bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of neuromuscular scoliosis with posterior-only pedicle screw fixation
Authors: Modi Hitesh N , Suh Seung-Woo , Song Hae-Ryong , Fernandez Harry M , Yang Jae-Hyuk
Published: June 2008

Background

To determine whether posterior-only approach using pedicle screws in neuromuscular scoliosis population adequately addresses the correction of scoliosis and maintains the correction over time.

Methods

Between 2003 and 2006, 26 consecutive patients (7 cerebral palsy, 10 Duchenne muscular dystrophy, 5 spinal muscular atrophy and 4 others) with neuromuscular scoliosis underwent posterior pedicle screw fixation for the deformity. Preoperative, immediate postoperative and final follow-up Cobb's angle and pelvic obliquity were analyzed on radiographs. The average age of the patients was 17.5 years (range, 8–44 years) and the average follow-up was 25 months (18–52 months).

Results

Average Cobb's angle was 78.53° before surgery, 30.70° after surgery (60.9% correction), and 33.06° at final follow-up (57.9% correction) showing significant correction (p < 0.0001). There were 9 patients with curves more than 90° showed an average pre-operative, post operative and final follow up Cobb's angle 105.67°, 52.33° (50.47% correction) and 53.33° (49.53% correction) respectively and 17 patients with curve less than 90° showed average per operative, post operative and final follow up Cobb's angle 64.18, 19.24(70% correction) and 21.41(66.64 correction); which suggests statistically no significant difference in both groups (p = 0.1284). 7 patients underwent Posterior vertebral column resection due to the presence of a rigid curve. The average spinal-pelvic obliquity was 16.27° before surgery, 8.96° after surgery, and 9.27° at final follow-up exhibited significant correction (p < 0.0001). There was 1 poliomyelitis patient who had power grade 3 in lower limbs pre-operatively, developed grade 2 power post-operatively and gradually improved to the pre-operative stage. There was 1 case of deep wound infection and no case of pseud-arthrosis, instrument failures or mortality.

Conclusion

Results indicate that in patients with neuromuscular scoliosis, acceptable amounts of curve correction can be achieved and maintained with posterior-only pedicle screw instrumentation without anterior release procedure.
OSPACS: Ultrasound image management system
Authors: Stott Will , Ryan Andy , Jacobs Ian J , Menon Usha , Bessant Conrad , Jones Christopher
Published: June 2008

Background

Ultrasound scanning uses the medical imaging format, DICOM, for electronically storing the images and data associated with a particular scan. Large health care facilities typically use a picture archiving and communication system (PACS) for storing and retrieving such images. However, these systems are usually not suitable for managing large collections of anonymized ultrasound images gathered during a clinical screening trial.

Results

We have developed a system enabling the accurate archiving and management of ultrasound images gathered during a clinical screening trial. It is based upon a Windows application utilizing an open-source DICOM image viewer and a relational database. The system automates the bulk import of DICOM files from removable media by cross-validating the patient information against an external database, anonymizing the data as well as the image, and then storing the contents of the file as a field in a database record. These image records may then be retrieved from the database and presented in a tree-view control so that the user can select particular images for display in a DICOM viewer or export them to external media.

Conclusion

This system provides error-free automation of ultrasound image archiving and management, suitable for use in a clinical trial. An open-source project has been established to promote continued development of the system.
Treatment of Myasthenia Gravis Acute Exacerbations with Intravenous Immunoglobulin
Authors: Gajdos Philippe , Chevret Sylvie
Published: June 2008

The results of four randomized controlled trials were examined to assess the efficacy of intravenous immunoglobulin (IVIG) for myasthenia gravis (MG) acute exacerbations. The first trial compared plasma exchange (PE) and IVIG in 87 patients. At day 15, the mean change in the Myasthenic Muscular Score (MMS) was 16.6 (95% CI 11.6–21.6) in the PE group and 15.6 (95% CI 10.9–20.3) in the IVIG group (Wilcoxon signed rank test, P = 0.65). The second trial compared IVIG to oral methylprednisolone, and 33 patients were included. The mean (SD) sum of the two most pathological items of the Quantitative Myasthenia Gravis Score (QMGS) at day 0 was 3.9 (1.1) for the IVIG group and 4.2 (0.7) for the methylprednisolone group. At day 14, these values were 2.9 (1.4) for the IVIG group and 2.8 (1.1) for the methylprednisolone group. The third trial compared IVIG 2 g/kg versus placebo for MG worsening. The mean change in QMGS at day 14 was –2.54 in the IVIG group and –0.89 in the placebo group (P= 0.047). A significant IVIG treatment effect was observed only in patients with more severe disease; the mean difference was −0.10 for mild MG (P= 0.914) and −3.39 for moderate to severe MG (P= 0.010). The last trial compared IGIV 2 g/kg versus 1 g/kg for MG acute exacerbation in 173 patients. The mean MMS change in both groups was similar (difference = 3.84; 95% CI −1.03 to 8.71; P = 0.12). In conclusion, IVIG may be used as treatment for MG acute exacerbations. IVIG at a dose of 1 g/kg may be sufficient.
Classical Complement Pathway in Experimental Autoimmune Myasthenia Gravis Pathogenesis
Authors: Christadoss Premkumar , Tüzün Erdem , Li Jing , Saini Shamsher S. , Yang Huan
Published: June 2008

