bluuebunny/crossref_metadata_2025 huggingface dataset:
Sociodemographic and socioeconomic determinants of health services utilization in Greece: the Hellas Health I study
Authors: Tountas Yannis , Oikonomou Nikolaos , Pallikarona Georgia , Dimitrakaki Christine , Tzavara Chara , Souliotis Kyriakos , Mariolis Anargiros , Pappa Evelina , Kontodimopoulos Nick , Niakas Dimitris
Published: February 2011

The purpose of the study was to estimate the demographic and socioeconomic determinants of utilization of the Greek primary and hospital health care services.

Data were obtained from the cross-sectional nationwide household survey Hellas Health I (2006). The sample ( N = 1005) was representative of the Greek adult population in terms of age and residency, and was selected by means of a three-stage, proportional-to-size sampling design.

The presence of a family doctor was reported in a higher degree by participants of higher social classes and private insurance. After adjusting for self-perceived general health and chronic illness, contacts with health care professionals during the past four weeks were found less for residents of rural areas, while contacts with health care professionals during the past 12 months were found less for men than women, for individuals without private insurance and for individuals of lower education. More out-of-pocket payments were reported by the 34–44 age group, rural area residents and individuals with private insurance. Higher use of private health care services was reported by participants of higher social classes and residents of rural areas and private insurance. Only hospital admissions were not directly influenced by demographic and socioeconomic factors.

The findings imply the existence of inequities in access and use of primary health services with clear implications to related policies.
The effect on patient loyalty of service quality, patient visit experience and perceived switching costs: lessons from one Taiwan university hospital
Authors: Wang Hsiu-Ling , Huang Jun-Ying , Howng Shen-Long
Published: February 2011

The reimbursement system changed from fee-for-service to fixed prospective payments in Taiwan, the effect on the physician–patient's relationship is worth being studied. We examined the relationship between patient visit experience, cost perceptions and the two important aspects of quality of care, curing and interpersonal performance, and patients' loyalty to the hospital physicians. A total of 404 patients from an acute care hospital in Taiwan, Kaohsiung Medical University Hospital (KMUH), were investigated using a self-administered mailing survey. All measures including patient loyalty (PL), curing service quality (CSQ), interpersonal service quality (ISQ), visit experience (VE) and perceived switching costs (PSC), were adapted and modified from existing scales. Our results showed that the physician's CSQ and ISQ positively affected patients' loyalty to KMUH. The interaction between the main effects of service quality, patients' VE and three types of switching visit costs, yielded additional insights into the importance of service quality for patient retention. The CSQ of physicians becomes a more important determinant of loyalty than ISQ as patients' VE increases. The importance of CSQ and ISQ increases in relation to PL as the perceived procedural and relational costs of changing care providers increases. Neither CSQ nor ISQ has a reduced relationship with PL as the perceived financial costs of switching hospitals increase. Our study indicates that the impact of CSQ and ISQ on loyalty varies according to the perceived visit costs of changing hospitals and the patients' VE.
Assessing the effects of drug price reduction policies on older people in Taiwan
Authors: Chu Hsuan-Lien , Liu Shuen-Zen , Romeis James C
Published: February 2011

This study investigates the initial effects of the government's prescription drug price reduction policies on outpatient hypertension treatment for the elderly in Taiwan. The National Health Insurance scheme has taken a number of steps in recent years to reduce drug prices. The data used in the study comprises the medical records of approximately 137,000 hypertension patients aged 65 and above. Regression analysis is used to determine whether the average cost of prescription drugs has declined as a result of the policy. In addition, the probit model is used to examine changes in physicians' prescribing behaviour for reduced-price and full-price drugs and the effect of drug substitution on health outcomes. We find that the average cost per prescription increased slightly despite the implementation of the price reduction policies. In addition, we found that physicians do substitute full-price drugs for reduced-price drugs. However, they appear to be reluctant to reduce the use of essential drugs, even when facing rate reductions. The evidence suggests that physicians consider the profit they can derive by prescribing certain drugs; hence, health policy officials should monitor the effects of possible drug substitutions when they design policies for their own countries.
A co-productive health leadership model to support the liberation of the NHS
Authors: Nicol Edward , Sang Bob
Published: February 2011

Summary

Following the recent white paper – Equity and Excellence: Liberating the NHS – we need a 21st-century model of leadership in the NHS that re-focuses on the centrality of the relationship between clinicians and patients. This paper argues the case for co-productive ‘Health Leadership’ that can meet the challenges set by the current Big Society agenda, Darzi and Wanless, so that we achieve a sustainable, high quality NHS, fit for the 21st century.
Outcomes of acetabular fracture fixation with ten years’ follow-up
Authors: Briffa N. , Pearce R. , Hill A. M. , Bircher M.
Published: February 2011

We report the outcome of 161 of 257 surgically fixed acetabular fractures. The operations were undertaken between 1989 and 1998 and the patients were followed for a minimum of ten years. Anthropometric data, fracture pattern, time to surgery, associated injuries, surgical approach, complications and outcome were recorded. Modified Merle D’Aubigné score and Matta radiological scoring systems were used as outcome measures. We observed simple fractures in 108 patients (42%) and associated fractures in 149 (58%).

