bluuebunny/crossref_metadata_2025 huggingface dataset:
The Recent Anti-Secession Law of the PRC
Authors: Gupta Ranjit
Published: December 2005

The Anti-Secession Law was adopted on 14 March 2005, the final day of the annual session of the National People's Congress of the PRC. This Taiwan-specific piece of legislation overshadowed Jiang Zemin's final exit from the political scene and can be considered as the most important business transacted at this session. This Chinese move has attracted considerable international attention in the media, amongst China scholars and from foreign governments. However, there is widespread divergence of views regarding the motivations for this action, its timing, its real import and potential consequences.
The Significance of the Chinese People's Liberation Army White Paper
Authors: Noumoff S.J.
Published: December 2005

In December 2004 the People's Liberation Army issued its status report, the White Paper, summarising its view of the global configuration of forces and projecting its response. The operating assumptions are: (1) while the international situation is stable, there are factors present of instability, uncertainty and insecurity, which are increasing, at the same time that hegemonism and unilateralism are gaining; (2) the tendency towards multi-polarisation is deepening; (3) new changes are altering the existing balance of power; (4) while the developing world is increasing global democratisation with a more vocal say, the gap between the North and the South is ever widening; (5) the world wide revolution in Military Affairs requires both new technology and new doctrines; (6) localised wars of a geopolitical, ethnic and religious nature are a constant threat; (7) any attempt by Taiwan to separate will be crushed; and (8) non-traditional threats are on the increase.

To properly position the White Paper in perspective, it is essential to examine the 1999 study by two senior PLA Colonels, Unrestricted Warfare, which was characterised by the US as the doctrine of a technologically weaker China as it confronts the superior US power. A careful examination of this study reveals a thoroughly thought-out evaluation of both US and Chinese strengths and weaknesses in technology, strategy and doctrine. There is little doubt that the wake-up call for the PLA was triggered by the Gulf War—Operation Desert Storm.

China's response, it is argued, is multiple—ranging from altering force levels to increasing its educational/technical levels; developing a seamless strategy for a transition from a peacetime to a wartime economy; seeking a leapfrog strategy in military technology; not falling into the trap of seeking superiority in all areas of military technology; and constructing and reinforcing an alliance structure of both multilateral institutional nature as well as on the bilateral level.
Wen Jiabao's South Asian Sojourn
Authors: Acharya Alka
Published: December 2005

Substantial, far-reaching and continuing changes constitute the milieu in which India–China relations are being recast and forged anew. In retrospect, all previous visits by Chinese premiers have represented a decisive and substantial perceptual and paradigmatic transformation in India–China relations. The April 2005 South Asia visit by the Chinese premier must also be placed in the context of a deepening economic and strategic engagement with the South Asian region. This is also in keeping with China's policy of ‘good neighbourliness’ on which it has laid so much stress, over the last decade and a half. Such a formulation though, can prevent one from seeing that there are different nuances to China's relations with each of the smaller countries of South Asia. India's centrality in the region is however evident. The relationship is now multilayered and operating at many different levels. The Joint Statement signed during the visit described the India–China relationship as a ‘strategic and cooperative partnership for peace and prosperity’, the precise nature of which is yet to evolve. In the economic and commercial fields, the advances have been quite remarkable, raising expectations of even greater increases. India–China cooperation in other regional and global theatres has in-built ambiguity. Both sides need to clarify these ambiguities as they move towards the realisation of the ‘strategic and cooperative partnership for peace and prosperity’.
Direct Flights Take Off
Authors: Jacob Jabin T.
Published: December 2005

The first direct flights between China and Taiwan since the end of the civil war in 1949 took place in early 2005. These were intended to facilitate travel by Taiwanese businessmen and their families in China for the Lunar New Year celebrations back home. Following the Taiwan–Hong Kong Aviation Agreement of 2002 and the charter flights of 2003, no flights took place in 2004 owing to political compulsions such as Chen Shuibian's call for a referendum on Chinese missiles and his subsequent reelection campaign. In 2005, the opposition KMT in Taiwan, by virtue of its strong electoral showing in December 2004 developed its own stake in the negotiations and was able to set up an alternate channel for talks with authorities in Beijing. Meanwhile, the nature of negotiations between China and Taiwan on cross-straits flights continues to be disputed, with China insisting on the domestic nature of the negotiations and subsequent agreements whereas Taiwan has consistently described them as having elements of international negotiations. The issue, while resulting in further political polarisation on the island, has also given Beijing increasing clout in Taiwanese domestic politics.
Better than a Bank for a Poor Man?
Authors: Lewinnek Elaine
Published: December 2005

