bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship Between Brain Glucose Metabolism Positron Emission Tomography (PET) and Electroencephalography (EEG) in Children With Continuous Spike-and-Wave Activity During Slow-Wave Sleep
Authors: Luat Aimee F. , Asano Eishi , Juhász Csaba , Chandana Sreenivasa R. , Shah Aashit , Sood Sandeep , Chugani Harry T.
Published: June 2007

We studied the relationship between brain glucose metabolism patterns and objectively measured interictal epileptiform abnormalities in six children with intractable epilepsy and continuous spike-and-wave activity during slow-wave sleep. Five of the six patients showed lateralized positron emission tomographic (PET) findings, with the hemisphere showing a relative increase in glucose metabolism concordant with the presumed origin of the generalized interictal spike activity delineated by quantitative electroencephalographic (EEG) analysis. One of these five patients achieved seizure freedom following cortical resection involving the areas of unilateral multifocal hypermetabolism, and another patient has been approved for cortical resection. The results in the present study add further support to the hypothesis that the general ized spike-waves in most cases of continuous spike-and-wave activity during slow-wave sleep are the result of secondary bilateral synchrony. Resective surgery can be effective in selected patients with uncontrolled seizures associated with continuous spike-and-wave activity during slow-wave sleep provided that there is concordance between focal abnormalities on PET and EEG. ( J Child Neurol 2005;20:682—690).
Neurophysiology of Rett Syndrome
Authors: Glaze Daniel G.
Published: June 2007

Rett syndrome is a neurodevelopmental disorder that in most cases is consequent to a mutation in the MECP2 gene. The central nervous system is the primary organ system involved in Rett syndrome. Neurophysiologic evaluations provide information concerning the developmental aspects of Rett syndrome and the character and extent of involvement of the central, peripheral, and autonomic nervous system pathways. Evoked potentials typically demonstrate intactness of peripheral auditory and visual pathways and suggest dysfunction of central or “higher” cortical pathways. Somatosensory evoked potentials can be characterized by “giant” responses, suggesting cortical hyperexcitability. Cortical hyperexcitability is further suggested by the findings of the electroencephalogram (EEG), which are primarily characterized by a loss of expected developmental features; the appearance of focal, multifocal, and generalized epileptiform abnormalities; and the occurrence of rhythmic slow (theta) activity, primarily in the frontal-central regions. Epileptic seizures are reported to occur frequently in Rett syndrome. However, many events presumed to be seizures have no EEG correlate during video-EEG monitoring. Impairment of the autonomic nervous system in Rett syndrome is suggested by an increased incidence of long Q—T intervals during electrocardiographic recordings and diminished heart rate variability. Autonomic nervous system dysfunction can contribute to the increased incidence of sudden unexpected death in Rett syndrome. ( J Child Neurol 2005;20:740—746).
Novel Motor and Somatosensory Activity Is Associated With Increased Cerebral Cortical Blood Volume Measured by Near-Infrared Optical Topography
Authors: Peyton Jeffery L. , Bass W. Thomas , Burke Bonnie L. , Frank L. Matthew
Published: June 2007

Recent reports suggest that learning is enhanced by emotion, spontaneity, and play. The mechanisms of this enhancement are unclear and might involve increased cortical stimulation by the limbic system. Since neuronal activity is tightly coupled to changes in cerebral blood flow and volume, the demonstration of increased cortical blood volume during playful versus routine motor and somatosensory activity would imply enhanced neuronal activity and provide insight into the complex interaction between play and learning. Near-infrared spectroscopy was used to detect changes in cortical blood volume during performance of (1) rudimentary visual, motor, and speech tasks; (2) integration of the tasks in a familiar routine manner; and (3) integration of the tasks in a novel, spontaneous, playful manner. No significant differences in cortical blood volume were found during the performance of the individual rudimentary tasks and their routine integration. However, the novel integration activity was associated with a significantly greater increase in frontal lobe oxyhemoglobin, deoxyhemoglobin, and total hemoglobin, as well as parietal lobe total hemoglobin. This small pilot study provides a limited measure of physiologic support for a relationship between play and learning. ( J Child Neurol 2005;20:817—821).
Postictal Paresis in Children With Benign Rolandic Epilepsy
Authors: Dai Alper I. , Weinstock Arie
Published: June 2007

Following a search for the presence of postictal paresis in a cohort of 70 patients with benign rolandic epilepsy of childhood, the symptomatology of the seizures and the presence of postictal paresis were reviewed. All children underwent a neurologic evaluation, including electroencephalography (EEG) and neuroimaging. Eight of the 70 patients (3 girls and 5 boys) were found to have postictal paresis. All patients had partial motor seizures involving predominantly the upper extremities and, to a lesser degree, the face and lower extremities. In all eight patients, the motor deficits resolved within 60 minutes. Follow-up neurologic examination was nonfocal in all patients. Seven of the eight patients experienced postictal paresis once, and one patient had two such episodes. Three of the eight patients experienced a brief speech arrest. The EEG in all patients demonstrated centrotemporal sharp waves. In seven patients, the sharp waves were bilateral and independent, and in one patient, the rolandic sharp waves were unilateral. A horizontal dipole with positivity at the central region was found in all patients using an average montage. In conclusion, we found an 11.5% association of postictal paresis in children with benign rolandic epilepsy of childhood, whereas 38% of children also had a brief speech arrest. The EEG was characteristic for benign rolandic epilepsy of childhood with bilateral asynchronous discharges in seven of eight patients (83%) and the presence of dipole in all patients. The presence of postictal paresis should not exclude the diagnosis of benign rolandic epilepsy of childhood. ( J Child Neurol 2005;20:834—836).
β 2-Adrenergic Receptor Activation and Genetic Polymorphisms in Autism: Data from Dizygotic Twins
Authors: Connors Susan L. , Crowell Dorothy E. , Eberhart Charles G. , Copeland Joshua , Newschaffer Craig J. , Spence Sarah J. , Zimmerman Andrew W.
Published: June 2007