The result was excellent in 75 patients (47%), good in 41 (25%), fair in 12 (7%) and poor in 33 (20%). Poor prognostic factors included increasing age, delay to surgery, quality of reduction and some fracture patterns. Complications were common in the medium- to long-term and functional outcome was variable. The gold-standard treatment for displaced acetabular fractures remains open reduction and internal fixation performed in dedicated units by specialist surgeons as soon as possible.
Biomechanical testing of a concept of posterior pelvic reconstruction in rotationally and vertically unstable fractures
Authors: Berber O. , Amis A. A. , Day A. C.
Published: February 2011

The purpose of this study was to assess the stability of a developmental pelvic reconstruction system which extends the concept of triangular osteosynthesis with fixation anterior to the lumbosacral pivot point. An unstable Tile type-C fracture, associated with a sacral transforaminal fracture, was created in synthetic pelves. The new concept was compared with three other constructs, including bilateral iliosacral screws, a tension band plate and a combined plate with screws. The pubic symphysis was plated in all cases. The pelvic ring was loaded to simulate single-stance posture in a cyclical manner until failure, defined as a displacement of 2 mm or 2°. The screws were the weakest construct, failing with a load of 50 N after 400 cycles, with maximal translation in the craniocaudal axis of 12 mm. A tension band plate resisted greater load but failure occurred at 100 N, with maximal rotational displacement around the mediolateral axis of 2.3°.

The combination of a plate and screws led to an improvement in stability at the 100 N load level, but rotational failure still occurred around the mediolateral axis. The pelvic reconstruction system was the most stable construct, with a maximal displacement of 2.1° of rotation around the mediolateral axis at a load of 500 N.
Biomechanical comparison of interfragmentary compression in transverse fractures of the olecranon
Authors: Wilson J. , Bajwa A. , Kamath V. , Rangan A.
Published: February 2011

Compression and absolute stability are important in the management of intra-articular fractures. We compared tension band wiring with plate fixation for the treatment of fractures of the olecranon by measuring compression within the fracture. Identical transverse fractures were created in models of the ulna. Tension band wires were applied to ten fractures and ten were fixed with Acumed plates. Compression was measured using a Tekscan force transducer within the fracture gap. Dynamic testing was carried out by reproducing cyclical contraction of the triceps of 20 N and of the brachialis of 10 N. Both methods were tested on each sample. Paired t-tests compared overall compression and compression at the articular side of the fracture.

The mean compression for plating was 819 N (sd 602, 95% confidence interval (CI)) and for tension band wiring was 77 N (sd 19, 95% CI) (p = 0.039). The mean compression on the articular side of the fracture for plating was 343 N (sd 276, 95% CI) and for tension band wiring was 1 N (sd 2, 95% CI) (p = 0.038).

During simulated movements, the mean compression was reduced in both groups, with tension band wiring at −14 N (sd 7) and for plating −173 N (sd 32). No increase in compression on the articular side was detected in the tension band wiring group.

Pre-contoured plates provide significantly greater compression than tension bands in the treatment of transverse fractures of the olecranon, both over the whole fracture and specifically at the articular side of the fracture. In tension band wiring the overall compression was reduced and articular compression remained negligible during simulated contraction of the triceps, challenging the tension band principle.
Comminuted fractures of the radial head and neck
Authors: Neumann M. , Nyffeler R. , Beck M.
Published: February 2011

Mason type III fractures of the radial head are treated by open reduction and internal fixation, resection or prosthetic joint replacement. When internal fixation is performed, fixation of the radial head to the shaft is difficult and implant-related complications are common. Furthermore, problems of devascularisation of the radial head can result from fixation of the plate to the radial neck.

In a small retrospective study, the treatment of Mason type III fractures with fixation of the radial neck in 13 cases (group 2) was compared with 12 cases where no fixation was performed (group 1). The mean clinical and radiological follow-up was four years (1 to 9). The Broberg-Morrey index showed excellent results in both groups. Degenerative radiological changes were seen more frequently in group 2, and removal of the implant was necessary in seven of 13 cases.

Post-operative evaluation of these two different techniques revealed similar ranges of movement and functional scores. We propose that anatomical reconstruction of the radial head without metalwork fixation to the neck is preferable, and the outcome is the same as that achieved with the conventional technique. In addition degenerative changes of the elbow joint may develop less frequently, and implant removal is not necessary.
Luxatio erecta of the hip
Authors: Kolar M. K. , Joseph S. , McLaren A.
Published: February 2011

We present the case of a young male patient with inferior dislocation of the hip and postulate a possible mechanism for this extremely rare injury.
Biodegradable antibiotic delivery systems
Authors: El-Husseiny M. , Patel S. , MacFarlane R. J. , Haddad F. S.
Published: February 2011

Bacterial infection in orthopaedic surgery can be devastating, and is associated with significant morbidity and poor functional outcomes, which may be improved if high concentrations of antibiotics can be delivered locally over a prolonged period of time. The two most widely used methods of doing this involve antibiotic-loaded polymethylmethacrylate or collagen fleece. The former is not biodegradable and is a surface upon which secondary bacterial infection may occur. Consequently, it has to be removed once treatment has finished. The latter has been used successfully as an adjunct to systemic antibiotics, but cannot effect a sustained release that would allow it to be used on its own, thereby avoiding systemic toxicity.

