bluuebunny/crossref_metadata_2025 huggingface dataset:
Botulinum toxin therapy of migraine and tension‐type headache: comparing different botulinum toxin preparations
Authors: Schulte‐Mattler W. J. , Martinez‐Castrillo J. C.
Published: January 2006

Most of the initial reports on botulinum toxin in tension‐type headache (TTH) and in migraine were positive. Unfortunately, these results were not reproduced in well‐designed, randomized controlled trials. So far, doses from 20 U (Botox®) to 500 U (Dysport®) have been studied in patients with chronic TTH, and doses from 16 to 200 U (Botox®) in patients with migraine. Overall, there is no evidence for a beneficial effect of botulinum toxin, although trends favoring botulinum toxin were reported. Experience with botulinum toxin type B (Myobloc®/NeuroBloc®) is limited and similar to the experience with the type A. Thus, a widespread use of botulinum toxin therapy in headache can currently not be recommended.
Botulinum toxin therapy of writer's cramp
Authors: Das C. P. , Dressler D. , Hallett M.
Published: January 2006

The pathophysiology and management of writer's cramp is one of the most challenging amongst the various forms of focal dystonias. Frequently, the dystonic postures are confounded by compensatory muscle activity. Correct identification of target muscles for botulinum toxin (BT) injections determines the treatment success. The dosages of different preparations vary, with 1 unit of Botox® roughly equalling 3.5 units of Dysport®. Electromyographic guided injections yield better results and may also decrease the amount of toxin required. Weakness of target muscles interfering with other non‐writing activities is a frequently encountered adverse effect. Studies have shown that BT is a safe long‐term therapy option.
Botulinum toxin treatment of sialorrhea: comparing different therapeutic preparations
Authors: Tan E.‐K.
Published: January 2006

In recent years, a number of potential new therapeutic indications of botulinum toxin injections have emerged, amongst which sialorrhea has attracted considerable attention. Based on open‐label and controlled studies, botulinum toxin can be used to improve sialorrhea in patients with Parkinson's disease, parkinsonian syndromes, motor neuron disease and cerebral palsy. The toxin can be injected blindly based on anatomic landmarks of the salivary glands, or localization can be facilitated by use of ultrasound guidance. There are few reported adverse effects. However, many more carefully designed, controlled studies are still required to address the specific questions related to selection of patients, the optimal injection technique, the appropriate dose of botulinum toxin and its long‐term effects.
Other indications of botulinum toxin therapy
Authors: Jost W. H.
Published: January 2006

The therapeutic possibilities of botulinum toxin are manifold and certainly not yet fully exhausted. Apart from the classical indications – focal dystonia and focal spasticity – its use in the management of wrinkles has become well known. Moreover, the toxin is now being administered in many medical fields, including many other kinetic disorders like rare dystonias and tremor. The toxin is also used in a great number of autonomic disorders such as focal hyperhidrosis and even rhinitis. Substantial advances have been made in the field of urology after injections into the sphincter and detrusor muscle. Studies for approval are meanwhile under way concerning the treatment of detrusor hyperreflexia. Gastroenterology is another important field for application of botulinum toxin – be it to the esophagus (e.g. achalasia), stomach, gallbladder, or anorectum. Anal fissure is considered a particularly common indication. Controlled studies for many indications are frequently lacking because of the limited incidence of some of these disorders and symptoms.
Using Population Viability Analysis to Predict the Effects of Climate Change on the Extinction Risk of an Endangered Limestone Endemic Shrub, Arizona Cliffrose
Authors: MASCHINSKI JOYCE , BAGGS JOANNE E. , QUINTANA‐ASCENCIO PEDRO F. , MENGES ERIC S.
Published: January 2006

Abstract:  The threat of global warming to rare species is a growing concern, yet few studies have predicted its effects on rare populations. Using demographic data gathered in both drought and nondrought years between 1996–2003 in central Arizona upper Sonoran Desert, we modeled population viability for the federally endangered Purshia subintegra (Kearney) Henrickson (Arizona cliffrose). We used deterministic matrix projection models and stochastic models simulating weather conditions during our study, given historical weather variation and under scenarios of increased aridity. Our models suggest that the P. subintegra population in Verde Valley is slowly declining and will be at greater risk of extinction with increased aridity. Across patches at a fine spatial scale, demographic performance was associated with environmental factors. Moist sites (patches with the highest soil moisture, lowest sand content, and most northern aspects) had the highest densities, highest seedling recruitment, and highest risk of extinction over the shortest time span. Extinction risk in moist sites was exacerbated by higher variance in recruitment and mortality. Dry sites had higher cumulative adult survival and lower extinction risk but negative growth rates. Steps necessary for the conservation of the species include introductions at more northern latitudes and in situ manipulations to enhance seedling recruitment and plant survival. We demonstrate that fine spatial‐scale modeling is necessary to predict where patches with highest extinction risk or potential refugia for rare species may occur. Because current climate projections for the 21st century imply range shifts at rates of 300 to 500 km/century, which are beyond even exceptional examples of shifts in the fossil record of 100–150 km, it is likely that preservation of many rare species will require human intervention and a long‐term commitment. Global warming conditions are likely to reduce the carrying capacity of many rare species' habitats.
Habitat Fragmentation Effects on Trophic Processes of Insect‐Plant Food Webs
Authors: VALLADARES GRACIELA , SALVO ADRIANA , CAGNOLO LUCIANO
Published: January 2006

