bluuebunny/crossref_metadata_2025 huggingface dataset:
Periventricular brain injury, visual motion processing, and
reading and spelling abilities in children who were extremely
low birthweight
Authors: DOWNIE ANDREA L.S. , JAKOBSON LORNA S. , FRISK VIRGINIA , USHYCKY IRENE
Published: June 2003

Among children born at extremely low birthweight (ELBW:
<1000 g at birth) there is an association between the presence
of periventricular brain injury (PVBI) and lowered performance
on tests of reading and spelling ability. The present study
was designed to determine if this association might be related
to underlying dysfunction in the subcortical magnocellular visual
pathway or its cortical targets in the dorsal stream, a prediction
motivated by the magnocellular theory of dyslexia. Thirty-five
ELBW children were divided into two groups based upon the presence
or absence of PVBI (no PVBI, n = 11;
PVBI, n = 24). The performance of these two
groups was compared to that of a group of healthy full term
children (n = 12) on a motion-defined form recognition
task believed to tap into the functioning of the magnocellular
pathway and/or the dorsal stream. ELBW children did, in
fact, show a striking impairment on this task, with 71% of the
sample performing at a level more than three standard deviations
below the mean of full term controls. Surprisingly, their
difficulties were not found to be related to either the presence
of brain injury (verified by neonatal cranial ultrasound) or
to problems with reading or spelling. An association was
documented, however, between difficulties with motion processing
and performance on several subtests of the Performance IQ scale
of the Wechsler Intelligence Scale for Children–Third
Edition. This latter finding is consistent with our earlier
suggestion that magnocellular pathway/dorsal stream dysfunction
may underlie problems with visuospatial and visuomotor performance
in this population. (JINS, 2003, 9, 440–449.)
Left hippocampal volume loss in Alzheimer's disease
is reflected in performance on odor identification: A structural
MRI study
Authors: MURPHY CLAIRE , JERNIGAN TERRY L. , FENNEMA-NOTESTINE CHRISTINE
Published: June 2003

The very high sensitivity and specificity of odor identification
tasks in discriminating between Alzheimer's patients and
normals suggests that they reflect the presence of underlying
neuropathology. Significant neuropathological changes are seen
in areas critical to processing olfactory information, even
in the early stages of Alzheimer's disease (AD). The current
study was designed to investigate whether performance on olfactory
tasks (odor threshold and odor identification) was related to
volumetric MRI measures of mesial temporal areas central to
olfactory information processing and important in the
neuropathology of AD. Participants were 8 male and 5 female
patients with probable AD, and 10 male and 12 female normal
age-matched controls, diagnosed at the UCSD Alzheimer's
Disease Research Center. The study investigated correlations
between volumetric measures of hippocampus, the parahippocampal
gyrus and the amygdala, and the psychophysical measures of
olfactory function. Robust relationships were observed between
mesial temporal lobe volumes and olfactory functional measures.
The finding of a strong relationship between left hippocampal
volume and performance on the odor identification task (r
= .85) is compatible with a left-hemisphere superiority for
verbally mediated olfactory tasks. The findings suggest a neural
substrate for the breakdown in functional performance on verbally
mediated odor identification tasks in Alzheimer's disease
and suggest the utility of quantitative MRI measures and
psychophysical performance in the assessment of AD. These results
support the potential clinical utility of inclusion of odor
identification tests in diagnostic batteries for detecting AD.
(JINS, 2003, 9, 459–471.)
ERRATUM
Authors: SAINT-CYR JEAN A.
Published: June 2003

The following is a correction for an error that occurred in
the Journal of the International Neuropsychological Society,
Vol. 9, No. 1. The Critical Review titled
“Frontal-striatal Circuit Functions: Context, Sequence,
and Consequence” by Jean A. Saint-Cyr had two lines of
copy accidentally omitted at the bottom of the second column
on page 103.
Facial affect recognition deficits in bipolar disorder
Authors: GETZ GLEN E. , SHEAR PAULA K. , STRAKOWSKI STEPHEN M.
Published: June 2003

Patients diagnosed with bipolar disorder (BPD), by definition,
have problems with emotional regulation. However, it remains
uncertain whether these patients are also deficient at processing
other people's emotions, particularly while manic. The
present study examined the ability of 25 manic bipolar patients
and 25 healthy participants on tasks of facial recognition and
facial affect recognition at three different presentation
durations: 500 ms, 750 ms, and 1000 ms. The groups did not differ
in terms of age, education, sex, ethnicity, or estimated IQ.
The groups did not differ significantly on either a novel
computerized facial recognition task or the Benton Facial
Recognition Test. In contrast, the bipolar group performed
significantly more poorly than did the comparison group on a
novel facial affect labeling task. Although the patient group
had slower reaction times on all 3 computerized tasks, the
presentation duration did not have an effect on performance
in the patients. This study suggests that patients with bipolar
disorder are able to recognize faces, but have difficulty
processing facial affective cues. (JINS, 2003, 9,
623–632.)
Motor adaptation in children with myelomeningocele: Comparison
to children with ADHD and healthy siblings
Authors: COLVIN ANDREW N. , YEATES KEITH OWEN , ENRILE BENEDICTA G. , COURY DANIEL L.
Published: June 2003