Gestational and genetic factors can contribute to autism during infancy and early childhood through their effects on fetal brain development. Previous twin studies have shown strong genetic components for the development of autism, a disorder that can have multiple causes. We investigated the effects of prenatal overstimulation of the β2-adrenergic receptor in dizygotic twins who were exposed to terbutaline, a selective β2-adrenergic receptor agonist used to treat premature labor, as a gestational factor. As a possible genetic mechanism, we studied two β2-adrenergic receptor polymorphisms in twins from whom DNA was available: glycine substitution at codon 16 (16G) and glutamic acid substitution at codon 27 (27E), which show diminished desensitization in vivo compared with the wild-type receptor. Continuous terbutaline exposure for 2 weeks or longer was associated with increased concordance for autism spectrum disorders in dizygotic twins (relative risk = 2.0), with a further increase in the risk for male twins with no other affected siblings (relative risk = 4.4). A significant association was found between the presence of 16G and 27E polymorphisms in autistic patients compared with population controls ( P = .006). Prenatal overstimulation of the β2-adrenergic receptor by terbutaline or by increased signaling of genetic polymorphisms of the β2-adrenergic receptor that have diminished desensitization can affect cellular responses and developmental programs in the fetal brain, leading to autism. ( J Child Neurol 2005;20:876—884).
Immature Mouse Unilateral Carotid Ligation Model of Stroke
Authors: Comi Anne M. , Johnston Michael V. , Wilson Mary Ann
Published: June 2007

Cerebral palsy in humans results from a diverse group of disorders that produce nonprogressive motor impairments in the developing brain. Stroke is an important cause of hemiparetic cerebral palsy in neonates and young children. We recently developed a new immature mouse model of stroke that demonstrates seizures, the severity of which correlates with brain injury. This model has strengths compared with other immature rodent models of ischemic injury, such as relative technical ease and the presence of seizures, as is seen in humans. This model also has relative weaknesses, such as the inability to titrate the severity of the injury with different periods of hypoxia. In addition, more work is needed to delineate the long-term consequences of the insult in this new model. ( J Child Neurol 2005;20:980—983).
Fat Intolerance in Developmentally Impaired Children With Severe Feeding Intolerance
Authors: Levine Arie , Levi Anat , Dalal Ilan , Shamir Raanan , Watemberg Nathan , Lerman-Sagie Tally , Lorberboym Mordechai
Published: June 2007

Children with a variety of genetic, metabolic, and neurologic disorders can suffer from severe feeding intolerance that is unresponsive to medical, surgical, and nutritional therapy. Developmentally disabled tube-fed children with severe upper gastrointestinal symptoms that persisted after fundoplication who were unresponsive to all medical, surgical, and nutritional interventions underwent a thorough gastrointestinal evaluation, including gastroscopy, pH-metry, upper gastrointestinal barium series, and gastric emptying studies. They were placed on a low-fat diet, and the symptoms before and after the diet were compared. The patients were then rechallenged with incremental increases in fat until the symptoms recurred or the patients reached their former fat concentration. Six children meeting the study criteria were evaluated. Four of these patients had a significant improvement in symptoms, oral intake and feeding tolerance with a decrease in fat intake, and relapse of symptoms when fat calories were increased. Improvement occurred in children who had been intolerant to duodenal feeding. We were subsequently able to wean two children from tube feeding. Dietary fat can provoke upper gastrointestinal symptoms in children with gastric and intestinal dysmotility. Short-term manipulation of dietary fat intake can improve tolerance to feeding. ( J Child Neurol 2006;21:167—170; DOI 10.2310/7010.2006.00018).
Behavioral Therapy for Treatment of Stereotypic Movements in Nonautistic Children
Authors: Miller Jonathan M. , Singer Harvey S. , Bridges Dana D. , Waranch H. Richard
Published: June 2007