In 1900, in Chicago and many other American cities, working-class immigrants owned homes at higher rates than native-born people. How did immigrants pay for these homes, and why? By examining real estate advertisements, records of Chicago’s Building & Loan Associations, the immigrant press, and observations of Chicago’s social workers, this article considers the meanings of home consumption. After borrowing from friends and building associations, immigrants kept boarders, grew market gardens, and even opened home-based commercial laundries, eroding home-work distinctions while sending out women and children to work to repay loans. They transgressed middle-class norms to achieve a hoped-for middle-class status. Many social workers questioned this, yet realtors asserted that houses were “better than a bank for a poor man.” With hindsight, and considering uninsured banks’ precariousness, this appears to have been true. Chicago’s workers made immense sacrifices for home ownership, contributing to Chicago’s sprawling suburban geography and to modern myths about the American dream.
The Light on the Horizon
Authors: Abbott Carl
Published: December 2005

American cities have never experienced modern total war, leaving Americans to imagine the impacts of catastrophic warfare on their urban centers. This article examines post-1945depictions of the death of U.S. cities in films, short stories, and novels from the “thriller,” “future war,” and science fiction genres since 1945. Cities are conspicuous by their absence from fictions of future war and its impacts, often disappearing offstage to allow the plot to follow survivors in small-town and rural settings. This pattern spans depictions of the immediate days after atomic bombing (or a surrogate disaster such as a stray meteor or plague) and stories set decades or centuries after the Big Blowup. Cities are often depicted as sources of danger even in their death throes and after, supporting the conclusion that these narratives express the strong fear of cities and the preference for middle landscapes that have long marked American culture.
Behavioral Assessment and Treatment of Pediatric Headache
Authors: Andrasik Frank , Schwartz Mark S.
Published: December 2005

Headaches are quite common in children and adolescents, and they appear to persist into adulthood in a sizable number of individuals. Assessment approaches (interview, pain diaries, and general and specific questionnaires) and behavioral treatment interventions (contingency management, relaxation, biofeedback, and cognitive behavior therapy) are reviewed, as is the evidence base for their use. The article concludes with practical suggestions for headache management.
Convergence and Mobility: Personal Income Trends in U.S. Metropolitan and Nonmetropolitan Regions
Authors: Hammond George W. , Thompson Eric
Published: December 2005

The authors find evidence of income convergence across all substate labor markets in the lower forty-eight U.S. states during the 1969 to 1999 period. However, convergence is not expressed in a uniform way across metropolitan/nonmetropolitan regions, across time periods, or across census regions. The authors show that catching up within the distribution is more common for nonmetropolitan regions than for metropolitan regions. Furthermore, the largest metropolitan regions show strong tendencies to converge toward the bottom of their income distribution while at the same time showing comparatively little distributional mobility. This contrasts with results for the smallest nonmetropolitan regions, which show no evidence of convergence but high levels of intradistributional mobility. The authors also examine the relationship between human capital accumulation and industry mix and subsequent distributional mobility. The results suggest that educational attainment is positively correlated with growth for metropolitan regions, but it appears to be less correlated with upward mobility within the nonmetropolitan distribution.
Regional Convergence in the European Union: A Stochastic Dominance Approach
Authors: Carrington Anca
Published: December 2005

This article offers a new approach in assessing the presence of regional convergence in income per capita and applies it to data for sixty-five regions of the European Union over the decade leading up to the entry into force of the Maastricht Treaty. Within the framework of distributional dynamics analysis, the author proposes the use of quantitative techniques traditionally employed to inform investment decision making under uncertainty. After investigating the intradistributional dynamics with Markov chains, the author tests for regional convergence using secondorder stochastic dominance. For the sample and time horizon considered, the author finds evidence of regional convergence that is neither fast nor continuous. In other words, the regions in the sample display high persistence in belonging to a certain income group, while subperiods of convergence and divergence in income per capita are discernible. The approach proposed is grounded in economic theory, offers information about changes across the entire distribution, and can be adapted to incorporate location into the analysis.
Multinationals' Location Choice, Agglomeration Economies, and Public Incentives
Authors: Barrios Salvador , Görg Holger , Strobl Eric
Published: December 2005

We study the regional location decision of multinationals in Ireland since the 1970s by focusing on the role played by agglomeration economies and by a distinct change in regional policy intent on dispersing industrial activity to the more disadvantaged areas of Ireland. We find that regional policy has only been effective in attracting low-tech firms to the disadvantaged areas during the time when there was a more indirect approach to regional policy. Our results also show that hi-tech firms spread more evenly across the country and that urbanization economies were for these firms a more important locational determinant than public incentives.
Genetic Technologies Meet the Public
Authors: Lassen Jesper , Jamison Andrew
Published: December 2005

To clarify concerns that the public has with genetic technologies, the article presents the results of focus group interviews conducted in Denmark in 2000. The concerns of the public are divided into three ideal-typical categories: social (dealing with environmental and health risks), economic (dealing with both the threats and opportunities of the new technologies), and cultural (taking up ethical and moral concerns). Following a general discussion of why it is important to take these discourses of concern seriously, each discursive category is discussed with examples taken from the focus group interviews.
Dismissed Content and Discontent
Authors: Neyland Daniel
Published: December 2005