Myelomeningocele is a common developmental malformation of
the central nervous system that usually results in motor deficits.
Previous studies of myelomeningocele have not examined motor
adaptation, which involves changes in the control of movements
that occur as a result of repeated task exposure but do not
depend on conscious recall of the exposure. We studied motor
adaptation in 17 children with myelomeningocele and shunted
hydrocephalus, 19 children with attention deficit/hyperactivity
disorder (ADHD), and 20 healthy siblings. All children were
8 to 15 years of age. They were administered 2 measures of motor
adaptation known to be sensitive to subcortical abnormalities
in adult neurological disorders. One task assessed the biasing
in weight judgments that occurs after exposure to heavy
versus light weights, and the other assessed the
adaptation in reaching movements that occurs when vision is
laterally displaced by prisms. Contrary to expectations, the
groups did not differ in motor adaptation. Children in all 3
groups displayed significant biasing in their weight judgments
and improvement in the accuracy of pointing during prism adaptation
trials. Performance on the 2 motor adaptation tasks was not
related to age or IQ. Weight biasing was positively related
to a measure of response disinhibition. The findings suggest
that myelomeningocele does not result in global impairment of
motor skills, but instead in a profile of intact and impaired
motor functions that potentially may be decomposed in accordance
with the neuroscience of motor skills. (JINS, 2003,
9, 642–652.)
Do children with myelomeningocele and hydrocephalus display
nonverbal learning disabilities? An empirical approach to
classification
Authors: YEATES KEITH OWEN , LOSS NANCY , COLVIN ANDREW N. , ENRILE BENEDICTA G.
Published: June 2003

As a group, children with myelomeningocele (MM) and early-onset
hydrocephalus demonstrate many of the features of the syndrome
of nonverbal learning disabilities (NLD). However, the frequency
with which individual children display a pattern of
neuropsychological functioning consistent with the NLD syndrome
is unknown. We addressed this question by comparing the prevalence
of NLD in 32 children with MM and shunted hydrocephalus to that
in a group of 27 healthy siblings. Participants, who were between
8 and 15 years of age, completed a neuropsychological test battery
that included 11 measures of possible assets and 17 measures
of possible deficits that define the NLD syndrome. As a group,
children with MM and shunted hydrocephalus displayed many of
the specific assets and deficits. However, they also displayed
significantly more variability in their patterns of assets and
deficits than siblings, reflecting the substantial individual
differences that characterize children with MM. About 50% of
the children with myelomeningocele displayed a pattern of assets
and deficits consistent with the NLD syndrome. Classification
as NLD was weakly related to cumulative medical risk, as well
as to left-handedness. The findings suggest a need for caution
in making generalizations regarding the applicability of the
NLD model to children with MM and early-onset hydrocephalus.
(JINS, 2003, 9, 653–662.)
The Correlation between Ion Beam/Material Interactions and
Practical FIB Specimen Preparation
Authors: Prenitzer B.I. , Urbanik-Shannon C.A. , Giannuzzi L.A. , Brown S.R. , Irwin R.B. , Shofner T.L. , Stevie F.A.
Published: June 2003

The focused ion beam (FIB) tool has been successfully used as both a
stand alone analytical instrument and a means to prepare specimens for
subsequent analysis by SEM, TEM, SIMS, XPS, and AUGER. In this work,
special emphasis is given to TEM specimen preparation by the FIB
lift-out technique. The fundamental ion/solid interactions that
govern the FIB milling process are examined and discussed with respect
to the preparation of electron transparent membranes. TRIM, a Monte
Carlo simulation code, is used to physically model variables that
influence FIB sputtering behavior. The results of such computer
generated models are compared with empirical observations in a number
of materials processed with an FEI 611 FIB workstation. The roles of
incident ion attack angle, beam current, trench geometry, raster
pattern, and target-material-dependent removal rates are considered.
These interrelationships are used to explain observed phenomena and
predict expected milling behaviors, thus increasing the potential for
the FIB to be used more efficiently with reproducible results.
Morphological Characterization of Elastin-Mimetic Block Copolymers
Utilizing Cryo- and Cryoetch-HRSEM
Authors: Wright Elizabeth R. , Conticello Vincent P. , Apkarian Robert P.
Published: June 2003

Elastin-mimetic block copolymers were produced by genetic
engineering. Genetically driven synthesis permitted control of the
final physiochemical characteristics of the block copolymers. We
designed BB and BAB block copolymers in which the A-block was
hydrophilic and the B-block was hydrophobic. By designing the
copolymers in this manner, it was proposed that they would
self-assemble into micellar aggregates that, at high concentration,
would form thermoreversible hydrogels. To analyze the three-dimensional
fine surface morphology of the copolymers, to the resolution level of a
few nanometers, we employed cryo-HRSEM. This method provided vast
expanses of the specimen in its frozen hydrated state for survey. In
our initial cryo-HRSEM studies, we observed the protein filaments and
micelles surrounded by lakes of vitreous ice. Upon examination at low
and intermediate magnifications, there was an extensive honeycomb-like
filamentous network. To delineate the fine morphology of the hydrogel
network at high magnification and to greater depths, we cryoetched away
unbound water from the sample surface, in high vacuum, prior to
chromium deposition. By using this technique, we were able to visualize
for characterization purposes the fine fibril networks formed from the
micellar aggregates over the surface of the hydrogel.
Electron Radiation Damage of MCM-41 and Related Materials
Authors: Blanford Christopher F. , Carter C. Barry
Published: June 2003

