bluuebunny/crossref_metadata_2025 huggingface dataset:
The Atrophogenic Potential and Dermal Tolerance of Calcipotriol/Betamethasone Dipropionate Ointment Compared with Betamethasone Dipropionate Ointment
Authors: Traulsen J. , Hughes-Formella B.J.
Published: August 2003

Background: Recently, a combination product (Daivobet® ointment: calcipotriol 50 µg/g, betamethasone dipropionate 0.5 mg/g) has been developed for the treatment of psoriasis. Objective: This study aimed to demonstrate that the atrophogenic potential of Daivobet is less or equal to the skin thinning produced by Diprosone® (betamethasone dipropionate 0.05 mg/g). Methods: The forearms of 45 subjects were treated with Daivobet and Diprosone or Daivobet and its vehicle twice daily over a 4-week period. Sonographic measurements for full skin thickness, clinical assessments and biopsies were carried out. Results: A confidence interval approach was used to establish that skin thinning following treatment with Daivobet was equal to or less than thinning with Diprosone. Histological results did not suggest differences between Daivobet and Diprosone. Clinical signs of atrophy or irritation were not observed. Conclusions: The atrophogenic potential of Daivobet and Diprosone was similar following twice daily application over a 4-week treatment period. Skin irritation was not observed.
Evaluating the Quality of Rosacea Studies: Implications for the Patient and Physician
Authors: Gupta Aditya K. , Chaudhry Maria M.
Published: August 2003

Background: Patients suffering from rosacea may experience frequent blushing and flushing, erythema, telangiectasia, and/or rhinophyma. In an attempt to find effective treatments, many studies have been performed. Objective: It is important to be able to evaluate the quality of clinical trials where agents have been used to treat rosacea, and to compare the effectiveness of the different therapies used for this indication. Methods: The reports on the efficacy and safety of the different drug therapies were evaluated using predetermined criteria. We searched MEDLINE (1966–2002) for studies where rosacea was treated with the various therapies. The criteria used to assess the quality of the studies were: randomization, blinding (double, single, or open), aims clearly defined, prior sample size calculation, whether inclusion and/or exclusion criteria were outlined, baseline comparison of patient characteristics and demographics, interventions and efficacy parameters defined, compliance assessed, statistical analysis performed including intention-to-treat evaluation of efficacy of therapy. Results: Using the above-mentioned criteria, each study was rated in order to determine the quality of the clinical trial. The maximum score a study could attain was 20. To determine if high-quality studies are cited more often than the lower-quality papers, the number of times a study had been cited since its publication was measured. We found 13 of the 42 studies scored greater than 14; these studies were rated as high-quality studies. There was no significant association between high-quality papers and the number of times they had been cited, suggesting that other factors are also taken into consideration when a given study is cited. Conclusion: It is important for investigators and clinicians to be aware of the parameters that count towards designing a high-quality protocol since such studies are more likely to reflect efficacy rates that are accurate. Furthermore, it is essential that when a study is written up, the pertinent information regarding the design of the trial and the manner in which it was conducted are conveyed to the reader.
A Frameshift Mutation of the ED1 Gene in Sibling Cases with X-Linked Hypohidrotic Ectodermal Dysplasia
Authors: Nishibu Akiko , Hashiguchi Takaki , Yotsumoto Shinichi , Takahashi Masafumi , Nakamura Koichiro , Kanzaki Tamotsu , Kaneko Fumio
Published: August 2003

X-linked hypohidrotic ectodermal dysplasia (XLHED; MIM 305100) is characterized by the absence or hypoplasia of hair, teeth, and sweat glands. The ED1 gene was identified as a responsive gene for XLHED. The patients were 2 Japanese brothers. Both had the same mutation in exon 1 of the ED1 gene, i.e. C deletion at nucleotide 49, which induced a frameshift starting from amino acid 17 and made a stop codon at amino acid 56, encoding the transmembrane site. The mutation caused the extracellular domain of ectodysplasin A to be completely absent. Their mother had a heterozygous allele; she congenitally lacked 1 tooth, and incisors appeared conical in form.
Early Development of Multiple Epithelial Neoplasms in Netherton Syndrome
Authors: Krasagakis K. , Ioannidou D.J. , Stephanidou M. , Manios A. , Panayiotides J.G. , Tosca A.D.
Published: August 2003

We report a case of Netherton syndrome manifested as congenital ichthyosiform erythroderma, trichorrhexis invaginata and atopy, who in early adulthood developed multiple, aggressive epithelial neoplasms in sun-exposed areas of the skin, in areas with papillomatous skin hyperplasia and at the left parotid region. The occurrence of cutaneous neoplasia has been reported in syndromes with congenital ichthyosis and suggests that the underlying genetic defects may cause the development of cancer in prone patients.
Detection of Human Papillomavirus Type 57 in the Tissue of a Plantar Epidermoid Cyst
Authors: Kashima Masato , Takahama Hideto , Baba Takako , Egawa Kiyofumi , Kitasato Hidero , Murakami Yosuke , Mizoguchi Masako
Published: August 2003