Mice deficient for complement factors C3, C4, or C5 are resistant to experimental autoimmune myasthenia gravis (EAMG). Acetylcholine receptor (AChR) immune lymph node cells (LNC) of C3 deficient mice produce less interleukin 6 (IL‐6), and EAMG‐resistant IL‐6 deficient mice have less serum C3. Increased serum C1q‐circulating immune complex (CIC) levels correlated with EAMG disease severity in RIIIS/J mice. The CIC promotes EAMG severity by stimulating the production of LNC IL‐6, serum C1q, and C3 via FCγR interaction. Therefore, EAMG/MG could be treated by blocking the activation of classical complement pathway (CCP) and/or IL‐6. Anti‐C1q antibody administration before and following AChR immunization suppressed EAMG by reducing LNC IL‐6 production and neuromuscular junction deposits of IgG, C3, and C5b‐C9 complexes. Treatment with low dose (10 μg) of anti‐C1q antibody twice a week for 4 weeks in mice with ongoing clinical EAMG reduced the clinical severity of disease and LNC IL‐6 production. Therefore, inhibitors of CCP factors C1q, C2, or C4 could treat MG and would preserve the alternate complement pathway activation. Our goal is to tailor MG therapy using anti‐C2/C4 reagents in combination, with or without anti‐cytokine (e.g., anti‐IL‐6) reagents.
Common Cellular and Diverse Genetic Basis of Thymoma‐associated Myasthenia Gravis
Authors: Ströbel Philipp , Chuang Wen‐Yu , Chuvpilo Sergei , Zettl Andreas , Katzenberger Tiemo , Kalbacher Hubert , Rieckmann Peter , Nix Wilfred , Schalke Berthold , Gold Ralf , Müller‐Hermelink Hans‐Konrad , Peterson Pärt , Marx Alexander
Published: June 2008

Generation of autoreactive CD4+ effector T cells and defective production of regulatory CD4+ T cells inside thymomas contribute to the development of myasthenia gravis (MG) in >90% of MG(+) thymomas. The molecular basis of these abnormalities is unknown. We report here that a) expression levels of class II major histocompatibility complex (MHCII) genes are variably decreased in thymomas, most prominently in histological WHO types A and AB; b) epithelial cells of type A and AB thymomas exhibit signal transducer and activator of transcription (STAT‐1)‐related defects of interferon‐γ (IFN‐γ) signaling and human leukocyte antigen (HLA)‐DR expression in vitro; c) the promoter III (pIII)‐ and pIV‐driven splice variants of the MHCII transactivator (CIITA) play a key role in MHCII gene expression in thymus and thymomas; and d) the pIV CIITA promoter is heavily methylated in thymomas. Recently, we also found that expression of the autoimmune regulator (AIRE) gene is absent from ∼95% of thymomas. Among all theses abnormalities, only better preserved expression levels of MHCII (P < 0.001) in thymomas were significantly associated with the presence of MG. Taking the association of a gain‐of‐function polymorphism of the CTLA‐4 and PTPN22 gene with MG in thymomas into account, we conclude that these acquired cellular abnormalities of the thymoma microenvironment in concert with inherited genetic high‐risk polymorphisms of immunoregulatory genes have an impact on intratumorous thymopoiesis and appear to tip the balance toward central tolerance failure and development of MG. The findings imply that IFN‐γ and STAT‐1 signaling play a role in MHCII expression in the human thymus and in the pathogenesis of paraneoplastic MG.
How Promiscuity Promotes Tolerance: The Case of Myasthenia Gravis
Authors: Kyewski Bruno , Taubert Richard
Published: June 2008

Central T cell tolerance in the thymus plays a nonredundant role in preventing organ‐specific autoimmunity. This role is largely attributable to promiscuous expression of tissue‐restricted auto‐antigens in medullary thymic epithelial cells (mTECs). The nascent T cell repertoire is exhaustively screened for potential autoreactivity against these ligands presented by mTECs. Failure of this screening process can result in organ‐specific autoimmune diseases affecting single or multiple organs. Here we discuss how promiscuous expression of the acetylcholine receptor α‐chain in the human thymus can potentially affect self‐tolerance toward this well characterized auto‐antigen and thus influence the disease course of myasthenia gravis.
Rebooting the Immune System with High‐Dose Cyclophosphamide for Treatment of Refractory Myasthenia Gravis
Authors: Drachman Daniel B. , Adams Robert N. , Hu Rong , Jones Richard J. , Brodsky Robert A.
Published: June 2008

A small but important proportion of patients with myasthenia gravis (MG) are refractory to conventional immunotherapy. We have treated 12 such patients by “rebooting” the immune system with high‐dose cyclophosphamide (Hi Cy, 200 mg/kg), which largely eliminates the mature immune system, while leaving hematopoietic precursors intact. The objective of this report is to describe the clinical and immunologic results of Hi Cy treatment of refractory MG. We have followed 12 patients clinically for 1–9 years, and have analyzed their humoral and cellular immunologic parameters. Hi Cy is safe and effective. All but one of the patients experienced dramatic clinical improvement for variable periods from 5 months to 7.5 years, lasting for more than 1 year in seven of the patients. Two patients are still in treatment‐free remission at 5.5 and 7.5 years, and five have achieved responsiveness to immunosuppressive agents that were previously ineffective. Hi Cy typically reduced, but did not completely eliminate, antibodies to the autoantigen AChR or to tetanus or diphtheria toxin; re‐immunization with tetanus or diphtheria toxoid increased the antibody levels. Despite prior thymectomy, T cell receptor excision circles, generally considered to reflect thymic emigrant T cells, were produced by all patients. Hi Cy treatment results in effective, but often not permanent, remission in most refractory myasthenic patients, suggesting that the immune system is in fact “rebooted,” but not “reformatted.” We therefore recommend that treatment of refractory MG with Hi Cy be followed with maintenance immunotherapy.
Myasthenia Gravis in the Elderly
Authors: Aarli Johan A.
Published: June 2008

