bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuropsychological functioning in first-episode schizophrenia
Authors: Kravariti Eugenia , Morgan Kevin , Fearon Paul , Zanelli Jolanta W. , Lappin Julia M. , Dazzan Paola , Morgan Craig , Doody Gillian A. , Harrison Glynn , Jones Peter B. , Murray Robin M. , Reichenberg Abraham
Published: September 2009

Background

Identifying neurocognitive subtypes in schizophrenia may help establish neurobiologically meaningful subtypes of the disorder, but is frequently confounded by differences in intellectual function between individuals with schizophrenia and controls.

Aims

To examine neuropsychological performance in individuals with epidemiologically based, first-onset schizophrenia and intellectually matched controls.

Method

Using standard IQ and reading tests, we examined the proportions of 101 people with epidemiologically derived, first-onset schizophrenia/schizoaffective disorder and 317 community controls, falling into three a priori defined intellectual categories: ‘stable good’, ‘deteriorated poor’ and ‘stable poor’. Neuropsychological function was compared between intellectually matched participants with schizophrenia and control subgroups.

Results

Multiple deficits in executive function, processing speed and verbal memory, but not visual/spatial perception/memory, were detected in all participant groups with schizophrenia compared with controls. The average effect size across the affected domains ranged from small to medium to large in the stable good, deteriorated poor and stable poor subgroups of participants with schizophrenia, respectively.

Conclusions

Compared with intellectually matched controls, people with epidemiologically derived, first-onset schizophrenia/schizoaffective disorder show multiple deficits in executive function, processing speed and verbal memory.
Long-term effectiveness of a parenting intervention for children at risk of developing conduct disorder
Authors: Bywater Tracey , Hutchings Judy , Daley David , Whitaker Chris , Yeo Seow Tien , Jones Karen , Eames Catrin , Edwards Rhiannon Tudor
Published: September 2009

Background

The typical pattern for intervention outcome studies for conduct problems has been for effect sizes to dissipate over time with decreasing effects across subsequent follow-ups.

Aims

To establish whether the short-term positive effects of a parenting programme are sustained longer term. To observe trends, and costs, in health and social service use after intervention.

Method

Parents with children aged 36–59 months at risk of developing conduct disorder (n = 104) received intervention between baseline and first follow-up (6 months after baseline n = 86) in 11 Sure Start areas in North Wales. Follow-ups two (n = 82) and three (n = 79) occurred 12 and 18 months after baseline. Child problem behaviour and parenting skills were assessed via parent self-report and direct observation in the home.

Results

The significant parent-reported improvements in primary measures of child behaviour, parent behaviour, parental stress and depression gained at follow-up one were maintained to follow-up three, as were improved observed child and parent behaviours. Overall, 63% of children made a minimum significant change (0.3 standard deviations) on the Eyberg Child Behavior Inventory problem scale between baseline and follow-up (using intention-to-treat data), 54% made a large change (0.8 standard deviations) and 39% made a very large change (1.5 standard deviations). Child contact with health and social services had reduced at follow-up three.

Conclusions

Early parent-based intervention reduced child antisocial behaviour and benefits were maintained, with reduced reliance on health and social service provision, over time.
Cost-effectiveness of a primary care model for anxiety disorders
Authors: König Hans-Helmut , Born Anja , Heider Dirk , Matschinger Herbert , Heinrich Sven , Riedel-Heller Steffi G. , Surall Daniel , Angermeyer Matthias C. , Roick Christiane
Published: September 2009

Background

Individuals with anxiety disorders often do not receive an accurate diagnosis or adequate treatment in primary care.

Aims

To analyse the cost-effectiveness of an optimised care model for people with anxiety disorders in primary care.

Method

In a cluster randomised controlled trial, 46 primary care practices with 389 individuals positively screened with anxiety were randomised to intervention (23 practices, 201 participants) or usual care (23 practices, 188 participants). Physicians in the intervention group received training on diagnosis and treatment of anxiety disorders combined with the offer of a psychiatric consultation–liaison service for 6 months. Anxiety, depression, quality of life, service utilisation and costs were assessed at baseline, 6-month and 9-month follow-up.

Results

Results

No significant differences were observed between intervention and control group on the Beck Anxiety Inventory, Beck Depression Inventory and EQ–5D during follow-up. Total costs were higher in the intervention group (€4911v.€3453,P= 0.09). The probability of an incremental cost-effectiveness ratio <€50 000 per quality-adjusted life year was below 10%.

Conclusions

The optimised care model did not prove to be cost-effective.
Psychiatric disorders and other health dimensions among Holocaust survivors 6 decades later
Authors: Sharon Asaf , Levav Itzhak , Brodsky Jenny , Shemesh Annarosa Anat , Kohn Robert
Published: September 2009

Background

No previous community-based epidemiological study has explored psychiatric disorders among those who survived the Holocaust.

Aims

To examine anxiety and depressive disorders, sleep disturbances, other health problems and use of services among individuals exposed and unexposed to the Holocaust.

Method

The relevant population samples were part of the Israel World Mental Health Survey. The interview schedule included the Composite International Diagnostic Interview and other health-related items.