Plantar epidermoid cysts with human papillomavirus (HPV) infection are not rare in Japan. Most of them show the cytopathic effect of HPV type 60 – homogeneous intracytoplasmic inclusion bodies. Our case presented a plantar epidermoid cyst with vacuolation around the granular cell layer without any features of HPV type 60. In situ hybridization and polymerase chain reaction followed by DNA sequencing analysis revealed an association with HPV type 57.
Lupus erythematosus tumidus in Childhood
Authors: Sonntag Monika , Lehmann Percy , Megahed Mosaad , Ruzicka Thomas , Kuhn Annegret
Published: August 2003

Lupus erythematosus (LE) is a rare disorder in childhood. Most patients reported in the literature present with systemic manifestations, and, to date, fewer than 20 children with chronic cutaneous LE have been documented. In this article, we describe 3 patients with childhood LE tumidus, an uncommon but distinct subtype of chronic cutaneous LE. The lesions are characterized by erythematous, urticaria-like, nonscarring plaques in sun-exposed areas and, unlike in other variants of chronic cutaneous LE, there is no epidermal involvement. The clinical, photobiological, and histologic features as well as the differential diagnoses of childhood LE tumidus are discussed and compared with the adult form of this disease.
Spontaneous Regression of Congenital Melanocytic Nevi without Evidence of the Halo Phenomenon
Authors: Kageshita Toshiro , Inoue Yuji , Ono Tomomichi
Published: August 2003

Spontaneous regression of a congenital melanocytic nevus is rare and has always been thought to be associated with a halo phenomenon, suggesting that an immunological mechanism is involved in the regression process. We describe herein 2 cases of complete congenital melanocytic nevus regression without the halo phenomenon in 2 Japanese girls. To our knowledge, such a clinical progression has not been previously reported. We will also discuss several different possible mechanisms of regression.
Photo Recall Phenomenon: An Adverse Reaction to Taxanes
Authors: Ee Hock-Leong , Yosipovitch Gil
Published: August 2003

Taxanes are a new group of chemotherapeutic agents, which share some pharmacological characteristics with methotrexate. Methotrexate has previously been reported to cause a photo recall phenomenon which develops 3–5 days after UV radiation, suggesting that taxanes can induce a similar reaction. This should be added to the list of cutaneous side-effects of this class of chemotherapeutic agents. We report a case of photo recall phenomenon in a 55-year-old Chinese woman with metastatic breast cancer who was undergoing chemotherapy with taxanes.
Familial Leiomyomatosis: A Review and Discussion of Pathogenesis
Authors: Garman M.E. , Blumberg M.A. , Ernst R. , Raimer S.S.
Published: August 2003

Multiple cutaneous leiomyomas of pilar origin have long been recognized to have an autosomal dominant inheritance. While the skin tumors are relatively uncommon and benign, women of affected families often develop uterine fibroids with associated infertility, pain and bleeding. In addition, a subset of these families harbors a predisposition to papillary renal cell carcinoma. Germline mutations in a recently identified classical tumor suppressor gene encoding fumarate hydratase are observed in these individuals. Appropriate screening measures for associated disorders are mandatory.
Psychological Treatment of Patients with Chronic Toxic Encephalopathy: Lessons from Studies of Chronic Fatigue and Whiplash
Authors: van Hout Moniek S.E. , Wekking Ellie M. , Berg Ina J. , Deelman Betto G.
Published: August 2003

Background: Chronic toxic encephalopathy (CTE), which can result from long-term exposure to organic solvents, is characterized by problems of attention and memory, fatigue and affective symptoms. There is little experience with (neuro)psychological treatment in this patient group. We reviewed treatment outcome studies of CTE and comparable syndromes, namely, chronic whiplash-associated disorder (WAD) and chronic fatigue syndrome (CFS), with a view to providing recommendations for the psychological treatment of patients with CTE. Methods: PubMed and PsychLIT were systematically searched and reference lists of retrieved articles were studied. The articles were classified according to study design and level of evidence. Results: The studies of CFS provided high-level evidence for the effectiveness of cognitive-behavior therapy (CBT) in challenging dysfunctional cognitions regarding the effectiveness of rest and in stimulating graded activity. The studies of WAD were methodologically weaker, and most evaluated a combination of CBT and graded activity training. There was some evidence that changing fatigue- or pain-related behaviors may result in cognitive improvement. Two uncontrolled studies of CTE evaluated cognitive rehabilitation techniques but yielded inconsistent findings. Conclusions: CBT techniques focusing on changing illness attributions and on stimulating graded activity might be useful for patients with CTE, diminishing fatigue-related problems of concentration and memory. Future studies should evaluate whether cognitive deficits of CTE patients as a result of neurotoxic effects of exposure should be treated by cognitive rehabilitation.
Enhancement of Antibody Responses to Influenza Vaccination in the Elderly following a Cognitive-Behavioural Stress Management Intervention
Authors: Vedhara Kav , Bennett Paul D. , Clark Sian , Lightman Stafford L. , Shaw Samantha , Perks Paula , Hunt Moira A. , Philip Judith M.D. , Tallon Deborah , Murphy Peter J. , Jones Roy W. , Wilcock Gordon K. , Shanks Nola M.
Published: August 2003

