bluuebunny/crossref_metadata_2025 huggingface dataset:
High mobility group box 1 potentiates the pro-inflammatory effects of interleukin-1β in osteoarthritic synoviocytes
Authors: García-Arnandis Isabel , Guillén Maria Isabel , Gomar Francisco , Pelletier Jean-Pierre , Martel-Pelletier Johanne , Alcaraz Maria José
Published: September 2010

Introduction

High mobility group box 1 (HMGB1) is released by necrotic cells or secreted in response to inflammatory stimuli. Extracellular HMGB1 may act as a pro-inflammatory cytokine in rheumatoid arthritis. We have recently reported that HMGB1 is released by osteoarthritic synoviocytes after activation with interleukin-1beta (IL-1β) The present study investigated the role of HMGB1 in synovial inflammation in osteoarthritis (OA).

Methods

HMGB1 was determined in human synovium using immunohistochemistry, comparing normal to OA. OA synoviocytes were incubated with HMGB1 at 15 or 25 ng/ml in the absence or presence of IL-1β (10 ng/ml). Gene expression was analyzed by quantitative PCR and protein expression by Western Blot and ELISA. Matrix metalloproteinase (MMP) activity was studied by fluorometric procedures and nuclear factor (NF)-κB activation by transient transfection with a NF-κB-luciferase plasmid.

Results

In the normal synovium, HMGB1 was found in the synovial lining cells, sublining cells, and in the vascular wall cells. The distribution of HMGB1 in OA synovium was similar but the number of HMGB1 positive cells was higher and HMGB1 was also present in infiltrated cells. In normal synovial membrane cells, HMGB1 was found mostly in the nuclei, whereas in OA, HMGB1 was generally found mostly in the cytoplasm. In OA synoviocytes, HMGB1 alone at concentrations of 15 or 25 ng/ml did not affect the production of IL-6, IL-8, CCL2, CCL20, MMP-1 or MMP-3, but in the presence of IL-1β, a significant potentiation of protein and mRNA expression, as well as MMP activity was observed. HMGB1 also enhanced the phosphorylated ERK1/2 and p38 levels, with a lower effect on phosphorylated Akt. In contrast, JNK1/2 phosphorylation was not affected. In addition, HMGB1 at 25 ng/ml significantly potentiated NF-κB activation in the presence of IL-1β.

Conclusions

Our results indicate that HMGB1 is overexpressed in OA synovium and mostly present in extracellular form. In OA synoviocytes, HMGB1 cooperates with IL-1β to amplify the inflammatory response leading to the production of a number of cytokines, chemokines and MMPs. Our data support a pro-inflammatory role for this protein contributing to synovitis and articular destruction in OA.
Overlapping genetic susceptibility variants between three autoimmune disorders: rheumatoid arthritis, type 1 diabetes and coeliac disease
Authors: Eyre Stephen , Hinks Anne , Bowes John , Flynn Edward , Martin Paul , Wilson Anthony G , Morgan Ann W , Emery Paul , Steer Sophia , Hocking Lynne J , Reid David M , Harrison Pille , Wordsworth Paul ,   Yorkshire Early Arthritis (YEAR) Consortium, Biologics in RA Control (BIRAC) Consortium, Thomson Wendy , Worthington Jane , Barton Anne
Published: September 2010

Introduction

Genome wide association studies, replicated by numerous well powered validation studies, have revealed a large number of loci likely to play a role in susceptibility to many multifactorial diseases. It is now well established that some of these loci are shared between diseases with similar aetiology. For example, a number of autoimmune diseases have been associated with variants in the PTPN22, TNFAIP3 and CTLA4 genes. Here we have attempted to define overlapping genetic variants between rheumatoid arthritis (RA), type 1 diabetes (T1D) and coeliac disease (CeD).

Methods

We selected eight SNPs previously identified as being associated with CeD and six T1D-associated SNPs for validation in a sample of 3,962 RA patients and 3,531 controls. Genotyping was performed using the Sequenom MassArray platform and comparison of genotype and allele frequencies between cases and controls was undertaken. A trend test P-value < 0.004 was regarded as significant.