Results

The Holocaust survivor group had higher lifetime (16.1%; OR = 6.8, 95% CI 1.9–24.2) and 12-month (6.9%; OR = 22.5, 95% CI 2.5–204.8) prevalence rates of anxiety disorders, and more current sleep disturbances (62.4%; OR = 2.5, 95% CI 1.4–4.4) and emotional distress (P<0.001) than their counterparts, but did not have higher rates of depressive disorders or post-traumatic stress disorder.

Conclusions

Early severe adversity was associated with psychopathological disorder long after the end of the Second World War, but not in all survivors. Age during the Holocaust did not modify the results.
Structure of genetic and environmental risk factors for dimensional representations of DSM–IV anxiety disorders
Authors: Tambs Kristian , Czajkowsky Nikolai , R⊘ysamb Espen , Neale Michael C. , Reichborn-Kjennerud Ted , Aggen Steven H. , Harris Jennifer R. , ⊘rstavik Ragnhild E. , Kendler Kenneth S.
Published: September 2009

Background

Twin data permit decomposition of comorbidity into genetically and environmentally derived correlations. No previous twin study includes all major forms of anxiety disorder.

Aims

To estimate the degree to which genetic and environmental risk factors are shared rather than unique to dimensionally scored panic disorder, generalised anxiety disorder, phobias, obsessive–compulsive disorder and post-traumatic stress disorder.

Method

Data obtained from 2801 young-adult Norwegian twins by means of the Composite International Diagnostic Interview were analysed with the Mx program.

Results

A multivariate common factor model fitted best. The latent liability to all anxiety disorders was substantially more heritable (54%) than the individual disorders (23% to 40%). Most of the genetic effect was common to the disorders. Genes contributed just over 50% to the covariance between liabilities.

Conclusions

The five anxiety disorders all share genetic and environmental risk factors. This has implications for the revision of the anxiety disorder section in DSM–V.
Confectionery consumption in childhood and adult violence
Authors: Moore Simon C. , Carter Lisa M. , van Goozen Stephanie H. M.
Published: September 2009

Diet has been associated with behavioural problems, including aggression, but the long-term effects of childhood diet on adult violence have not been studied. We tested the hypothesis that excessive consumption of confectionery at age 10 years predicts convictions for violence in adulthood (age 34 years). Data from age 5, 10 and 34 years were used. Children who ate confectionery daily at age 10 years were significantly more likely to have been convicted for violence at age 34 years, a relationship that was robust when controlling for ecological and individual factors.
Implementation science: understanding the translation of evidence into practice
Authors: Tansella Michele , Thornicroft Graham
Published: September 2009

This editorial summarises what is known about accelerating the transfer of discoveries in the health sciences into implementation in routine clinical practice. Three phases are described: adoption in principle, early implementation, and persistence of implementation. Facilitators and barriers to the implementation across these phases are discussed.
Invited commentary on … Mental health research priorities in low- and middle-income countries
Authors: Araya Ricardo
Published: September 2009

There are huge inequalities in health research within and between countries. It is argued that this may hinder the process of setting and tackling mental health priorities. If this were true, establishing research priorities would be important. However, this is not a simple process and one must be aware of its limitations. Despite a plethora of declarations, funding for mental health research in low- and middle-income countries remains hard to find. In the absence of funding, establishing research priorities is seen by many as an exercise of lesser importance.
Do we know the legal framework in child and adolescent mental health services? Survey of specialist registrars
Authors: Khan Faeza , Khan Faria , Hackett Latha , Ross Kenneth
Published: September 2009

Aims and Method

This survey was conducted as part of the baseline assessment of trainees' needs concerning the legal aspects of child care and to evaluate the implications for the regional academic programme. A group of specialist registrars in child and adolescent psychiatry in the North Western Deanery completed a questionnaire-based survey.

Results

None of the specialist registrars had experience in forensic child and adolescent psychiatry. With regard to the legislation: 13 (100%) mentioned the Mental Health Act 1983; 12 (92.3%) the Children Act 1989; 7 (53.8%) the Human Rights Act 1998. of those surveyed, 13 (100%) were aware of parental responsibility; 10 (76.9%) identified the Children Act as being less stigmatising as compared to the Mental Health Act. Five (38.4%) had written court reports, and eight (61.5%) felt fairly confident after the 1-day training course. Overall interest in becoming an expert witness was 69.2% (n=9).

Clinical Implications

Deficits in knowledge about the legal framework, limited experience in forensic placements and lack of interest in becoming an expert witness need to be further explored.
Outcomes of information provision to callers to a psychiatric medication helpline
Authors: Olofinjana Olubanke , Connolly Anne , Taylor David
Published: September 2009

Aims and Method

To examine outcomes of information received by callers to a psychiatric medication helpline. A questionnaire was completed over the telephone with 123 callers, asking about the reason for contacting the helpline, frequency of self-referral to a healthcare professional, action taken as a result of information received, and satisfaction with the service and quality of information received.

Results

Almost half of callers reported changes to their medication (stopping, starting, switching or dose adjustment) after consulting the helpline, with the majority receiving reassurance, referral, review and monitoring. Over half contacted a healthcare professional afterwards. Satisfaction with the quality of information and service provided by the helpline was very high.