The article compares the relative stability of MCM-41 and related
mesoporous materials in electron beam at an accelerating voltage of
100–300 kV. The work encountered in electron microscopy presents
a comparison with similar research that has been carried out on
nonporous and microporous silicates, especially α-quartz and
zeolite Y. The trends in stability are analyzed, classifying the
effects of sample preparation, organic and inorganic moieties, and
electron accelerating voltage on beam stability. A higher synthesis
temperature, the use of an acid catalyst in the synthesis, and the
presence of additional organic or inorganic material within the
channels were all found to stabilize these materials. The dose required
to completely disrupt the structure increased with accelerating voltage
for nearly all samples, suggesting a primarily radiolytic damage
mechanism. The exception, MCM-41 containing nanometer-sized titania
particles in its channels, was found to be almost insensitive to
accelerating voltage.
Coulomb stress accumulation along the San Andreas Fault system
Authors: Smith Bridget , Sandwell David
Published: June 2003

Stress accumulation rates along the primary segments of the San Andreas Fault system are computed using a three‐dimensional (3‐D) elastic half‐space model with realistic fault geometry. The model is developed in the Fourier domain by solving for the response of an elastic half‐space due to a point vector body force and analytically integrating the force from a locking depth to infinite depth. This approach is then applied to the San Andreas Fault system using published slip rates along 18 major fault strands of the fault zone. GPS‐derived horizontal velocity measurements spanning the entire 1700 × 200 km region are then used to solve for apparent locking depth along each primary fault segment. This simple model fits remarkably well (2.43 mm/yr RMS misfit), although some discrepancies occur in the Eastern California Shear Zone. The model also predicts vertical uplift and subsidence rates that are in agreement with independent geologic and geodetic estimates. In addition, shear and normal stresses along the major fault strands are used to compute Coulomb stress accumulation rate. As a result, we find earthquake recurrence intervals along the San Andreas Fault system to be inversely proportional to Coulomb stress accumulation rate, in agreement with typical coseismic stress drops of 1–10 MPa. This 3‐D deformation model can ultimately be extended to include both time‐dependent forcing and viscoelastic response.
Atmospheric budget implications of the temporal and spatial trends in methyl bromide concentration
Authors: Reeves Claire E.
Published: June 2003

Methyl bromide (CH3Br) is an important ozone‐depleting gas for which 20th century trends of the atmospheric concentration have recently been derived from air trapped in Antarctic firn. In this paper, a two‐dimensional (2‐D) global model, with a coupled atmosphere and ocean, is used to examine this historical trend, analyzing its implication for the various source strengths and the lifetime of CH3Br. The results illustrate that not only is the current understanding of the present‐day atmospheric budget of CH3Br incomplete but so too is our understanding of the budget of CH3Br prior to major industrial emissions and anthropogenic changes to it. This difference cannot be explained by the overall error in the model results as determined from the uncertainties in the major source and sink terms. Either the estimate of the sink strength is too large or there is an underestimate of a known “nonindustrial” source or an unaccounted “nonindustrial” source, or some combination of these. Further, the results imply that the increase in the “anthropogenically influenced” sources during the 20th century is underestimated or that the sink strength is too strong. Since this applies to both before and after 1950, this suggests that the increase in nonfumigant sources and possibly fumigant sources is underestimated, assuming the sinks not to be overestimated. A longer lifetime has the effect of not only increasing the absolute concentrations but also increasing the rate of growth in concentrations and thus improving the agreement with the firn data. The sensitivity of the results to the uncertainties in the individual source and sink terms is assessed. The budget is also examined in terms of the properties of an artificial source necessary to provide balance. Other data sets of observed CH3Br concentration are also used to evaluate the modeled source and sink scenarios in terms of seasonal and latitudinal variations.
Past extent of sea ice in the northern North Atlantic inferred from foraminiferal paleotemperature estimates
Authors: Sarnthein Michael , Pflaumann Uwe , Weinelt Mara
Published: June 2003

Using 150 core top samples, we developed a conservative but fairly robust new measure to reconstruct past changes in (maximum) seasonal sea ice distribution in the northern North Atlantic, hitherto a major unknown. The proxy is based on Similarity Maximum Modern‐Analog Technique (SIMMAX) estimates of threshold temperatures near the sea surface (SST). Today, almost 100% of all sites with SST >2.5°C during summer, >0.4° for winters 1978–1987, and >0.75°C for Little Ice Age winters lie seaward of the sea ice margin. When applied to >60 sediment records of the Last Glacial Maximum, this proxy shows that peak glacial sea ice was far more restricted than in the “classic”CLIMAP Project Members[1981]reconstruction. During glacial summer, sea ice only covered the Arctic Ocean and western Fram Strait. The northern North Atlantic and Nordic Seas were largely ice‐free and thus formed a high‐latitude moisture source for the continued buildup of continental ice sheets. In contrast, sea ice spread far south across the Iceland Faeroe Ridge during glacial winter, with an inferred patch of sea ice also in the central east Atlantic, near the center of the Azores High. A broad ice‐free channel extended from 50° to 60°N, forming an ideal site for large‐scale convection of glacial upper North Atlantic Deep Water. The extreme seasonality in glacial sea ice formation and melt in the Nordic Seas implies a major consumption of the regional energy income.
End‐to‐end simulator of two‐dimensional interferometric radiometry
Authors: Corbella Ignasi , Camps Adriano , Zapata Miguel , Marcos Fernando , Martínez Francisco , Torres Francesc , Vall‐llossera Mercè , Duffo Nuria , Bará Javier
Published: June 2003