Background: Previous research has demonstrated that the psychological morbidity experienced by informal caregivers is associated with increased vulnerability to infectious diseases, in particular influenza. A pragmatic trial was conducted to examine whether a stress management intervention (SMI) could reduce psychological morbidity and enhance the antibody response to influenza vaccination in the elderly, and whether changes in immune response of SMI participants were associated with hypothalamic-pituitary-adrenal (HPA) axis activity. Methods: Forty-three elderly spousal carers of dementia patients and 27 non-carer controls were recruited. Sixteen carers were allocated to an 8-week SMI or a non-intervention condition (n = 27). The non-carers formed a no treatment, ‘normal’ comparison group. At the end of the SMI or its equivalent time period, all participants received an influenza vaccination. IgG antibody titres to the vaccine were measured 0, 2, 4 and 6 weeks post-vaccine. Results: There was evidence of elevated distress in both carer groups compared with non-carer controls throughout the SMI period, but no between-group differences in salivary cortisol. Immune responses to the vaccine revealed that 50% of SMI carers, 7% of non-intervention carers and 29% of non-carer controls produced a four-fold increase in antibody titre. Conclusions: The immune response to influenza vaccination appears amenable to improvement through stress management, although the mechanisms underlying this effect remain unclear.
Depressive Symptoms Lead to Impaired Cellular Immune Response
Authors: Fortes Cristina , Farchi Sara , Forastiere Francesco , Agabiti Nera , Pacifici Roberta , Zuccaro Piergiorgio , Perucci Carlo A. , Ebrahim Shah
Published: August 2003

Background: The association between depression and immune response is not yet clear. The biological mechanisms by which depression alters the immune system is not yet understood. The purpose of this study was to investigate the longitudinal relationship between depressive symptoms and cellular immune response. Methods: A cohort study with a baseline measurement and three annual health assessments was set up in a residential home for elderly people in Rome, Italy. A total of 166 residents aged 65 years and older, mean age 81 years, were interviewed and blood samples were collected at each annual assessment. Percentage changes in lymphocytes and T-cell subsets related to depressive symptoms were estimated over a period of 4 years, using regression models for repeated measurements. Results: Elderly people with seven or more symptoms of depression, according to the Geriatric Depression Scale, had a lower percentage of CD4+DR+ T-cells over 4 years [β = –20.2; 95% confidence interval (CI) = –33.0 to –4.9] and CD8+DR+ T-cells (β = –26.9; 95% CI = –42.5 to –7.0) than elderly with less than seven symptoms of depression, after adjusting for confounding factors (sex, age, marital status, education, smoking habit, nutritional status, chronic diseases, disability and the use of benzodiazepines). Conclusion: The results of this study suggest an adverse effect of depressive symptoms on immune response. It remains to be determined whether these depression-associated immune changes are related to the onset or course of physical illness and the increased mortality observed in depressed old people.
Do Somatic Complaints Predict Subsequent Symptoms of Depression?
Authors: Terre Lisa , Poston Walker S. Carlos , Foreyt John , St. Jeor Sachiko T.
Published: August 2003

Background: Evidence suggests substantial comorbidity between symptoms of somatization and depression in clinical as well as nonclinical populations. However, as most existing research has been retrospective or cross-sectional in design, very little is known about the specific nature of this relationship. In particular, it is unclear whether somatic complaints may heighten the risk for the subsequent development of depressive symptoms. Methods: We report findings on the link between symptoms of somatization (assessed using the SCL-90-R) and depression 5 years later (assessed using the CES-D) in an initially healthy cohort of community adults, based on prospective data from the RENO Diet-Heart Study. Results: Gender-stratified multiple regression analyses revealed that baseline CES-D scores were the best predictors of subsequent depressive symptoms for men and women. Baseline scores on the SCL-90-R somatization subscale significantly predicted subsequent self-reported symptoms of depressed mood 5 years later, but only in women. However, somatic complaints were a somewhat less powerful predictor than income and age. Conclusions: Our findings suggest that somatic complaints may represent one, but not necessarily the most important, risk factor for the subsequent development of depressive symptoms in women in nonclinical populations. The results also highlight the importance of including social variables in studies on women’s depression as well as conducting additional research to further examine predictors of depressive symptoms in men.
The Relationship of Psychological Well-Being to Distress and Personality
Authors: Ruini Chiara , Ottolini Fedra , Rafanelli Chiara , Tossani Eliana , Ryff Carol D. , Fava Giovanni A.
Published: August 2003