Clinical Implications

Information provided by a psychiatric medication helpline can result in changes to caller's treatment and increase contact with other healthcare professionals.
Quality standards for community mental health teams
Authors: Laugharne Richard , Shankar Rohit
Published: September 2009

There is an increasing requirement for mental health services to demonstrate the quality of care provided. We have developed a quality report of our local community mental health team in Cornwall and suggest quality measures that we believe are useful to patients and clinicians, and possible to implement without overwhelming busy team members. They include measures of satisfaction, accessibility, safe process and review, outcomes, evidence-based practice and staff performance. Different teams may need different standards but we hope this paper will stimulate discussion and debate.
Recruiting psychiatrists – a Sisyphean task?
Authors: Brown Nick , Vassilas Christopher A. , Oakley Clare
Published: September 2009

In 2009, the Royal College of Psychiatrists piloted a system for national recruitment to the first year of training (CT1) in England. This paper reviews the changes in recruitment of UK medical graduates to psychiatry over the past 20 years, both within the West Midlands and nationally. Fewer UK graduates are entering psychiatric training in the West Midlands despite the introduction of pre-registration training in psychiatry and the expansion of medical schools in the region; this picture is reflected nationally. Reasons for the continuing problems in recruitment are discussed and suggestions made for improving the attractiveness of psychiatry as a medical specialty. the latter include: engaging more closely with medical students, continuing to lobby politically with regard to overseas recruitment and presenting a unified vision of the profession.
Body Composition and Bone Mineral Density in Children with Premature Adrenarche and the Association of LRP5 Gene Polymorphisms with Bone Mineral Density
Authors: Utriainen Pauliina , Jääskeläinen Jarmo , Saarinen Anne , Vanninen Esko , Mäkitie Outi , Voutilainen Raimo
Published: September 2009

Context: Precocious increase in adrenal androgen production is the hallmark of premature adrenarche (PA). Adrenal androgens have anabolic properties.

Objective: The objective of the study was to test whether body composition and bone mineral density (BMD) are altered in PA and study whether genetic variation in low-density lipoprotein receptor-related protein 5 (LRP5) affects BMD in PA.

Design: This was a cross-sectional study.

Setting: The study was conducted at a university hospital.

Subjects and Measures: The study included 126 prepubertal children (64 with PA, 10 boys; 62 non-PA controls, 10 boys). Femoral neck and lumbar spine areal and calculated volumetric BMD (dual energy X-ray absorptiometry), body composition (bioimpedance), serum 25-hydroxyvitamin D, and markers of bone turnover and calcium homeostasis were compared between the PA and control groups. Single-nucleotide polymorphisms of LRP5 were determined and associated with BMD.

Results: Children with PA had higher femoral neck and lumbar spine BMDareal than the controls (Z-score 0.56 vs. −0.09, P < 0.001, and 0.20 vs. −0.31, P = 0.009, respectively). However, the mean BMDs did not differ significantly between the groups when adjusted for height or bone size. BMDareal correlated strongly with height sd score in both groups. Among the PA children, LRP5 single-nucleotide polymorphism E644E minor variant was associated with lower and F549F minor variant with higher BMD. Total body fat mass, fat percent, serum PTH, and alkaline phosphatase concentrations were higher and 25-hydroxyvitamin D lower in the PA group.

Conclusions: Prepubertal children with PA had higher BMDareal compared with healthy controls. This was mainly explained by their increased height. LRP5 polymorphisms may contribute to bone mass accrual in prepubertal PA children.

Children with premature adrenarche have increased areal bone mineral density determined by their enhanced growth in height.
Genetic evidence that the higher plant Rab-D1 and Rab-D2 GTPases exhibit distinct but overlapping interactions in the early secretory pathway
Authors: Pinheiro Hazel , Samalova Marketa , Geldner Niko , Chory Joanne , Martinez Alberto , Moore Ian
Published: September 2009

GTPases of the Rab1 subclass are essential for membrane traffic between the endoplasmic reticulum (ER) and Golgi complex in animals, fungi and plants. Rab1-related proteins in higher plants are unusual because sequence comparisons divide them into two putative subclasses, Rab-D1 and Rab-D2, that are conserved in monocots and dicots. We tested the hypothesis that the Rab-D1 and Rab-D2 proteins of Arabidopsis represent functionally distinct groups. RAB-D1 and RAB-D2a each targeted fluorescent proteins to the same punctate structures associated with the Golgi stacks and trans-Golgi-network. Dominant-inhibitory N121I mutants of each protein inhibited traffic of diverse cargo proteins at the ER but they appeared to act via distinct biochemical pathways as biosynthetic traffic in cells expressing either of the N121I mutants could be restored by coexpressing the wild-type form of the same subclass but not the other subclass. The same interaction was observed in transgenic seedlings expressing RAB-D1 [N121I]. Insertional mutants confirmed that the three Arabidopsis Rab-D2 genes were extensively redundant and collectively performed an essential function that could not be provided by RAB-D1, which was non-essential. However, plants lacking RAB-D1, RAB-D2b and RAB-D2c were short and bushy with low fertility, indicating that the Rab-D1 and Rab-D2 subclasses have overlapping functions.
Kinase-activity-independent functions of atypical protein kinase C inDrosophila
Authors: Kim Soya , Gailite Ieva , Moussian Bernard , Luschnig Stefan , Goette Maik , Fricke Karen , Honemann-Capito Mona , Grubmüller Helmut , Wodarz Andreas
Published: September 2009