Abstract:  Habitat fragmentation is the transformation of once‐extensive landscapes into smaller, isolated remnants surrounded by new types of habitat. There is ample evidence of impoverished biodiversity as a consequence of habitat fragmentation, but its most profound effects may actually result from functional changes in ecological processes such as trophic interactions. We studied the trophic processes of herbivory and parasitism in insect‐plant food webs composed of hundreds of species in a fragmented woodland landscape. We recorded all plant species, collected mined leaves, and reared leafminers and parasitoids from 19 woodland remnants. Herbivory and parasitism rates were then analyzed in relation to woodland size and edge or interior location. Herbivory by leaf‐mining insects and their overall parasitism rates decreased as woodland remnants became smaller. For each remnant the intensity of both processes differed between edge and interior. Our results provide novel evidence of the magnitude of habitat fragmentation effects, showing they can be so pervasive as to affect trophic processes of highly complex food webs and suggesting a response associated with trophic specialization of the involved organisms as much as with their trophic level.
Bycatch of Marine Mammals in U.S. and Global Fisheries
Authors: READ ANDREW J. , DRINKER PHEBE , NORTHRIDGE SIMON
Published: January 2006

Abstract:  Fisheries bycatch poses a significant threat to many populations of marine mammals, but there are few published estimates of the magnitude of these catches. We estimated marine mammal bycatch in U.S. fisheries from 1990 to 1999 with data taken from the stock assessment reports required by the U.S. Marine Mammal Protection Act. The mean annual bycatch of marine mammals during this period was 6215 ± 448 (SE). Bycatch of cetaceans and pinnipeds occurred in similar numbers. Most cetacean (84%) and pinniped (98%) bycatch occurred in gill‐net fisheries. Marine mammal bycatch declined significantly over the decade, primarily because of a reduction in the bycatch of cetaceans. Total marine mammal bycatch was significantly lower after the implementation of take reduction measures in the latter half of the decade. We derived a crude first estimate of marine mammal bycatch in the world's fisheries by expanding U.S. bycatch with data on fleet composition from the Food and Agriculture Organization. The global bycatch of marine mammals is in the hundreds of thousands. Bycatch is likely to have significant demographic effects on many populations of marine mammals. Better data are urgently needed to fully understand the impact of these interactions.
Alcohol Consumption and Risk of Coronary Heart Disease in Older Adults: The Cardiovascular Health Study
Authors: Mukamal Kenneth J. , Chung Hyoju , Jenny Nancy S. , Kuller Lewis H. , Longstreth W.T. , Mittleman Murray A. , Burke Gregory L. , Cushman Mary , Psaty Bruce M. , Siscovick David S.
Published: January 2006

OBJECTIVES: To evaluate several aspects of the relationship between alcohol use and coronary heart disease in older adults, including beverage type, mediating factors, and type of outcome.

DESIGN: Prospective cohort study.

SETTING: Four U.S. communities.

PARTICIPANTS: Four thousand four hundred ten adults aged 65 and older free of cardiovascular disease at baseline.

MEASUREMENTS: Risk of incident myocardial infarction or coronary death according to self‐reported consumption of beer, wine, and spirits ascertained yearly.

RESULTS: During an average follow‐up period of 9.2 years, 675 cases of incident myocardial infarction or coronary death occurred. Compared with long‐term abstainers, multivariate relative risks of 0.90 (95% confidence interval (CI)=0.71–1.14), 0.93 (95% CI=0.73–1.20), 0.76 (95% CI=0.53–1.10), and 0.58 (95% CI=0.39–0.86) were found in consumers of less than one, one to six, seven to 13, and 14 or more drinks per week, respectively (P for trend=.007). Associations were similar for secondary coronary outcomes, including nonfatal and fatal events. No strong mediators of the association were identified, although fibrinogen appeared to account for 9% to 10% of the relationship. The associations were statistically similar for intake of wine, beer, and liquor and generally similar in subgroups, including those with and without an apolipoprotein E4 allele.

CONCLUSION: In this population, consumption of 14 or more drinks per week was associated with the lowest risk of coronary heart disease, although clinicians should not recommend moderate drinking to prevent coronary heart disease based on this evidence alone, because current National Institute on Alcohol Abuse and Alcoholism guidelines suggest that older adults limit alcohol intake to one drink per day.
A Nonpharmacological Intervention to Improve Sleep in Nursing Home Patients: Results of a Controlled Clinical Trial
Authors: Ouslander Joseph G. , Connell Bettye Rose , Bliwise Donald L. , Endeshaw Yohannes , Griffiths Patricia , Schnelle John F.
Published: January 2006

OBJECTIVES: To improve nighttime sleep in nursing home patients.

DESIGN: Controlled clinical trial.

SETTING: Eight community nursing homes enrolled two at a time.

PARTICIPANTS: Of 1,077 patients assessed in the eight nursing homes, 638 (59%) were eligible, and consent was obtained for 273 (43% of those eligible). Of the 230 who underwent baseline assessments, 173 completed the immediate‐intervention phase of the trial (77 in the intervention group and 96 in the control group). A total of 160 subjects completed the intervention (77 in the immediate‐intervention group and 83 in the delayed‐intervention phase).