We have defined myasthenia gravis (MG) in the elderly as onset after the age of 50 years. MG is diagnosed more often today than previously. The increase is mainly found in patients over the age of 50 years. Neurologists therefore see more old patients with MG now than before. Prevalence of the early‐onset form of MG seems to be unchanged. Recent data indicate that MG may still be substantially underdiagnosed in very old people. Ptosis, diplopia, weakness of the facial muscles, and problems of articulation are important clinical signs in MG and are easier to detect in a youthful appearance. Since ageing causes a decrease in the total eyelid area with sagging of the lower eyelids, a ptosis may be more difficult to diagnose in the elderly. In addition, diplopia may not be detected because of reduced vision due to macular degeneration or cataract formation. Ocular symptoms of MG are therefore more easily missed in the elderly. Thymomatous MG is more common among older patients than it is in younger onset. The mean age at onset of MG for thymoma cases is 50–60 years. Approximately 10–15% of all MG patients have a thymoma, and around 40% of all thymoma cases are associated with MG. During normal aging, the thymus tissue becomes atrophic and replaced with fat. Recent data on MG thymus pathology suggest that lymphocyte accumulation indicating residual thymus may also be found in the elderly, and that there is little qualitative difference between the young and the old thymus from MG patients. The mean concentration of antibodies to acetylcholine receptor (AChR) is lower in MG in the elderly than in early‐onset or thymoma‐associated MG. Seronegative MG is less common among older patients. Approximately 30% of patients with late‐onset, nonthymoma MG have antibodies to titin, while such antibodies are extremely scarce in early‐onset MG. Titin antibodies in MG patients seem to be associated with a higher frequency of DR7 antigen and a decrease of DR3 antigen. The antibody response in MG may therefore be influenced by the genetic background.
Recent Structural and Mechanistic Insights into Endplate Acetylcholine Receptors
Authors: Sine Steven M. , Gao Fan , Lee Won Yong , Mukhtasimova Nuriya , Wang Hai‐Long , Engel Andrew G.
Published: June 2008

Voluntary movement mediated by skeletal muscle relies on endplate acetylcholine receptors (AChR) to detect nerve‐released ACh and depolarize the muscle fiber. Recent structural and mechanistic studies of the endplate AChR have catalyzed a leap in our understanding of the molecular steps in this chemical‐to‐electrical transduction process. Studies of acetylcholine binding protein (AChBP) give insight into ACh recognition, the first step in activation of the AChR. An atomic structural model of the Torpedo AChR at a resolution of 0.4 nm, together with single‐ion channel recording methods, allow tracing of the link between the agonist binding event and gating of the ion channel, as well as determination of how the channel moves when it opens to allow flow of cations. Structural models of the human AChR enable precise mapping of disease‐causing mutations, while studies of the speed with which single AChR channels open and close cast light on pathogenic mechanisms.
The Novel Estrogen Receptor, G Protein-Coupled Receptor 30, Mediates the Proliferative Effects Induced by 17β-Estradiol on Mouse Spermatogonial GC-1 Cell Line
Authors: Sirianni Rosa , Chimento Adele , Ruggiero Carmen , De Luca Arianna , Lappano Rosamaria , Andò Sebastiano , Maggiolini Marcello , Pezzi Vincenzo
Published: June 2008

Many studies have indicated that estrogens could have a role in the regulation of testicular function. However, it remains uncertain whether estrogens are able to directly activate signaling pathways in male germ cells. Estrogens are synthesized by the enzyme aromatase and classically act by binding to estrogen receptors (ERs)-α and ERβ. Knockout mice for both receptor isoforms exhibit a testicular phenotype that is less severe than aromatase knockout mice, suggesting the existence of an estrogen-binding receptor that may compensate for the lack of ERs. Recently studies using estrogen-sensitive tumor cell lines have demonstrated that the G-protein-coupled receptor (GPR)-30 binds and mediates estrogen action through the activation of the epidermal growth factor receptor (EGFR)/ERK/fos transduction pathway. The present study investigated the ability of 17β-estradiol (E2) to activate this pathway in the mouse spermatogonial cell line (GC-1). Using the GC-1 cell line as a model system, we demonstrated that GC-1 cells express GPR30 and ERα but not ERβ. E2, the selective GPR30 agonist G1, and the selective ERα agonist 4,4′,4″-(4-propyl-[1H]pyrazole-1,3,5-triyl) trisphenol activated the rapid ERK1/2-fos signaling cascade. This response was abrogated by the EGFR inhibitor AG1478, ERK inhibitor PD98059 and ER inhibitor ICI 182780, or by silencing GPR30 expression. Moreover, E2 and G1 up-regulated cyclin D1 expression and GC-1 cell proliferation. Our results indicate for the first time that estrogens, through a cross talk between GPR30 and ERα, activate the rapid EGFR/ERK/fos pathway, which in turn stimulate mouse GC-1 cell proliferation. Further studies to elucidate the involvement of rapid estrogen signaling pathways in the regulation of male fertility are warranted.
The cell biology of autophagy in metazoans: a developing story
Authors: Meléndez Alicia , Neufeld Thomas P.
Published: June 2008

The cell biological phenomenon of autophagy (or `self-eating') has attracted increasing attention in recent years. In this review, we first address the cell biological functions of autophagy, and then discuss recent insights into the role of autophagy in animal development, particularly in C. elegans, Drosophila and mouse. Work in these and other model systems has also provided evidence for the involvement of autophagy in disease processes, such as neurodegeneration, tumorigenesis, pathogenic infection and aging. Insights gained from investigating the functions of autophagy in normal development should increase our understanding of its roles in human disease and its potential as a target for therapeutic intervention.
Performance measures of the illiterate E-chart vision-screening test used in Northern District Israeli school children
Authors: Ore Liora , Garzozi Hanna J , Tamir Ada , Stein Nili , Cohen-Dar Michal
Published: June 2008

Objectives

To evaluate the screening performance of 6/6 and 6/12 vision cut-offs with an illiterate E-chart implemented by a public health nurse to test children for ocular abnormalities and uncorrected refractive error. The gold standard diagnosis is an eye examination performed by an ophthalmologist.