Polarity of many cell types is controlled by a protein complex consisting of Bazooka/PAR-3 (Baz), PAR-6 and atypical protein kinase C (aPKC). In Drosophila, the Baz–PAR-6–aPKC complex is required for the control of cell polarity in the follicular epithelium, in ectodermal epithelia and neuroblasts. aPKC is the main signaling component of this complex that functions by phosphorylating downstream targets, while the PDZ domain proteins Baz and PAR-6 control the subcellular localization and kinase activity of aPKC. We compared the mutant phenotypes of an aPKC null allele with those of four novel aPKC alleles harboring point mutations that abolish the kinase activity or the binding of aPKC to PAR-6. We show that these point alleles retain full functionality in the control of follicle cell polarity, but produce strong loss-of-function phenotypes in embryonic epithelia and neuroblasts. Our data, combined with molecular dynamics simulations, show that the kinase activity of aPKC and its ability to bind PAR-6 are only required for a subset of its functions during development, revealing tissue-specific differences in the way that aPKC controls cell polarity.
Centrosomal localization of Diversin and its relevance to Wnt signaling
Authors: Itoh Keiji , Jenny Andreas , Mlodzik Marek , Sokol Sergei Y.
Published: September 2009

Wnt pathways regulate many developmental processes, including cell-fate specification, cell polarity, and cell movements during morphogenesis. The subcellular distribution of pathway mediators in specific cellular compartments might be crucial for the selection of pathway targets and signaling specificity. We find that the ankyrin-repeat protein Diversin, which functions in different Wnt signaling branches, localizes to the centrosome in Xenopus ectoderm and mammalian cells. Upon stimulation with Wnt ligands, the centrosomal distribution of Diversin is transformed into punctate cortical localization. Also, Diversin was recruited by Frizzled receptors to non-homogeneous Dishevelled-containing cortical patches. Importantly, Diversin deletion constructs, which did not localize to the centrosome, failed to efficiently antagonize Wnt signaling. Furthermore, a C-terminal construct that interfered with Diversin localization inhibited Diversin-mediated β-catenin degradation. These observations suggest that the centrosomal localization of Diversin is crucial for its function in Wnt signaling.
Finding events of electrocardiogram and arterial blood pressure signals via discrete wavelet transform with modified scales
Authors: Ghaffari A , Homaeinezhad M R , Akraminia M , Davaeeha M
Published: September 2009

A robust electrocardiogram (ECG) wave detection-delineation algorithm that can be applied to all ECG leads is developed in this study on the basis of discrete wavelet transform (DWT). By applying a new simple approach to a selected scale obtained from DWT, this method is capable of detecting the QRS complex, P-wave, and T-wave as well as determining parameters such as start time, end time, and wave sign (upward or downward). In the proposed method, the selected scale is processed by a sliding rectangular window of length n and the curve length in each window is multiplied by the area under the absolute value of the curve. In the next step, an adaptive thresholding criterion is conducted on the resulted signal. The presented algorithm is applied to various databases including the MIT-BIH arrhythmia database, European ST-T database, QT database, CinC Challenge 2008 database as well as high-resolution Holter data gathered in the DAY Hospital. As a result, the average values of sensitivity and positive prediction Se = 99.84 per cent and P+ = 99.80 per cent were obtained for the detection of QRS complexes with an average maximum delineation error of 13.7, 11.3, and 14.0 ms for the P-wave, QRS complex, and T-wave respectively. The presented algorithm has considerable capability in cases of a low signal-to-noise ratio, high baseline wander, and in cases where QRS complexes and T-waves appear with abnormal morphologies. Especially, the high capability of the algorithm in the detection of the critical points of the ECG signal, i.e. the beginning and end of the T-wave and the end of the QRS complex was validated by the cardiologist and the maximum values of 16.4 and 15.9 ms were recognized as absolute offset error of localization respectively. Finally, in order to illustrate an alternative capability of the algorithm, it is applied to all 18 subjects of the MIT-BIH polysomnographic database and the end-systolic and end-diastolic points of the blood pressure waveform were extracted and values of sensitivity and positive prediction Se = 99.80 per cent and P+ = 99.86 per cent were obtained for the detection of end-systolic, end-diastolic pulses.
Nanomechanical properties and microtribological behaviours of human tooth enamel
Authors: Zheng J , Huang Y , Qian L M , Zhou Z R
Published: September 2009

Nanomechanical properties and microtribological behaviours of human tooth enamel have been investigated using the nanoindentation and nanoscratch techniques. Nanoscratch tests were conducted along different directions in the occlusal and axial sections of enamel under different normal loads. The results showed that for a single enamel rod, the hardness and Young's modulus were higher in the central head area and tended to be lower in the edge area, especially in the tail area. In the occlusal section, the enamel presented higher wear resistance at low loads owing to the compact alternate arrangement of mineral and organic phases within the enamel and the heterogeneous mechanical properties of enamel rods. No obvious material removal occurred, and the surface lesion of enamel was characterized mainly by plastic deformation. As the load increased, significant material removal occurred as a result of brittle delamination, and the coefficient of friction increased and fluctuated. The wear resistance of the axial section was inferior to that of the occlusal section, and moreover, the enamel demonstrated anisotropic microtribological properties in the axial section. Both the friction coefficient and wear loss were higher when the scratches were conducted along the direction of enamel rods.
Evaluation of Seismic Damage of Multi-Storey RC Frames with Damage-Based Inelastic Spectra
Authors: Wei Jianwu , Lu Yong
Published: September 2009