INTERVENTION: Trained research staff provided the intervention, which included daytime physical activity and attempts to keep subjects out of bed, evening bright light exposure, a consistent bedtime routine, nighttime care routines designed to minimize sleep disruption, and strategies to reduce nighttime noise. Subjects from one nursing home received the intervention (Group 1), whereas subjects in the second nursing home served as a control group (Group 2); then Group 2 received the intervention.

MEASUREMENTS: Primary outcomes included measures of sleep recorded using wrist actigraphy in all subjects and polysomnography in a subgroup of subjects. Secondary measures included assessments of mood and behavior using the Neuropsychiatric Inventory, the Geriatric Depression Scale, and behavioral observations.

RESULTS: There were no significant differences in any of the primary actigraphic sleep outcome measures between the intervention and control group after the immediate‐intervention phase of the trial. In the 160 subjects who completed the intervention, there were no significant changes in any actigraphic measure of nighttime sleep, nor were there any significant changes in measures of sleep in the 45 subjects who had baseline and intervention polysomnography.

CONCLUSION: This multicomponent, nonpharmacological intervention conducted by trained research staff had no effect on nighttime sleep in this sample of nursing home patients. Enhanced nonpharmacological interventions should be developed and tested and combined with environmental interventions to mitigate noise when feasible. Adjunctive drug therapy may be needed to improve sleep in a substantial proportion of this population and should be tested in addition to nonpharmacological interventions in rigorous clinical trials.
Prospective Multicenter Study of Acute Asthma in Younger Versus Older Adults Presenting to the Emergency Department
Authors: Banerji Aleena , Clark Sunday , Afilalo Marc , Blanda Michelle P. , Cydulka Rita K. , Camargo Carlos A.
Published: January 2006

OBJECTIVES: To describe acute asthma in younger versus older adults presenting to the emergency department (ED).

DESIGN: Prospective cohort study. Asthmatic adults were divided into three age groups: 18 to 34, 35 to 54, and 55 and older. The analysis was restricted to never smokers and smokers with fewer than 10 pack‐years.

SETTING: ED.

PARTICIPANTS: Two thousand sixty‐four patients aged 18 and older with a physician diagnosis of asthma.

MEASUREMENTS: Medications and peak expiratory flow.

RESULTS: There were 1,158 (56%) subjects aged 18 to 34; 777 (37%) aged 35 to 54; and 129 (6%) aged 55 and older. Older patients were most likely to have a primary care provider (65%, 74%, and 91%, respectively; P< .001); most were not taking inhaled corticosteroids (39%, 55%, and 48%, respectively; P<.001). Older patients reported fewer ED visits for asthma (2, 2, and 1, respectively; P=.001) but were more likely to report asthma hospitalization (24%, 31%, and 37%, respectively; P<.001). All groups had severe exacerbations (initial percentage predicted peak flow: 47, 47, and 47, respectively; P=.50), but older patients were least likely to report severe symptoms (72%, 79%, and 67%, respectively; P=.001). Older patients did not respond as well to bronchodilators, even after controlling for other demographic factors, markers of asthma severity, and ED management (change between initial and final peak expiratory flow, using subjects aged 18 to 34 as reference: aged 35–54, β=–0.7 (95% CI=−9.4–8.0); aged ≥55, β=−18.4 (−31.9 to −4.9)). The smaller change in peak expiratory flow contributed most to older patients' greater likelihood of hospitalization.

CONCLUSION: Older asthma patients were less responsive to emergency bronchodilation. This may reflect chronic undertreatment with inhaled corticosteroids.
Oral Care Provided by Certified Nursing Assistants in Nursing Homes
Authors: Coleman Patricia , Watson Nancy M.
Published: January 2006

The purpose of this study was to describe the actual daily oral care provided by certified nursing assistants (CNAs) for dentate elderly nursing home (NH) residents who required assistance with oral care. The study was conducted in five nonrandomly selected NHs in upstate New York using real‐time observations of CNAs providing morning care to residents, retrospective chart review, and CNA screening interviews. Oral care standards developed and validated by a panel of 10 experts (dentists, dental hygienists, registered nurses) to be appropriate for dentate NH residents were used to evaluate the oral care provided by 47 primary dayshift CNAs to a convenience sample of 67 residents. CNAs were blinded to the study's specific focus on oral care. Adherence to individual standards was low, ranging from a high of 16% to a low of 0%. Teeth were brushed and mouths rinsed with water in 16% of resident observations. One resident had her tongue brushed.

Standards never met were brushing teeth at least 2 minutes, flossing, oral assessment, rinsing with mouthwash, and wearing clean gloves during oral care. Most residents (63%) who received oral care assistance were resistive to CNA approaches. For most observations, oral care supplies were not evident. Actual oral care provided to residents contrasts sharply with CNAs' self‐reported practices in the literature and suggests that NH residents who need assistance receive inadequate oral health care.
Quality of Life in Prostate Cancer Patients Taking Androgen Deprivation Therapy
Authors: Dacal Kirsten , Sereika Susan M. , Greenspan Susan L.
Published: January 2006

OBJECTIVES: To examine the effect of androgen deprivation therapy (ADT) on health‐related quality of life (HRQOL), self‐reported HRQOL was compared in prostate cancer patients receiving short‐ (<6 months) or long‐term (≥6 months) ADT and healthy controls.

DESIGN: Cross‐sectional study.

SETTING: Academic medical center in Pittsburgh, Pennsylvania.

PARTICIPANTS: Ninety‐six men, including those with prostate cancer receiving short‐term, long‐term, and no ADT and healthy controls. Men taking medications or having diseases known to affect bone mineral metabolism were excluded.