Background: The concept of psychological well-being has been neglected for a long time in scientific literature. Over the last decades, however, many psychometric instruments have been developed to measure it. The aim of the present study was to analyze the concept of psychological well-being and its relationship to distress and personality traits. It is clinically and empirically important to establish where the measures of well-being are located in relation to symptomatology indices and personality traits. Methods: A sample of 450 subjects in the general population completed three self-rating scales for the assessment of symptomatology (Kellner’s Symptom Questionnaire), psychological well-being (Ryff’s Psychological Well-Being Scales, PWB), and personality traits (Cloninger’s Tridimensional Personality Questionnaire). The assessment was repeated after 1 month. Pearson’s coefficient was used to analyze PWB test-retest reliability and correlations between well-being, distress and personality indicators. Exploratory factor analysis was performed for both assessments. Results: Test-retest Pearson’s coefficients were satisfactory for all six PWB scales. Exploratory factor analyses showed a 4- or 5-factor structure, where well-being, distress and personality remained separated. PWB scales were negatively and significantly correlated with all symptom scales, but only with one personality dimension, TPQ Harm Avoidance. Mean-level differences by gender showed that in general women significantly presented with lower levels of well-being (except in Positive Relations) and higher levels of distress and personality disturbances. Conclusions: The results suggest that the relationship of well-being to distress and personality is complex. Psychological well-being could not be equated with the absence of symptomatology or with personality traits. PWB scales measure an attitude toward optimal functioning that is crucial for a comprehensive consideration of individuals in clinical settings.
Axes I and II Comorbidity and Treatment Experiences in Eating Disorder Subjects
Authors: Milos Gabriella Franca , Spindler Anja Margareta , Buddeberg Claus , Crameri Aureliano
Published: August 2003

Background: The present study determined the psychiatric comorbidity of Axes I and II in a sample of subjects with eating disorders (EDs). The objective was to investigate associations between comorbidity and current and past treatment. Methods: In a sample of 248 women (77 anorexia nervosa, 137 bulimia nervosa, 34 eating disorders not otherwise specified), psychiatric comorbidity of Axes I and II was determined with the Structured Clinical Interview of DSM-IV. Current and past treatment since ED onset were also assessed. Results: High levels of psychiatric comorbidity were found in the total sample (71% Axis I and 68% Axis II). Only 17% of cases had no psychiatric comorbidity. Anxiety (52%) and affective disorders (50%) were the most common Axis I diagnoses. Personality disorders of Clusters C (52%) and B (23%) were most common for Axis II. Twenty-one percent of participants who were not in treatment at the time had a history of inpatient treatment, and an additional 59% had a history of outpatient treatment. Thirty-eight percent of participants currently in outpatient treatment had a history of inpatient treatment. Participants with multiple comorbidity (Axes I and II) had the highest proportion of cases who had been treated by health professionals. Higher levels of comorbidity were associated with experiences in more intense treatment settings (ranging from no treatment to inpatient treatment). Conclusions: ED subjects with greater comorbidity require more treatment encounters and more intense treatment settings. The association between comorbidity and treatment experiences may represent a bias in the assessment of comorbidity when samples with heterogeneous treatment history are recruited.
Transcranial Magnetic Stimulation in the Reversal of Motor Conversion Disorder
Authors: Schönfeldt-Lecuona Carlos , Connemann Bernhard J. , Spitzer Manfred , Herwig Uwe
Published: August 2003

Background: There is no agreement on the most effective therapy for motor conversion symptoms. Functional electric stimulation has been successfully used to reverse conversion paralysis. We tested the therapeutic potential of high-frequency repetitive transcranial magnetic stimulation (rTMS) in a 20-year-old patient suffering from a conversion paralysis of the right arm. Method: rTMS was applied to the contralateral motor cortex. Stimulations were performed on working days at a frequency of 15 Hz (train length 2 s; inter-train interval 4 s) yielding 4,000 pulses/day. Results: Within 12 weeks, motor function, hyposensibility and muscle bulk were completely restored. Conclusions: The patient recovered completely during rTMS treatment. In addition to possible psychological effects, rTMS may have had a causal therapeutic effect by strengthening corticocortical connections and thereby priming voluntary movements. Further controlled studies are needed.
Evolutionary Developmental Psychology: A New Tool for Better Understanding Human Ontogeny
Authors: Hernàndez Blasi Carlos , Bjorklund David F.
Published: August 2003

Evolutionary developmental psychology (EDP) is described and contrasted with previous (e.g., sociobiology) and other contemporary (e.g., mainstream evolutionary psychology) approaches to applying evolutionary theory to human behavior. We argue that understanding the ‘whys’ of development will help us acquire a better understanding of the ‘hows’ and ‘whats’ of development, and that in addressing the ‘whys’ an EDP perspective has the potential to provide a fuller understanding of human ontogeny. To this end, we propose five ways of applying EDP to contemporary issues of psychological development. These include (1) classifying developmental features according to their evolutionary or functional status, (2) proposing hypotheses and microtheories to explore the function of developmental traits, (3) collecting data from different sources to test developmental evolutionary hypotheses, (4) describing the phylogenetic and sociocultural history of human developmental features and (5) designing ‘evolutionary experiments’. We argue that an EDP approach should not be seen as replacing other, more proximal, explanations of development, but rather that an evolutionary perspective should be incorporated in all accounts of human ontogeny.
Socialization for Competence: Cultural Models of Infancy
Authors: Keller Heidi
Published: August 2003