Setting

A cross-sectional population-based study was conducted among 2113 students' ages 6–7 and 13–14 years old in 70 Northern District Israeli schools.

Methods

Students were tested by nurses and ophthalmologists. A nurse examination was carried out using the illiterate E-chart for vision measurement. The medical examination included vision history, clinical eye examination, vision and retinoscopy testing. The Physician's evaluation of whether students needed a referral for diagnostic procedures, treatment and/or follow-up was recorded. Screening test's performance was determined using ophthalmologist's decision regarding referral as the gold standard. Detection rate (DR), false-positive rate (FPR), odds affected positive result (OAPR), positive predictive value (PPV) and negative predictive value (NPV) were estimated overall and by students' demographic characteristics.

Results

For vision >6/6 cut-off in at least one eye (eyes tested separately): DR – 71.9% (95% CI 65.8–78.7%), FPR – 22.8% (95% CI 17.9–28.9%), OAPR – 0.98:1 (95% CI 0.84:1–1.15:1), PPV – 52.7% (95% CI 45.4–61.2%), NPV – 90.9% (95% CI 88.7–93.1%). For 6/12 vision cut-off, namely vision 6/12 or worse in both eyes (tested separately): DR – 58.6 (95% CI 51.8–66.4%), FPR – 15.2% (95% CI 10.9–21.1%), OAPR – 1.13:1 (95% CI 0.94:1–1.35:1), PPV – 61.1% (95% CI 52.9–70.6%), NPV – 87.6% (95% CI 84.9–90.4%).

Conclusions

Vision-screening test performance measures are mild. It is suggested to change vision cut-off level that denotes vision abnormality from current policy of vision not equal 6/6 in both eyes (tested separately) to vision 6/12 or worse in both eyes (tested separately). This change will result in reduction of FPR from 22% to 15%, concomitant with an increase in false-negative rate from 28% to 41%. Students may be equally screened by either a senior or a less experienced nurse.
The Role of Targeted Communication and Contagion in Product Adoption
Authors: Manchanda Puneet , Xie Ying , Youn Nara
Published: June 2008

The two main influences leading to adoption at the individual consumer level are marketing communication and interpersonal communication. Although evidence of the effect of these two influences is abundant at the market level, there is a paucity of research documenting the simultaneous effect of both influences at the individual consumer level. Thus, the primary objective of this paper is to fill the gap in the literature by documenting the existence and magnitude of both influences at the individual customer level while controlling for unobserved temporal effects.

The pharmaceutical industry provides an appropriate context to study this problem. It has been conjectured that adoption and usage patterns of a new drug by physicians—“contagion”—acts as a “consumption externality,” as it allows a given physician to learn about the efficacy and use of the drug. In addition, pharmaceutical companies target individual physicians via marketing activities such as detailing, sampling, and direct-to-consumer advertising. Our data contain the launch of a new drug from an important drug category. We chose two unrelated markets (Manhattan and Indianapolis) for our empirical analysis. We model an individual physician's decision to adopt a new drug in a given time period as a binary choice decision. This decision is modeled as a function of temporal trends (linear and quadratic) and individual physician-level contagion and marketing activity (both individual level and market level). Our contagion measure aggregates the adoption behavior of geographically near physicians for each physician in our sample.

Our results from the Manhattan market indicate that both targeted communication and contagion have an effect on the individual physician's adoption decision. A major challenge is to rule out alternative explanations for the detected contagion effect. We therefore carry out a series of tests and show that this effect persists even after we control for the effects of time, individual salespeople, other marketing instruments, local market effects, and the effects of some institutional factors. We believe that our contagion effect arises because the consumption externality is stronger for geographically close physicians. We discuss some underlying processes that are probably giving rise to the contagion effect we detected.

Finally, we compute the social multiplier of marketing and find it to be about 11%. We also use the estimated parameters to compare the relative effect of contagion and targeted marketing. We find that marketing plays a large (relative) role in affecting early adoption. However, the role of contagion dominates from month 4 onward and, by month 17 (or about half the duration of our data), asymptotes to about 90% of the effect.
Hochauflösende Laser-Speckle-Methode zur Charakterisierung komplexer thermomechanischer Eigenschaften von Vielschicht-Systemen (Application of a High-Resolution Laser-Speckle Strain Gauge for the Characterization of Thermomechanical Properties of Multilayer Systems)
Authors: Kothbauer Roland , Ruptisch Stefan J. , Zagar Bernhard , Zimprich Peter
Published: June 2008