This review explores the newer biodegradable carrier systems which are currently in the experimental phase of development and which may prove to be more effective in the treatment of osteomyelitis.
Hyperosmolarity protects chondrocytes from mechanical injury in human articular cartilage
Authors: Amin A. K. , Huntley J. S. , Patton J. T. , Brenkel I. J. , Simpson A. H. R. W. , Hall A. C.
Published: February 2011

The aim of this study was to determine whether exposure of human articular cartilage to hyperosmotic saline (0.9%, 600 mOsm) reduces in situ chondrocyte death following a standardised mechanical injury produced by a scalpel cut compared with the same assault and exposure to normal saline (0.9%, 285 mOsm). Human cartilage explants were exposed to normal (control) and hyperosmotic 0.9% saline solutions for five minutes before the mechanical injury to allow in situ chondrocytes to respond to the altered osmotic environment, and incubated for a further 2.5 hours in the same solutions following the mechanical injury.

Using confocal laser scanning microscopy, we identified a sixfold (p = 0.04) decrease in chondrocyte death following mechanical injury in the superficial zone of human articular cartilage exposed to hyperosmotic saline compared with normal saline.

These data suggest that increasing the osmolarity of joint irrigation solutions used during open and arthroscopic articular surgery may reduce chondrocyte death from surgical injury and could promote integrative cartilage repair.
A multicentre study of the long-term results of using a flat-back polyethylene glenoid component in shoulder replacement for primary osteoarthritis
Authors: Young A. , Walch G. , Boileau P. , Favard L. , Gohlke F. , Loew M. , Molé D.
Published: February 2011

We report the long-term clinical and radiological outcomes of the Aequalis total shoulder replacement with a cemented all-polyethylene flat-back keeled glenoid component implanted for primary osteoarthritis between 1991 and 2003 in nine European centres. A total of 226 shoulders in 210 patients were retrospectively reviewed at a mean of 122.7 months (61 to 219) or at revision. Clinical outcome was assessed using the Constant score, patient satisfaction score and range of movement. Kaplan-Meier survivorship analysis was performed with glenoid revision for loosening and radiological glenoid loosening (sd) as endpoints. The Constant score was found to improve from a mean of 26.8 (sd 10.3) pre-operatively to 57.6 (sd 20.0) post-operatively (p < 0.001). Active forward flexion improved from a mean of 85.3° (sd 27.4) pre-operatively to 125° (sd 37.3) postoperatively (p < 0.001). External rotation improved from a mean of 7° (sd 6.5) pre-operatively to 30.3° (sd 21.8°) post-operatively (p < 0.001). Survivorship with revision of the glenoid component as the endpoint was 99.1% at five years, 94.5% at ten years and 79.4% at 15 years. Survivorship with radiological loosening as the endpoint was 99.1% at five years, 80.3% at ten years and 33.6% at 15 years.

Younger patient age and the curettage technique for glenoid preparation correlated with loosening. The rate of glenoid revision and radiological loosening increased with duration of follow-up, but not until a follow-up of five years. Therefore, we recommend that future studies reporting radiological outcomes of new glenoid designs should report follow-up of at least five to ten years.
Early metallosis-related failure after total knee replacement
Authors: Willis-Owen C. A. , Keene G. C. , Oakeshott R. D.
Published: February 2011

Metallosis is a rare cause of failure after total knee replacement and has only previously been reported when there has been abnormal metal-on-metal contact. We describe 14 patients (15 knees) whose total knee replacement required revision for a new type of early failure caused by extensive metallosis. A modification of a cementless rotating platform implant, which had previously had excellent long-term survival, had been used in each case. The change was in the form of a new porous-beaded surface on the femoral component to induce cementless fixation, which had been used successfully in the fixation of acetabular and tibial components. This modification appeared to have resulted in metallosis due to abrasive two-body wear. The component has subsequently been recalled and is no longer in use. The presentation, investigation, and findings at revision are described and a possible aetiology and its implications are discussed.
Re-ossification of the pelvis following hemipelvectomy for trauma
Authors: Wansbrough G. , Boyne N. , Pollard C. W.
Published: February 2011

We present a patient who underwent delayed sub-periosteal hemipelvectomy for control of infection and to enable soft-tissue cover after trauma. At four months after amputation, clinical examination and radiographs demonstrated almost complete re-ossification of the hemipelvis. This has allowed the patient to regain sitting balance and to use a walking prosthesis designed for patients following disarticulation of the hip. After 14 months from injury, no perineal hernia has developed, and no dysfunction of pelvic organs is attributable to heterotopic bone formation or adhesions.