In the context of performance-based design, structural damage as a comprehensive measure of the seismic demand against the available capacity may be used as an effective performance indicator. Accurate methods of damage estimation usually require sophisticated dynamic response analysis and yet they do not necessarily yield the best results due to the great uncertainties involved in the seismic input. A simple and rational method based on well-constructed response spectra could be more desirable, especially in a design environment. In this paper, a methodology is developed to estimate the seismic damage of multi-storey reinforced concrete (RC) frames in terms of both the overall (global) damage and the damage distribution. The multi-storey frame is first transformed into an equivalent SDOF system, so that the damage in the equivalent SDOF system can be found from the damage-based inelastic spectra for a specified seismic intensity. Numerical investigation on a series of generic frames under a selection of real ground motions indicates that the SDOF damage and the overall damage of the actual frame correlates in a consistent manner, thus the conversion from the established SDOF damage back to the overall frame damage is rather straightforward. Two alternative methods are proposed for the prediction of the distribution of damage along the frame height, one using the modal pushover analysis, and the other based on the structural characterization using a storey capacity factor.
Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle procedures
Authors: Ibrahim S. A. R. , Hamido F. , Al Misfer A. K. , Mahgoob A. , Ghafar S. A. , Alhran H.
Published: September 2009

A total of 218 patients with unilateral anterior cruciate ligament deficiency were randomly assigned to one of four groups. In group A an anatomical double bundle anterior cruciate ligament reconstruction was performed; group B were treated by a single bundle using an Endobutton for femoral fixation; in group C by a single bundle using RigidFix cross pins for femoral fixation; and in group D by a single bundle using a bioabsorbable TransFix II screw for femoral fixation. For tibial fixation a bioabsorbable Intrafix interference screw was used for all the groups and the graft was fashioned from the semitendinosus and gracilis tendons in all patients. In all, 18 patients were lost to follow-up. The remaining 200 were subjected to a clinical evaluation, with assessment of the anterior drawer, Lachman’s and the pivot-shift tests, and KT-1000 arthrometer measurement. They also completed the International Knee Documentation Committee, Lysholm knee and Tegner activity scores.

At a mean of 29 months (25 to 38) follow-up there were no significant differences concerning time between injury and range of movement and Lysholm knee scores among the four groups. However, the double bundle method showed significantly better results for the pivot-shift test (p = 0.002). The KT 1000 measurements showed a mean difference between the reconstructed knee and the patients’ normal knee of 1.4 mm in the double bundle group and 2.4 mm in the single bundle group; which was statistically significant. The Lachman and anterior drawer tests also showed superior results for the double bundle method. The International Knee Documentation Committee scale showed no significant difference among the groups (p < 0.001).

On clinical evaluation the double bundle group showed less laxity than the single bundle groups. However, regardless of the technique, all knees were improved by anterior cruciate ligament reconstruction compared with their pre-operative status.
Imageless computer navigation without pre-operative templating may lead to malpreparation of the femoral head in hip resurfacing
Authors: Olsen M. , Davis E. T. , Chiu M. , Gamble P. , Tumia N. , Boyle R. A. , Schemitsch E. H.
Published: September 2009

The computed neck-shaft angle and the size of the femoral component were recorded in 100 consecutive hip resurfacings using imageless computer-navigation and compared with the angle measured before operation and with actual component implanted. The reliability of the registration was further analysed using ten cadaver femora. The mean absolute difference between the measured and navigated neck-shaft angle was 16.3° (0° to 52°). Navigation underestimated the measured neck-shaft angle in 38 patients and the correct implant size in 11. Registration of the cadaver femora tended to overestimate the correct implant size and provided a low level of repeatability in computing the neck-shaft angle.

Prudent pre-operative planning is advisable for use in conjunction with imageless navigation since misleading information may be registered intraoperatively, which could lead to inappropriate sizing and positioning of the femoral component in hip resurfacing.
A prospective, cohort study comparing translaminar screw fixation with transforaminal lumbar interbody fusion and pedicle screw fixation for fusion of the degenerative lumbar spine
Authors: Grob D. , Bartanusz V. , Jeszenszky D. , Kleinstück F. S. , Lattig F. , O’Riordan D. , Mannion A. F.
Published: September 2009

In a prospective observational study we compared the two-year outcome of lumbar fusion by a simple technique using translaminar screws (n = 57) with a more extensive method using transforaminal lumbar interbody fusion and pedicular screw fixation (n = 63) in consecutive patients with degenerative disease of the lumbar spine. Outcome was assessed using the validated multidimensional Core Outcome Measures Index. Blood loss and operating time were significantly lower in the translaminar screw group (p < 0.01). The complication rates were similar in each group (2% to 4%). In all, 91% of the patients returned their questionnaire at two-years. The groups did not differ in Core Outcome Measures Index score reduction, 3.6 (sd 2.5) (translaminar screws) vs 4.0 (sd 2.8) (transforaminal lumbar interbody fusion) (p = 0.39); ‘good’ global outcomes, 78% (translaminar screws) vs 78% (transforaminal lumbar interbody fusion) (p = 0.99) or satisfaction with treatment, 82% (translaminar screws) vs 86% (transforaminal lumbar interbody fusion) (p = 0.52).