Berührungslose Dehnungsmessverfahren für Materialien in Mikrometerdimensionen, wie sie in der Mikroelektronik und Mikrosystemtechnik Verwendung finden, gewinnen in den Materialwissenschaften zunehmend an Bedeutung. Die mechanischen Eigenschaften dieser “Mikromaterialien” können deutlich von jenen, die an Makroproben gewonnen wurden, abweichen. Zur Erhöhung der Zuverlässigkeit von Mikrosystemen ist daher die Materialprüfung in kleinen Dimensionen notwendig. Dabei spielen optische Methoden, die ohne Messmarken an der Probenoberfläche und ohne Probenpräparierung auskommen, eine besondere Rolle und eröffnen völlig neue Prüfmöglichkeiten, die mit Standardmethoden nicht gegeben sind.
Green–Ampt Model for Layered Soils with Nonuniform Initial Water Content Under Unsteady Infiltration
Authors: Liu Jintao , Zhang Jiabao , Feng Jie
Published: June 2008

The Green–Ampt equation is often used to estimate infiltration in hydrologic modeling. Only a few of the currently used simulation models, however, can simulate infiltration into a heterogeneous soil with nonuniform initial soil water content by the Green–Ampt equation during nonsteady rainfall. In this study, we derived an infiltration model for layered soils under nonsteady infiltration based on the Green–Ampt method (Green–Ampt for Layered Soils, or GALS). In the GALS model, a formula for estimating average suction (S) was derived to include initial soil water effect, and the soil profile was divided into several layers to consider both soil texture and initial soil moisture effects on infiltration. The new model can predict infiltration capacity, ponding time, and cumulative infiltration. Three infiltration experiments, steady‐state infiltration into a layered soil with nonuniform initial soil water content, nonsteady infiltration into a layered soil with uniform soil water content; and nonsteady‐state infiltration into a layered soil with nonuniform soil water content, were conducted for model testing. Comparison showed that the GALS model was in good agreement with another Green–Ampt‐based model and the measured data.
Utilization of Three Non-Edible Vegetable Oils for the Production of Biodiesel Catalysed by Enzyme
Authors: Haldar Sandip Kumar , Nag Ahindra
Published: June 2008

Enzymatic transesterification by using lipase as catalyst has become more attractive for the production of biodiesel
due to easy separation of products such as glycerol and fatty acid esters. Comparative studies of enzyme catalyzed
transesterification of three less attended non edible oils (jatropha, karanja and putranjiva) have been discussed. The
maximum yield has been obtained at 3:1 molar ratio of methanol and oil at 40°C and 8hrs reaction time. The percentage
of conversion has been analyzed by Gas chromatography and 400 MHz 1H NMR. It has been observed that degummed
vegetable oil gives higher conversion in transesterification reaction than straight vegetable oil. Secondary alcohol gives
better result than methanol for the production of biodiesel due to its higher miscibility nature in oil.
Clinical Practice: Giant Cell Tumour of the Jaw Mimicking Bone Malignancy on Three-Dimensional Computed Tomography (3D CT) Reconstruction
Authors: Lanza Alessandro , Laino Luigi , Rossiello Luigi , Perillo Letizia , Ermo Antonio Dell , Cirillo Nicola
Published: June 2008

A wide range of diseases may present with radiographic features of osteolysis. Periapical inflammation, cysts and benign tumours, bone malignancies, all of these conditions may show bone resorption on radiograph. Features of the surrounding bone, margins of the lesion, and biological behaviour including tendency to infiltration and root resorption, may represent important criteria for distinguishing benign tumours from their malign counterpart, although the radiographic aspect of the lesion is not always predictive. Therefore a critical differential diagnosis has to be reached to choose the best management. Here, we report a case of giant cell tumour (GCT) whose radiological features by computed tomography (CT) suggested the presence of bone malignancy, whereas the evaluation of a routine OPT scan comforted us about the benign nature of the lesion. A brief review of the literature on such a benign but locally aggressive neoplasm is also provided.
Multisystemic Therapy for Adolescents With Poorly Controlled Type 1 Diabetes
Authors: Ellis Deborah , Naar-King Sylvie , Templin Thomas , Frey Maureen , Cunningham Phillippe , Sheidow Ashli , Cakan Nedim , Idalski April
Published: June 2008

OBJECTIVE—The study aim was to determine if multisystemic therapy (MST), an intensive home-based psychotherapy, could reduce hospital admissions for diabetic ketoacidosis (DKA) in youth with poorly controlled type 1 diabetes over 24 months. Potential cost savings from reductions in admissions were also evaluated.

RESEARCH DESIGN AND METHODS—A total of 127 youth were randomly assigned to MST or control groups and also received standard medical care.

RESULTS—Youth who received MST had significantly fewer hospital admissions than control subjects (χ2 = 11.77, 4 d.f., n = 127; P = 0.019). MST-treated youth had significantly fewer admissions versus their baseline rate at 6-month (P = 0.004), 12-month (P = 0.021), 18-month (P = 0.046), and 24-month follow-up (P = 0.034). Cost to provide MST was 6,934 USD per youth; however, substantial cost offsets occurred from reductions in DKA admissions.

CONCLUSIONS—The study demonstrates the value of intensive behavioral interventions for high-risk youth with diabetes for reducing one of the most serious consequences of medication noncompliance.
Wolfram Syndrome (Diabetes Insipidus, Diabetes, Optic Atrophy, and Deafness)
Authors: d'Annunzio Giuseppe , Minuto Nicola , D'Amato Elena , de Toni Teresa , Lombardo Fortunato , Pasquali Lorenzo , Lorini Renata
Published: June 2008

OBJECTIVE—Wolfram syndrome is an autosomal recessive neurodegenerative disorder characterized by diabetes insipidus, diabetes (nonautoimmune), optic atrophy, and deafness (a set of conditions referred to as DIDMOAD). The WFS1 gene is located on the short arm of chromosome 4. Wolfram syndrome prevalence is 1 in 770,000 live births, with a 1 in 354 carrier frequency.