This paper conceptualizes cultural models about the developmental period of infancy. The models are derived from existing literature and our own research. We are especially focusing on observational studies assessing infants’ parenting experiences (breastfeeding, body contact, body stimulation, object stimulation, face to face contact and attention to positive and negative stimuli) in rural, agrarian Cameroonian Nso and urban German middle-class families. We also report results from video-based ethnographic interviews about parental ethnotheories in these two cultural communities. We propose an apprentice model that is typical for rural agrarian cultural contexts, committed to interdependent socialization goals like harmonious family relationships and obligation to the family system. Stimulation and training, especially of physical growth and motor development are considered as adequate parenting. We propose an equality model of infancy, that is typical for urban middle-class cultural contexts and informed by independent development goals, like an autonomous agency and uniqueness. Communicative exchange between (quasi) equal partners especially in the face-to-face context and object play are considered as the adequate developmental arena. Both models embody different conceptions of competence. They nevertheless coexist to varying degrees in different sociocultural and historical environments.
Add-On Benefit to Coronary Artery Bypass Grafting of Treatment with Ramipril for Major Cardiac Events and Left Ventricular Remodeling in Intermediate-Risk Patients
Authors: Kjøller-Hansen Lars , Thiis Jens J. , Steffensen Rolf , Grande Peer
Published: August 2003

Background: It is not yet settled whether there is an add-on benefit to coronary artery bypass grafting (CABG) of treatment with an angiotensin-converting enzyme (ACE) inhibitor in patients with only moderately impaired left ventricular function and no clinically recognized heart failure. Objective: To assess whether treatment with an ACE inhibitor improves the clinical outcome and left ventricular remodeling after CABG in such intermediate-risk patients. Methods: At a median of 7 days after CABG, 130 patients with a mean left ventricular ejection fraction (LVEF) of 0.42 (SD 0.06), no recent myocardial infarction and no clinically recognized heart failure were randomized to and commenced treatment with ramipril or placebo (target dose 10 mg) and were subsequently followed for a median of 33 months (range 12–46 months). A preoperative and at least one postoperative echocardiogram were obtained in 108 patients. Results: Ramipril reduced the incidence of the triple composite end point of cardiac death, acute myocardial infarction and development of clinical heart failure (relative risk 0.41, 95% confidence interval 0.18–0.97; p = 0.045). Ramipril also had a beneficial effect on the change in left ventricular end-systolic volume index from preoperatively (ramipril group –0.22 ml/m2 and placebo group +4.90 ml/m2, p = 0.036), but did not reduce the incidence of recurrent angina. Multivariate analyses revealed that the beneficial effects with ramipril were independent of baseline variables including the LVEF. Patients who suffered the triple composite end point had a lower health-related quality of life score, dyspnea-fatigue rating and exercise capacity during the study period. Conclusion: These results suggest an add-on benefit of ramipril for major cardiac events and remodeling after CABG in intermediate-risk patients and therefore may justify recommendation of treatment with ramipril after CABG in such patients.
The Influence of Multiple Variables on the Prevalence of Aspirin Prescribing in Patients with Known Coronary Artery Disease
Authors: Avelar Erick , Woods Scott E. , Doerzbacher Meg , Borckardt Sharyn
Published: August 2003

Background and Objective: To determine the prevalence of aspirin prescribing in patients with known coronary artery disease (CAD) at admission and discharge as well as the changes in the prevalence, both as a function of the patients’ status and the specialty of the treating physician. Methods: This was a retrospective chart review. Patients admitted with a diagnosis of CAD during a 1-year period were studied. Data were collected on aspirin prescribing prior to admission, aspirin prescribed at discharge, age, gender, insurance status, physician type, smoking, hypercholesterolemia, hypertension and diabetes. Results: 1,061 charts were reviewed. After adjustment, there was a significantly higher rate of aspirin prescribing prior to admission for male patients [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.01–1.75] and patients with hypercholesterolemia (OR 1.37, 95% CI 1.05–1.78). At hospital discharge, there was no significant difference with respect to any of the eight variables of interest. For all patients, the prescribing of aspirin was significantly higher at discharge than prior to hospital admission (85 vs. 69%, p < 0.05). Conclusion: In the present sample, aspirin use in patients with known CAD was higher at hospital discharge. Our results indicate an improvement in the care of patients with known CAD, but this is still suboptimal considering the evidence of benefit.
Intraoperative Stress Echocardiography
Authors: Jeger Raban V. , Filipovic Miodrag , Buser Peter T. , Seeberger Manfred D.
Published: August 2003

Echocardiography at rest is used to detect both chronic and acute coronary artery disease (CAD). It can also be used to identify mechanical complications of myocardial infarction and provides prognostic information by analyzing systolic and diastolic ventricular function. Segmental wall motion abnormalities (SWMA) are characteristic of scarred or ischemic tissue. Stress testing, e.g. dobutamine stress echocardiography (DSE), is able to detect and assess the severity of CAD. Low-dose DSE detects viable but not contractile myocardium in patients with SWMA at rest, whereas high-dose DSE reveals demand ischemia in patients without SWMA at rest. Perioperatively, echocardiography is usually performed by the transesophageal approach. It is used to monitor high-risk cardiac patients during cardiac and noncardiac surgery, to establish or confirm a cardiovascular pathology in emergency cases, to guide therapy in intraoperative hemodynamic instability and to assess the results of reconstructive cardiac surgery. Intraoperative transesophageal DSE (TEDSE) is a safe and accurate test with a high sensitivity and specificity to detect demand ischemia. It can be used for risk stratification in urgent noncardiac surgery and in patients with an increased risk of cardiac complications. Furthermore, intraoperative TEDSE can guide therapeutic management during and after coronary bypass grafting by the assessment of myocardial viability and coronary flow reserve. Finally, TEDSE can serve as a research tool to evaluate demand ischemia in CAD with a high sensitivity and specificity.
Interim Analyses in Clinical Trials
Authors: Skovlund Eva
Published: August 2003