Results

We found statistically significant evidence for association of the TAGAP locus with RA (P = 5.0 × 10-4). A marker at one other locus, C1QTNF6, previously associated with T1D, showed nominal association with RA in the current study but did not remain statistically significant at the corrected threshold.

Conclusions

In exploring the overlap between T1D, CeD and RA, there is strong evidence that variation within the TAGAP gene is associated with all three autoimmune diseases. Interestingly a number of loci appear to be specific to one of the three diseases currently studied suggesting that they may play a role in determining the particular autoimmune phenotype at presentation.
Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review
Authors: Price Laura C , Wort Stephen J , Finney Simon J , Marino Philip S , Brett Stephen J
Published: September 2010

Introduction

Pulmonary vascular dysfunction, pulmonary hypertension (PH), and resulting right ventricular (RV) failure occur in many critical illnesses and may be associated with a worse prognosis. PH and RV failure may be difficult to manage: principles include maintenance of appropriate RV preload, augmentation of RV function, and reduction of RV afterload by lowering pulmonary vascular resistance (PVR). We therefore provide a detailed update on the management of PH and RV failure in adult critical care.

Methods

A systematic review was performed, based on a search of the literature from 1980 to 2010, by using prespecified search terms. Relevant studies were subjected to analysis based on the GRADE method.

Results

Clinical studies of intensive care management of pulmonary vascular dysfunction were identified, describing volume therapy, vasopressors, sympathetic inotropes, inodilators, levosimendan, pulmonary vasodilators, and mechanical devices. The following GRADE recommendations (evidence level) are made in patients with pulmonary vascular dysfunction: 1) A weak recommendation (very-low-quality evidence) is made that close monitoring of the RV is advised as volume loading may worsen RV performance; 2) A weak recommendation (low-quality evidence) is made that low-dose norepinephrine is an effective pressor in these patients; and that 3) low-dose vasopressin may be useful to manage patients with resistant vasodilatory shock. 4) A weak recommendation (low-moderate quality evidence) is made that low-dose dobutamine improves RV function in pulmonary vascular dysfunction. 5) A strong recommendation (moderate-quality evidence) is made that phosphodiesterase type III inhibitors reduce PVR and improve RV function, although hypotension is frequent. 6) A weak recommendation (low-quality evidence) is made that levosimendan may be useful for short-term improvements in RV performance. 7) A strong recommendation (moderate-quality evidence) is made that pulmonary vasodilators reduce PVR and improve RV function, notably in pulmonary vascular dysfunction after cardiac surgery, and that the side-effect profile is reduced by using inhaled rather than systemic agents. 8) A weak recommendation (very-low-quality evidence) is made that mechanical therapies may be useful rescue therapies in some settings of pulmonary vascular dysfunction awaiting definitive therapy.

Conclusions

This systematic review highlights that although some recommendations can be made to guide the critical care management of pulmonary vascular and right ventricular dysfunction, within the limitations of this review and the GRADE methodology, the quality of the evidence base is generally low, and further high-quality research is needed.
Phase IB Study of the mTOR Inhibitor Ridaforolimus With Capecitabine
Authors: Perotti Antonella , Locatelli Alberta , Sessa Cristiana , Hess Dagmar , Viganò Lucia , Capri Giuseppe , Maur Michela , Cerny Thomas , Cresta Sara , Rojo Federico , Albanell Joan , Marsoni Silvia , Corradino Irene , Berk Lori , Rivera Victor M. , Haluska Frank , Gianni Luca
Published: September 2010

Purpose

Synergistic/additive cytotoxicity in tumor models and widespread applicability of fluoropyrimidines in solid tumors prompted the study of the combination of the mammalian target of rapamycin (mTOR) inhibitor, non-prodrug rapamycin analog ridaforolimus, with capecitabine.

Patients and Methods

Thirty-two adult patients were treated. Intravenous ridaforolimus was given once weekly for 3 weeks and capecitabine was given from days 1 to 14 every 4 weeks. Ridaforolimus was given at 25, 37.5, 50, or 75 mg with capecitabine at 1,650 mg/m2 or 1,800 mg/m2 divided into two daily doses. Pharmacokinetics of both drugs were determined during cycles 1 and 2. Pharmacodynamic studies in peripheral blood mononuclear cells (PBMCs) and wound tissue of the skin characterized pathways associated with the metabolism or disposition of fluoropyrimidines and mTOR and ERK signaling.