Although typically described in autistic, mentally retarded, and sensory-deprived individuals, motor stereotypies also occur in normal children. In this preliminary report, the behavior modification techniques of habit reversal and differential reinforcement of other behavior were evaluated as a therapeutic modality for the suppression of stereotypic movements in nonautistic subjects. Twelve children, ages 6 to 14 years, with physiologic stereotypies were treated using a standardized treatment protocol. Clinical outcomes were based on differences between assessments obtained at baseline and on telephone follow-up. Evaluation scales included measures of the frequency, intensity, interference, and number of stereotypies (Stereotypy Severity Scale motor portion and Stereotypy Linear Analog Scale) and assessment of global function (Child Global Assessment Scale and Stereotypy Severity Scale global portion). The results were correlated with the child's level of motivation and the number of treatment sessions. After a mean follow-up of 12.1 months, motor stereotypies showed significant improvement on the Stereotypy Linear Analog Scale and Stereotypy Severity Scale total score, P = .009 and P = .046, respectively. Both scales showed a relationship between the number of treatment sessions attended and a reduction in movements. The Child Global Assessment Scale also improved with therapy, but there was no correlation with the number of treatment sessions. Highly motivated patients had greater improvement on the Stereotypy Linear Analog Scale and Stereotypy Severity Scale scales compared with less motivated patients, but motivation had no impact on the Child Global Assessment Scale. The combined use of habit reversal and differential reinforcement of other behavior is beneficial in reducing motor stereotypies in nonautistic children. ( J Child Neurol 2006;21:119—125; DOI 10.2310/7010.2006.00025).
Developmental Regression and Mitochondrial Dysfunction in a Child With Autism
Authors: Poling Jon S. , Frye Richard E. , Shoffner John , Zimmerman Andrew W.
Published: June 2007

Autistic spectrum disorders can be associated with mitochondrial dysfunction. We present a singleton case of developmental regression and oxidative phosphorylation disorder in a 19-month-old girl. Subtle abnormalities in the serum creatine kinase level, aspartate aminotransferase, and serum bicarbonate led us to perform a muscle biopsy, which showed type I myofiber atrophy, increased lipid content, and reduced cytochrome c oxidase activity. There were marked reductions in enzymatic activities for complex I and III. Complex IV (cytochrome c oxidase) activity was near the 5% confidence level. To determine the frequency of routine laboratory abnormalities in similar patients, we performed a retrospective study including 159 patients with autism ( Diagnostic and Statistical Manual of Mental Disorders-IV and Childhood Autism Rating Scale) not previously diagnosed with metabolic disorders and 94 age-matched controls with other neurologic disorders. Aspartate aminotransferase was elevated in 38% of patients with autism compared with 15% of controls ( P < .0001). The serum creatine kinase level also was abnormally elevated in 22 (47%) of 47 patients with autism. These data suggest that further metabolic evaluation is indicated in autistic patients and that defects of oxidative phosphorylation might be prevalent. ( J Child Neurol 2006;21:170—172; DOI 10.2310/7010.2006.00032).
Molar Tooth Sign in Fetal Brain Magnetic Resonance Imaging Leading to the Prenatal Diagnosis of Joubert Syndrome and Related Disorders
Authors: Fluss Joel , Blaser Susan , Chitayat David , Akoury Hani , Glanc Phyllis , Skidmore Martin , Raybaud Charles
Published: June 2007

Joubert syndrome is a rare autosomal recessive disorder characterized by ataxia, developmental delay, and oculomotor and respiratory abnormalities in relation to cerebellar vermian and midbrain dysgenesis. The midbrain dysgenesis is responsible for the molar tooth sign on axial magnetic resonance imaging (MRI). This classic hallmark of Joubert syndrome has been identified in other disorders sharing overlapping clinical and radiologic features with Joubert syndrome. Recent identification of two different genes points to genetic heterogeneity in this group of disorders, now entitled Joubert syndrome and related disorders, making a genetic prenatal diagnosis not readily available. In addition, fetal ultrasonography lacks sensitivity in regard to posterior fossa malformation. Fetal MRI is now acknowledged as the method of choice to delineate posterior fossa malformation in a fetus. The identification of a molar tooth sign has, however, rarely been documented by a fetal brain MRI. We report a case of Joubert syndrome diagnosed prenatally using fetal MRI. We also discuss the etiology of Joubert syndrome in view of the recent genetic advances and murine models of cerebellar dysgenesis. ( J Child Neurol 2006;21:320—324; DOI 10.2310/7010.2006.00075).
Long Survival Following Bacterial Meningitis-Associated Brain Destruction
Authors: Repertinger Susan , Fitzgibbons William P. , Omojola Mathew F. , Brumback Roger A.
Published: June 2007

This report describes the brain autopsy of a boy who at age 4½ years experienced an episode of fulminant Haemophilus influenzae type b bacterial meningitis, resulting in massive brain destruction and the clinical signs of brain death. However, medical intervention maintained him for an additional two decades. Subsequent autopsy revealed a calcified intracranial spherical structure weighing 750 g and consisting of a calcified shell containing grumous material and cystic spaces with no recognizable neural elements grossly or microscopically. This case represents an example of long survival of brain death with a living body. (J Child Neurol 2006;21:591—595; DOI 10.2310/7010.2006.00137).
Maternal Risk Factors for Term Neonatal Seizures: Population-Based Study in Colorado, 1989—2003
Authors: Hall Deborah A. , Wadwa R. Paul , Goldenberg Neil A. , Norris Jill M.
Published: June 2007