MEASUREMENTS: The 36‐item Short Form Medical Outcomes Study Health Survey (an HRQOL assessment) and a comorbidity index were administered to each participant. Characteristics, including body composition (assessed using dual‐energy x‐ray absorptiometry) and gonadal status (serum total and free testosterone) were measured approximately 3 months or less before the HRQOL assessment.

RESULTS: As expected, men receiving ADT had significantly lower levels of testosterone, free testosterone, and lean body mass, as well as greater body fat and comorbidity index (all P<.01) than men not receiving ADT (i.e., men with prostate cancer and healthy controls). Participants receiving ADT reported significantly poorer QOL in the areas of physical function (P<.001), general health (P<.001), and physical health component summary (P<.001) than men not receiving ADT. There were no significant differences in HRQOL outcomes between participants receiving short‐ or long‐term ADT. Comorbidity and testosterone levels were associated with several QOL scales. After controlling for the significant joint predictors of comorbidity and total testosterone using hierarchical regression analysis, ADT was no longer a significant predictor, and only comorbidity and total testosterone contributed to the explanation of the variance of the physical health component summary. Comorbidity alone contributed to the explanation of the variance in physical function, bodily pain, general health, and vitality.

CONCLUSION: Patients with prostate cancer who were receiving ADT experience worse HRQOL than those not receiving ADT, but duration of ADT was not a contributing factor. After controlling for comorbidity, total testosterone level rather than ADT accounted for a small yet statistically significant percentage of the total variance of the physical health component summary. These findings have important clinical implications regarding the decision to treat prostate cancer patients with ADT.
Can High‐Risk Older Drivers Be Identified Through Performance‐Based Measures in a Department of Motor Vehicles Setting?
Authors: Ball Karlene K. , Roenker Daniel L. , Wadley Virginia G. , Edwards Jerri D. , Roth David L. , McGwin Gerald , Raleigh Robert , Joyce John J. , Cissell Gayla M. , Dube Tina
Published: January 2006

OBJECTIVES: To evaluate the relationship between performance‐based risk factors and subsequent at‐fault motor vehicle collision (MVC) involvement in a cohort of older drivers.

DESIGN: Prospective cohort study.

SETTING: Motor Vehicle Administration (MVA) field sites in Maryland.

PARTICIPANTS: Of the 4,173 older drivers invited to participate in the study, 2,114 individuals aged 55 to 96 agreed to do so. These analyses focus on 1,910 individuals recruited through MVA field sites.

MEASUREMENTS: Gross Impairment Screening Battery, which included Rapid Pace Walk, Head/Neck Rotation, Foot Tap, Arm Reach, Cued Recall, Symbol Scan, Visual Closure subtest of the Motor Free Visual Perception Test (MVPT), Delayed Recall, and Trail Making Test with an Abbreviated Part A and standard Part B; Useful Field of View (UFOV®) subtest 2; a Mobility Questionnaire; and MVC occurrence.

RESULTS: In drivers aged 55 and older with intact vision (20/70 far visual acuity and 140° visual field), age, sex, history of falls, and poorer cognitive performance, as measured using Trails B, MVPT, and UFOV subtest 2, were predictive of future at‐fault MVC involvement. After adjusting for annual mileage, participants aged 78 and older were 2.11 as more likely to be involved in an at‐fault MVC, those who made four or more errors on the MVPT were 2.10 times as likely to crash, those who took 147 seconds or longer to complete Trails B were 2.01 times as likely to crash, and those who took 353 ms or longer on subtest 2 of the UFOV were 2.02 times as likely to incur an at‐fault MVC. Older adults, men, and individuals with a history of falls were more likely to be involved in subsequent at‐fault MVCs.

CONCLUSION: Performance‐based cognitive measures are predictive of future at‐fault MVCs in older adults. Cognitive performance, in particular, is a salient predictor of subsequent crash involvement in older adults. High‐risk older drivers can be identified through brief, performance‐based measures administered in a MVA setting.
Home Automated External Defibrillators in a Geriatric Population: A Brief Discussion of the Evidence
Authors: Peery C. Andrew , Galanos Anthony N.
Published: January 2006

The literature has identified significant successes in cardiac resuscitation with the use of automated external defibrillators (AEDs) in public areas. As of September 2004, the Food and Drug Administration has authorized the purchase of these devices by the general public without a prescription. For the practicing geriatrician attempting to understand the utility of these devices in a geriatric population, this article reviews the relevant literature of cardiac resuscitation and AEDs, with special attention to large public access trials.
Three‐Dimensional Analysis of Pulmonary Venous Ostial and Antral Anatomy: Implications for Balloon Catheter‐Based Pulmonary Vein Isolation
Authors: AHMED JAMEEL , SOHAL SANDEEP , MALCHANO ZACHARY J. , HOLMVANG GODTFRED , RUSKIN JEREMY N. , REDDY VIVEK Y.
Published: January 2006

Background: Balloon ablation catheters using various energy sources are being developed to perform pulmonary vein (PV) isolation to treat atrial fibrillation. Prior evaluations of 2D CT/MR images are limited by the frequent elliptical shape of the PV ostia, the nonorthogonal orientation of the PVs to the left atrial (LA) chamber, and difficulty in appreciating through‐slice curvature. To provide anatomical data relevant to balloon catheter ablation, 3D surface reconstructions of LA‐PVs were generated and analyzed to define ostial architecture and size.