Actor-network theory (ANT) has contributed greatly to the development of science and technology studies. However, recent critiques appear to have left ANT in a gloomy theoretical black box. What is the likelihood of ANT exiting its current theoretical discontent? Is ANT worthy of salvation and on what grounds? Law argues that recent critiques stem from ANT’s development into a particular theoretical strategy. However, this article will argue that by focusing on strategy as messy and impure, ANT can be afforded the opportunity to shift from a fixed approach to an ambiguous and contingent strategy, well placed to carry on. The article achieves such an argument by first highlighting how ANT has contributed to a recent study of strategy in action; second, by outlining the strategic aspects of ANT; and third, by using the study of strategy in action as a means of engaging with ANT’s current theoretical discontent.
Farm Families and the American Revolution
Authors: Baller William
Published: December 2005

This article examines family dynamics and mobilization for the American Revolution in the overlooked region of central Massachusetts. Results indicate that warfare and the farming culture frequently clashed. Some militiamen found that farming life failed to prepare them for wartime stresses and the rigors of camp life. Rugged individualism and military regimentation did not always mesh. Based on vital records, military service records, and family histories, the article also shows how birth order shaped military recruitment. Family responsibilities and a suffocating patriarchy sometimes impeded mobilization. Harvesting duties and family emergencies forced some to have to choose between one’s home and the patriot cause. The article also explores links between family ties and loyalism and the Revolution’s impact on patriarchy and inheritance patterns.
“Everything They Hate”: Michèle, Mildred, and Elite Haitian Marrying Strategies in Historical Perspective
Authors: Burnham Thorald M.
Published: December 2005

This article explores the extent to which the 1980 marriage of Haitian president Jean-Claude Duvalier contributed to his political demise in February 1986. The author argues that the marriage was a strategic mistake by the Haitian president, because it formalized an alliance between himself and a political kinship group (the Bennetts) that alienated his most important base of support, the black middling classes. This article also suggests that a similar mistake was committed in 1996 by President Jean-Bertrand Aristide when he married his U.S. legal advisor, Mildred Trouillot. These marriage strategies, however, can only be understood in the context of the historical class and color divisions that have remained an integral part of the Haitian sociopolitical sphere of the urban elite.
The theory and practice of supermax prisons
Authors: Mears Daniel P. , Reisig Michael D.
Published: December 2005

Over the last two decades, super-maximum custody (or ‘supermax’) prisons have become increasingly common throughout the American correctional landscape. Although these institutions can be justified using a variety of arguments (e.g. retribution), one of the most commonly used rationalizations is that they promote higher levels of prison order throughout the systems in which they are used. Because of the lack of direct empirical evidence to support this claim, we refer to this argument as the ‘system-wide order’ conjecture. In this essay, we explore the different pathways through which supermax prisons may achieve system-wide order. Our analysis suggests that the conceptual foundation upon which the system-wide order conjecture rests is unstable, and that empirical research is needed to resolve debates about the merits of supermax prisons in contributing to order in prison systems. We conclude by identifying critical research gaps that must be addressed to better understand the effects of this high-cost correctional approach.
Reality-based television and police–citizen encounters
Authors: Shon Phillip Chong Ho , Arrigo Bruce A.
Published: December 2005

Recent theoretical analyses concerning mental illness argue that persons labeled as such are punished first through discourse, subsequently legitimized, knowingly or not, through social effect. In this framework, punishment is an artifact of unconscious and symbolic forces whose structuration can be positionally, relationally and provisionally decoded through careful textual exegeses. Linked to several strains of postmodern inquiry, a number of application studies have examined the varied sociological and criminological contexts in which this phenomenon operates; including the reality construction undertaken by legal and psychiatric decision brokers and tribunals. However, one under-investigated dimension to this critical theory of punishment is found within popular media portrayals, including reality-based television programming. This study explores the intertextual construction and situated meaning of mental illness derived from the acclaimed television show, COPS. By appropriating the methodological tools of discourse analysis, this article describes the richly detailed, constitutive order lurking behind and through one excerpted police–citizen (P–C) encounter. At issue here is the dialogical function of fear and laughter, and the manner in which each uniquely functioned to transform the phenomenon of mental illness into the sign of punishment, expressed through harms of reduction and repression. Several social and justice policy implications stemming from this inquiry also are described.
Prison buildup and disorder
Authors: Useem Bert , Piehl Anne M.
Published: December 2005

In contrast to the predictions of many, the prison buildup in the USA did not lead to dramatic increases in chaos behind bars. Instead, prison riots have become rarer, the homicide rate among inmates has declined dramatically and a smaller proportion of inmates are held in segregation and protective custody. Escapes are less common. What caused, then, the trend toward greater, rather than less, order? Neither demographics nor the development of supermax facilities are found to be responsible for much of the improvement. Rather, the data are consistent with the position that political and correctional leadership made prison institutions more effective. There may well be many negative social consequences of the prison buildup, but diminished prison order was not one.
The Opening and Closing of Breaches
Authors: Killias Martin
Published: December 2005