Results

Two recommended doses (RDs) were defined: 75 mg ridaforolimus/1,650 mg/m2 capecitabine and 50 mg ridaforolimus/1,800 mg/m2 capecitabine. Dose-limiting toxicities were stomatitis and skin rash. One patient achieved a partial response lasting 10 months and 10 of 29 evaluable patients had stable disease for ≥ 6 months. The only pharmacokinetic interaction was a ridaforolimus-induced increase in plasma exposure to fluorouracil. PBMC data suggested that prolonged exposure to capecitabine reduced the ridaforolimus inhibition of mTOR. Ridaforolimus influenced the metabolism of fluoropyrimidines and inhibited dihydropyrimidine dehydrogenase, behavior similar to that of rapamycin. Inhibition of the target thymidylate synthase by capecitabine was unaffected. mTOR and ERK signaling was inhibited in proliferating endothelial cells and was more pronounced at the RD with the larger amount of ridaforolimus.

Conclusion

Good tolerability, feasibility of prolonged treatment, antitumor activity, and favorable pharmacologic profile support further investigation of this combination.
Results of the CONFIRM Phase III Trial Comparing Fulvestrant 250 mg With Fulvestrant 500 mg in Postmenopausal Women With Estrogen Receptor–Positive Advanced Breast Cancer
Authors: Di Leo Angelo , Jerusalem Guy , Petruzelka Lubos , Torres Roberto , Bondarenko Igor N. , Khasanov Rustem , Verhoeven Didier , Pedrini José L. , Smirnova Iya , Lichinitser Mikhail R. , Pendergrass Kelly , Garnett Sally , Lindemann Justin P.O. , Sapunar Francisco , Martin Miguel
Published: September 2010

Purpose

We compared fulvestrant 500 mg regimen with the approved dose of fulvestrant 250 mg per month for treatment of postmenopausal women with estrogen receptor–positive advanced breast cancer who experienced progression after prior endocrine therapy.

Patients and Methods

Comparison of Faslodex in Recurrent or Metastatic Breast Cancer (CONFIRM) is a double-blind, parallel-group, multicenter, phase III study. Patients were randomly assigned to fulvestrant 500 mg (500 mg intramuscularly [IM] on day 0, then 500 mg IM on days 14 and 28 and every 28 days thereafter) or 250 mg every 28 days. Primary end point was progression-free survival (PFS). Secondary end points included objective response rate, clinical benefit rate (CBR), duration of clinical benefit (DoCB), overall survival (OS), and quality of life (QOL).

Results

PFS was significantly longer for fulvestrant 500 mg (n = 362) than 250 mg (n = 374) (hazard ratio [HR] = 0.80; 95% CI, 0.68 to 0.94; P = .006), corresponding to a 20% reduction in risk of progression. Objective response rate was similar for fulvestrant 500 mg and 250 mg (9.1% v 10.2%, respectively). CBR was 45.6% for fulvestrant 500 mg and 39.6% for fulvestrant 250 mg. DoCB and OS were 16.6 and 25.1 months, respectively, for the 500-mg group, whereas DoCB and OS were 13.9 and 22.8 months, respectively, in the 250-mg group. Fulvestrant 500 mg was well tolerated with no dose-dependent adverse events. QOL was similar for both arms.

Conclusion

Fulvestrant 500 mg was associated with a statistically significant increase in PFS and not associated with increased toxicity, corresponding to a clinically meaningful improvement in benefit versus risk compared with fulvestrant 250 mg.
Lung Adenocarcinoma From East Asian Never-Smokers Is a Disease Largely Defined by Targetable Oncogenic Mutant Kinases
Authors: Sun Yihua , Ren Yan , Fang Zhaoyuan , Li Chenguang , Fang Rong , Gao Bin , Han Xiangkun , Tian Weidong , Pao William , Chen Haiquan , Ji Hongbin
Published: September 2010

Purpose

To determine the proportion of lung adenocarcinomas from East Asian never-smokers who harbor known oncogenic driver mutations.