Methods and Results: Using MRI datasets obtained from 101 paroxysmal AF patients, the LA‐PVs were segmented to generate 3D LA‐PV surface reconstructions. Using both external and endoluminal projections, the PV ostial and antral regions were identified and evaluated. In the left PVs, a common left‐sided ostium was identified in 94 patients, with an ostial circumference of 95 ± 15 mm. Branching of the left PVs occurred 0–5 mm away from the common left ostium in 43 patients (43%), 5–15 mm away from the common os in 37 patients (37%), and >15 mm away from the common os in 14 patients (14%). In patients with either distinct left PV ostia, or common os <15 mm (87 patients), the individual LSPV/LIPV ostial circumferences were 67 ± 12 mm and 58 ± 9 mm, respectively. Mean left antral circumference was 114 ± 17 mm. In the right PVs, the ostial circumferences of the RSPV/RIPV were 68 ± 11 mm and 66 ± 11 mm, respectively. Mean right antral circumference was 107 ± 19 mm. Assuming ideal deformation of the LA chamber anatomy, the minimal diameters of a balloon ablation catheter required to isolate 95% of the RSPV, RIPV, LSPV, LIPV, LCPV, left antrum, and right antrum are 29 mm, 28 mm, 29 mm, 24 mm, 40 mm, 46 mm, and 47 mm, respectively.

Conclusion: Analysis of 3D surface reconstructions of LA‐PV anatomy reveals that balloon catheter‐based ablation of the PVs is likely feasible in most patients, but balloon ablation of the common PV antra would be problematic.
Effects of Right Bundle Branch Block on the Antidromic Circus Movement Tachycardia in Patients with Presumed Atriofascicular Pathways
Authors: STERNICK EDUARDO B. , RODRIGUEZ LUZ‐MARIA , TIMMERMANS CARL , SOSA EDUARDO , CRUZ FERNANDO E.S. , GERKEN LUIZ M. , FAGUNDES MÁRCIO , SCANAVACCA MAURÍCIO , WELLENS HEIN J.J.
Published: January 2006

Background: The typical and most common tachycardia in patients with atriofascicular pathways is a macro reentrant tachycardia, with anterograde conduction over the decrementally conducting bypass tract and retrograde conduction over the right bundle branch‐His‐AV node axis resulting in a short V‐right bundle branch and short V‐H interval.

Objectives: To report on changes in rate and QRS configuration when right bundle branch block (RBBB) develops spontaneously during antidromic tachycardia using an atriofascicular fiber.

Methods: Three of 25 patients with an antidromic circus movement tachycardia using a right‐sided atriofascicular pathway showed episodes of right bundle branch block (RBBB) during ventriculo‐atrial conduction. Effect of retrograde RBBB on tachycardia rate and QRS configuration was studied using intracardiac and extracardiac recordings.

Results: All 3 patients showed prolongation of their V‐A interval when retrograde RBBB occurred during tachycardia, resulting in a longer tachycardia cycle length. The VA time increase ranged from 85 to 100 msec, with a mean 346 ± 5 msec. Two of the 3 patients also showed a change in QRS configuration due to a more leftward shift of the frontal plane QRS axis.

Conclusion: Rate changes in antidromic tachycardia in patients with atriofascicular fibers can be based on a shift in VA conduction from one bundle branch to the other. This may be accompanied by changes in the frontal plane QRS axis because of a change in ventricular activation sequence.
Electrocardiographic Events Preceding Onset of Atrial Fibrillation: Insights Gained Using an Implantable Loop Recorder
Authors: SCHWARTZMAN DAVID , BLAGEV DENITZA P. , BROWN MARK L. , MEHRA RAHUL
Published: January 2006

Introduction: Previous reports demonstrate that individual patients may have distinctive electrocardiographic patterns preceding atrial fibrillation (AF) onset. However, these observations are based on single recordings, and are thus limited by their “snapshot” derivation; it is unclear whether patterns observed on these recordings are consistent over time. We hypothesized that the use of an implantable loop recorder (ILR) would be feasible for serial, long‐term characterization of electrocardiographic events preceding AF onset.

Methods and Results: An ILR was implanted in 29 patients with AF. Patients were instructed to activate the device immediately upon experiencing AF symptoms. Analysis focused on the electrocardiographic segment immediately preceding AF; each segment was classified as one of six patterns: short/long, normal sinus rhythm, absolute sinus bradycardia, relative sinus bradycardia, absolute sinus tachycardia, or relative sinus tachycardia. From a total of 318 device activations, 105 AF onsets were suitable for analysis, acquired from 21 patients over a mean follow‐up interval of 7 months. Although AF was frequently triggered by an atrial premature beat that emerged during normal sinus rhythm, most patients demonstrated a variety of onset patterns. Degeneration of uniform atrial tachycardia to AF was rare. Significant delay in device activation relative to AF onset was common, as was activation in the absence of AF.

