI in a group of patients suspected of having familial colorectal cancer (CRC), but sensitivity is very low in the total group of newly diagnosed CRC patients. Therefore, a new strategy is needed for the identification of HNPCC. [source] Clinical Outcome of Overdenture Treatment on Two Nonsubmerged and Nonsplinted Astra Tech MicrothreadŌ ImplantsCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2009Hugo De Bruyn DDS ABSTRACT Background: The use of two implants for mandibular overdenture stabilization improves the patients' comfort and well-being. This treatment could be more cost-effective if surgery and prosthetic treatment could be performed by one clinician in the normal setting of a dental clinic. Purpose: The aim of this retrospective clinical study was to describe implant success, restorative outcome, and the patients' opinion of mandibular overdenture treatment on two early-loaded, nonsplinted Astra Tech TiOblast MicrothreadŌ (Astra Tech Dental, Mölndal, Sweden) implants. Materials and Methods: Thirty-seven consecutive patients treated with implant-supported mandibular overdentures were invited for a clinical examination. Implant survival, marginal bone level, quality of implant and prosthetic treatment, and the patients' opinion by means of questionnaires were scored. Results: Thirty-four patients attended the examination. Two implants were lost in one patient and the failure rate for the total group of patients was 3%. As 8 of the 33 remaining patients were still in the provisional loading stage, they were not included in the final clinical and radiographic examination. Based on 25 patients and 50 implants with a mean follow-up of 18.8 months (range 4,33), implant positioning and occlusion/articulation scored perfect in 74 to 80% of the cases. Retention of the dentures was rated perfect in 80%, but 20% needed minor activation of the attachments, 20% showed signs of abrasion, and 20% had already been repaired. The average marginal bone level was 0.8 mm below the reference point. The mean pocket depth was 2.1 mm, and 54% of the peri-implant tissues were free of bleeding. The patients were appreciative of the work carried out by their dentist and they indicated a significant improvement in their well-being and quality of life. Conclusions: It can be concluded that the Astra Tech implant system was successfully used by the general dentist both surgically and prosthetically with minimal implant failures and prosthetic complications and that this led to high levels of patient appreciation and overall satisfaction. [source] | ||||||||||||||||