Patients and Methods

In this surgical series, 52 resected lung adenocarcinomas from never-smokers (< 100 cigarettes in a lifetime) at a single institution (Fudan University, Shanghai, China) were analyzed concurrently for mutations in EGFR, KRAS, NRAS, HRAS, HER2, BRAF, ALK, PIK3CA, TP53 and LKB1.

Results

Forty-one tumors harbored EGFR mutations, three harbored EML4-ALK fusions, two harbored HER2 insertions, and one harbored a KRAS mutation. All mutations were mutually exclusive. Thus, 90% (47 of 52; 95% CI, 0.7896 to 0.9625) of lung adenocarcinomas from never-smokers were found to harbor well-known oncogenic mutations in just four genes. No BRAF, NRAS, HRAS, or LKB1 mutations were detected, while 15 had TP53 mutations. Four tumors contained PIK3CA mutations, always together with EGFR mutations.

Conclusion

To our knowledge, this study represents the first comprehensive and concurrent analysis of major recurrent oncogenic mutations found in a large cohort of lung adenocarcinomas from East Asian never-smokers. Since drugs are now available that target mutant EGFR, HER2, and ALK, respectively, this result indicates that prospective mutation testing in these patients should successfully assign a targeted therapy in the majority of cases.
Quality Cancer Care for Adolescents and Young Adults: A Position Statement
Authors: Zebrack Brad , Mathews-Bradshaw Beth , Siegel Stuart
Published: September 2010

Purpose

This consensus-based position statement on behalf of the LIVESTRONG Young Adult Alliance (Alliance) offers recommendations to enhance oncologic care of adolescent and young adult (AYA) patients with cancer.

Background

In 2005 to 2006, the National Cancer Institute and the Lance Armstrong Foundation jointly sponsored the Adolescent and Young Adult Oncology Progress Review Group (PRG). The PRG report included the directive to develop standards of care for AYA patients with cancer and to disseminate these guidelines to the community. To this end, the Alliance convened a meeting of experts (clinicians, researchers, and advocates) in June 2009 and derived this position statement.

Results

Quality care for AYAs depends on four critical elements: timely detection; efficient processes for diagnosis, initiation of treatment, and promotion of adherence; access to health care professionals who possess knowledge specific to the biomedical and psychosocial needs of this population; and research that will ultimately derive objective criteria for the development of AYA oncology care guidelines. Achieving quality care for AYAs will require assistance with management of disease and treatment effects; cognizance of the unique psychosocial context for AYA growth and development; assessment of and attention to cognitive, psychiatric, and psychosocial issues; facilitated transition to treatment care; and referral to age-appropriate information and support services.

Conclusion

Dissemination of recommendations stated here will raise awareness of the need for AYA-specific care guidelines and assist providers in the delivery of care that is responsive to the distinct needs of AYAs with cancer.
Functional characterization of theDrosophila MRP(mitochondrial RNA processing) RNA gene
Authors: Schneider Mary D. , Bains Anupinder K. , Rajendra T.K. , Dominski Zbigniew , Matera A. Gregory , Simmonds Andrew J.
Published: September 2010

MRPRNA is a noncoding RNA component of RNase mitochondrial RNA processing (MRP), a multi-protein eukaryotic endoribonuclease reported to function in multiple cellular processes, including ribosomal RNA processing, mitochondrial DNA replication, and cell cycle regulation. A recent study predicted a potentialDrosophilaortholog ofMRPRNA (CR33682) by computer-based genome analysis. We have confirmed the expression of this gene and characterized the phenotype associated with this locus. Flies with mutations that specifically affectMRPRNA show defects in growth and development that begin in the early larval period and end in larval death during the second instar stage. We present several lines of evidence demonstrating a role forDrosophila MRPRNA in rRNA processing. The nuclear fraction ofDrosophila MRPRNA localizes to the nucleolus. Further, a mutant strain shows defects in rRNA processing that include a defect in 5.8S rRNA processing, typical ofMRPRNA mutants in other species, as well as defects in early stages of rRNA processing.
MicroRNA sponges: Progress and possibilities
Authors: Ebert Margaret S. , Sharp Phillip A.
Published: September 2010