RESEARCH DESIGN AND METHODS—We evaluated six Italian children from five unrelated families. Genetic analysis for Wolfram syndrome was performed by PCR amplification and direct sequencing.

RESULTS—Mutation screening revealed five distinct variants, one novel mutation (c.1346C>T; p.T449I) and four previously described, all located in exon 8.

CONCLUSIONS—Phenotype-genotype correlation is difficult, and the same mutation gives very different phenotypes. Severely inactivating mutations result in a more severe phenotype than mildly inactivating ones. Clinical follow-up showed the progressive syndrome's seriousness.
Introductory: Civil Society, Participation, and Religion1
Authors: Plichtová Jana
Published: June 2008

Introductory: Civil Society, Participation, and Religion1
Handling Religious Diversity: The Case of "Holy/Rest Days" in Italy
Authors: Faitini Tiziana , Povino Alessandroantonio
Published: June 2008

Handling Religious Diversity: The Case of "Holy/Rest Days" in Italy

The accommodation of a plurality of values within the same institutional framework is one of the main challenges with which contemporary democracies have been persistently confronted. This challenge has recently gained strength even in such traditionally homogeneous countries as Italy, as a consequence of an increase in the number of residents committed to diverse religious beliefs. Against this backdrop, this paper focuses on the case of requests for the legal recognition of religion-specific holy/rest days in Italy. The analysis of such a case will disclose—or so we believe—some valuable pointers as to how democratic societies could try to accommodate religious diversity in a way that is both respectful of the specificities of each religious group and compatible with the typically liberal commitment to the safeguard of individual freedom.
Introducing Deliberative Democracy: A Goal, a Tool, or Just a Context?1
Authors: Bianchi Gabriel
Published: June 2008

Introducing Deliberative Democracy: A Goal, a Tool, or Just a Context?1

The concept of deliberative democracy is presented within a wide spectrum of variety of its operationalizations. Since the applicability of the principle of deliberation to the functioning of human society is of the author's primary interest, dilemmas of deliberative democracy related to different problems associated with deliberation in practice are described in some detail. The key questions raised aiming at elucidating the "ontology" of deliberativeness are as follows: is it only a tool for solving the problems of society and politics? Is it a context within which other processes decide on the running of society? Or does it embody a goal of democracy?
Behind the Limes: On the Quest for an Eastern Dimension of European Identity
Authors: Hocman Juraj
Published: June 2008

Behind the Limes: On the Quest for an Eastern Dimension of European Identity

Although the integration processes in Western Europe have been studied for decades, the idea of European identity as a specific area of scholarship is relatively new. This interest coincides with fundamental changes that have occurred in Europe since 1989 and that may impact the internal coherence of the enlarged European Union. Over the past decades, the East-West dichotomy has been magnified due to the impact of Communism in the East, which exacerbated an already existent sense in the West of Eastern Europe's primordial otherness. Since four decades of Communism in East Central and Southern Europe produced only two, or at most, three generations that were raised and lived under a totalitarian regime, a long-term historical perspective is essential for a better understanding of the mutual estrangement. The paper examines the origins and key moments in the alienation of Eastern and Western Europe as reflected in ancient, medieval and modern history. It focuses on the present stage of perception of East Central Europe in the West. In the final part, it identifies societal values that may re-generate socio-cultural cohesiveness aimed at filling the gap between the two parts of Europe.
Direct Access to Physical Therapy in the Netherlands: Results From the First Year in Community-Based Physical Therapy
Authors: Leemrijse Chantal J , Swinkels Ilse CS , Veenhof Cindy
Published: June 2008

Background

In 2006, direct access to physical therapy was introduced in the Netherlands. Before this policy measure, evaluation and treatment by a physical therapist were only possible following referral by a physician.

Objective

The objectives of this study were to investigate how many patients use direct access and to establish whether these patients have a different profile than referred patients.

Methods

Electronic health care data from the National Information Service for Allied Health Care (LiPZ), a nationally representative registration network of 93 Dutch physical therapists working in 43 private practices, were used.

Results

In 2006, 28% of the patients seen by a physical therapist came by direct access. Patients with non–further-specified back problems, patients with nonspecific neck complaints, and higher-educated patients were more likely to refer themselves to a physical therapist, as were patients with health problems lasting for less than 1 month. Younger patients made more use of direct access. In addition, patients with recurring complaints more often referred themselves, as did patients who had received earlier treatment by a physical therapist. Patients with direct access received fewer treatment sessions. Compared with 2005, there was no increase in the number of patients visiting a physical therapist.

Limitations

Data came only from physical therapists working on general conditions in general practices. Severity of complaints is not reported.

Conclusions

A large, specific group of patients utilized self-referral, but the total number of patients seen by a physical therapist remained the same. In the future, it is important to evaluate the consequences of direct access, both on quality aspects and on cost-effectiveness.
Ion-Molecule Reactions and Chemical Composition of Emanated from Herculane Spa Geothermal Sources
Authors: Cosma Constantin , Suciu Ioan , Jäntschi Lorentz , Bolboacă Sorana D.
Published: June 2008

The paper presents a chemical composition analysis of the gases emanated from geothermal sources in the Herculane Spa area (Romania). The upper homologues of methane have been identified in these gases. An ion-molecule reaction mechanism could be implicated in the formation of the upper homologues of methane. The CH4+ ions that appear under the action of radiation are the starting point of these reactions. The presence of hydrogen in the emanated gases may be also a result of these reactions.
Targeting Receptor Tyrosine Kinases for Chemoprevention by Green Tea Catechin, EGCG
Authors: Shimizu Masahito , Shirakami Yohei , Moriwaki Hisataka
Published: June 2008