An end‐to‐end simulator for the assessment of the performances of a spaceborne interferometric radiometer measuring the brightness temperature of Earth's surface (ground and sea) is presented. The tool covers the complete simulation of the input brightness temperature map, the full instrument modeling, the instrumental error correction, and the inversion algorithm to recover the brightness temperature. The output maps are presented in a graphical format including most of the standard cartographic projections. The simulator has been developed with two main objectives: (1) to provide the engineers a tool to predict system performance, and (2) to provide the scientific and end users a tool to help them in the implementation and improvement of algorithms for the Soil Moisture and Ocean Salinity (SMOS) retrieval for the SMOS Earth Explorer Opportunity Mission of the European Space Agency.
Sesquiterpene ozonolysis: Origin of atmospheric new particle formation from biogenic hydrocarbons
Authors: Bonn Boris , Moortgat Geert K.
Published: June 2003

Atmospheric new aerosol particle formation observed in remote areas (e.g., in Finland, Portugal and in the U.S.). is generally attributed to low‐volatile oxidation products of monoterpenes (C10H16), which are emitted by the vegetation. In this article we show that this atmospheric new particle formation is not caused by monoterpene products, but most likely initiated by very low‐volatile substances produced during sesquiterpene (C15H24)‐ozone reactions. For this purpose, the nucleation times of the most abundant monoterpene reactions have been calculated and discussed exemplarily for the Finnish site Hyytiälä, at which nucleation events have been observed. In addition, the important negative influence of water vapor on the nucleation threshold of the β‐caryophyllene‐ozone reaction has been studied in detail at different dew points in the laboratory. Therein, the saturation vapor pressure of the nucleating compounds was estimated to be less than 1.2 · 10−10 hPa, which is recommended for atmospheric homogeneous nucleation of non‐volatile organics.
EEG phenotype in alcoholism: increased coherence in the depressive subtype
Authors: Winterer G. , Enoch M.‐A. , White K. V. , Saylan M. , Coppola R. , Goldman D.
Published: June 2003

Objective:  Electroencephalography (EEG) power and coherence changes may be trait markers for alcoholism providing clues to brain mechanisms of vulnerability. However, it is unclear whether alpha power and coherence differences reflect reversible toxic or withdrawal effects of alcohol.

Method:  The EEGs of 10 non‐abstinent and 16 long‐term abstinent alcoholics (7.7 ± 5.8 years) and 25 controls were analyzed. Levels of anxiety and depression were assessed by questionnaire.

Results:  No statistically significant EEG power differences were observed between groups, although the numerical difference between alcoholics and controls was similar to that previously reported. Bilateral, intrahemispheric, posterior coherences were significantly increased in the alpha and beta frequency bands both in long‐term abstinent and non‐abstinent alcohol‐dependent subjects – particularly when depressiveness was included as a covariate.

Conclusion:  These results suggest that increased EEG‐coherence (cortical synchronization) may serve as endophenotype for alcoholism in conjunction with increased depressiveness and point to a possible involvement of GABAergic and/or glutamatergic neurotransmission.
Residual symptoms in elderly major depression remitters
Authors: Gastó C. , Navarro V. , Catalán R. , Portella M. J. , Marcos T.
Published: June 2003

Objective:  To assess residual symptoms in severe geriatric major depression in remission, and to determine baseline clinical and sociodemographic predictors of residual symptoms in remitters.

Method:  A total of 108 elderly patients with unipolar major depression were evaluated and treated naturalistically for 9 months so as to record the predictors of residual symptoms in remitters. In order to reduce the likelihood of confusing residual symptoms with normal effects of age, 30 control subjects were also monitored.

Results:  Seventy‐nine patients (73.1%) were considered remitters and 82.3% of remitters showed residual symptoms. Medical burden, chronic stress and subjective social support were the only variables which predicted the severity of residual symptoms in remitters.

Conclusion:  Residual symptoms in elderly patients with major depression in remission should not only be attributed exclusively to intrinsic factors of the illness or the age of the individual patient, but also to external factors.
Sertraline‐induced hypomania: a genuine side‐effect
Authors: Mendhekar D. N. , Gupta D. , Girotra V.
Published: June 2003

Objective: Antidepressants including selective serotonin reuptake inhibitor (SSRI)‐associated mania or hypomania has been well documented in the literature but these patients with switch have either mood disorders or various risk factors for bipolar disorder. This case report examines SSRI‐induced hypomania in a patient with dissociative disorder and highlights hypomania as a genuine side‐effect of sertraline rather than a switch.

Method: A 23‐year‐old female patient with dissociative disorder has been described.

Results: Hypomanic symptoms emerged during treatment with sertraline at the dose of 50 mg/day after 3–4 days of initiation of therapy and had complete recovery within 7 days after stopping sertraline.

Conclusion: In the absence of risk factors for manic switch, sertraline‐induced hypomania may be a true side‐effect of drug.
Antidepressants: psychiatrists' opinions and clinical practice
Authors: Depont F. , Rambelomanana S. , Le Puil S. , Begaud B. , Verdoux H. , Moore N.
Published: June 2003

Objective: To describe and compare psychiatrists’ opinion on antidepressant drugs and their prescriptions to depressed patients.