The patient’s mobility with a prosthesis is similar to that expected of a through-hip amputee.
A medium-term comparison of hybrid hip replacement and Birmingham hip resurfacing in active young patients
Authors: Baker R. P. , Pollard T. C. B. , Eastaugh-Waring S. J. , Bannister G. C.
Published: February 2011

We compared the medium-term clinical and radiological results of hybrid total hip replacement (THR) with metal-on-metal Birmingham hip resurfacing (BHR) in two groups of 54 young patients matched for age, gender, body mass index and pre-operative levels of activity.

The clinical outcome was assessed by the University of California, Los Angeles (UCLA) activity score, the Oxford Hip Score (OHS) and the EuroQol scores. Radiologically, all hips were assessed for migration and osteolysis, the hybrid THRs for polyethylene wear and the BHRs for a pedestal sign. The mean follow-up of the patients with a hybrid THR was ten years and for those with a BHR, nine years. Four patients with a hybrid THR and one with a BHR had died. In each group five were lost to follow-up. The revision rate of the hybrid THRs was 16.7% (9 of 54) and of the BHRs 9.3% (5 of 54) (p = 0.195). Radiographs of a further eight hybrid THRs demonstrated wear and osteolysis, and they await revision (p = 0.008). Of the unrevised BHRs 90% had radiological changes, of which approximately 50% had progressed over the previous four years. All hybrid THRs demonstrated linear polyethylene wear with a mean of 1.24 mm (0.06 to 3.03). The BHRs recorded superior OHS (p = 0.013), UCLA (p = 0.008), and EuroQol visual analogue scores (p = 0.009).

After nine years, patients with BHRs remained more active and had a lower rate of revision than those with hybrid THRs. Both groups demonstrated progressive radiological changes at medium-term follow-up.
What are the radiological predictors of functional outcome following fractures of the distal radius?
Authors: Ng C. Y. , McQueen M. M.
Published: February 2011

The fracture most commonly treated by orthopaedic surgeons is that of the distal radius. However, as yet there is no consensus on what constitutes an ‘acceptable’ radiological position before or after treatment. This should be defined as the position that will predict good function in the majority of cases. In this paper we review the radiological indices that can be measured in fractures of the distal radius and try to identify potential predictors of functional outcome. In patients likely to have high functional demands, we recommend that the articular reconstruction be achieved with less than 2 mm of gap or step-off, the radius be restored to within 2 mm of its normal length, and that carpal alignment be restored. The ultimate aim of treatment is a pain-free, mobile wrist joint without functional limitation.
Posterolateral corner injuries of the knee
Authors: Pacheco R. J. , Ayre C. A. , Bollen S. R.
Published: February 2011

We retrospectively reviewed the hospital records of 68 patients who had been referred with an injury to the posterolateral corner of the knee to a specialist knee surgeon between 2005 and 2009. These injuries were diagnosed based on a combination of clinical testing and imaging and arthroscopy when available. In all, 51 patients (75%) presented within 24 hours of their injury with a mean presentation at eight days (0 to 20) after the injury. A total of 63 patients (93%) had instability of the knee at presentation. There was a mean delay to the diagnosis of injury to the posterolateral corner of 30 months (0 to 420) from the time of injury. In all, the injuries in 49 patients (72%) were not identified at the time of the initial presentation, with the injury to the posterolateral corner only recognised in those patients who had severe multiple ligamentous injuries. The correct diagnosis, including injury to the posterolateral corner, had only been made in 34 patients (50%) at time of referral to a specialist knee clinic. MRI correctly identified 14 of 15 injuries when performed acutely (within 12 weeks of injury), but this was the case in only four of 15 patients in whom it was performed more than 12 weeks after the injury.

Our study highlights a need for greater diligence in the examination and investigation of acute ligamentous injuries at the knee with symptoms of instability, in order to avoid failure to identify the true extent of the injury at the time when anatomical repair is most straightforward.
Is routine chemical thromboprophylaxis after total hip replacement really necessary in a Japanese population?
Authors: Yokote R. , Matsubara M. , Hirasawa N. , Hagio S. , Ishii K. , Takata C.
Published: February 2011

Prophylaxis against venous thromboembolism after elective total hip replacement is routinely recommended. Our preference has been to use mechanical prophylaxis without anticoagulant drugs. A randomised controlled trial was performed to evaluate whether the incidence of post-operative venous thromboembolism was reduced by using pharmacological anticoagulation with either fondaparinux or enoxaparin in addition to our prophylactic mechanical regimen. A total of 255 Japanese patients who underwent primary unilateral cementless total hip replacement were randomly assigned to one of three postoperative regimens, namely injection of placebo (saline), fondaparinux or enoxaparin. There were 85 patients in each group. All also received the same mechanical prophylaxis during and after the operation, regardless of their assigned group. The primary measurement of efficacy was the presence of a venous thromboembolic event by day 11, defined as deep-vein thrombosis detected by ultrasonography, documented symptomatic deep-vein thrombosis or documented symptomatic pulmonary embolism. The duration of follow-up was 12 weeks.