Conclusions: Using the ILR, serial, long‐term characterization of electrocardiographic events preceding AF onset was feasible, and typically demonstrated a varied pattern within individuals. There was significant incongruity between symptomatic and electrocardiographic AF burden. As described here, ILR technology is inadequate for the purpose of accurate characterization of AF burden.
Thorough QT/QTc Not So Thorough: Removes Torsadogenic Predictors from the T‐Wave, Incriminates Safe Drugs, and Misses Profibrillatory Drugs
Authors: HONDEGHEM LUC M.
Published: January 2006

Drug‐induced QT prolongation has such a strong correlation with torsade de pointes (TdP) that it comes to serve as a surrogate for TdP. As a result, drugs that prolong QT by as little as a few ms, even without any evidence of TdP, may get dropped from development or blocked from approval. However, measurement of QT with ms accuracy may be impossible to achieve. Worse, some drugs that lengthen the QT interval are not only not proarrhythmic, they may even be antiarrhythmic; while some that shorten the QT can be strongly proarrhythmic. Indeed, proarrhythmia related to repolarization disturbances is caused by triangulation, reverse use dependence, instability, and dispersion (TRIaD). When TRIaD is present with QT prolongation it commonly yields TdP, but when TRIaD is combined with QT shortening it preferentially leads to VF instead. While TdP is lethal in less than 20% of instances, VF is much more morbid. Worse, available evidence suggests that there is more death from drug‐induced fibrillation than TdP. Thus, QT prolongation alone is not very useful. Instead, the T‐wave should be used in alternate ways: extraction of TRIaD.
Effects of Sildenafil Citrate on Defibrillation Efficacy
Authors: SHINLAPAWITTAYATORN KREKWIT , SUNGNOON RATTAPONG , CHATTIPAKORN SIRIPORN , CHATTIPAKORN NIPON
Published: January 2006

Introduction: Although fatal arrhythmia and sudden death have been reported in patients taking sildenafil citrate, its effect on defibrillation efficacy has not been investigated. The aim of this study was to test the hypothesis that sildenafil citrate increases the shock strength required to successfully defibrillate during ventricular fibrillation (VF).

Methods and Results: A total of 26 pigs (20–25 kg) were randomly assigned into three groups. In each group, the defibrillation threshold (DFT) was determined at the beginning of the study using a three‐reversal up/down protocol. Each shock (RV‐SVC, biphasic) was delivered after 10 seconds of VF. Group 1 (n = 10) received 50 mg and group 2 (n = 10) received 100 mg of sildenafil citrate intravenously at a rate of 2 mL/minute for 50 minutes. Group 3 (n = 6) received 100 mL of saline intravenously at the same rate as in group 1. The DFT was determined again after the drug (drug‐DFT) and saline (saline‐DFT) administration. For 100‐mg sildenafil citrate infusion, the DFT (483 ± 39 V, 18 ± 3 J) was significantly (P < 0.003 and P < 0.01, respectively) higher than the control‐DFT (407 ± 123 V, 13 ± 7 J). This sildenafil citrate infusion increased the DFT ∼19% by voltage, and ∼38% by total energy. After 50‐mg sildenafil citrate infusion, the DFT (454 ± 28 V, 15 ± 2 J) was not different than the control DFT (449 ± 28 V, 15 ± 2 J). Saline infusion (391 ± 18 V, 12 ± 1 J) did not alter the control DFT (399 ± 22 V, 12 ± 1 J).

Conclusion: The 100‐mg sildenafil citrate infusion, representing a supra‐therapeutic plasma level, significantly increased the DFT. This finding indicates that VF occurring during supra‐therapeutic sildenafil citrate treatment would require a stronger shock to successfully defibrillate.
Lethal and sublethal effects of Brevibacillus laterosporus on the housefly (Musca domestica)
Authors: Ruiu Luca , Delrio Gavino , Ellar David J. , Floris Ignazio , Paglietti Bianca , Rubino Salvatore , Satta Alberto
Published: January 2006

Sporulated cultures of an isolate of the entomopathogenic bacterium Brevibacillus laterosporus (Laubach) from soil in Sardinia (Italy) were highly toxic by ingestion to both adults and juveniles of the housefly, Musca domestica L. (Diptera: Muscidae). Toxicity was associated with spores as the culture supernatant was not toxic and no parasporal inclusions were observed. The level of toxicity varied with the concentration of spores, the time of exposure to the treated diet, and the stage of insect development. Comparative LC50 values were 0.72 × 108 and 1.75 × 108 spores per gram of diet for 1st and 2nd instar larvae, respectively, and 3.84 × 108 spores per gram for adults. A significant increase in larval development time and reductions in pupal weight and emergence rate were observed when larvae were fed on diets containing sublethal concentrations of spores. Adults surviving after feeding on a sublethal diet showed a significant reduction in fecundity and longevity. Similarly, adults from treated larvae exhibited a lower fecundity, although their longevity was not influenced. A relationship between pupal weight and adult fecundity was found. Pupal stage duration and egg eclosion were not significantly affected.
Quantitative trait loci for resistance to herbivores in willow: field experiments with varying soils and climates
Authors: Rönnberg‐Wästljung A.C. , Åhman I. , Glynn C. , Widenfalk O.
Published: January 2006