Tea is one of the most popular beverages consumed worldwide. Epidemiologic studies show an inverse relationship between consumption of tea, especially green tea, and development of cancers. Numerous in vivo and in vitro studies indicate strong chemopreventive effects for green tea and its constituents against cancers of various organs. (–)-Epigallocatechin-3-gallate (EGCG), the major catechin in green tea, appears to be the most biologically active constituent in tea with respect to inhibiting cell proliferation and inducing apoptosis in cancer cells. Recent studies indicate that the receptor tyrosine kinases (RTKs) are one of the critical targets of EGCG to inhibit cancer cell growth. EGCG inhibits the activation of EGFR (erbB1), HER2 (neu/erbB2) and also HER3 (neu/erbB3), which belong to subclass I of the RTK superfamily, in various types of human cancer cells. The activation of IGF-1 and VEGF receptors, the other members of RTK family, is also inhibited by EGCG. In addition, EGCG alters membrane lipid organization and thus inhibits the dimerization and activation of EGFR. Therefore, EGCG inhibits the Ras/MAPK and PI3K/Akt signaling pathways, which are RTK-related cell signaling pathways, as well as the activation of AP-1 and NF-κB, thereby modulating the expression of target genes which are associated with induction of apoptosis and cell cycle arrest in cancer cells. These findings are significant because abnormalities in the expression and function of RTKs and their downstream effectors play a critical role in the development of several types of human malignancies. In this paper we review evidence indicating that EGCG exerts anticancer effects, at least in part, through inhibition of activation of the specific RTKs and conclude that targeting RTKs and related signaling pathway by tea catechins might be a promising strategy for the prevention of human cancers.
Men who target women: specificity of target, generality of aggressive behavior
Authors: Anderson Craig A. , Anderson Kathryn B.
Published: June 2008

Two studies examined the effects of individual differences identified by the Confluence Model of aggression against women [Malamuth Linz, Hevey et al., 1995] and the General Aggression Model [GAM: Anderson and Carnagey, 2004] as predictors of male‐on‐female aggression. Study 1, a correlational study, found that hostile masculinity predicts self‐reported sexual aggression independently of nonsexual aggression against women, and is itself predicted by proneness to general hostility, masculine gender role stress, and violent attitudes toward women. Furthermore, hostility toward women independently predicted sexual and nonsexual aggression against women, above the effects of general attitudes toward violence and general levels of hostility and aggression. Study 2, an experimental study, found that under high provocation, high hostility toward women predicted increases in male nonsexual aggression against women and slight decreases in male aggression against men. This effect remained significant even after controlling for general attitudes toward violence and for general levels of hostility and aggression, indicating that males who are highly hostile toward women specifically target women and that their aggression toward women generalizes beyond sexual aggression. The findings are discussed in terms of a model that integrates the Confluence Model with GAM. Aggr. Behav. 34:605–622, 2008. © 2008 Wiley‐Liss, Inc.
Visualization of the foaming mechanism of polyethylene blown by chemical blowing agents under ambient pressure
Authors: Pop‐Iliev Remon , Dong Ning , Xu Donglai , Park Chul B.
Published: June 2008

Understanding the fundamental mechanisms that govern the foaming process is the most essential universal prerequisite for developing effective processing strategies for fabricating high‐quality foamed plastic products using any type of foaming technology. Despite chemically blown foaming of thermoplastics under atmospheric pressure has been successfully implemented in rotational foam molding over the last decade, the related open literature does not provide substantial research addressing the fundamentals of this unique foaming mechanism. The present study focuses on clarifying the fundamental foaming mechanisms that govern the successful manufacture of thermoplastic foams using a chemical blowing agent under low‐pressure (atmospheric) conditions. The presented research is mainly based on observing a series of visualization experiments conducted using a custom‐made visualization system including an optical microscope and a computerized CCD camera imaging system, which was utilized for investigating the behavior of foamable polyethylene samples prepared by using the compression‐molding method. © 2008 Wiley Periodicals, Inc. Adv Polym Techn 26:213–222, 2007; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/adv.20102
UV‐curing of acrylate thin films onto Al2O3 particles via free‐radical polymerization
Authors: Feng Jianxin , Lu Chunmeng , Zhu Linjie , Wang Peng , Tan Victor , Zhang Qi , Teng Shuli , Patel Subhash H. , Young Ming‐Wan , Gogos Costas G.
Published: June 2008

The UV curing of ultrathin films of acrylates on Al2O3 particles has been studied by using photodifferential scanning calorimetry (photo‐DSC). Effects on curing of the chemical structure of the monomers, thickness of the films, type of initiators, and the presence of oxygen were investigated. Results show that photopolymerization of ultrathin films on the particle surface is much more sensitive to oxygen poisoning than the thick films on flat surfaces, and the conversion of monomers depends on the types of monomers and initiators selected. When alpha hydroxyl ketones (Esacure KIP100F) were used as photoinitiators, the final double‐bond conversions of both difunctional and trifunctional monomers can only reach up to 10% in the presence of air. The curing kinetics of monomers on particles in either air or nitrogen at the early stages of polymerization can be well fitted with calculations based on the quasi‐steady‐state assumption. Esacure 1001M, a sulfur‐containing benzophenone, has been used together with 2‐ethylhexyl‐4‐dimethylamino benzoate (Esacure EHA) as the initiating system to combat the oxygen‐poisoning effect. It was found that this system is much more effective than Esacure KIP100F in achieving high conversions of monomers in the presence of oxygen. This has been further demonstrated by Fourier transform infrared spectroscopy (FTIR). © 2008 Wiley Periodicals, Inc. Adv Polym Techn 26:272–283, 2007; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/adv.20108
Gray matter atrophy is related to long‐term disability in multiple sclerosis
Authors: Fisniku Leonora K. , Chard Declan T. , Jackson Jonathan S. , Anderson Valerie M. , Altmann Daniel R. , Miszkiel Katherine A. , Thompson Alan J. , Miller David H.
Published: June 2008

Objective

To determine the relation of gray matter (GM) and white matter (WM) brain volumes, and WM lesion load, with clinical outcomes 20 years after first presentation with clinically isolated syndrome suggestive of multiple sclerosis (MS).