The rate of venous thromboembolism was 7.2% with the placebo, 7.1% with fondaparinux and 6.0% with enoxaparin (p = 0.95 for the comparison of all three groups). Our study confirmed the effectiveness and safety of mechanical thromboprophylaxis without the use of anticoagulant drugs after total hip replacement in Japanese patients.
Morphological analysis of collapsed regions in osteonecrosis of the femoral head
Authors: Motomura G. , Yamamoto T. , Yamaguchi R. , Ikemura S. , Nakashima Y. , Mawatari T. , Iwamoto Y.
Published: February 2011

In order to investigate the mechanisms of collapse in osteonecrosis of the femoral head, we examined which part of the femoral head was the key point of a collapse and whether a collapsed region was associated with the size of the necrotic lesion. Using 30 consecutive surgically removed femoral heads we retrospectively analysed whole serial cut sections, specimen photographs, specimen radiographs and histological sections.

In all of the femoral heads, collapse consistently involved a fracture at the lateral boundary of the necrotic lesion. Histologically, the fractures occurred at the junction between the thickened trabeculae of the reparative zone and the necrotic bone trabeculae. When the medial boundary of the necrotic lesion was located lateral to the fovea of the femoral head, 18 of 19 femoral heads collapsed in the subchondral region. By contrast, when the medial boundary was located medial to the fovea, collapse in the subchondral region was observed in four of 11 femoral heads (p = 0.0011). We found that collapse began at the lateral boundary of the necrotic lesion and that the size of the necrotic lesion seemed to contribute to its distribution.
2-Hydroxypropyl derivatives of 1,2,3-thiadiazole and 1,2,3-triazole: Synthesis and antifungal activity
Authors: Morzherin Yury , Prokhorova Polina E. , Musikhin Dmitry A. , Glukhareva Tatiana V. , Fan Zhijin
Published: February 2011

A series of novel 5-(2-hydroxypropyl)amino-1,2,3-thiadiazole and 5-(2-hydroxy-propyl)sulfanyl-1,2,3-triazole derivatives were designed and synthesized as candidate fungicides. The new compounds were identified by NMR and IR spectroscopy, mass spectrometry, and elemental analysis. Their antifungal activities were evaluated.
Improved Zr-2.5Nb Pressure Tubes for Reduced Diametral Strain in Advanced CANDU Reactors
Authors: Bickel G. A. , Griffiths M. , Douchant A. , Douglas S. , Woo O. T. , Buyers A.
Published: February 2011

In an Advanced CANDU Reactor (ACR) (ACR is a registered trademark of Atomic Energy of Canada Limited), pressure tubes of cold-worked Zr-2.5Nb materials will be used in the reactor core to contain the fuel bundles and the light water coolant. They will be subjected to higher temperature, pressure, and flux than those in a CANDU (CANDU is a registered trademark of Atomic Energy of Canada Limited) reactor, and accordingly require a thicker wall (6.5 mm for ACR versus 4.2 mm for CANDU). In order to ensure that these tubes will perform acceptably over their 30-year design life in such an environment, a study to model and forecast the performance of these thicker pressure tubes has been undertaken. One of the main requirements for the pressure tube is to have low diametral creep. Based on previous experience with CANDU reactor pressure tube performance and manufacture, an assessment of the grain structure and texture of the ACR pressure tubes indicates that the in-reactor creep deformation will be improved. Analysis of the distribution of texture parameters from a trial batch of 26 tubes shows that the variability is reduced relative to tubes fabricated in the past. This reduction in variability together with a shift to a coarser grain structure will result in a reduction in diametral creep design limits and thus a longer economic life for the fuel channels of the advanced CANDU reactor.
Receptor for advanced glycation end-products expression in subcutaneous adipose tissue is related to coronary artery disease
Authors: Rodiño-Janeiro B K , Salgado-Somoza A , Teijeira-Fernández E , González-Juanatey J R , Álvarez E , Eiras S
Published: February 2011

Objective

Obesity, a risk factor for coronary artery disease (CAD), is associated with inflammation and reactive oxygen species (ROS) production, while advanced glycation end-products, through their receptor (AGER or RAGE), play an important role on these processes. The aim of this study was to analyze the expression levels of RAGE, NADPH oxidase subunits, and catalase in adipose tissue in relation with CAD.

Design and methods

Patients undergoing heart surgery were included in two groups: with and without CAD. Epicardial adipose tissue (EAT) and subcutaneous adipose tissue (SAT) biopsies were analyzed for gene expression by RT-quantitative PCR, immunohistochemistry, or western blot.

Results

RAGE mRNA and protein expression in SAT from patients with CAD was lower than in patients without CAD. However, there was no change in EAT from patients with or without CAD. P22-PHOX and RAGE gene expression were higher in EAT than in SAT, whereas catalase mRNA levels were lower. NADPH oxidase subunits and catalase mRNA expression were not influenced by CAD. Whereas NADPH oxidase-dependent oxidative response of SAT and EAT to lipid circulating levels could be different; glycemic levels were not related with the analyzed genes expression.