Long-term trends in crime suggest that increases have usually been provoked by ‘breaches’, i.e. sudden new opportunities for offending that opened as a result of changes in the technological or social environment. Such ‘breaches’ often go unnoticed over extended periods of time. Once discovered, they provoke rapid increases in offences that usually provoke defensive actions aimed at curbing such developments. Once ‘breaches’ are closed, crime waves tend to fade away. Often ‘breaches’ open opportunities that are not (yet) covered by criminal law. Law-making has, over centuries, been aimed at filling such gaps. Interestingly, efficient preventive (e.g. situational) measures are envisaged only once the behaviour to be prevented has been made a crime through new legislation. Thus, preventive action and legislation are both responses to new opportunities that threaten important social interests, and it is ‘breaches’ that drive both prevention and legislation.
The ‘Drug–Crime Link’ from a Self-Control Perspective
Authors: Ribeaud Denis , Eisner Manuel
Published: December 2005

The present paper explores to what extent low self-control can account for the ‘drug–crime link’, i.e. the correlation between substance use and delinquency. Based on a large representative sample of Swiss 9th grade students, we reassess the dimensionality of Grasmick et al.'s self-control scale and propose a fivedimensional second-order factor model. This model is then used as a predictor of two correlated behavioural continua, one measuring overall delinquency and the other overall substance use. Results indicate that self-control is a strong and stable predictor of both types of behaviour. However, although self-control substantially accounts for the correlation between delinquency and substance use, a considerable residual correlation remains. It is argued that dynamic or ‘state-dependent’ factors are most likely to account for this residual correlation. Analyses of the predictive power of individual sub-dimensions of self-control further indicate that self-control might be reduced to the sub-dimensions of ‘risk-seeking’ and ‘impulsivity’. Results are discussed in the broader context of past research and of the ongoing theoretical debate.
Sentencing Outcomes in a Multinational Society
Authors: Fishman Gideon , Rattner Arye , Turjeman Hagit
Published: December 2005

The focus of this paper is the effect of nationality on prison disposition in Israel. An interaction between the nationality of the judge, the perpetrator and the victim is examined. The data were collected in the northern district courts in Israel and consist of 1394 court records. The results show that being an Arab defendant is an inherent liability in the Israeli criminal justice system – they are more likely than Jews to receive prison sentences. Arab judges seem to be more punitive than their Jewish colleagues are. The nationality of the victim plays a significant role only in cases tried by Arab judges. In the case of an Arab judge and a Jewish victim the likelihood of an Arab defendant getting a prison sentence is higher than when the victim is an Arab. This leads to a consideration of the effect of stereotypes and the majority–minority and in–out group relations on the performance of the justice system.
Joining and Leaving Gangs
Authors: Bendixen Mons , Endresen Inger M. , Olweus Dan
Published: December 2005

Gang membership is repeatedly reported to be one of the strongest predictors of antisocial behaviour. However, whether this association primarily reflects a selection effect or whether it primarily is related to a facilitation of antisocial behaviour within the gang has scarcely been an object of empirical study. This paper examines how antisocial behaviour and gang membership are associated among adolescents across time, using longitudinal data from a representative sample of Norwegian adolescents ( N= 1203). Initial cross-group comparisons revealed that gang members were markedly more involved in general antisocial behaviour than non-gang members not only during periods of active gang membership but also during other periods, thereby supporting the theory that there is a selection effect. This effect was smaller for violence than for other forms of antisocial behaviour. Results from longitudinal analyses that compared behavioural changes among gang members and non-gang members during periods when the gang members joined and left a gang demonstrated that active gang affiliation strongly facilitated general antisocial behaviour as well as violent behaviour. Taken together, the results give strong support to the theory that both selection and facilitation processes contribute to the association between gang membership and antisocial involvement.
The Prognostic Significance of Burglary in Company
Authors: Hodgson Beth , Costello Andrew
Published: December 2005

Information on 4521 cleared domestic burglaries was examined for patterns of co-offending. It was found that novice burglars co-offending with people equally inexperienced in burglary did not go on to have prolonged burglary careers. A first burglary committed as a lone offender and a first burglary committed with a more experienced burglar are each associated with longer subsequent burglary careers.
Advocacy and people with learning disabilities in the UK
Authors: Rapaport Joan , Manthorpe Jill , Moriarty Jo , Hussein Shereen , Collins Jean
Published: December 2005

Advocacy schemes have been established throughout the United Kingdom (UK) but their evaluation by funders is varied. This article reviews the literature in respect of models of evaluation of advocacy schemes for people with learning disability. It discusses the six main models and the issues that arise in evaluation. The advantages and disadvantages of each model are analysed. The article concludes that whilst fears exist about the potential for evaluation to infringe advocacy schemes’ autonomy, funders need to undertake such a process for reasons of public accountability. Advocacy schemes may find it useful to consider which model of evaluation works best for them and will be appropriate and useful for their funders.
Empowerment, policy levels and service forums
Authors: Brandon Toby
Published: December 2005