The main purpose of performing interim analyses in a clinical trial is to stop the trial once a convincing treatment difference can be demonstrated. The major problem with repeated significance tests during inclusion and/or follow-up in a clinical trial is that the more often one analyses accumulating data, the greater the probability of obtaining a statistically significant result even when there is in reality no treatment difference. To allow for repeated testing, one must therefore choose a more stringent nominal significance level as a criterion for stopping the trial. This paper presents two simple strategies for undertaking interim analyses.
Quality of Life in Laryngectomees after Prosthetic Voice Restoration
Authors: Schuster Maria , Lohscheller Jörg , Kummer Peter , Hoppe Ulrich , Eysholdt Ulrich , Rosanowski Frank
Published: August 2003

Background: In oncology, the paradigms for evaluating the results of treatment have shifted over the last few years. Preserving or restoring the quality of life has become an equally important aim of medical treatment as complete excision of the tumor and the duration of patient survival. Following laryngectomy, adequate speech restoration is one major aim of therapy. Different replacement strategies of voice production such as tracheoesophageal speech, esophageal speech, or electrolarynx are in use. The reporting department is able to restore speech in more than 90% of the patients; the majority uses tracheoesophageal speech with Provox® voice prosthesis. The purpose of the study was to assess the quality of life in laryngectomees after successful voice restoration with Provox voice prosthesis. Patients and Methods: In a cross-sectional study 25 laryngectomees whose voice had been restored by tracheoesophageal puncture and Provox voice prosthesis were examined for quality of life. The Short Form 36-Item Health Survey (SF-36) was used as an international and highly standardized test. Results: In comparison with a standardized healthy German male population, the patients showed more limited physical functioning as well as more restricted physical and emotional role functions. However, the laryngectomees did not attain lower scores for bodily pain. According to the patients’ statements their social functioning, vitality, and their mental health were not excessively limited; mental health and vitality were even better than in patients with heart or renal failure and hepatitis C. General health was fairly similar to a standard population. Conclusions: After laryngectomy, patients have deficits in physical and emotional well-being. Concepts of therapy should increasingly focus on how to deal with physical limitations and the patient’s apperception. Successfully restored voice minimizes social, mental and vitality limitations. The SF-36 is a suitable instrument for quality of life assessment in order to define disease-dependent and individual limitations of quality of life in laryngectomees and should lead to individual interventions.
Auswirkungen der Elektrostimulation subkortikaler Hirnstrukturen auf das glottale Schwingungsverhalten bei Patienten mit Morbus Parkinson und multipler Sklerose
Authors: Pützer Manfred , Barry William J. , Moringlane Jean Richard , Fuss Gerhard , Spiegel Jörg , Dillmann Ulrich , Sittinger Helmut
Published: August 2003

Die vorliegenden Studie hat die Auswirkungen neurostimulatorischer Eingriffe auf die glottale Phonation bei 3 Patienten mit Morbus Parkinson und 3 Patienten mit multipler Sklerose zum Gegenstand. Unter Verwendung zweier Stimmanalyseprogramme (MDVP von Kay Elemetrics und EGG-Programm von Marasek) mit akustischer bzw. elektrophysiologischer Untersuchungsausrichtung wurden Vokalproduktionen der Patienten analysiert, die unter Stimulation bzw. Nichtstimulation aufgezeichnet wurden. In einem ersten Schritt können durch signifikant unterschiedliche Mittelwerte der Analyseparameter die intrasubjektiven Stimulationsauswirkungen nachgewiesen werden. Sie sind in verschiedener Ausprägung vor allem bei den Patienten mit M. Parkinson vorhanden. In einem zweiten Schritt erfolgt der geschlechtsgebundene Vergleich der individuellen Patientendaten unter den Bedingungen der Stimulation bzw. Nichtstimulation mit den Referenzdaten einer umfangreichen Kontrollgruppe stimmgesunder erwachsener Personen (150 männliche und 150 weibliche). Diese intersubjektiv referentielle Bewertung erweist sich im Vergleich zur intrasubjektiven Betrachtung auf Grund unterschiedlicher Ergebnisse bei den meisten Patienten als sinnvoll. Die pathologiebezogenen Tendenzen unter Stimulationseinwirkung bestehen bei den Personen mit M. Parkinson in einer relativen Verschlechterung des glottalen Schwingungsablaufs, während bei den Personen mit multipler Sklerose eine hyperfunktionelle Komponente bei der Phonation deutlich wird, auf Grund derer eine longitudinale Betrachtung des Phonationsverhaltens nach Elektrodenimplantation unter chronischer Stimulation für notwendig erachtet werden kann.
Bifurcations and Chaos in the Cries of Full-Term and Preterm Infants
Authors: Robb Michael P.
Published: August 2003