Conclusions

This study demonstrates that RAGE expression in SAT, but not in EAT, is down-regulated in patients with CAD with respect to those without CAD. Although changes were not observed for NADPH oxidase subunits or catalase expression between CAD and non-CAD patients, a possible relationship between ROS production and RAGE expression in adipose tissues cannot be ruled out.
A unique exonic splicing mutation in the CYP17A1 gene as the cause for steroid 17α-hydroxylase deficiency
Authors: Qiao Jie , Han Bing , Liu Bing-Li , Liu Wei , Wu Jia-Jun , Pan Chun-Ming , Jiang He , Gu Ting , Jiang Bo-Ren , Zhu Hui , Lu Ying-Li , Wu Wan-Ling , Chen Ming-Dao , Song Huai-Dong
Published: February 2011

Background

17α-Hydroxylase/17,20-lyase deficiency (17OHD) caused by a mutation in the CYP17A1 gene is characterized by hypertension, hypokalemia, and abnormal development of the genitalia. The majority of CYP17A1 mutations are located in the coding sequence, and several intronic splicing site mutations have been reported.

Objective

A 2.5-year-old girl with 46,XY disordered sex development exhibited a nearly normal basal cortisol level and reduced sexual steroids. This study is aimed to explore the molecular basis and analyze its possible influence on the phenotype of the patient.

Methods and results

Mutation analysis revealed compound heterozygous CYP17A1 mutations, with c.985_987delinsAA in one allele and a synonymous substitution (c.1263G>A) in another allele. In vitro expression analysis of the allelic minigene showed that the novel nucleotide variation located in exon 8 induces a splicing signal, which results in an aberrant splicing of CYP17A1 mRNA and a missing portion of exon 8. The translation product includes the deletion of six or seven amino acids from residue position 415 without causing a frameshift. Consistent with the result of molecular modeling, functional studies in transiently transfected HEK-293T cells with the aberrantly spliced enzyme proteins showed that the deleted proteins completely abolished the enzyme activity. However, RT-PCR indicated the existence of a small fraction of normal, functionally intact enzyme, which may explain the partial masculinization of this patient.

Conclusion

This is the first description of an exonic splicing mutation in CYP17A1 relevant to the 17OHD phenotype. It also demonstrates the importance of studying synonymous change in such patients with less severe phenotype.
Differential effects of cortisol and 11-deoxycorticosterone on ion transport protein mRNA levels in gills of two euryhaline teleosts, Mozambique tilapia (Oreochromis mossambicus) and striped bass (Morone saxatilis)
Authors: Kiilerich Pia , Tipsmark Christian K , Borski Russell J , Madsen Steffen S
Published: February 2011

The role of cortisol as the only corticosteroid in fish osmoregulation has recently been challenged with the discovery of a mineralocorticoid-like hormone, 11-deoxycorticosterone (DOC), and necessitates new studies of the endocrinology of osmoregulation in fish. Using an in vitro gill explant incubation approach, DOC-mediated regulation of selected osmoregulatory target genes in the gill was investigated and compared with that of cortisol in two euryhaline teleosts, Mozambique tilapia (Oreochromis mossambicus) and striped bass (Morone saxatilis). The effects were tested in gills from both fresh water (FW)- and seawater (SW)-acclimated fish. Both cortisol and DOC caused an up-regulation of the Na+,K+-ATPase α1 subunit in SW-acclimated tilapia but had no effect in FW-acclimated fish. Cortisol conferred an increase in Na+,K+,2Cl− cotransporter (NKCC) isoform 1a transcript levels in FW- and SW-acclimated tilapia, whereas DOC had a stimulatory effect only in SW-acclimated fish. Cortisol had no effect on NKCC isoform 1b mRNA levels at both salinities, while DOC stimulated this isoform in SW-acclimated fish. In striped bass, cortisol conferred an up-regulation of Na+,K+-ATPase α1 and NKCC transcript levels in FW- and SW-acclimated fish, whereas DOC resulted in down-regulation of these transcripts in FW-acclimated fish. It was also found that both corticosteroids may rapidly (30 min) alter the mitogen-activated protein kinase signalling pathway in gill, inducing phosphorylation of extracellular signal-regulated kinase 1 (ERK1) and ERK2 in a salinity-dependent manner. The study shows a disparate organisation of corticosteroid signalling mechanisms involved in ion regulation in the two species and adds new evidence to a role of DOC as a mineralocorticoid hormone in teleosts.
Core Concepts: Intraventricular Hemorrhage
Authors: Whitelaw Andrew
Published: February 2011

The very preterm infant is uniquely vulnerable to bleeding into the cerebral ventricles because of the numerous but unsupported blood vessels in the subependymal germinal matrix and unstable blood pressure and flow resulting from preterm delivery and respiratory distress. Approximately 25% of infants whose birthweights are 500 to 1,500 g have some intraventricular hemorrhage (IVH). Even a small IVH is associated with an increased risk of disability. A large IVH is sometimes complicated by hemorrhagic parenchymal infarction (also known as grade 4 IVH), which is believed to arise when venous occlusion from hematoma impairs perfusion in periventricular white matter. Large unilateral infarctions are usually associated with contralateral hemiparesis, but cognitive function may be less impaired. Prenatal glucocorticoid therapy reduces IVH by nearly 50% in randomized trials. Postnatal indomethacin reduces IVH, but reduced disability has not been consistently documented.
Screening for Visual Impairment in Children Ages 1–5 Years: Update for the USPSTF
Authors: Chou Roger , Dana Tracy , Bougatsos Christina
Published: February 2011

CONTEXT:

Screening could identify preschool-aged children with vision problems at a critical period of visual development and lead to treatments that could improve vision.