This article will examine empowerment through policy at three levels: governmental, service and ‘street’. It will focus in particular on ‘street level’ policy, drawing on qualitative interviews and an analysis of documentation within a day centre for adults with learning difficulties. The recorded behaviour of the workers and the structure of the day centre affected service users’ experience of power. This is discussed through the theoretical construction of the organization’s ‘service forum’ that contains its ‘posture’, a set of formal values and beliefs owned by the organization, and the ‘culture’, which is the unofficial day-to-day presentation of the service. Finally the use of such an approach is considered with regards to the future analysis of services for people with learning difficulties.
Empowerment and the architecture of rights based social policy
Authors: Stainton Tim
Published: December 2005

This article considers what the notions of empowerment, rights and citizenship imply in the way of structures and policies. It argues that a coherent model is emerging with recognizable elements. The article begins with a brief discussion of some background and theoretical questions. It then examines four elements: support for people to articulate their claims; support for people to identify, obtain and manage supports necessary to actualize their claims; providing control over resources; and governance. Examples will be drawn primarily from the UK and British Columbia, Canada to illustrate the elements. The article then looks at some of the issues related to successful implementation of a rights or empowerment based model of policy and structures for supporting people labelled as having a learning disability.
Empowerment, self-advocacy and resilience
Authors: Goodley Dan
Published: December 2005

This article critiques the relationship between the aims of ‘learning disability’ policy and the realities of the self-advocacy movement. A previous study found that self-advocacy can be defined as the public recognition of the resilience of people with learning difficulties. In the current climate of Valuing People, partnership boards and ‘user empowerment’, understanding resilience is crucial to the support of authentic forms of self-advocacy. This article aims to address such a challenge. First, understandings of resilience in relation to self-empowerment and self-advocacy are briefly considered. Second, the current policy climate and service provision rhetoric are critically explored. Third, it is argued that we need to recognize how self-advocacy groups celebrate resilience through a variety of social and identity-shifting actions. How current policy responds to these aspects of resilience is questioned. It is concluded that the lived reality of self-advocacy needs to be foregrounded in any attempt to understand empowerment.
Bone Loss after Initiation of Androgen Deprivation Therapy in Patients with Prostate Cancer
Authors: Greenspan Susan L. , Coates Penelope , Sereika Susan M. , Nelson Joel B. , Trump Donald L. , Resnick Neil M.
Published: December 2005

Context: Although androgen deprivation therapy (ADT) for prostate cancer is associated with bone loss, little is known about when this bone loss occurs.

Objective: We postulated that men on ADT would experience the greatest bone loss acutely after initiation of ADT.

Design and Setting: We conducted a 12-month prospective study at an academic medical center.

Patients or Other Participants: We studied 152 men with prostate cancer (30 with acute ADT, <6 months; 50 with chronic ADT, ≥6 months; and 72 with no ADT) and 43 healthy age-matched controls.

Main Outcome Measures: We assessed bone mineral density (BMD) of the hip, wrist, total body, and spine; body composition; and markers of bone turnover.

Results: After 12 months, men receiving acute ADT had a significant reduction in BMD of 2.5 ± 0.6% at the total hip, 2.4 ± 1.0% at the trochanter, 2.6 ± 0.5% at the total radius, 3.3 ± 0.5% at the total body, and 4.0 ± 1.5% at the posteroanterior spine (all P < 0.05). Men with chronic ADT had a 2.0 ± 0.6% reduction in BMD at the total radius (P < 0.05). Healthy controls and men with prostate cancer not receiving ADT had no significant reduction in BMD. Both use and duration of ADT were associated with change in bone mass at the hip (P < 0.05). Men receiving acute ADT had a 10.4 ± 1.7% increase in total body fat and a 3.5 ± 0.5% reduction in total body lean mass at 12 months, whereas body composition did not change in men with prostate cancer on chronic ADT or in healthy controls (P < 0.05). Markers of bone formation and resorption were elevated in men receiving acute ADT after 6 and 12 months compared with the other men with prostate cancer and controls (P < 0.05). Men in the highest tertile of bone turnover markers at 6 months had the greatest loss of bone density at 12 months.

Conclusions: Men with prostate cancer who are initiating ADT have a 5- to 10-fold increased loss of bone density at multiple skeletal sites compared with either healthy controls or men with prostate cancer who are not on ADT, placing them at increased risk of fracture. Bone loss is maximal in the first year after initiation of ADT, suggesting initiation of early preventive therapy.
The Valine Allele of the V89L Polymorphism in the 5-α-Reductase Gene Confers a Reduced Risk for Hypospadias
Authors: Thai Hanh T. T. , Kalbasi Mina , Lagerstedt Kristina , Frisén Louise , Kockum Ingrid , Nordenskjöld Agneta
Published: December 2005

Context: Hypospadias is one of the most common malformations in man, with an incidence of 1:300 in newborn boys. No gene has been identified that causes isolated hypospadias, but the androgenic influence is important during male genital development.

Objective: A key enzyme for the androgenic function is steroid 5-α-reductase (SRD5A2). The V89L polymorphism in the SRD5A2 gene has been studied and found to be of functional importance. The leucine version of the enzyme is 30% less efficient than the valine variant.