The microRNA (miRNA) “sponge” method was introduced three years ago as a means to create continuous miRNA loss of function in cell lines and transgenic organisms. Sponge RNAs contain complementary binding sites to a miRNA of interest, and are produced from transgenes within cells. As with most miRNA target genes, a sponge's binding sites are specific to the miRNA seed region, which allows them to block a whole family of related miRNAs. This transgenic approach has proven to be a useful tool to probe miRNA functions in a variety of experimental systems. Here we will discuss the ways sponge and related constructs can be optimized and review recent applications of this method with particular emphasis on stable expression in cancer studies and in transgenic animals.
Role of the College in the Funding and Delivery of Surgical Research: Recommendations of an Advisory Group
Authors: Jeevan R , Emin A , Dickinson L , Palser TR , Coomer M , Williams NS
Published: September 2010

Surgical research includes basic science and laboratory-based in vitro investigation, translational work to develop in vitro findings into investigations and treatments, and clinically oriented work to evaluate and improve current practice. Academic surgery has undergone a shift in priorities and funding in the UK. A move towards laboratory-based research has led to reductions in translational work and practice evaluation, an issue highlighted by Bell in 2003.
The Concept of Surgical Assessment: Part 3 – Characteristics of the Ideal Assessment Tool
Authors: Okoro T , Sirianni C , Brigden D
Published: September 2010

Adequate documentation of technical competence in surgery has come under increased scrutiny in recent years. The stipulation in the European Working Time Regulations of a 48-hour working week, an emphasis on operating room efficiency and concerns about medical errors and patient safety may limit the ability of a teaching faculty to provide graded responsibility with adequate skill acquisition in a surgical training programme.
The rise and rise of the MJDF
Authors: Escudier Michael
Published: September 2010

All dental graduates now enter a foundation training programme that prepares them for further career choices in terms of general dental practice (with the option of developing enhanced skills in areas of interest) and specialist training pathways. The Faculty of General Dental Practice (UK) (FGDP(UK)) and Faculty of Dental Surgery (FDS) at The Royal College of Surgeons of England offer a single assessment as a clear marker of the successful completion of this period of training: the Diploma of Membership of the Joint Dental Faculties (MJDF). This enables career choices to be held open in the important early years following graduation. The graduate may then choose to follow the FGDP(UK)'s Career Pathway for general dental practitioners or specialist training pathways offered by the FDS and other dental faculties in the UK.
Logarithmically improved regularity criteria for the 3D viscous MHD equations
Authors: Zhou Yong , Fan Jishan
Published: September 2010

In this paper, various logarithmically improved regularity criteria for the 3D MHD equations are established in terms of the velocity field and pressure respectively. These regularity criteria can be regarded as log in time improvements of the standard Serrin's criteria established before.
A bound on the degree of schemes defined by quadratic equations
Authors: Alzati Alberto , Sierra José Carlos
Published: September 2010

We consider complex projective schemes defined
by quadratic equations and satisfying a technical hypothesis on the
fibres of the rational map associated to the linear system of
quadrics defining X. Our assumption is related to the syzygies of
the defining equations and, in particular, it is weaker than
properties N2
, and K2
. In this setting, we show that
the degree d of is bounded by a function
of its codimension c, whose asymptotic behavior is given by
, thus improving the obvious bound . More precisely, we get the bound
. Furthermore, if X satisfies
property or , we obtain the better bound
. Some classification
results are also given when equality holds.
Modeling the Spray Atomization of Emulsion Embedded Agricultural Solutions
Authors: Qin Kuide , Cloeter Mike , Tank Holger , Liu Lei , Wilson Steve , Yin De-Wei
Published: September 2010