OBJECTIVE:

To determine the effectiveness of screening preschool-aged children for impaired visual acuity on health outcomes.

METHODS:

We searched Medline from 1950 to July 2009 and the Cochrane Library through the third quarter of 2009, reviewed reference lists, and consulted experts. We selected randomized trials and controlled observational studies on preschool vision screening and treatments, and studies of diagnostic accuracy of screening tests. One investigator abstracted relevant data, and a second investigator checked data abstraction and quality assessments.

RESULTS:

Direct evidence on the effectiveness of preschool vision screening for improving visual acuity or other clinical outcomes remains limited and does not adequately address whether screening is more effective than no screening. Regarding indirect evidence, a number of screening tests have utility for identification of preschool-aged children with vision problems. Diagnostic accuracy did not clearly differ for children stratified according to age, although testability rates were generally lower in children 1 to 3 years of age. Treatments for amblyopia or unilateral refractive error were associated with mild improvements in visual acuity compared with no treatment. No study has evaluated school performance or other functional outcomes.

CONCLUSIONS:

Although treatments for amblyopia or unilateral refractive error can improve vision in preschool-aged children and screening tests have utility for identifying vision problems, additional studies are needed to better understand the effects of screening compared with no screening.
Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure
Authors:   Subcommittee on Febrile Seizures
Published: February 2011

OBJECTIVE:

To formulate evidence-based recommendations for health care professionals about the diagnosis and evaluation of a simple febrile seizure in infants and young children 6 through 60 months of age and to revise the practice guideline published by the American Academy of Pediatrics (AAP) in 1996.

METHODS:

This review included search and analysis of the medical literature published since the last version of the guideline. Physicians with expertise and experience in the fields of neurology and epilepsy, pediatrics, epidemiology, and research methodologies constituted a subcommittee of the AAP Steering Committee on Quality Improvement and Management. The steering committee and other groups within the AAP and organizations outside the AAP reviewed the guideline. The subcommittee member who reviewed the literature for the 1996 AAP practice guidelines searched for articles published since the last guideline through 2009, supplemented by articles submitted by other committee members. Results from the literature search were provided to the subcommittee members for review. Interventions of direct interest included lumbar puncture, electroencephalography, blood studies, and neuroimaging. Multiple issues were raised and discussed iteratively until consensus was reached about recommendations. The strength of evidence supporting each recommendation and the strength of the recommendation were assessed by the committee member most experienced in informatics and epidemiology and graded according to AAP policy.

CONCLUSIONS:

Clinicians evaluating infants or young children after a simple febrile seizure should direct their attention toward identifying the cause of the child's fever. Meningitis should be considered in the differential diagnosis for any febrile child, and lumbar puncture should be performed if there are clinical signs or symptoms of concern. For any infant between 6 and 12 months of age who presents with a seizure and fever, a lumbar puncture is an option when the child is considered deficient in Haemophilus influenzae type b (Hib) or Streptococcus pneumoniae immunizations (ie, has not received scheduled immunizations as recommended), or when immunization status cannot be determined, because of an increased risk of bacterial meningitis. A lumbar puncture is an option for children who are pretreated with antibiotics. In general, a simple febrile seizure does not usually require further evaluation, specifically electroencephalography, blood studies, or neuroimaging.
Pediatric Primary Health Care
Authors:   Committee on Pediatric Workforce
Published: February 2011

This Policy Statement was revised. See https://doi.org/10.1542/peds.2021-055553.
Expanding Perspectives for Comprehending Visual Images in Multimodal Texts
Authors: Serafini Frank
Published: February 2011

The texts that adolescents encounter today are often multimodal, meaning they incorporate a variety of modes, including visual images, hypertext, and graphic design elements along with written text. Expanding the perspectives readers use to make sense of the multimodal texts is an important aspect of comprehension instruction. Moving beyond the traditional cognitive strategies often incorporated in instruction frameworks for comprehending written texts, this article presents three additional perspectives for comprehending visual images. Examples from each perspective are included to help middle and high school teachers expand the strategies students draw from to interpret and understand visual images and multimodal texts.
Lessons in Contingent, Recursive Humility
Authors: Vagle Mark D.
Published: February 2011

In this article, the author argues that critical work in teacher education should begin with teacher educators turning a critical eye on their own practices. The author uses Lesko's conception of contingent, recursive growth and change to analyze a lesson he observed as part of a phenomenological study aimed at understanding more about what it is like to cultivate tact in teaching practice. The author discusses two sets of practical considerations for teacher educators—one centering on times teacher educators are struck by something when observing teacher candidates and the other on times teacher educators miss something. This analysis suggests that preparing critical middle grades literacy teachers demands that the teacher educator proceed with a healthy dose of contingent, recursive humility.
Designing and Assessing Productive Group Work in Secondary Schools
Authors: Vaca Javier , Lapp Diane , Fisher Douglas
Published: February 2011

A history teacher examines what is successful and not successful in group work in his high school classroom and gives concrete suggestions for improving group practice. Topics discussed include preparing students for group work, supporting collaboration, inviting critical analysis, and assessing both group and individual performance.
Factors Associated with Response to Methylphenidate in Advanced Cancer Patients
Authors: Yennurajalingam Sriram , Palmer J. Lynn , Chacko Ray , Bruera Eduardo
Published: February 2011

Learning Objectives

After completing this course, the reader will be able to: Identify the specific patient characteristics associated with response to methylphenidate as treatment for cancer-related fatigue.Compare day 1 patient response to methylphenidate to day 8 response and evaluate as a predictor of long-term improvement.