Method: Between January and September 1999 a representative sample of French psychiatrists was asked their opinion of the 15 most prescribed antidepressants, and then to describe the treatments of the current depressive episode of four depressive patients each, their changes and the reason thereof.

Results: A total of 232 psychiatrists and 935 patients participated. The best ranked antidepressants were clomipramine, paroxetine and amitriptyline for efficacy, tianeptine, paroxetine and citalopram for tolerability. In patients, the most often prescribed were paroxetine, fluoxetine and venlafaxine. Those least often stopped for intolerance were tianeptine (2.9%), citalopram (5.2%), venlafaxine (3.3%) and amitriptyline (5.7%) for lack of efficacy. There was no difference in stopping rates for inefficacy of tricyclics and serotonin‐selective agents.

Conclusion: The best predictors for the prescribed antidepressants were the psychiatrists' overall rankings and opinions of the tolerability of the drug.
Rapid‐cycling bipolar disorder: effects of long‐term treatments
Authors: Tondo L. , Hennen J. , Baldessarini R. J.
Published: June 2003

Objective: To compare responses to long‐term treatment of rapid‐cycling (RC) vs. non‐RC bipolar disorder patients and assess relative effectiveness of specific agents in RC patients.

Method: Studies identified by literature searching were analyzed for effects of RC status and treatment‐type on clinical outcome (recurrence or non‐improvement per exposure‐time), using random‐effects methods to estimate pooled rates and their 95% CI for quantitative meta‐analytic modeling.

Results: Data were obtained from 16 reports with 25 trial‐arms involving 1856 (905 RC and 951 non‐RC) patients treated with carbamazepine, lamotrigine, lithium, topiramate, or valproate, alone or with other agents over an average of 47.5 months (7347 total patient‐years). Estimated RC prevalence was 15.4%. Crude rates (%/month) of recurrence (2.31/1.20) and clinical non‐improvement (1.93/0.49) averaged 2.9‐fold greater in RC vs. non‐RC subjects. The pooled RC/non‐RC risk ratio (RR) for inferior treatment‐response (in 13 direct comparisons) was 1.40 (CI 1.26—1.56; P < 0.0001). Pooled crude recurrence and non‐improvement rates suggested no clear advantage for any treatment, nor superiority for anticonvulsants over lithium. However, only lithium vs. carbamazepine could be directly compared (in four treatment‐arms) meta‐analytically in RC patients (RR = 0.93, CI 0.74–1.18, indicating no difference in effectiveness).

Conclusion: As expected, RC was associated with lower effectiveness of all treatments evaluated. Direct comparisons of specific treatment alternatives for RC patients were rare, and provided no secure evidence of superiority of any treatment. Additional long‐term studies comparing RC/non‐RC patients randomized to specific treatments are required.
The Danish PET/depression project: cognitive function and regional cerebral blood flow
Authors: Ravnkilde B. , Videbech P. , Clemmensen K. , Egander A. , Rasmussen N. A. , Gjedde A. , Rosenberg R. , Gade A.
Published: June 2003

Objective: To clarify the relationship between cognitive functions and regional cerebral blood flow (rCBF) in a large group of depressed patients compared with healthy controls.

Method: A set of principal components was extracted from scores of a battery of neuropsychological tests of 40 patients suffering from major depression and 49 healthy controls. The components were correlated by multiple linear regression analyses to selected regions of interest in the brain obtained from positron emission tomography images.

Results: In contrast to findings in the healthy controls, cognitive functions in the depressed patients correlated significantly with rCBF in specified regions of interest in only a few instances.

Conclusion: Our study indicates that disturbed cognitive functions in depression do not relate to specific areas of the brain in the same way as normal cognitive functioning, suggesting that the abnormalities of brain function in major depression may be qualitative, rather than quantitative, in nature.
Evaluation of the PAHO/WHO training program on the detection and treatment of depression for primary care nurses in Panama
Authors: Moreno P. , Saravanan Y. , Levav I. , Kohn R. , Miranda C. T.
Published: June 2003

Objective:This study evaluated the efficacy of a training program developed by Pan American Health Organization/World Health Organization (PAHO/WHO) for primary care nurses aimed at improving their capacity to detect and manage depression.

Method:Changes in knowledge and clinical practice were assessed in a group of primary care nurses in Panama who underwent the program. They were compared with a group of controls.

Results:Nurses who underwent the training program showed a statistically significant improvement in knowledge and detection of depressive disorders. In addition, they increased their notification of patients with depression to the primary care physician. No change was noted in the control group.

Conclusion:The results point to the benefit of the PAHO/WHO training program for primary care nurses in the care of major depression. Further studies are required to confirm these results.
Explanatory models of psychosis among community health workers in South India
Authors: Joel D. , Sathyaseelan M. , Jayakaran R. , Vijayakumar C. , Muthurathnam S. , Jacob K. S.
Published: June 2003

Objective:  To examine commonly held indigenous beliefs about mental illness, which often differ markedly from the biomedical models, among community health workers in rural South India.

Method:  Indigenous beliefs about chronic psychosis were elicited from community health workers. The Short Explanatory Model Interview formed the basis of the interview.

Results:  A variety of indigenous beliefs, which contradicted the biomedical model, were elicited. A significant proportion of health workers did not recognize chronic psychosis as a disease condition, believing that it was caused by black magic, evil spirits and poverty, and felt that doctors could not help.