Neonatal seizures in term infants are rare but have important potential implications for brain development. Risk factors for neonatal seizures in term infants have been less well defined than those among preterm infants. To evaluate the relationship between maternal risk factors and neonatal seizures in the first 72 hours of life in term infants, a case-control study using the Colorado Birth Certificate Registry was conducted. Term neonates in all hospitals in Colorado with and without seizures in the first 72 hours were studied. After adjusting for vaginal delivery in the setting of herpes infection and post-term delivery, preexisting diabetes in the mother (odds ratio 4.30, 95% confidence interval 1.64—11.27, P < .01) and fetal distress (odds ratio 5.88, 95% confidence interval 4.60—7.13, P < .0001) were independent risk factors for neonatal seizures in term infants. These findings are confirmatory of previous reports that maternal preexisting diabetes and fetal distress increase the risk of neonatal seizure in term infants. Although we cannot establish the pathophysiology of neonatal seizures from this analysis, hypoxic-ischemic brain injury and hypoglycemia in infants of diabetic mothers are known causes of neonatal seizures that can be represented in this analysis by fetal distress and maternal preexisting diabetes, respectively. Maternal diabetic vasculopathy can also be a contributing factor. (J Child Neurol 2006;21:795—798; DOI 10.2310/7010.2006.00189).
Cerebellar Lesions in Tuberous Sclerosis Complex
Authors: Eluvathingal Thomas J. , Behen Michael E. , Chugani Harry T. , Janisse James , Bernardi Bruno , Chakraborty Pulak , Juhasz Csaba , Muzik Otto , Chugani Diane C.
Published: June 2007

We assessed the structural and functional imaging features of cerebellar lesions and their neurobehavioral correlates in a large cohort of patients with tuberous sclerosis complex. A consecutive series of 78 patients with tuberous sclerosis complex underwent magnetic resonance imaging (MRI) and positron emission tomography (PET) studies with [18F]fluorodeoxyglucose (FDG) and α-[11C]methyl-L-tryptophan (AMT) as part of their evaluation for epilepsy surgery. Neurobehavioral assessment included the Gilliam Autism Rating Scales (GARS) and the Vineland Adaptive Behavior Scales (VABS). Twenty-one patients (27%) had cerebellar lesions (10 boys; mean age 9 ± 8 years; 9 had right-sided, 10 had left-sided, and 2 had bilateral cerebellar lesions). The lesions showed decreased glucose metabolism (0.79 ± 0.10) and increased (1.04 ± 0.10) AMT uptake compared with the normal (nonlesional) cerebellar cortex. Comparisons between patients with (n = 20) and without (n = 57) a cerebellar lesion on neurobehavioral functioning, controlling for the number and location of cortical tubers, revealed that the cerebellar lesion group had higher overall autistic symptomatology. Within-group analyses of the cerebellar lesion group revealed that children with right-sided cerebellar lesions had higher social isolation and communicative and developmental disturbance compared with children with left-sided cerebellar lesions. The side of the cerebellar lesion was not related to adaptive behavior functioning. These findings provide additional empiric support for a role of the cerebellum in autistic symptomatology. Further investigation of the potential role of the right cerebellum in autism, particularly with regard to the dentatothalamofrontal circuit, is warranted. (J Child Neurol 2006;21:846—851; DOI 10.2310/7010.2006.00192).
Usefulness of Ocular Compression During Electroencephalography in Distinguishing BreathHolding Spells and Syncope From Epileptic Seizures
Authors: Khurana Divya S. , Valencia Ignacio , Kruthiventi Seshurao , Gracely Edward , Melvin Joseph J. , Legido Agustin , Kothare Sanjeev V.
Published: June 2007

Episodes of syncope or breath-holding spells are often misdiagnosed as epileptic events. The purpose of this study was to assess the usefulness of an electroencephalogram (EEG) with ocular compression to distinguish breath-holding spells and syncope from epileptic seizures. A retrospective analysis was performed on the EEG records of all children on whom ocular compression was performed from 2000 to 2003. Data from 116 patients with a clinical diagnosis consistent with either syncope or breath-holding spells were compared with a group of 46 patients with epilepsy. The RR interval during ocular compression was significantly higher in syncope patients compared with patients with epilepsy (P < .005). Using 2 seconds of asystole as the cutoff, the sensitivity of ocular compression was 26%, with 100% specificity. The change in RR interval from baseline to ocular compression also distinguished patients with breathholding spells and syncope from patients with epilepsy. Even a small increase of 0.5 seconds in the RR interval demonstrated a sensitivity of 46%, with a specificity of 98%. Ocular compression performed during an EEG is useful in distinguishing patients with breath-holding spells and syncope from those with epileptic seizures. A requirement of a 2-second period of asystole with ocular compression excludes many patients. Our data indicate that an RR interval increase of 0.5 seconds over baseline identifies additional patients with increased vagal tone. Prompt and accurate diagnosis of the etiology of loss of consciousness might preclude the need for further extensive and expensive evaluation and reduce patient and parental distress. (J Child Neurol 2006;21:907—910; DOI 10.2310/7010.2006.00209).
A Review of Atypical Clinical Manifestations of Acute Myocardial Infarction
Authors: Neill Kathleen M.
Published: June 2007

This review describes pertinent demographic and ill ness characteristics of patients who are seen with atyp ical symptoms of acute myocardial infarction. The determination of psychosocial, behavioral, and envi ronmental patterns of patients complaining of chest discomfort adds important information to the clinical assessment of chest pain. Systematic information about the pain and other symptoms of acute myocardial infarc tion and about the variables that influence these symp toms can assist practitioners as well as sufferers of myo cardial pain to resolve the uncertainty surrounding it.
Prolonged Intubation Versus Tracheostomy in the Adult
Authors: Colice Gene L.
Published: June 2007