The two fusion techniques differed markedly in their extent and the cost of the implants, but were associated with almost identical patient-orientated outcomes.

Extensive three-point stabilisation is not always required to achieve satisfactory patient-orientated results at two years.
Biological reconstruction after resection of bone tumours around the knee
Authors: Abed Y. Y. , Beltrami G. , Campanacci D. A. , Innocenti M. , Scoccianti G. , Capanna R.
Published: September 2009

We reviewed 25 patients who had undergone resection of a primary bone sarcoma which extended to within 5 cm of the knee with reconstruction by a combination of a free vascularised fibular graft and a massive allograft bone shell. The distal femur was affected in four patients and the proximal tibia in 21. Their mean age at the time of operation was 19.7 years (5 to 52) and the mean follow-up period 140 months (28 to 213). Three vascularised transfers failed. The mean time to union of the fibula was 5.6 months (3 to 10) and of the allograft 19.6 months (10 to 34). Full weight-bearing was allowed at a mean of 21.4 months (14 to 36). The mean functional score at final follow-up was 27.4 (18 to 30) using a modfied 30-point Musculoskeletal Tumour Society rating system. The overall limb-salvage rate was 88%. The results of our study suggest that the combined use of a vascularised fibular graft and allograft is of value as a limb-salvage procedure for intercalary reconstruction after resection of bone tumours around the knee, especially in skeletally immature patients.
Blood metal ion concentrations after hip resurfacing arthroplasty
Authors: Langton D. J. , Sprowson A. P. , Joyce T. J. , Reed M. , Carluke I. , Partington P. , Nargol A. V. F.
Published: September 2009

There have been no large comparative studies of the blood levels of metal ions after implantation of commercially available hip resurfacing devices which have taken into account the effects of femoral size and inclination and anteversion of the acetabular component. We present the results in 90 patients with unilateral articular surface replacement (ASR) hip resurfacings (mean time to blood sampling 26 months) and 70 patients with unilateral Birmingham Hip Resurfacing (BHR) implants (mean time 47 months).

The whole blood and serum chromium (Cr) and cobalt (Co) concentrations were inversely related to the size of the femoral component in both groups (p < 0.05). Cr and Co were more strongly influenced by the position of the acetabular component in the case of the ASR, with an increase in metal ions observed at inclinations > 45° and anteversion angles of < 10° and > 20°. These levels were only increased in the BHR group when the acetabular component was implanted with an inclination > 55°.

A significant relationship was identified between the anteversion of the BHR acetabular component and the levels of Cr and Co (p < 0.05 for Co), with an increase observed at anteversion angles < 10° and > 20°. The median whole blood and serum Cr concentrations of the male ASR patients were significantly lower than those of the BHR men (p < 0.001). This indicates that reduced diametral clearance may equate to a reduction in metal ion concentrations in larger joints with satisfactory orientation of the acetabular component.
Limb lengthening with a submuscular locking plate
Authors: Oh C.-W. , Song H.-R. , Kim J.-W. , Choi J.-W. , Min W.-K. , Park B.-C.
Published: September 2009

Ten patients, who were unsuitable for limb lengthening over an intramedullary nail, underwent lengthening with a submuscular locking plate. Their mean age at operation was 18.5 years (11 to 40). After fixing a locking plate submuscularly on the proximal segment, an external fixator was applied to lengthen the bone after corticotomy. Lengthening was at 1 mm/day and on reaching the target length, three or four screws were placed in the plate in the distal segment and the external fixator was removed. All patients achieved the pre-operative target length at a mean of 4.0 cm (3.2 to 5.5). The mean duration of external fixation was 61.6 days (45 to 113) and the mean external fixation index was 15.1 days/cm (13.2 to 20.5), which was less than one-third of the mean healing index (48 days/cm (41.3 to 55). There were only minor complications.

Lengthening with a submuscular locking plate can successfully permit early removal of the fixator with fewer complications and is a useful alternative in children or when nailing is difficult.
Factors determining quality of life and level of sporting activity after internal fixation of an isolated acetabular fracture
Authors: Giannoudis P. V. , Nikolaou V. S. , Kheir E. , Mehta S. , Stengel D. , Roberts C. S.
Published: September 2009

We investigated whether patients who underwent internal fixation for an isolated acetabular fracture were able to return to their previous sporting activities.

We studied 52 consecutive patients with an isolated acetabular fracture who were operated on between January 2001 and December 2002. Their demographic details, fracture type, rehabilitation regime, outcome and complications were documented prospectively as was their level and frequency of participation in sport both before and after surgery. Quality of life was measured using the EuroQol-5D health outcome tool (EQ-5D).