A typical agricultural chemical spray process involves atomizing a liquid stream of diluted pesticide solution through hydraulic spray nozzles that inherently produce a wide spectrum of spray droplet sizes. Finer droplets have higher potential for off-target movement or drift, which is of concern due to its potential impact on neighboring crops and livestock, sensitive ecological resources, and human health. Research by the Spray Drift Task Force and others has demonstrated that, although spray nozzle selection and application parameters are the key factors to produce the desired droplet size spectrum, the physical properties of the spray solution have significant effects on the droplet size distribution for various kinds of nozzles. One of these properties of many spray fluids is the inclusion of an oil phase in the form of an emulsion. The effect of oil-in-water emulsions on the spray droplet size distribution has been demonstrated by previous work. However, the mechanisms of this effect are largely unknown. In this study, a method to model this effect was proposed. A characteristic dimensionless number for connecting the bulk spray properties and the microscopic emulsion droplet properties was defined as the ratio between the emulsion recovery time and the spray atomization time. This study will help in the design of agricultural spray nozzles and the optimization of anti-drift spray additives.
General Epistatic Models of the Risk of Complex Diseases
Authors: Song Yun S , Wang Fulton , Slatkin Montgomery
Published: September 2010

The range of possible gene interactions in a multilocus model of a complex inherited disease is studied by exploring genotype-specific risks subject to the constraint that the allele frequencies and marginal risks are known. We quantify the effect of gene interactions by defining the interaction ratio, $\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(C_{\mathrm{R}}{=}K_{\mathrm{R}}/K_{\mathrm{R}}^{\mathrm{I}}\) \end{document}$, where KR is the recurrence risk to relatives with relationship R for the true model and $\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(K_{\mathrm{R}}^{\mathrm{I}}\) \end{document}$ is the recurrence risk to relatives for a multiplicative model with the same marginal risks. We use a Markov chain Monte Carlo (MCMC) procedure to sample from the space of possible models. We find that the average of CR increases with the number of loci for both low frequency (p = 0.03) and higher frequency (p = 0.25) causative alleles. Furthermore, the probability that CR > 1 is nearly 1. Similar results are obtained when more weight is given to risk models that are closer to the comparable multiplicative model. These results imply that, in general, gene interactions will result in greater heritability of a complex inherited disease than is expected on the basis of a multiplicative model of interactions and hence may provide a partial explanation for the problem of missing heritability of complex diseases.
Children With Complex Chronic Conditions in Inpatient Hospital Settings in the United States
Authors: Simon Tamara D. , Berry Jay , Feudtner Chris , Stone Bryan L. , Sheng Xiaoming , Bratton Susan L. , Dean J. Michael , Srivastava Rajendu
Published: September 2010

OBJECTIVES:

Hospitalized children are perceived to be increasingly medically complex, but no such trend has been documented. The objective of this study was to determine whether the proportion of pediatric inpatient use that is attributable to patients with a diagnosis of one or more complex chronic condition (CCC) has increased over time and to assess the degree to which CCC hospitalizations are associated with attributes that are consistent with heightened medical complexity.

METHODS:

A retrospective observational study that used the 1997, 2000, 2003, and 2006 Kids Inpatient Databases examined US hospitalizations for children. Attributes of medical complexity included hospital admissions, length of stay, total charges, technology-assistance procedures, and mortality risk.

RESULTS:

The proportion of inpatient pediatric admissions, days, and charges increased from 1997 to 2006 for any CCC and for every CCC group except hematology. CCCs accounted for 8.9% of US pediatric admissions in 1997 and 10.1% of admissions in 2006. These admissions used 22.7% to 26.1% of pediatric hospital days, used 37.1% to 40.6% of pediatric hospital charges, accounted for 41.9% to 43.2% of deaths, and (for 2006) used 73% to 92% of different forms of technology-assistance procedures. As the number of CCCs for a given admission increased, all markers of use increased.

CONCLUSIONS:

CCC-associated hospitalizations compose an increasing proportion of inpatient care and resource use. Future research should seek to improve methods to identify the population of medically complex children, monitor their increasing inpatient use, and assess whether current systems of care are meeting their needs.
Home Intervention Improves Cognitive and Social-Emotional Scores in Iron-Deficient Anemic Infants
Authors: Lozoff Betsy , Smith Julia B. , Clark Katy M. , Gloria Perales Carmen , Rivera Francisca , Castillo Marcela
Published: September 2010

BACKGROUND:

Iron-deficiency anemia (IDA) is associated with alterations in infant behavior and development that may not be corrected with iron therapy.