As a basis for genetic improvement of willow (Salix spp.) for use in wood biomass production, quantitative trait loci (QTLs) responsible for resistance to herbivores have been identified in a tetraploid hybrid F2 population originating from a cross between Salix dasyclados (Wimm.) and Salix viminalis (L.) (Salicaceae). Symptoms of herbivory, caused by various insects and game, and, in addition, leaf rust, were assessed in three field locations with varying soils and climates. Eleven damage traits (lost leaf area, leaf discoloration, leaf blisters, leaf‐mite symptoms, leaf‐margin cuts, and various estimates of shoot‐tip damage by a gall midge, game, and lepidopterans) were submitted to QTL analysis. A composite interval mapping approach was used to estimate the number of QTLs, the magnitude of the QTLs, and their position on genetic linkage maps. Most of the identified QTLs were specific for each trait and location, but a few QTLs common across the locations were also detected. Each QTL explained between 8 and 24% of the phenotypic variation, depending on damage trait and field location. Clusters of QTLs for different traits were found at several linkage groups, indicating either a common genetic base or tightly linked QTL. Our results emphasize the need for verification of QTL studies over different environments.
Dimensional characteristics of DSM‐IV personality disorders in a large epidemiological sample
Authors: Moran P. , Coffey C. , Mann A. , Carlin J. B. , Patton G. C.
Published: January 2006

Objective:  To assess the five‐factor model (FFM) characteristics of young adults with Diagnostic Statistical Manual‐IV (DSM‐IV) personality disorders in a large community study.

Method:  As part of the eighth wave of a cohort study, 1469 young adults (mean age: 24 years) completed the NEO‐five factor inventory, 1145 of whom also had an informant‐based personality disorder assessment.

Results:  The prevalence of personality disorder was 18.6% (95% CI: 16.5–20.7). There were consistent positive associations with neuroticism and negative associations with agreeableness across all three clusters of personality disorder.

Conclusion:  In young adults, high neuroticism and low agreeableness are consistent dimensional characteristics of all personality disorder clusters.
Soft tissue around three different implant types after 1.5 years of functional loading without oral hygiene
Authors: Watzak Georg , Zechner Werner , Tangl Stefan , Vasak Christoph , Donath Karl , Watzek Georg
Published: January 2006

The purpose of this study was to determine the peri‐implant soft tissue dimension (PSD) and peri‐implant bone level (BL) of dental implants with different designs and surface modifications after functional loading without oral hygiene. Three types of dental implants were placed in the posterior jaws of adult baboons, three of the same design per quadrant, and fitted with fixed partial dentures. After 1.5 years of functional loading and plaque accumulation, all implants showed severe peri‐implant mucositis and comparatively high BL. A histomorphometric evaluation of the sulcus depth (SD), the dimension of the junctional epithelium (JE) and the connective tissue contact (CTC) resulted in no significant differences between the three implant designs, neither in the maxilla nor in the mandible (P>0.05). The sum of SD, JE and CTC forming the PSD was nearly the same in the maxilla (commercially pure titanium, CpTi: 3.5 mm 2.9/4.1 confidence interval (CI); titanium plasma sprayed (TPS): 3.5 mm 2.9/4.2 CI; sand blasted acid‐etched (GBAE): 3.2 mm 2.7/3.9 CI) and in the mandible (CpTi: 3.2 mm 2.6/3.8 CI; TPS: 3.2 mm 2.6/3.8 CI; GBAE: 3.2 mm 2.7/3.9 CI; P>0.05). There was no difference in BL around the three implant designs (maxilla: CpTi: 0.9 mm 0.5/1.6 CI; TPS: 0.9 mm 0.5/1.5CI; GBAE: 0.9 mm 0.5/1.6 CI; mandible: CpTi: 0.8 mm 0.5/1.2 CI; TPS: 0.6 mm 0.4/0.9 CI; GBAE: 0.7 mm 0.5/1.1 CI; P>0.05). Overall, the data presented did not show any significant differences in peri‐implant soft tissue conditions in baboons. Moreover, plaque accumulation and propagation of peri‐implant mucositis after 1.5 years of functional loading was not influenced by implant design and surface modifications in baboons.
Non‐grafted sinus implants in periodontally compromised patients: a time‐to‐event analysis
Authors: Ellegaard Birgit , Baelum Vibeke , Kølsen‐Petersen Jens
Published: January 2006

Abstract: This study reports the results of implant therapy involving a sinus membrane lift and of conventional implant therapy in 68 periodontally compromised patients treated between June 1990 and June 2002. Patients had at least two implants inserted, one of which was placed in the maxillary sinus region following fenestration of the lateral sinus wall and lifting of the sinus membrane. Two implant systems were used: a two‐stage system (Astra®) and a one‐stage system (ITI®). Annual follow‐up visits included recording of plaque, probing pocket depth and measurement of the radiographic distance in millimeter from the implant shoulder to the alveolar crest. Survival analysis showed that the proportion of implants that had not been explanted after 5 years ranged between 88.7% for ITI® sinus implants and 97% for ASTRA® conventional implants. After 10 years, the proportion of implants remaining in situ ranged between 59% for ITI® conventional implants and 97% for ASTRA® conventional implants. Cox regression analyses showed that the factors influential for implant explantation were implant type (HRITI=2.8), implant length (HR10 mm=3.1), patient being a smoker (HRsmoking=2.2) and patient having at least 20 natural teeth (HR20 teeth=3.8). Our results demonstrate that sinus implants may be inserted with the same success as conventional implants in periodontally compromised patients.
Multiple dental fractures following tongue barbell placement: a case report
Authors: Brennan Maire , O'Connell Brian , O'Sullivan Michael
Published: January 2006

Abstract –  The number of adolescents and young adults undergoing intra‐oral piercing, is increasing worldwide. There have been several case reports documenting oral and systemic complications of this practice. These include damage to the dentition, gingivae, infection, speech impediments and nerve damage. The case presented here draws attention to the possibility of multiple tooth fracture as a result of trauma incurred from a barbell inserted into the tongue.
Prevalence and risk of traumatic gingival recession following elective lip piercing
Authors: Leichter Jonathan W. , Monteith Brian D.
Published: January 2006