The development of mechanical ventilators that can en sure adequate respiration for long periods of time has led to the problem of determining how to best integrate patients into the machine's airflow circuits. Tracheal tubes with inflatable cuffs efficiently connect the patient to the machine, but the tubes may be placed in one of two ways. Each option has relative advantages and disad vantages. Translaryngeal intubation (TLI) can be per formed safety and quickly and is the preferred first step in airway management. However, when TLI is needed for prolonged periods, it may damage the larynx. Tra cheostomy, on the otherhand, has potential operative and tracheal complications, but presents little risk to the larynx and may be better tolerated by the patient requir ing long-term intubation. This review provides a histor ical background of these two methods and analyzes their respective advantages and complications. Guide lines for the optimal use of TLI and tracheostomy, par ticularly in adult patients requiring long-term intuba tion, are developed by comparing the risks and benefits of these two methods.
Analytic Reviews : Hemodynamic Management of the Adult Respiratory Distress Syndrome
Authors: Courtney Broaddus V. , Berthiaume Yves , Biondi James W. , Matthay Michael A.
Published: June 2007

Hemodynamic management is an essential aspect of the care of patients with adult respiratory distress syn drome (ARDS). On the basis of current knowledge, our proposed goals of management are to maximize pe ripheral oxygen delivery while attempting to minimize further lung damage or dysfunction. The major patho physiologic abnormalities of ARDS are an increased lung vascular permeability, right-to-left intrapulmonary shunting, and pulmonary vascular resistance. These abnormalities must be understood to select the proper therapy. Although all patients with ARDS share these abnormalities, they differ in their associated clinical conditions and underlying cardiovascular status. Be cause each ARDS patient may respond differently to therapy, hemodynamic management must be selected empirically with the goal of therapy as a guide. We have considered available therapeutic options including posi tive end-expiratory pressure, volume depletion, volume expansion, vasopressors, and vasodilators. In the future hemodynamic management of patients with ARDS will likely change as better methods of patient assessment and treatment are developed.
Analytic Reviews : Initiating Mechanical Ventilation
Authors: Grum Cyril M. , Morganroth Melvin L.
Published: June 2007

Mechanical ventilation is a central facet of intensive care medicine. Technological progress has led to major advances in this field. Initiation of mechanical ventila tion remains standard; however, many options are now available to continue mechanical ventilation. These mechanical options include assist-control ventilation, intermittent mandatory ventilation, pressure support ventilation, positive end-expiratory pressure, and high- frequency ventilation. The sophistication of ventilators has also allowed more procedures to be performed dur ing mechanical ventilation, including bronchoscopy and transbronchial biopsy. Complications do occur during mechanical ventilation, but can be minimized by vigi lance and use of proper procedures. The recent increase in home care will lead to increased use of alternatives to conventional ventilatory modes. Finally, more well- designed studies are needed as newer techniques are promoted.
Deep Venous Thrombosis and Pulmonary Embolism in Trauma Patients
Authors: Shackford Steven R. , Moser Kenneth M.
Published: June 2007

Trauma patients are at exceedingly high risk for the development of deep venous thrombosis and pulmo nary embolism. The incidence, pathophysiology, diag nosis, prophylaxis, and therapy of deep venous throm bosis and pulmonary embolism in the trauma patient are reviewed. The type of injury, systemic pertubations, and enforced immobility are important factors in pathogenesis. Patients with lower extremity injuries and spine fractures with paraplegia appear to be at highest risk. Orthopedic devices used to treat these injuries of ten preclude the conventional noninvasive diagnostic modalities. Further, hemorrhagic risk often impacts the judgment regarding the use of prophylactic measures as well as the therapy once deep venous thrombosis is diagnosed. Better data regarding the incidence of ve nous thromboembolism and the applicability of existing diagnostic, prophylactic, and treatment approaches in this population are needed.

Accidents are responsible for over 140,000 deaths and approximately 70 million nonfatal injuries an nually in the United States [1]. Most of the fatalities occur within hours of injury as a result of exsangui nation or a lethal head injury, but approximately 20% survive for days or weeks [2], usually in the intensive care unit. The primary causes of late death are sepsis and multiple-organ failure [2]. Increasing evidence, however, suggests that pulmonary embo lism (PE) is now becoming a leading cause of late death, especially in some high-risk groups [3-5]. The increase in the incidence of PE is due in part to improvements in trauma care, which have lowered the early mortality rate [6-8], leaving more patients at risk for late death. In addition, autopsy examina tions, used more frequently to audit trauma care systems [6,9], have documented an increase in clini cally unsuspected deep venous thrombosis (DVT) and PE.