There was a significant reduction in level of activity, frequency of participation in sport (both p < 0.001) and EQ-5D scores in patients of all age groups compared to a normal English population (p = 0.001). A total of 22 (42%) were able to return to their previous level of activities: 35 (67%) were able to take part in sport at some level. Of all the parameters analysed, the Matta radiological follow-up criteria were the single best predictor for resumption of sporting activity and frequency of participation.
One-stage versus two-stage bilateral unicompartmental knee replacement
Authors: Chan W. C. W. , Musonda P. , Cooper A. S. , Glasgow M. M. S. , Donell S. T. , Walton N. P.
Published: September 2009

We retrospectively studied the major complications occurring after one- and two-stage bilateral unicompartmental knee replacements (UKR). Between 1999 and 2008, 911 patients underwent 1150 UKRs through a minimally invasive approach in our unit. Of these, 159 patients (318 UKRs) had one-stage and 80 patients (160 UKRs) had two-stage bilateral UKRs.

The bilateral UKR groups were comparable in age and American Society of Anaesthesiology grade, but more women were in the two-stage group (p = 0.019). Mechanical thromboprophylaxis was used in all cases. Major complications were recorded as death, pulmonary embolus, proximal deep-vein thrombosis and adverse cardiac events within 30 days of surgery. No statistical differences between the groups were found regarding the operating surgeon, the tourniquet time or minor complications except for distal deep-vein thrombosis. The anaesthetic times were longer for the two-stage group (p = 0.0001).

Major complications were seen in 13 patients (8.2%) with one-stage operations but none were encountered in the two-stage group (p = 0.005). Distal deep-vein thrombosis was more frequent in the two-stage group (p = 0.036).

Because of the significantly higher risk of major complications associated with one-stage bilateral UKR we advocate caution before undertaking such a procedure.
Endoprosthetic reconstruction of the distal tibia and ankle joint after resection of primary bone tumours
Authors: Shekkeris A. S. , Hanna S. A. , Sewell M. D. , Spiegelberg B. G. I. , Aston W. J. S. , Blunn G. W. , Cannon S. R. , Briggs T. W. R.
Published: September 2009

Endoprosthetic replacement of the distal tibia and ankle joint for a primary bone tumour is a rarely attempted and technically challenging procedure. We report the outcome of six patients treated between 1981 and 2007. There were four males and two females, with a mean age of 43.5 years (15 to 75), and a mean follow-up of 9.6 years (1 to 27). No patient developed a local recurrence or metastasis. Two of the six went on to have a below-knee amputation for persistent infection after a mean 16 months (1 to 31). The four patients who retained their endoprosthesis had a mean musculoskeletal tumour society score of 70% and a mean Toronto extremity salvage score of 71%. All were pain free and able to perform most activities of daily living in comfort.

A custom-made endoprosthetic replacement of the distal tibia and ankle joint is a viable treatment option for carefully selected patients with a primary bone tumour. Patients should, however, be informed of the risk of infection and the potential need for amputation if this cannot be controlled.
Total hip replacement in patients with neurological conditions
Authors: Queally J. M. , Abdulkarim A. , Mulhall K. J.
Published: September 2009

Neurological conditions affecting the hip pose a considerable challenge in replacement surgery since poor and imbalanced muscle tone predisposes to dislocation and loosening. Consequently, total hip replacement (THR) is rarely performed in such patients. In a systematic review of the literature concerning THR in neurological conditions, we found only 13 studies which described the outcome. We have reviewed the evidence and discussed the technical challenges of this procedure in patients with cerebral palsy, Parkinson’s disease, poliomyelitis and following a cerebrovascular accident, spinal injury or development of a Charcot joint. Contrary to traditional perceptions, THR can give a good outcome in these often severly disabled patients.
Use of Combination Therapy with a β-Blocker and Milrinone in Patients with Advanced Heart Failure
Authors: Jennings Douglas L , Thompson Melissa L
Published: September 2009

Objective:

To review the literature evaluating the clinical effects of combination therapy with a β-blocker and milrinone in patients with severe heart failure (HF).

Data Sources:

Literature was accessed through MEDLINE (1950–June 2009), PubMed (1966–June 2009), and International Pharmaceutical Abstracts (1970–June 2009), with combinations of the following terms: positive inotrope, milrinone, dobutamine, and β-receptor blocker. In addition, reference citations from publications identified were reviewed.

Study Selection and Data Extraction:

All articles that examined the effect of combination therapy with a β-blocker and milrinone on clinical endpoints in patients with advanced HF were assessed.

Data Synthesis:

A search of the literature revealed 4 studies examining the clinical effects of combination therapy with a β-blocker and milrinone. Three of these studies were retrospective reviews, while one was a post hoc subgroup analysis from the OPTIME-CHF study. Concomitant therapy with milrinone and a β-blocker was well tolerated, with no significant increase in adverse events or deterioration in clinical status in any study. Tolerability rates for combination therapy ranged from 88% to 92%. In 2 of the studies, roughly 50% of the patients in the combination arm were able to be weaned off milrinone. One study suggested a mortality reduction in favor of combination therapy over milrinone alone, while another study suggested no difference in mortality with combination therapy versus milrinone monotherapy. One study suggested a potential increase in mortality when β-blocker therapy was withdrawn in patients who were started on milrinone. None of the studies demonstrated any significant differences in hospitalization rates. All of the studies were limited by their retrospective nature and small sample size.