Conclusion:  The results of the study suggest that training programmes should elicit and discuss local beliefs prior to the teaching of the biomedical model of mental disorders.
A targeted deletion in the endocytic receptor gene Endo180 results in a defect in collagen uptake
Authors: East Lucy , McCarthy Afshan , Wienke Dirk , Sturge Justin , Ashworth Alan , Isacke Clare M
Published: June 2003

The four members of the mannose receptor family (the mannose receptor, the M‐type phospholipase A2 receptor, DEC‐205 and Endo180) share a common extracellular arrangement of an amino‐terminal cysteine‐rich domain followed by a fibronectin type II (FNII) domain and multiple C‐type lectin‐like domains (CTLDs). In addition, all have a short cytoplasmic domain, which mediates their constitutive recycling between the plasma membrane and the endosomal apparatus, suggesting that these receptors function to internalize ligands for intracellular delivery. We have generated mice with a targeted deletion of Endo180 exons 2–6 and show that this mutation results in the efficient expression of a truncated Endo180 protein that lacks the cysteine‐rich domain, the FNII domain and CTLD1. Analysis of embryonic fibroblasts reveals that this mutation does not disrupt the C‐type lectin activity that is mediated by CTLD2, but results in cells that have a defect in collagen binding and internalization and an impaired migratory phenotype.
Blocking‐type anti‐TSH receptor antibodies and relation to responsiveness to antithyroid drug therapy and remission in Graves’ disease
Authors: Tada Hisato , Mizuta Ikuko , Takano Toru , Tatsumi Ke‐ita , Izumi Yukiko , Hidaka Yoh , Amino Nobuyuki
Published: June 2003

objective Antithyroid drugs are effective in some patients with Graves’ disease but not in others. The factors responsible for this difference are still unknown. We examined the relationship between the nature of anti‐TSH receptor (TSH‐R) antibodies and responsiveness to drugs in Graves’ disease.

patients Twenty‐eight untreated patients with Graves’ disease were treated with thiamazole and followed for up to 13 years.

measurement Antithyroid microsomal antibodies (MCHAs) and antithyroglobulin antibodies (TGHAs) were measured by the passive haemagglutination method. Anti‐TSH‐R antibodies were measured by a radioreceptor assay (TBII), and thyroid‐stimulating antibodies (TSAbs) and TSH‐stimulation blocking antibodies (TSBAbs) were measured by bioassays using FRTL‐5 cells. Blocking antibodies were also measured by the conversion assay. In order to confirm the usefulness of the conversion assay, in vitro experiments using mixtures of TSAb serum and TSBAb serum were performed.

results In in vitro conversion experiments, the conversion assay sensitively detected coexisting blocking antibodies. TSBAb was found in seven patients and a positive conversion ratio was found in four patients, and, of these, three patients had both antibodies. Finally, eight patients (28·6%) had blocking antibodies and 25 of 28 patients (89·3%) had stimulating antibodies. These patients with blocking antibodies (Group A) responded well initially to antithyroid drugs and showed earlier normalization of the serum T4 level (3·0 ± 1·2 weeks) than patients without blocking antibodies (Group B, 10·7 ± 8·5, P < 0·001). Unexpectedly, remission of Graves’ thyrotoxicosis was earlier in Group B (5·1 ± 4·4 years) than in Group A (8·0 ± 4·3 years, P < 0·05). Other parameters, including serum T4, goitre size, ophthalmopathy, TBII, TSAb, TGHA and MCHA, were not different between the two groups.

conclusions Graves’ patients with coexisting blocking antibodies initially respond well to thiamazole but are relatively slow to achieve remission. Measurement of blocking antibodies may be useful for selection of treatment options in Graves’ disease.
Chylomicron remnant metabolism studied with a new breath test in postmenopausal women with and without type 2 diabetes mellitus
Authors: Dane‐Stewart C. A. , Watts G. F. , Barrett P. H. R. , Stuckey B. G. A. , Mamo J. C. L. , Martins I. J. , Redgrave T. G.
Published: June 2003

objectives The kinetic basis for the effect of type 2 diabetes mellitus (DM) on postprandial lipoproteins has not been fully established. We investigated chylomicron remnant metabolism using a stable isotope breath test and fasting measurements of plasma apolipoprotein (apo) B‐48 and apoC‐III concentrations in postmenopausal women with and without type 2 DM.

patients Twenty‐four postmenopausal women without DM and 14 postmenopausal women with diet‐controlled DM of similar age and body mass index (BMI) were studied in the postabsorptive state.

methods The fractional catabolic rate (FCR) of an intravenously injected chylomicron remnant‐like emulsion was determined from the appearance of 13CO2 in the breath using isotope‐ratio mass spectrometry and multicompartmental modelling. apoB‐48, a marker of particle number of intestinal lipoproteins, was determined immunoelectrophoretically. apoC‐III was measured by immunoturbidimetric assay.

results Compared with the nondiabetic women, the women with DM had significantly higher plasma apoB‐48 concentration (16·40 ± 1·18 mg/l vs. 13·0 ± 0·9 mg/l; mean ± standard error mean; P = 0·021), higher plasma apoC‐III concentration (204·24 ± 15·18 mg/l vs. 170·74 ± 10·75 mg/l; P = 0·042) and lower FCR of the chylomicron remnant‐like emulsion (0·06 ± 0·05 pools/h vs. 0·12 ± 0·02 pools/h; P < 0·001). In the diabetic patients, the FCR of the emulsion was correlated significantly with plasma apoB‐48 levels (r = −0·641, P = 0·007) but not with apoC‐III levels.