Design, Setting, Patients, and Results: We have genotyped 158 hypospadias cases and 96 unaffected controls for this polymorphism and found a significant negative association for the V89 allele in hypospadias (odds ratio, 0.24; 95% confidence interval, 0.14–0.41 for homozygous individuals). This indicates that a fully functional 5-α-reductase enzyme (homozygous for V89) protects the male urethral development. This association is shown regardless of heredity, ethnicity, and severity of phenotype. We have also sequenced a selected material of 37 sporadic cases of more severe hypospadias for mutations in the androgen receptor AR, SRD5A2, and 17β-hydroxysteroid dehydrogenase HSD17B3 genes and found only two previously described mutations, one in the AR and one in the SRD5A2 gene.

Conclusion: This finding is in accordance with the assumption that functional polymorphisms may play an important role in complex disorders such as hypospadias when several genes as well as environmental factors contribute to the etiology.
Synthesis of Thyroid Hormone Binding Proteins Transthyretin and Albumin by Human Trophoblast
Authors: McKinnon Brett , Li Huika , Richard Kerry , Mortimer Robin
Published: December 2005

Context: Mechanisms regulating materno-fetal transfer of thyroid hormone are not well understood. Modulation of trophoblast type 3 iodothyronine deiodinase (D3) may play an important role.

Objective: The objective of this study was to investigate trophoblast thyroid hormone binding proteins that may modulate interactions between D3 and T4.

Design: Placentas were obtained by informed consent from women delivering normal infants by repeat cesarean section at 38–40 wk gestation. T4 and T3 binding was examined in human placenta. Serum thyroid hormone binding proteins were identified by Western blotting, and their mRNA was examined by RT-PCR. Presence of these proteins in trophoblast was determined by immunocytochemistry and immunofluorescence. Cytosol was progressively purified to reveal additional thyroid hormone binding proteins that were identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry. Effects of mefenamic acid on placental deiodination were examined by HPLC.

Results: We detected high-affinity T4 and T3 binding in human placental cytosol. All three major serum-binding proteins, T4 binding globulin (TBG), transthyretin (TTR), and albumin, were present in cytosol. TTR mRNA and albumin mRNA were detected in human placenta, and TTR and albumin were identified histochemically in syncytiotrophoblasts. Neither TBG mRNA nor TBG was detected, suggesting that plasma TBG had contaminated the cytosol preparation. Low-affinity thyroid hormone binding proteins α-1-antitrypsin and α-1-acid glycoprotein were also identified. Addition of mefenamic acid, a potent inhibitor of thyroid hormone binding, to placental cytosol significantly enhanced deiodination of T4 by D3.

Conclusions: Placenta produces a series of thyroid hormone binding proteins that may modify thyroid hormone deiodination and materno-fetal thyroid hormone transport.
Hypothalamic-Pituitary Dysfunction after Irradiation of Nonpituitary Brain Tumors in Adults
Authors: Agha Amar , Sherlock Mark , Brennan Sinead , O’Connor Stephen A. , O’Sullivan Eoin , Rogers Bairbre , Faul Clare , Rawluk Daniel , Tormey William , Thompson Christopher J.
Published: December 2005

Context: Hypothalamic-pituitary (HP) dysfunction is common in children treated with cranial radiotherapy (RT) for brain tumors, but there is little known about the risk of HP dysfunction in adults treated with RT for primary nonpituitary brain tumors.

Objective: The objective was to study the frequency of HP dysfunction in adults after RT for nonpituitary brain tumors.

Method: We studied 56 adult patients who received external beam RT for primary nonpituitary brain tumors at time intervals of 12–150 months after RT. The control group consisted of 20 RT-naive patients with primary brain tumors. GH and adrenal axes were assessed using the insulin tolerance test or the glucagon stimulation test. Gonadotroph, thyrotroph, and lactotroph function were assessed using baseline blood measurements. The biological effective dose (BED) to the HP axis was calculated in the RT patients.

Results: Hypopituitarism was present in 41% of patients. The frequency of GH, ACTH, gonadotropin, and TSH deficiencies, and hyperprolactinemia was 32, 21, 27, 9, and 32%, respectively. Any degree of hypopituitarism and GH deficiency was significantly associated with longer time interval from RT and greater BED. However, gonadotropin deficiency and hyperprolactinemia were only related to BED, whereas ACTH deficiency was only significantly associated with the time interval from RT. One RT-naive patient was GH deficient.

Conclusion: Adult patients treated with cranial irradiation for primary nonpituitary brain tumors are at high risk of hypopituitarism, which is time and dose dependent. Long-term surveillance and periodic evaluation are needed. We recommend that adult late effect clinics, similar to those for children, should be established.
Aneurysmal Rupture During Coiling: Low Incidence and Good Outcomes at a Single Large Volume Center
Authors: Brisman Jonathan L. , Niimi Yasunari , Song Joon K. , Berenstein Alejandro
Published: December 2005

OBJECTIVE:

To study the incidence and clinical outcomes of intraoperative aneurysm rupture (IOR) during endovascular coil embolization at a single large volume center and to review the literature on this subject to determine whether IOR rupture rate and mortality correlate with volume of aneurysms treated at a given center and years since the institution of Guglielmi detachable coils as a treatment modality.