This review was prompted because of the appar ent increase in DVT and PE in the trauma popula tion, and because the trauma patient presents very difficult and unique problems compared with the nontrauma patient with regard to the diagnosis, prophylaxis, and treatment of these disorders. In this review, we address the incidence, pathophys iology, diagnosis, treatment, and prophylaxis of DVT and PE in the trauma patient. We do not con sider the entities of fat embolism or pulmonary microemboli as a cause of late pulmonary failure.
Analytic Reviews : Oxygen Toxicity
Authors: Jenkinson Stephen G.
Published: June 2007

Oxygen therapy is administered to patients to decrease tissue hypoxia and to relieve arterial hypoxemia. High concentrations of oxygen often are used for short pe riods of time in patients with acute respiratory illnesses, and concentrations only slightly higher than ambient levels are administered for much longer time periods to patients with chronic respiratory diseases. Supplying oxygen to plants, animals, or bacteria has long been known to produce varying amounts of tissue damage; toxicity increases as concentrations of oxygen or the pressure used during exposure increases. End-organ damage from hyperoxia depends on both the concentra tion of oxygen administered and the pressure during the exposure. Prolonged exposure to hyperbaric oxygen (> 2.5 atmosphere of pressure) causes both central nervous system and pulmonary toxicity that results in atelectasis, pulmonary edema, and seizures. Lung dam age as a result of normobaric hyperoxia is the predomi nant manifestation of toxicity. A severe retinopathy (re trolental fibroplasia) also can occur in neonates during oxygen exposures at ambient pressure, and cases have been reported to occur with only modest increases in inspired oxygen concentrations. For these reasons, the lowest possible concentration of oxygen that relieves tissue hypoxia is administered to patients, and the oxy gen concentration is stabilized when the desired thera peutic goals are accomplished.
Decentralized Clinical Chemistry Testing: Quality of Results Obtained by Residents and Interns in an Acute Care Setting
Authors: Nanji Amin A. , Poon Raymond , Hinberg Irwin
Published: June 2007

We evaluated the quality of results obtained for near- patient testing by residents and interns (MDs) using desk-top analyzers. The instruments evaluated were the Reflotron analyzer, the Seralyzer, the Vision analyzer, and the Kodak DT60 analyzer. Low- and high-concen trations of control materials were used for precision studies. Results obtained by MDs were compared with those obtained by a trained technologist for comparison studies. The range of precision obtained by MDs was 4.6 to 6.6% for the Reflotron analyzer, 3.6 to 20.7% for the Seralyzer, 1.7 to 5.3% for the Vision analyzer, and 2.7 to 13% for the Kodak DT60 analyzer. The range of correla tion coefficients for each of the analyzers was 0.980 to 0.994 for the Reflotron analyzer, 0.763 to 0.933 for the Seralyzer, 0.989 to 0.999 for the Vision analyzer, and 0.987 to 0.999 for the Kodak DT60. The percentage of results for each of the analyzers when the results ob tained by MDs were more than 10% different from the trained technologist's results were 17.3% for the Reflo tron, 44% for the Seralyzer, 0% for the Vision, and 17% for the Kodak DT60. The discrepancies between MD and the trained technologist's results are related to the complexity of the instruments used.
Multiple System Organ Failure in the Adult Respiratory Distress Syndrome
Authors: Heyman Stephen J. , Rinaldo Jean E.
Published: June 2007

Recently completed studies suggest that patients with the adult respiratory distress syndrome (ARDS) manifest early evidence of multiple-site endothelial injury. Ex trapulmonary disease is usually the cause of death in these patients. Furthermore, prognosis in individual cases of ARDS is strongly influenced by specific organ failures (e.g., hepatic and renal failure). The mechanisms by which ARDS and extrapulmonary organ system fail ure interact, however, are poorly delineated. We ad dress three aspects of the multisystemic nature of ARDS. First, we analyze evidence that suggests ARDS is a mul tisystem disorder fron the outset, involving panendothe lial injury mediated by cellular interactions and humoral substances that act similarly at many vascular target sites. Second, we discuss the role of three extrapulmo nary organs in the modulation of ARDS: the liver, the gastrointestinal mucosa, and the kidneys. Third, we ad dress the unifying hypothesis that uncontrolled ongoing inflammation, which is often but not always caused by infection, is the essential link between ARDS and its progression to multiple system organ failure.
The Effect of Mucine, IgA, Urea, and Lysozyme on the Corrosion Behavior of Various Non-precious Dental Alloys and Pure Titanium in Artificial Saliva
Authors: Bilhan H. , Bilgin T. , Cakir A.F. , Yuksel B. , Von Fraunhofer J.A.
Published: June 2007

The corrosion of dental alloys has biological, functional, and aesthetic consequences. Various studies have shown that protein solutions can inhibit the corrosion of alloys. This study is planned to determine the relationship of organic constituents of saliva and the corrosion of dental alloys. The organic constituents are IgA, mucine, urea, and lysozyme which are encountered in the highest amounts in saliva and the dental materials are titanium (Ti), Co—Cr—Mo and Ni—Cr—Mo alloys, and dental amalgam, the most often used metallic components in dentistry. In particular, the interactions between the commonest salivary proteins, IgA, mucine, urea and lysozyme, and Ti, Co—Cr—Mo, Ni—Cr—Mo and dental amalgam were investigated. Each alloy was evaluated by cyclic polarization in each medium. The general anodic and cathodic behavior during forward and reverse cycles, the corrosion and passivation current densities (μA/cm2 ), and the corrosion and the pitting potentials (mV) were determined. The results have shown that Ni—Cr—Mo and dental amalgam alloys are highly susceptible to corrosion in all the investigated media. The Co—Cr—Mo alloy has shown high passive current densities in the solution of mucine and lysozyme in artificial saliva. Titanium instead, has shown a high resistance to corrosion and a stable passive behavior in all media, especially in a solution of mucine and IgA in synthetic saliva. Mucine and IgA, as well as urea and lysozyme, appeared to enhance the formation of a passive film layer on the Ti metal surface, thus inhibiting the corrosion. Based on the study findings, and especially considering the problem of nickel allergy and toxicity of mercury released from dental amalgam, the use of Co—Cr—Mo alloys and Ti to Ni—Cr—Mo alloys is recommended and alternatives to dental amalgam should be sought for patients with impaired salivary flow.
C3A Cell Behaviors on Micropatterned Chitosan— Collagen—Gelatin Membranes
Authors: Yu Bo-Yi , Chou Pei-Hsun , Chen Chang-An , Sun Yi-Ming , Kung Shieh-Shiuh
Published: June 2007