conclusions In postmenopausal women, diabetes mellitus appears to decrease the catabolism of chylomicron remnants and result in an accumulation of these particles in plasma. This may chiefly be due to decreased clearance by hepatic receptors related to an effect of insulin resistance. Impairment in the catabolism of chylomicron remnants may contribute to increased risk of atherosclerosis in postmenopausal women with type 2 diabetes mellitus.
Primary medical therapy for acromegaly
Authors: Sheppard Michael C.
Published: June 2003

There is now considerable evidence that the clinical outcome in patients with acromegaly can be improved very substantially by means of better surgical expertise and effective medical therapies used in a flexible and innovative manner. Medical therapy alone in patients who have not undergone surgery or radiotherapy (primary medical therapy) offers the prospect of near normalisation of GH/IGF‐I levels together with substantial tumour shrinkage in a significant number of patients.
A 3‐year prospective study to assess uterine growth in girls with Turner's syndrome by pelvic ultrasound
Authors: McDonnell Ciara M. , Coleman Lee , Zacharin Margaret R.
Published: June 2003

objective Adult women with Turner's syndrome who have used the donor ovum IVF programme are reported to have reduced pregnancy outcome with an increased risk for first trimester spontaneous abortion. This is considered to be related to a small uterine size and reduced endometrial thickness. This study examines whether adequate oestrogen replacement during the early adolescent years will result in normal adult uterine dimensions, with consequent reduction in these pregnancy risks.

design A prospective evaluation of uterine dimensions by pelvic ultrasound examination over 3 years, in a group of 18 girls commencing pubertal induction with oestrogen or entering puberty spontaneously.

patients Girls with Turner's syndrome attending the outpatient clinc at the Royal Children's Hospital and due to start oestrogen treatment were invited to participate in the study.

measurements Data were collected for clinical parameters of age, pubertal staging, menarche, oestrogen dose and karyotype. Ultrasonographic measurements of uterine length, sagittal and transverse width, endometrial cavity and identification of ovaries were also included.

results The mean age at commencement of the study was 14·6 years, mean age at final evaluation was 17·1 years. Karyotype was 45XO in 6/18, mosaic in 12/18. Spontaneous pubertal onset occurred in 5/18. One of these later required the addition of oestrogen treatment. Pubertal induction with oestrogen was used in 13/18 girls. A total of 15/18 girls have either achieved spontaneous menarche or are using adult doses of oestrogen and progestogen with regular withdrawal bleeds. All 18 girls have achieved a uterine length of 5·8–8·6 cm (mean 7·04 cm) within the normal adult range (5–8 cm). Mean uterine volume was 30·23 cm3.

conclusion The study suggests that adequate oestrogen replacement in early to mid adolescence mimicking spontaneous timing of puberty results in normal uterine growth and adult uterine dimensions. Further follow‐up of uterine growth in these girls is warranted.
Feasibility of a randomized trial on adjuvant radio‐iodine therapy in differentiated thyroid cancer
Authors: Dragoiescu C. , Hoekstra O. S. , Kuik D. J. , Lips P. , Plaizier M. A. B. D. , Rodrigus P. T. R. , Huijsmans D. A. K. C. J. M. , Ribot J. G. , Kuijpens J. , Coebergh J. W. W. , Teule G. J. J.
Published: June 2003

background Justification for adjuvant radio‐iodine (I‐131) therapy in differentiated thyroid cancer (DTC) is purely based on retrospective data. This is true for ablative therapy and even more so for high‐dosage adjuvant schedules. Randomized trials on the latter application are considered impossible due to anticipated formidable sample sizes required in a disease with an overall excellent prognosis like DTC.

objective To develop and validate a model that could stratify for risk of recurrence, rather than survival, as is usually done in prognostic indices, and secondly, to use this model to estimate the sample size required for a randomized trial.

design, patients and results From databases of three large Dutch centres, we identified 342 consecutive patients without known residual DTC after (near‐) total thyroidectomy. Using Cox proportional hazards analysis, a model was validated that clearly distinguished risk categories of recurrence using commonly available baseline variables. The model included age, N stage at presentation and T stage in papillary carcinoma. According to this stratification, a subset of patients at substantial risk for relapse (30–40%) was identified. They could be eligible for a trial assessing the impact of high‐dose adjuvant I‐131 on recurrence rates. Assuming a clinically relevant effect of 30% reduction of relapses, 290 patients would have to be entered in either arm (α 0·05, power 80%).

conclusion We conclude that even though a randomized trial on this issue will be difficult to design and conduct, sample size is not the main problem.
Re‐assessment of growth hormone secretion in young adult patients with childhood‐onset growth hormone deficiency
Authors: Donaubauer Juliane , Kiess Wieland , Kratzsch Jürgen , Nowak Tanja , Steinkamp Heinz , Willgerodt Helmut , Keller Eberhard , Group Study
Published: June 2003

objective Patients with childhood‐onset GH deficiency (coGHD) need retesting in late adolescence or young adulthood to verify whether they need to continue GH treatment. For this purpose the Growth Hormone Research Society (GRS) recommends the insulin tolerance test (ITT), or as an alternative the arginine + growth hormone releasing hormone test (ARG + GHRH test) as a diagnostic tool in adolescents and adults. However, there are no standardized cut‐off levels based on normal GH secretion for determining GHD vs. GH sufficiency in young adults for the ITT, the ARG + GHRH test or the pyridostigmine + GHRH (PD + GHRH) test, a further new GH stimulation test.