METHODS:

We reviewed the aneurysm database at the Center for Endovascular Surgery since its inception (1997–2003) and reviewed 600 consecutively treated intracranial aneurysms in which coiling was attempted. All patients who sustained an IOR were studied. Procedural and follow-up angiograms as well as clinical outcomes were retrospectively reviewed. A literature review was conducted.

RESULTS:

Six patients (1.0%) experienced IOR (1.4% in acutely ruptured lesions, 0% in unruptured). All six had presented with diffuse subarachnoid hemorrhage (Fisher Grade 3) and in good clinical grade (Hunt & Hess Grades 1–3). One patient was rendered permanently disabled secondary to delay in controlling the IOR. All others were neurologically unchanged. A review of the literature revealed a trend in correlation between volume of aneurysms treated and IOR rate; no statistically significant correlation was found between volume of aneurysms treated or years since the introduction of GDC technology and IOR rates or mortality.

CONCLUSION:

IOR remains a serious risk of endosaccular coiling of intracranial aneurysms, with aneurysms presenting with subarachnoid hemorrhage at greater risk for this complication. This risk can be minimized with very low associated morbidity and mortality (incidence 1%, 17% morbidity, 0% mortality at our institution).
Spontaneous Spinal Subarachnoid Hemorrhage Secondary to Spinal Aneurysms: Diagnosis and Treatment Paradigm
Authors: Gonzalez L Fernando , Zabramski Joseph M. , Tabrizi Peyman , Wallace Robert C. , Massand Manoj G. , Spetzler Robert F.
Published: December 2005

INTRODUCTION:

Isolated spinal aneurysms are rare; only a few have been reported. To the best of our knowledge, this series represents the largest experience with four ruptured spinal aneurysms, all of which were treated surgically.

METHODS:

Clinical information from the hospital charts and diagnostic images of four patients with the diagnosis of spinal aneurysms were reviewed from the senior authors' (RFS, JMZ) office database, surgical reports, and radiological imaging database. Follow-up examinations were performed by phone interview, when possible, and by chart review.

RESULTS:

Between 1997 and 2004, four patients with ruptured spinal aneurysms underwent surgical treatment. All aneurysms were located within the spinal canal and manifested with spinal subarachnoid hemorrhage. No collagen disease, aortic coartaction, arteriovenous fistula, or arteriovenous malformations were identified in these patients.

CONCLUSION:

Subarachnoid hemorrhage within the spinal cord can be caused by ruptured aneurysms. Spinal aneurysms are rare, but should be considered within the differential diagnosis of patients with intracranial subarachnoid hemorrhage when cranial angiography is negative. Magnetic resonance imaging and selective spinal angiography are useful for workup, but definitive diagnosis may require surgical exploration.
Stereotactic Aspiration and Antibiotic Treatment Combined with Hyperbaric Oxygen Therapy in the Management of Bacterial Brain Abscesses
Authors: Kutlay Murat , Çolak Ahmet , Yıldız Şenol , Demircan Nusret , Akın Osman Niyazi
Published: December 2005

OBJECTIVE:

Despite advances in surgical techniques in the management of the brain abscess, long-term antibiotics are as crucial to cure as the initial surgical procedure itself. This study was designed to evaluate the effect of adjuvant hyperbaric oxygen (HBO) therapy on the duration of antibiotic treatment.

METHODS:

Between 1999 and 2004, 13 patients with bacterial brain abscesses treated with stereotactic aspiration combined with HBO and systemic antibiotic therapy. Patients younger than 18 years of age were excluded from this study. Postoperatively, all patients were given a 4-week course of intravenous antibiotics. Additionally, patients received hyperbaric oxygen (HBO, 100% O2 at 2.5 ATA for 60 min) twice daily for five consecutive days, and an additional treatment (100% O2 at 2.5 ATA for 60 min daily) was given for 25 days.

RESULTS:

There were eight male and five female patients. Their ages ranged between 18 and 71 years, with a mean of 43.9 years. The average duration of follow-up was 9.5 months (range, 8–13 mo). This treatment modality allowed infection control and healing for all 13 patients with 0% recurrence rate. HBO treatment was tolerated well, and there were no adverse effects of pressurization. At the end of the follow-up period, 12 patients had a good outcome: nine are without sequelae, and three have a mild hemiparesis but are capable of self-care. One patient has a moderate hemiparesis.

CONCLUSION:

Although the number of patients is small, this series represents the largest reported group of brain abscess patients treated with stereotactic aspiration combined with antibiotic and HBO therapy. Our preliminary results indicate that the length of time on antibiotics can be shortened with the use of HBO as an adjunctive treatment.
Linear Accelerator Radiosurgery for Trigeminal Neuralgia
Authors: Richards Gregory M. , Bradley Kristin A. , Tomé Wolfgang A. , Bentzen Søren M. , Resnick Daniel K. , Mehta Minesh P.
Published: December 2005

OBJECTIVE:

To report the clinical outcomes following treatment of trigeminal neuralgia with linear accelerator-based radiosurgery.