The influence of the properties and surface micropatterning of chitosan—collagen—gelatin (CCG) blended membranes on C3A cell's activities has been investigated. It is aimed to guide the cell growth and improve the growth rate in vitro for the application in tissue engineering. Masters with micropatterns are prepared on stainless steel plates by photolithography. The CCG membranes with surface micropatterns are then fabricated by soft lithography and dry—wet phase inversion techniques. The morphology and metabolic activity of cultured C3A cells on the membranes are recorded. When the C3A cells are seeded on the membranes with micropattern spacing of 200 μm width and 80 μm depth, they adhere and aggregate in the groove of the membranes in a few minutes. The aggregated cells migrate up to the surface of the ridge later. This phenomenon, however, is not found on membranes with a micropattern spacing of 500 μm width. In addition, it is demonstrated that the cells on the CCG membranes with micropatterns have higher metabolism and growth rates than those on the flat CCG membranes and on T-flask discs. Micropatterning on the membrane surface can affect the distribution of cells and the communication among cells, and results in a difference in cell adhesion, morphology, mobility, and growth activity.
HRP-Loaded Bioresorbable Microspheres: Effect of Copolymer Composition and Molecular Weight on Microstructure and Release Profile
Authors: Zilberman Meital , Grinberg Orly
Published: June 2007

Poly(DL-lactic-co-glycolic acid) microspheres are prepared using a double-emulsion technique and are loaded with the model enzyme horseradish peroxidase (HRP). These microspheres can be used alone or as coatings for bioresorbable fibers that may be used as scaffolds for tissue regeneration applications. The present study focuses on the effect of the copolymer's composition and initial molecular weight on the microsphere structure, encapsulation efficiency, and cumulative protein release for 12 weeks. The release profiles generally exhibits an initial burst effect accompanied by slow release over an extended period of time, during which diffusion rather than degradation controlled HRP release from these structures. An increase in the initial molecular weight or in the copolymer's lactic acid content results in larger microspheres with smoother surfaces, and a decrease in the burst release and in the total HRP release. Molecular weight is found to have a stronger effect than copolymer composition. We demonstrate that it is possible to obtain versatile release profiles, which can be tailored for specific applications by choosing the right initial molecular weight and copolymer composition.
Bone Formation on the Apatite-coated Zirconia Porous Scaffolds within a Rabbit Calvarial Defect
Authors: Kim Hae-Won , Shin Seung-Yun , Kim Hyoun-Ee , Lee Yong-Moo , Chung Chong-Pyoung , Lee Hae-Hyoung , Rhyu In-Chul
Published: June 2007

Previously, a strong and bioactive ceramic scaffold consisting of a porous zirconia body coated with apatite double layers (fluorapatite (FA) as an inner layer and hydroxyapatite (HA) as an outer layer) was successfully fabricated. In this contribution, the authors investigate the in vivo performance of the engineered bioceramic scaffolds using a rabbit calvarial defect model. In particular, the porosity and pore size of the scaffolds are varied in order to observe the geometrical effects of the scaffolds on their bone formation behaviors. The scaffolds supported on a zirconia framework can be produced with an extremely high porosity (~84—87%), while retaining excellent compressive strength (~7—8 MPa), which has been unachievable in the case of pure apatite scaffolds (~74% porosity with ~2MPa strength).

The experimental groups used in this study include three types of zirconia scaffolds coated with apatite; high porosity (~87%) with large pore size (~500— 700 μm): AZ-HL, high porosity (~84%) with small pore size (~150—200 μm): AZ-HS, and low porosity (~75%) with large pore size (~500—700 μm): AZ-LL, as well as one type of HA porous scaffold: low porosity (~74%) with a large pore size (~500—700 μm) for the purpose of comparison. The scaffolds prepared with dimensions of ~ 10 mm (diameter) × 1.2 mm (thickness) are grafted in rabbit calvaria defects. The histological sections are made at 4 and 12 weeks after surgery and immunohistochemical analyses are performed on the samples.

All of the specimens show a good healing response without adverse tissue reactions. Good healing is shown at 4 weeks post-surgery with the ingrowth of new bone into the macropore-channels of the scaffolds. The newly formed bone amounts to ~19.9—24.2% of the initial defect area, depending on the scaffold type, but there is no statistical significance between the scaffold groups. However, the defects without the scaffolds (control group) show a significantly lower bone formation ratio (~4.3%). At twelve weeks after surgery, the extent of new bone formation is more pronounced in all of the scaffold groups. All of the scaffold groups show significantly higher bone formation ratios (26.7—46.9%) with respect to the control without the graft. In the comparison between the scaffold groups, those with high porosities (AZ-HL and AZ-HS) exhibit significantly higher bone formation as compared to the scaffold with low porosity (AZ-LL).