patients and measurements We studied 43 patients (28 with organic coGHD, 15 with idiopathic coGHD; 30 males, 13 females; aged 20·4 years, range 16·2–25·4; body mass index 23·5, range 16·3–35·8) using the ARG [0·5 g/kg intravenously (i.v.)] + GHRH (1 µg/kg i.v.) test, the PD (120 mg orally) + GHRH (1 µg/kg i.v.) test and the ITT (0·1 IU/kg i.v.) and compared these data with the results of 40 healthy age‐ and weight‐matched volunteers.

results The GH response in patients was significantly lower than in healthy controls: ARG + GHRH test, 0·8 µg/l (interquartile range 0·3–2·6) vs. 51·8 µg/l (32·6–71·2) in controls (P < 0·0001); PD + GHRH test, 0·9 µg/l (0·3–1·9) vs. 40·4 µg/l (27·1–54·4) in controls (P < 0·0001); ITT, 0.1 µg/l (0·0–0·8) vs. 20·3 µg/l (14·7–31·7) in controls (P < 0·0001). In the ARG + GHRH test we found a diagnostic sensitivity of 100% and a specificity of 97·5% for a cut‐off range from 15·1 to 20·3 µg/l, in the PD + GHRH test a sensitivity of 100% and a specificity of 97% (cut‐off range 9·1–13·1 µg/l) and in the ITT a sensitivity and specificity of 100% each within a cut‐off range from 2·7 to 8·8 µg/l.

conclusion There were no marked differences in sensitivity and specificity in young adults among ARG + GHRH test, PD + GHRH test and the ITT in assessing GH secretion. Because of the lack of side‐effects, the ARG + GHRH test is the recommended method for re‐evaluation of coGHD in young adults when pituitary GHD is suspected. Furthermore, in adult patient groups where organic pituitary coGHD is common, the ITT may be completely replaced by the ARG + GHRH test. Because of the predominance of hypothalamic GHD in childhood, the ITT is commonly performed for the re‐evaluation of patients with childhood‐onset GHD because of its mechanism of GH stimulation. The present results confirm the high discriminatory capability of the ITT in young adults.
Clinical presentation and outcome of pituitary adenomas in teenagers
Authors: Cannavò S. , Venturino M. , Curtò L. , De Menis E. , D’Arrigo C. , Tita P. , Billeci D. , Trimarchi F.
Published: June 2003

objective Pituitary adenomas rarely occur in childhood and adolescence, but their mass effect and endocrine abnormalities can compromise both quality and length of life. In this study we evaluated the symptoms at onset and the long‐term consequences induced in teenagers by functioning or nonfunctioning pituitary adenomas.

design and patients Clinical, biochemical and neuroradiological data of 44 young patients (12 males and 32 females, aged 16·3 ± 1·9 years at diagnosis) with pituitary adenomas were evaluated retrospectively at baseline and after therapy. Patients underwent surgery, radiotherapy and/or medical treatment depending on clinical history and endocrine secretion of the tumour. Follow‐up ranged from 8 to 252 months (median 55 months).

measurements Baseline and dynamic pituitary function were evaluated in all cases at diagnosis and after treatments. Magnetic resonance imaging (MRI) or computed tomography (CT) scan were performed before therapy and during follow‐up. Hormone levels were measured using commercial radioimmunologic or immunoradiometric methods.

results Pituitary macroadenomas (group 1) or microadenomas (group 2) were found in 61% and 39% of cases, respectively. Overall, 68% were PRL‐secreting, 7% GH‐secreting, 5% ACTH‐secreting and 20% nonfunctioning. The most frequent symptoms at onset were oligoamenorrhoea (62%) and galactorrhoea (59%) in the girls, and headache (58%) in the boys. Pubertal development was delayed in 12/27 (44%) cases with macroadenoma. Growth failure was observed in 4/44 (9%) patients (3 in group 1 and 1 in group 2). At diagnosis, hypopituitarism was detected in 10/27 (37%) patients with macroadenoma. Surgery alone cured 4/18 (22%) and 4/9 (44%) patients in group 1 and group 2, respectively. Adjuvant therapies (second surgery and/or radiotherapy and/or medical treatment) cured the disease in 2/13 (15%) patients with macroadenoma and allowed a persistent normalization in other 4/13 (31%) and 2/4 (50%) cases in group 1 and group 2, respectively. Medical treatment alone cured 2/9 (22%) patients with PRL‐secreting macroadenoma and normalized PRL levels in another six (66%) with macroprolactinoma and in 2/7 (28%) patients with microprolactinoma.

conclusion Delay of growth was rarely observed in teenagers with pituitary adenomas. At the onset of the disease, many girls complained of oligoamenorrhoea and galactorrhoea, while headache and delay of pubertal development were the symptoms more frequently referred by boys. Surgery alone was effective in a minority of patients and adjuvant therapies were helpful to obtain the remission of the disease in many cases. In patients with PRL‐secreting pituitary adenoma, medical treatment, both as first choice or as adjuvant therapy, normalizes serum PRL levels in 14/27 (52%) cases.