CME This article is available for continuing medical education credit at CME.TheOncologist.com

Background.

There has been increasing interest in the use of methylphenidate for cancer-related fatigue (CRF) in patients with advanced cancer. However, there is limited literature on the specific patient characteristics associated with response to methylphenidate. Our objective of this study was to identify the specific patient characteristics associated with response to methylphenidate and to compare day 1 response with day 8 response.

Methods.

We retrospectively reviewed the records of patients in two prospective controlled clinical trials that we had conducted who had received methylphenidate for cancer-related fatigue. Baseline patient characteristics, symptoms (as assessed by the Edmonton Symptom Assessment System [ESAS] and Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F]), and response (change in fatigue) at the end of day 1 treatment were analyzed to determine their association with response to methylphenidate on day 8.

Results.

A total of 82 patients with advanced cancer who received methylphenidate for CRF were included in our review. The median age was 55 years, 66% were female, 74% were white, and the most common cancer type was breast (37%). Fifty out of 82 patients (61%) responded to methylphenidate (≥7 points in FACIT-F). The intensity of baseline fatigue positively correlated with the response to methylphenidate (p < .001). Change in fatigue in response to methylphenidate was not associated with intensity of baseline depression, anxiety, drowsiness, or daily opioid dose. Better improvement of fatigue after treatment on day 1 was associated with more improvement with fatigue on day 8 as assessed by FACIT-F (p = .0004) and ESAS (p = .0001). Day 1 response as a predictor of day 8 response had a sensitivity of 0.84, a positive predictive value of 0.67, and specificity of 0.6.

Conclusions.

Response to methylphenidate is associated with higher baseline fatigue but not with higher baseline depression or sedation. Additionally, day 1 improvement is highly sensitive as a predictor of long-term improvement.
Coupling biogeochemical cycles in urban environments: ecosystem services, green solutions, and misconceptions
Authors: Pataki Diane E , Carreiro Margaret M , Cherrier Jennifer , Grulke Nancy E , Jennings Viniece , Pincetl Stephanie , Pouyat Richard V , Whitlow Thomas H , Zipperer Wayne C
Published: February 2011

Urban green space is purported to offset greenhouse‐gas (GHG) emissions, remove air and water pollutants, cool local climate, and improve public health. To use these services, municipalities have focused efforts on designing and implementing ecosystem‐services‐based “green infrastructure” in urban environments. In some cases the environmental benefits of this infrastructure have been well documented, but they are often unclear, unquantified, and/or outweighed by potential costs. Quantifying biogeochemical processes in urban green infrastructure can improve our understanding of urban ecosystem services and disservices (negative or unintended consequences) resulting from designed urban green spaces. Here we propose a framework to integrate biogeochemical processes into designing, implementing, and evaluating the net effectiveness of green infrastructure, and provide examples for GHG mitigation, stormwater runoff mitigation, and improvements in air quality and health.
Modeling coupled biogeochemical cycles
Authors: Rastetter Edward B
Published: February 2011

Organisms require about 30 essential elements to sustain life. The cycles of these elements are coupled to one another through the specific physiological requirements of the organisms. Here, I contrast several approaches to modeling coupled biogeochemical cycles using an example of carbon, nitrogen, and phosphorus accumulation in a Douglas‐fir (Pseudotsuga menziesii) forest ecosystem and the response of that forest to elevated atmospheric carbon dioxide concentrations and global warming. Which of these approaches is most appropriate is subject to debate and probably depends on context; nevertheless, this question must be answered if scientists are to understand ecosystems and how they might respond to a changing global environment.
Responses and feedbacks of coupled biogeochemical cycles to climate change: examples from terrestrial ecosystems
Authors: Finzi Adrien C , Austin Amy T , Cleland Elsa E , Frey Serita D , Houlton Benjamin Z , Wallenstein Matthew D
Published: February 2011

The biogeochemical cycles of carbon (C), nitrogen (N), and phosphorus (P) are fundamental to life on Earth. Because organisms require these elements in strict proportions, the cycles of C, N, and P are coupled at molecular to global scales through their effects on the biochemical reactions controlling primary production, respiration, and decomposition. The coupling of the C, N, and P cycles constrains organismal responses to climatic and atmospheric change, suggesting that present‐day estimates of climate warming through the year 2100 are conservative. N and P supplies constrain C uptake in the terrestrial biosphere, yet these constraints are often not incorporated into global‐scale analyses of Earth's climate. The inclusion of coupled biogeochemical cycles is critical to the development of next‐generation, global‐scale climate models.