Based on the present in vivo test performed within a rabbit calvaria defect model, it is concluded that the apatite-coated zirconia scaffolds show good bone forming ability and are considered to be a promising scaffolding material for bone regeneration since they possess a high level of both mechanical and biological properties.
“The Mill Ran Today”: Patterns of Work in a Mid-Nineteenth Century Northwest Missouri Woolen Mill
Authors: Lentz-Hees Elizabeth S. , Wilson Laurel E.
Published: June 2007

Mid-nineteenth century woolen mills in northwest Missouri represented proprietary rather than corporate mill ownership found in the northeastern United States. Although the work performed by mill operatives was similar in both types of mills, forms of mill management and the daily rhythm of work differed. The first purpose of this study was to determine the patterns of work at the Watkins Woolen Mill (WWM), near Lawson, Missouri. The second purpose was to compare WWM weavers to the New England mill girl profile (Dublin, 1979). Data revealed that weavers at the WWM worked irregular weeks compared to the 12-hour, six-day work weeks common in corporate New England mills; that the weavers’ work culture included job-sharing and on-the-job training; and that there were sibling employment patterns similar to Dublin’s (1979) study. Weavers at the WWM experienced a “dual loyalty” to their home and to the mill (Zonderman, 1986).
Textiles and Apparel in Global Context: Bridging Gaps and Forging Linkages
Authors: Douglas Sara U. , Lakner Hilda Buckley
Published: June 2007

As an introduction to this focused issue of the Clothing and Textiles Research Journal, the editors suggest that the issue represents new approaches to the scholarly dissemination of thought in the discipline of textiles and apparel. Diversity in terms of subject matter, cultural approaches to education, cross-cultural collaboration, and comparative investigation are represented. The articles are ordered into three groupings: markets and marketing, cultural differences and similarities, and education. The editors highlight the important contributions of each to the scholarship of the discipline.
Size Variation in Women’s Pants
Authors: Kinley Tammy R.
Published: June 2007

The U.S. sizing system involves the use of a size code to direct customers to garments most likely to fit their body. The popular press reports expensive clothes tend to run large and there is inconsistency within each size category. The purpose of this study was to determine how much inconsistency there is within size categories, the difference in size of two different price points (inexpensive and expensive), and two different types of label (national and private) of women’s pants. To this end, the waist, crotch, and inseam of 1011 pairs of pants were measured. Inconsistency was found in each size category, expensive pants generally were larger in measurement, and little significant difference was found between national and private label merchandise except for sizes 4 and 6.
Technology’s Impact on Creative Traditions: Pieceful Co-Existence in Quilting
Authors: Johnson Joyce Starr , Hawley Jana M.
Published: June 2007

Technology shapes both the meaning of quilts and the process of quilting. By using technology, the quilter molds her art form and ultimately preserves the values that quilting holds. For this study, we sought to investigate the influence of Internet technologies on quilters, using Behuniak-Long’s (1994) framework of the interaction between technology and three key social values (patience, connectedness, and expression). The source of data for this study was an electronic bulletin board that consisted of 1192 messages posted by 52 members of an on-line quilting group. Qualitative analysis of the electronic bulletin board messages was conducted, and findings indicate that quilters have adopted and used technology to enhance their lives without sacrificing social values and are maintaining the integrity of their work. By adopting technology on their own terms, they maintain the social values that quilting represents to them.
High Volume Instrument and Glucose Analysis of Acid Treated, Rinsed, and/or Heated and Autoclaved Cotton Fibers
Authors: Foulk Jonn A.
Published: June 2007

Cottons contaminated with stickiness from physiological and/or entomological sugars cause multiple processing problems in textile mills. Textile mills request cotton with no stickiness or need methods to remove stickiness and consequently avoid processing problems. Little is understood of how fractional removal of sugar contamination affects glucose levels and fiber properties by changing the protective exterior layers (composed of substances such as pectins, waxes, and proteins). The objective of this study was to evaluate the effectiveness of heat (dry and steam), acid catalysis, and water rinsing in lowering sugar levels and their affect on fiber properties. Sticky cotton was treated with a catalyst or rinsed in water and subjected to elevated temperatures for varying times. This study evaluated steps that could be taken at the cotton gin or textile mill to potentially remove sugar contaminants from cotton. Although costly and time consuming, water rinsing appears to be the most advantageous process to lower sugar levels while maintaining or improving fiber quality. Further studies are needed to determine an economical and efficient method of removing sugar contamination.
Human Complexity: Development of a Theoretical Framework for the Clothing and Textile Field
Authors: Beach Joni Leigh , Kincade Doris H. , Schofield-Tomschin Sherry
Published: June 2007

Recognizing the dynamic, complex nature of human systems and their interaction with multiple other systems led to the research question: What multidimensional theoretical framework could address this complexity and provide an expanded view for research and education, specifically in the field of clothing and textiles [CT]? Metatheory, a study of theories, was conducted using a qualitative research design. Data were collected from documents pertaining to systems theory and social psychology theories used by CT and were analyzed by the constant comparative method. Four main themes were identified—relationship, process, organization, and outcomes. The Human-Environment Systems Theoretical Framework was developed through an integration of the themes. Recommendations are made for using this holistic perspective to address dynamic, complex human-environment problems.