Pain-induced crying episodes were collected from groups of full-term and preterm infants and analyzed acoustically for the relative occurrence of various dysphonation segments. The crying episodes of full-term infants were found to contain a greater number of bifurcation and aperiodic segments compared to preterm infants. The results suggest that bifurcation and aperiodic segments are normally occurring phonatory events during infant crying. The differences observed between infant groups are discussed in regard to neuromaturational differences in infants’ expression to a painful stimulus.
Characteristics of Diadochokinesis in Multiple Sclerosis and Parkinson’s Disease
Authors: Tjaden Kris , Watling Elizabeth
Published: August 2003

Diadochokinesis (DDK) for speakers with dysarthria has been described using a variety of acoustic measures. A clinical protocol for the objective assessment of DDK requires a unified approach, however, to facilitate implementation across clinics and laboratories. A protocol for the acoustic analysis of DDK that incorporates temporal and energy measures has been used to describe DDK characteristics for dysarthria secondary to stroke as well as ataxic dysarthria. The current study sought to validate and extend the protocol to a new set of etiological groups, including dysarthria secondary to multiple sclerosis (MS) and Parkinson’s disease (PD). The results suggest that temporal measures are more useful than energy measures for distinguishing among dysarthria secondary to MS, dysarthria secondary to PD, and healthy controls. The results also highlight the value of including both alternating and sequential motion rate tasks in the assessment of DDK and of supplementing quantitative measures with qualitative spectrographic observations.
Changes in Teachers’ Voice Quality during a Working Day with and without Electric Sound Amplification
Authors: Jónsdottir Valdis , Laukkanen Anne-Maria , Siikki Ilona
Published: August 2003

The present study investigated changes in the voice quality of teachers during a working day (a) in ordinary conditions and (b) when using electrical sound amplification while teaching. Classroom speech of 5 teachers was recorded with a portable DAT recorder and a head-mounted microphone during the first and the last lesson of a hard working day first in ordinary conditions and the following week using amplification. Long-term average spectrum and sound pressure level (SPL) analyses were made. The subjects’ comments were gathered by questionnaire. Voice quality was evaluated by 2 speech trainers. With amplification, SPL was lower and the spectrum more tilted. Voice quality was evaluated to be better. The subjects reported less fatigue in the vocal mechanism. Spectral tilt decreased and SPL increased during the day. There was a tendency for perceived asthenia to decrease. No significant changes were observed in ordinary conditions. The acoustic changes seem to reflect a positive adaptation to vocal loading. Their absence may be a sign of vocal fatigue.
A Life Course Approach to Assessing Causes of Dental Caries Experience: The Relationship between Biological, Behavioural, Socio-Economic and Psychological Conditions and Caries in Adolescents
Authors: Nicolau B. , Marcenes W. , Bartley M. , Sheiham A.
Published: August 2003

The objective of this study was to further elucidate the relationship between relevant biological, behavioural, socio-economic and psychological conditions, experienced in very early life and along the life course, and dental caries experience using the life course approach. A two-phase study was carried out in Brazil. In the first phase, 652 13-year-olds were clinically examined and interviewed. In the second phase, 330 families were randomly selected for interview to collect information on the teenagers’ early years of life. Clinical assessment included dental caries, periodontal and traumatic dental injury status. The data analysis involved multiple logistic regression analysis. Adolescents born in a non-brick house, those with a low birth weight and those who were the second or later child in the family were statistically significantly more likely to have a high DMF-T. In conclusion, the results of this study show that there is an association between socio-economic and biological factors in very early life and levels of caries in adolescents.
Socio-Demographic Features and Fluoride Technologies Contributing to Higher Fluorosis Scores in Permanent Teeth of Canadian Children
Authors: Maupomé G. , Shulman J.D. , Clark D.C. , Levy S.M.
Published: August 2003

Objective: To examine levels of fluorosis among children in two Canadian communities exposed to flouride. Background: One community had discontinued flouride, the other had maintained it. Water supplies, however, were fluoridated for all the children when their esthetically important teeth were mineralized. Methods: We examined 8,277 children to assess Thystrup-Fejerskov Index (TFI) scores. Multivariate Poisson regression models were used to identify the relationship between TFI and water fluoride status, age, gender, SES, and dietary and fluoride exposure histories (supplements, rinses, toothpaste amount, tooth brushing frequency, and tooth brushing starting age). Parent(s) completed questionnaires. Results: Overall, levels of fluorosis were low to mild, with residents of the fluoridation-ended communities having marginally higher TFI scores than those of the still-fluoridated community. Females had higher TFI scores than males. Children aged 10 years or more had higher TFI scores than younger children. Consuming bottled water between birth and 6 months of age was protective. Exposure to fluoridation technologies was consistently associated with fluorosis experience. Children who began brushing with fluoride toothpaste between their first and second birthdays had higher TFI scores than those who began between their second and third birthdays, regardless of daily brushing frequency. Children who regularly used supplements had higher TFI scores than those who did not. Children with a college-educated father had higher TFI scores than those whose fathers had less education. Conclusions: Higher fluoride exposure slightly increased the likelihood that a child had a higher TFI score, especially when more fluoridation technologies were used at home.
Seasonal Variation of Fluoride Intake by Children in a Subtropical Region
Authors: Lima Y.B.O. , Cury J.A.
Published: August 2003