Methods

Seventy‐three patients were studied a mean of 20 years from first presentation with a clinically isolated syndrome (33 of whom developed relapsing‐remitting MS and 11 secondary‐progressive MS, with the rest experiencing no further definite neurological events), together with 25 healthy control subjects. GM and WM volumetric measures were obtained from three‐dimensional T1‐weighted brain magnetic resonance images using Statistical Parametric Mapping 2.

Results

Significant GM (p < 0.001) and WM atrophy (p = 0.001) was seen in MS patients compared with control subjects. There was significantly more GM, but not WM atrophy, in secondary‐progressive MS versus relapsing‐remitting MS (p = 0.003), and relapsing‐remitting MS versus clinically isolated syndrome (p < 0.001). GM, but not WM, fraction correlated with expanded disability status scale (rs = −0.48; p < 0.001) and MS Functional Composite scores (rs = 0.59; p < 0.001). WM lesion load correlated with GM (rs = −0.63; p < 0.001), but not with WM fraction. Regression modeling indicated that the GM fraction explained more of the variability in clinical measures than did WM lesion load.

Interpretation

In MS patients with a relatively long and homogeneous disease duration, GM atrophy is more marked than WM atrophy, and reflects disease subtype and disability to a greater extent than WM atrophy or lesions. Ann Neurol 2008
Lewis Base Catalyzed 1,3‐Dithiane Addition to Carbonyl and Imino Compounds Using 2‐Trimethylsilyl‐1,3‐dithiane
Authors: Michida Makoto , Mukaiyama Teruaki
Published: June 2008

Lewis base‐catalyzed 1,3‐dithiane addition to electrophiles such as carbonyl compounds and N‐substituted aldimines with 2‐trimethylsilyl‐1,3‐dithiane (TMS‐dithiane) is described. By the activation of the carbon‐silicon bond in the presence of a Lewis base catalyst such as tetrabutylammonium phenoxide (PhONnBu4), a 1,3‐dithiane addition reaction proceeded smoothly to afford the corresponding adducts in good to high yields under mild conditions. This synthesis is also applied to the reactions of ketones having α‐protons, and of N‐substituted aldimines.
Biomimetic Iron‐Catalyzed Asymmetric Epoxidation of Aromatic Alkenes by Using Hydrogen Peroxide
Authors: Gelalcha Feyissa Gadissa , Anilkumar Gopinathan , Tse Man Kin , Brückner Angelika , Beller Matthias
Published: June 2008

A novel and general biomimetic non‐heme Fe‐catalyzed asymmetric epoxidation of aromatic alkenes by using hydrogen peroxide is reported herein. The catalyst consists of ferric chloride hexahydrate (FeCl3⋅6 H2O), pyridine‐2,6‐dicarboxylic acid (H2(pydic)), and readily accessible chiral N‐arenesulfonyl‐N′‐benzyl‐substituted ethylenediamine ligands. The asymmetric epoxidation of styrenes with this system gave high conversions but poor enantiomeric excesses (ee), whereas larger alkenes gave high conversions and ee values. For the epoxidation of trans‐stilbene (1 a), the ligands (S,S)‐N‐(4‐toluenesulfonyl)‐1,2‐diphenylethylenediamine ((S,S)‐4 a) and its N′‐benzylated derivative ((S,S)‐5 a) gave opposite enantiomers of trans‐stilbene oxide, that is, (S,S)‐2 a and (R,R)‐2 a, respectively. The enantioselectivity of alkene epoxidation is controlled by steric and electronic factors, although steric effects are more dominant. Preliminary mechanistic studies suggest the in situ formation of several chiral Fe‐complexes, such as [FeCl(L*)2(pydic)]⋅HCl (L*=(S,S)‐4 a or (S,S)‐5 a in the catalyst mixture), which were identified by ESIMS. A UV/Vis study of the catalyst mixture, which consisted of FeCl3⋅6 H2O, H2(pydic), and (S,S)‐4 a, suggested the formation of a new species with an absorbance peak at λ=465 nm upon treatment with hydrogen peroxide. With the aid of two independent spin traps, we could confirm by EPR spectroscopy that the reaction proceeds via radical intermediates. Kinetic studies with deuterated styrenes showed inverse secondary kinetic isotope effects, with values of kH/kD=0.93 for the β carbon and kH/kD=0.97 for the α carbon, which suggested an unsymmetrical transition state with stepwise O transfer. Competitive epoxidation of para‐substituted styrenes revealed a linear dual‐parameter Hammett plot with a slope of 1.00. Under standard conditions, epoxidation of 1 a in the presence of ten equivalents of H218O resulted in an absence of the isotopic label in (S,S)‐2 a. A positive nonlinear effect was observed during the epoxidation of 1 a in the presence of (S,S)‐5 a and (R,R)‐5 a.