Abstract – The aims of this study were to evaluate the prevalence, risk and odds ratios of gingival recession defects associated with elective lip piercing and wearing of stud jewelry, and to attempt to identify risk factors that might permit the incidence of recession and its severity to be predicted, using Miller's classification. Ninety‐one subjects with lip piercing and labrets were evaluated with regard to gender, age, smoking history, orthodontic history, and labret characteristics. An age‐matched group of 54 individuals without peri‐oral piercing provided the control. Gingival recession was recorded on teeth opposing a labret in 68.13% of pierced subjects. By contrast, only 22.2% of unpierced individuals demonstrated recession. The odds ratio between pierced and control groups indicates a likelihood of recession 7.5 times greater in a pierced individual wearing a labret than in an unpierced individual. Logistical regression analysis showed that age, gender, smoking and labret configuration did not significantly influence the development of recession. Furthermore, an illustrative example indicates that piercing and provision of a labret might typically increase the risk of recession occurring from 34.4% (pre‐piercing) to 80.8 %. Recession severity was greater in the pierced group, with Miller's class 2 and 3 defects observed in 18.7% of the pierced but not at all in the unpierced group. Ordinal regression identified previous orthodontic treatment as the only significant predictor of Miller's grade. We concluded that a clear link exists between lip piercing, labret use and gingival recession. Belief that labret placement and configuration can be modified to provide protection is unfounded.
Trauma to an osseointegrated anterior dental implant: a case report
Authors: Allen Edith M. , Allen P. Finbarr
Published: January 2006

Abstract –  Single tooth implant systems have been shown to offer a safe and highly predictable option for the replacement of anterior teeth. There is however, a paucity of evidence on the result of trauma to single tooth implant systems, particularly in the vulnerable anterior maxillary area. This article presents a report on the outcome of a traumatic incident to an osseointegrated single tooth implant.
Evaluation of the topical effect of alendronate on the root surface of extracted and replanted teeth. Microscopic analysis on rats’ teeth
Authors: Lustosa‐Pereira Adriana , Garcia Roberto Brandão , De Moraes Ivaldo Gomes , Bernardineli Norberti , Bramante Clovis Monteiro , Bortoluzzi Eduardo Antunes
Published: January 2006

Abstract –  The treatment of choice for tooth avulsion is replantation. The ideal replantation should be realized as quickly as possible, or at least, the avulsed tooth should be kept in an adequate solution to preserve the periodontal ligament attached to the root. If that is not possible, treatment of the radicular surface should be done in order to prevent radicular resorption. The purpose of this study was to test sodium alendronate as a substance for topical treatment of the radicular surface of avulsed teeth in an attempt to prevent the occurrence of dental resorptions. Fifty‐four rat maxillary right central incisors were extracted and replanted. Group I – extra‐alveolar dry period of 15 min, intracanal dressing with calcium hydroxide (CALEN®, S.S. White, Artigos Dentários LTDA, Rio de Janeiro, Brazil) and replantation; Groups II and III – extra‐alveolar dry periods of 30 and 60 min, respectively, immersion in 1% sodium hypochlorite for 30 min for removal of the periodontal ligament, washing in saline solution for 5 min, and treatment of the radicular surface with 3.2 mg/l sodium alendronate solution for 10 min. Intracanal dressing with calcium hydroxide and replantation followed. At 15, 60, and 90 days post‐reimplantation, the animals were killed and the samples obtained and processed for microscopic analysis. The results indicated that sodium alendronate was able to reduce the incidence of radicular resorption, but not of dental ankylosis. No significant differences were observed regarding variations in the extra‐alveolar periods among the groups.
Overview of vascular injuries in Yemen: Experience from a single tertiary referral hospital
Authors: Ghallab Nagi Homesh
Published: January 2006

Background:  Vascular injuries are seen in blunt and penetrating trauma. They have been well documented during wartime, but there have been few reviews of vascular trauma in civilian practice. In Yemen, gunshot injuries seen frequently where civilian violence is common. The present study aimed to describe our experience in the management of vascular injuries in civilian practice.

Methods:  A prospective study included 132 patients with 163 vascular injuries who were admitted to the surgical department at Al‐Thawra Teaching Hospital between December 1997 and March 2002.

Results:  Eighty‐seven per cent of the patients were males and the median age was 28.5 years. The most common cause of vascular injury was gunshot injury (59.8%), followed by stab wounds and car accidents. The commonest vessels injured were the common femoral arteries, followed by the brachial and popliteal arteries (19, 18 and 18 injuries, respectively). Associated injuries were recorded in 72 patients and included 47 fractures. Treatment included vein graft interposition in 67, ligation in 52 and end to end anastomosis or lateral primary repair in 34 injuries. Fasciotomy was performed for 39 patients and amputation performed in 11 cases. The mortality reached 9.8% and the commonest cause (nine out of 13 deaths) was due to gunshot wounds. The median hospital stay was 13.5 days.

Conclusion:  Gunshot wounds represent the majority of vascular injuries in Yemen. Shortage of vascular surgery services in most of the Yemeni Hospitals represents a major problem. Legislation and regulation to take up arms is of paramount importance for injury prevention in Yemen.