Since the optimum fluoride concentration in drinking water established for temperate countries has been considered not to be appropriate for tropical and subtropical climates, this study was conducted in Piracicaba, a subtropical, optimally fluoridated Brazilian community. The daily fluoride intake by 23 children (aged 20–30 months) from diet (liquids and solids) during the four seasons of the year was evaluated. Duplicate-plate samples of foods and beverages were collected for 2 days in each season of the year. The difference of fluoride intake during the 4 seasons was not statistically significant (p > 0.05). However, the adjusted data, based on the volume of the diet collected and on the assumption of a constant fluoride concentration in the drinking water, showed that fluoride intake during spring-summer was statistically higher than that observed during the fall-winter seasons (p < 0.05). The fluoride dose to which the children were submitted during the hot seasons would be 19% higher than that found during the cold ones. Although this dose difference would not to be a concern for a subtropical area, it could be relevant for a region with a genuine tropical climate.
Caries Progression and Inhibition in Human and Bovine Root Dentine in situ
Authors: Hara A.T. , Queiroz C.S. , Paes Leme A.F. , Serra M.C. , Cury J.A.
Published: August 2003

Since the use of bovine instead of human dentine to evaluate cariogenic and anticariogenic substances is not well established, this in situ study was conducted. Eleven volunteers wore palatal acrylic devices containing 4 dentine slabs (2 human and 2 bovine). Sucrose solution (20%) was dripped over all slabs 4 times a day, simulating a cariogenic challenge. Dentifrice slurries, fluoridated or not, were dripped over specified dentine slabs 3 times a day to evaluate caries reduction. After 14 days, the biofilm formed on the dentine slabs was collected for microbiological analysis. In dentine, mineral loss (ΔZ) and lesion depth (LD) were determined by cross-sectional microhardness and by polarized light microscopy, respectively. The total streptococci and mutans streptococci counts in the biofilm formed either on human or on bovine slabs, whether treated or not with fluoride dentifrice, were not statistically different. The ΔZ and the LD values of dentine treated with fluoride dentifrice were significantly lower than the values of dentine treated with non-fluoride dentifrice. The differences in the ΔZ and LD values between the human and bovine dentine were not statistically significant. The results suggest that bovine dentine can be used instead of human to evaluate caries development and inhibition.
Microbial Ingrowth Around Single- and Multi-Component Adhesives Studied in vitro
Authors: Preussker S. , Klimm W. , Pöschmann M. , Koch R.
Published: August 2003

The aim of this study was to compare the in vitro microbial leakage in 4 micro-hybrid composites in combination with 4 single-component dental adhesives (Scotchbond 1/Z100 MP = group 1; Syntac Single-Component/Tetric Flow = group 3; OptiBond Solo/XRV Herculite = group 5; Solobond M/Arabesk Top = group 7) and 4 multi-component dental adhesives (Scotchbond Multi-Purpose/Z100 MP = group 2; Syntac/Tetric Flow = group 4; OptiBond FL/XRV Herculite = group 6; Solobond Plus/Arabesk Top = group 8). Ninety-four mixed standardized Class V cavities of human caries-free extracted premolars were filled with eight different composite adhesive systems using a one-layer (groups 1–4) or a two-layer technique (groups 5–8). After thermocycling and incubation in a broth culture of Streptococcus mutans and Lactobacillus acidophilus, followed by decalcification and staining, the extent and the type of microbial leakage were measured histologically. The extent of microbial leakage in the composite restorations was very low in all groups and there were no significant differences between adhesives. Z100 MP in combination with single- and multi-component adhesives showed a significantly higher microbial leakage than Tetric Flow systems (U test: p = 0.037). XRV Herculite adhesive systems showed significantly less extensive microbial leakage than Arabesk Top adhesive systems (U test: p < 0.001). The single-component dental adhesives achieved a marginal adaptation of composites comparable to that of multi-component adhesives in vitro.
Terahertz Pulse Imaging: A Pilot Study of Potential Applications in Dentistry
Authors: Crawley David A. , Longbottom Christopher , Cole Bryan E. , Ciesla Craig M. , Arnone Don , Wallace Vincent P. , Pepper Michael
Published: August 2003

The improvement in the detection of caries offers the possibility for dramatic improvement in dental healthcare. Current caries detection rates suggest that there may be scope for improvement. This paper describes a preliminary study to examine applications of terahertz pulse imaging (TPI) to caries detection. We present results for the detection of early stage caries in the occlusal enamel layer of a range of human tooth cross sections using TPI. Higher attenuation of terahertz radiation was observed in carious enamel as compared with healthy enamel. Hypomineralised enamel had different absorption spectra and contrast compared to carious enamel in TPI images. These results have important implications for extending TPI to other medical imaging applications where both early diagnosis and safety issues are important.