Conclusions:

Data are insufficient to make firm conclusions on the clinical benefit of combination therapy with a β-blocker and milrinone in patients with advanced HF, although it appears that this regimen is well tolerated and may allow weaning of inotropic support.
Auditory Brainstem Evoked Responses in Newborns With Down Syndrome
Authors: Kittler Phyllis M. , Phan Ha T. T. , Gardner Judith M. , Miroshnichenko Inna , Gordon Anne , Karmel Bernard Z.
Published: September 2009

Auditory brainstem evoked responses (ABRs) were compared in 15 newborns with Down syndrome and 15 sex-, age-, and weight-matched control newborns. Participants had normal ABRs based upon values specific to 32- to 42-weeks postconceptional age. Although Wave III and Wave V component latencies and the Wave I–III interpeak latency (IPL) were shorter in ABRs of infants with Down syndrome, the Wave III–V IPL was not, pointing to anomalies in the lower rather than upper brainstem auditory pathways. Shorter Down syndrome ABR latencies have been reported at many ages. Extending these findings to newborns suggests that the underlying basis for this develops prenatally. ABR patterns in infants with Down syndrome were similar to reports for intrauterine growth restricted newborns.
Evidence for Slowing as a Function of Index of Difficulty in Young Adults With Down Syndrome
Authors: Lam Melanie Y. , Hodges Nicola J. , Virji-Babul Naznin , Latash Mark L.
Published: September 2009

Speed–accuracy trade-offs in persons with Down syndrome and typically developing controls were tested with a Fitts' task. Movement time scaled linearly with index of difficulty in both groups, and there were no accuracy differences. Persons with Down syndrome were slower than typically developing individuals. Regression analysis on movement time and index of difficulty showed a nearly two-fold higher regression coefficient and a nearly three-fold larger intercept value in the Down syndrome group. The dwell time on a target was much longer for Down syndrome persons but scaled with index of difficulty in about the same percentage for participants in both groups. Because of differences primarily related to scaling, we conclude that mechanisms of motor control are similar in Down syndrome and typically developing groups.
Neuerscheinungen auf dem Fachwörterbuchmarkt
Authors: Lück Erich
Published: September 2009

Der Sprachkundige braucht Fachwörterbücher. Oft erscheinen sie in wenig bekannten Verlagen. Wir möchten unsere Leser auf Neuerscheinungen aufmerksam machen. Die bibliografischen Angaben sind den Nationalbibliografien, Verlagsprospekten und anderen Quellen entnommen und werden ohne Gewähr wiedergegeben.
Juvenile Suicide in Confinement—Findings from the First National Survey
Authors: Hayes Lindsay M.
Published: September 2009

Findings from the first national survey on juvenile suicide in confinement are provided, and include the extent and distribution of juvenile suicides, as well as descriptive data on demographic characteristics of each victim, incident, and juvenile facility which sustained the suicide. Among the significant findings were that suicides were evenly distributed, i.e., the same number of deaths occurred within the first few days of confinement as occurred over many months of confinement; most deaths occurred during traditional waking hours; a strong association between room confinement and suicide was found, and no relationship between intoxication and suicide was found. Suicide prevention resources were found to be particularly lacking in juvenile detention centers that experienced suicides.
Predicting Deliberate Self‐Harm in Adolescents: A Six Month Prospective Study
Authors: O'Connor Rory C. , Rasmussen Susan , Hawton Keith
Published: September 2009

Few studies have investigated the extent to which psychosocial/psychological factors are associated with the prediction of deliberate self‐harm (DSH) among adolescents. In this study, 737 pupils aged 15–16 years completed a lifestyle and coping survey at time one and 500 were followed up six months later. Six point two percent of the respondents (n = 31) reported an act of DSH between Time 1 and Time 2. In multivariate analyses, worries about sexual orientation, history of sexual abuse, family DSH, anxiety, and self‐esteem were associated with repeat DSH during the course of the study, but history of sexual abuse was the only factor predictive of first‐time DSH. The findings suggest that school‐based programs focused on how young people cope with psychosocial stressors may offer promise.
Prevalence of Suicide Risk Factors and Suicide‐Related Outcomes in the National Mental Health Study, Colombia
Authors: Posada‐Villa José , Camacho Juan Camilo , Valenzuela José Ignacio , Arguello Arturo , Cendales Juan Gabriel , Fajardo Roosevelt
Published: September 2009

A community survey in 4,426 adults was undertaken as part of the World Mental Health Survey Initiative reporting the prevalence and risk factors for suicide‐related outcomes in Colombia. Lifetime prevalence estimates of suicide ideation, plans, attempts, and risk factors for suicide‐related outcomes were assessed. Retrospective reports of disorders age‐of‐onset were used to study associations between primary mental disorders and first onset of suicide‐related outcomes. Risks of plans and attempts were highest with ideation early age‐of‐onset and within the first year. The highest risk for ideation and attempt among ideators occurred in the 18–29 age group. After first employment (defined as the first paid job accepted by the respondent) and presence of mental disorders constituted risk factors. Impulse‐control disorders were strongest diagnostic predictors.