METHODS:

Twenty-eight patients with medication refractory idiopathic trigeminal neuralgia were treated with a single fraction of 80 Gy to the trigeminal nerve root. For treatment delivery, a 4-mm collimator and a 7-arc technique were delivered using a stereotactic floor stand system with an isocenter stability of 0.2 ± 0.1 mm to minimize dose to the brainstem. Treatment delivery time was approximately 55 minutes.

RESULTS:

With a median follow-up of 12 months (range, 1–40 mo), 57% of patients achieved complete pain relief and 75% (exact 95% confidence interval, 55 to 89%) had their pain reduced to 3 or less on a 10-point pain scale. Median time to pain relief was 1 month. Four patients did not respond to treatment. The actuarial mean time to pain recurrence in responders was 14 months, and the actuarial mean response duration in major to complete responders was 16 months. Women had significantly longer mean time to pain recurrence than men (16 versus 7 months; P = 0.05). Three patients reported new mild facial numbness after radiosurgery and one patient developed neurotrophic keratopathy.

CONCLUSION:

Linear accelerator-based radiosurgery for medication refractory trigeminal neuralgia provides effective pain relief with a low complication rate.
Missile-Caused Complete Lesions of the Peroneal Nerve and Peroneal Division of the Sciatic Nerve: Results of 157 Repairs
Authors: Roganovic Zoran
Published: December 2005

OBJECTIVE:

There are few large-volume studies of the repair of complete missile-caused peroneal nerve and peroneal division lesions. In this prospective study, the outcomes of such repairs are studied and the factors influencing the outcomes are analyzed.

METHODS:

During a 3-year period, 157 patients with complete missile-caused lesions of the peroneal nerve or peroneal division were treated surgically in the Belgrade Military Medical Academy: 37 patients with high-level (above the middle of the thigh), 90 patients with intermediate-level (above the popliteal crease), and 30 patients with low-level repairs. After at least 4 years of follow-up, outcome was defined on the basis of motor recovery, neurophysiological recovery, and patient judgment of the quality of outcome (poor, insufficient, good, or excellent). Good and excellent outcomes were considered successful. The factors of repair level, defect length, manner of repair, preoperative interval, severity of tissue damage in the repair region, and patient age were studied for their effect on outcome.

RESULTS:

A successful outcome was obtained in 10.8% of high-level repairs, 31.1% of intermediate-level repairs, and 56.7% of low-level repairs (P < 0.001). Nerve defect and preoperative interval were significantly shorter for patients with a successful outcome compared with those with an unsuccessful outcome (P< 0.001). Worsening of the outcome began with the nerve defect larger than 4 cm and preoperative interval greater than 3 months (P< 0.001). Severity of local tissue damage significantly influenced the outcome (P= 0.008). Repair level (P< 0.001), preoperative interval (P= 0.001), severity of local tissue damage (P= 0.011), and length of nerve defect (P= 0.011) were independent predictors for a successful outcome.

CONCLUSION:

After peroneal nerve or peroneal division repairs, a successful outcome is most probable with low-level lesions repaired in the first 3 months after injury using grafts smaller than 4 cm. Conversely, high-level repairs delayed for more than 7 months after injury and using grafts larger than 8 cm are probably not worthwhile.
Pulsatile Tinnitus and the Intrameatal Vascular Loop: Why Do We Not Hear Our Carotids?
Authors: De Ridder Dirk , De Ridder Leo , Nowé Vicky , Thierens Hubert , Van de Heyning Paul , Møller Aage
Published: December 2005

OBJECTIVE:

Pulsatile tinnitus is characterized by hearing the heart beat or respiration in one or both ears. In 15% of patients with pulsatile tinnitus, no cause can be found. Other investigators have suggested that a vascular loop entering the internal auditory meatus can be another cause of arterial, pulse synchronous tinnitus. If so, we should constantly hear the arterial pulsations of the carotid arteries passing through the petrous bone.

METHODS:

Using magnetic resonance imaging, 17 patients with unilateral pulsatile tinnitus and 46 with non-pulsatile tinnitus were analyzed for the presence of a vascular loop entering into the internal acoustic meatus. Four temporal bones were sectioned to find structural differences between the internal acoustic meatus and the pericarotid area. Four patients with intrameatal vascular loops and ipsilateral pulsatile tinnitus underwent surgery by Teflon interpositioning between the loop and the cochlea.

RESULTS:

In unilateral pulsatile tinnitus, a statistically highly significant amount of intrameatal vascular loops was noted in comparison to non-pulsatile tinnitus. A well-developed pericarotid venous plexus was found histologically. Three of the four patients who underwent surgery were initially tinnitus free, but pulsations recurred after 3 months in one patient.

CONCLUSION:

Vascular loops in the internal auditory canal may generate pulsatile tinnitus. It may be treated by placing Teflon between the cochlea and the intrameatal vascular loop. One then does not hear the pulsation of the carotids due to a dampening effect of a pericarotid venous plexus.