OBJECTIVE:

To determine if a home-based intervention to foster child development improves behavior and development of infants with IDA.

METHODS:

Infants with IDA and nonanemic infants aged 6 and 12 months were treated with oral iron and randomly assigned to a year of surveillance or intervention. Infants in the surveillance group were visited weekly, and information on iron intake, feeding, and health were recorded. Infants in the intervention were visited weekly, and the home visits included an hour-long program to foster child development by providing support to the mother-infant relationship. The number of infants enrolled was 128 (66 who received intervention) and 149 (70 intervention) at 6 and 12 months, respectively. Psychologists who were unaware of iron status and intervention assignment assessed infants' cognitive, motor, and social-emotional development (Bayley Scales) at the beginning, midpoint, and end of the year; 116 6-month-olds and 134 12-month-olds had at least 2 assessments. Hierarchical linear modeling was used to analyze change over time.

RESULTS:

Infants with IDA, regardless of enrollment age, were rated as less positive in social-emotional behavior at baseline. There were significant interactions between iron status and intervention associated with change in cognitive performance and positive social-emotional behavior. Infants with IDA who received intervention had developmental trajectories comparable to those of nonanemic infants in the intervention and surveillance groups, but these infants did not catch up in social-emotional behavior. Infants with IDA who received surveillance showed less increase in cognitive scores and had declines in positive social-emotional ratings.

CONCLUSIONS:

Home-based intervention to foster child development improved cognitive and social-emotional scores in infants with IDA, but social-emotional differences remained between infants with IDA and those without IDA.
Motor Outcomes After Neonatal Arterial Ischemic Stroke Related to Early MRI Data in a Prospective Study
Authors: Husson Béatrice , Hertz-Pannier Lucie , Renaud Cyrille , Allard Dominique , Presles Emilie , Landrieu Pierre , Chabrier Stéphane ,   for the AVCnn Group
Published: September 2010

OBJECTIVE:

We aimed to correlate early imaging data with motor outcomes in a large, homogeneous, cohort of infants with neonatal (diagnosed before 29 days of life) arterial ischemic stroke (AIS).

METHODS:

From a prospective cohort of 100 children with neonatal AIS, we analyzed the MRI studies performed within the 28 first days of life for 80 infants evaluated at 2 years of age. The relationships between infarction location and corticospinal tract (CST) involvement and motor outcomes were studied

RESULTS:

Seventy-three infarctions involved the middle cerebral artery (MCA) territory. Of those, 50 were superficial infarctions, 5 deep infarctions, and 18 mixed infarctions. The CST was involved in 24 cases. Nineteen patients with MCA infarctions (26% [95% confidence interval: 16%–34%]) developed hemiplegia. Mixed infarctions (P < .0001) and CST involvement (P < .0001) were highly predictive of hemiplegia. In contrast, 88% of children with isolated superficial MCA infarctions did not exhibit impairment.

CONCLUSIONS:

Accurate prediction of motor outcomes can be obtained from early MRI scans after neonatal AIS. The absence of involvement of the CST resulted in normal motor development in 94% of cases. CST involvement resulted in congenital hemiplegia in 66% of cases.
Head-Circumference Distribution in a Large Primary Care Network Differs From CDC and WHO Curves
Authors: Daymont Carrie , Hwang Wei-Ting , Feudtner Chris , Rubin David
Published: September 2010

OBJECTIVE:

To compare currently available head-circumference growth curves to curves constructed from clinical measurements from patients in a large US primary care network (PCN).

PATIENTS AND METHODS:

We performed a retrospective cohort study of 75 412 patients in an urban-suburban PCN. Patients with a birth weight of <1500 g or gestational age of <33 weeks at birth were excluded. We compared percentile values and the proportion of head-circumference observations above the 95th percentile and below the 5th percentile for the existing and PCN curves.

RESULTS:

The PCN curves were most similar to the National Center for Health Statistics (NCHS) curves and were substantially different from the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) curves. The overall proportion of observations above the 95th percentile was 4.9% (PCN), 6.2% (NCHS), 8.6% (CDC), and 14.0% (WHO). The proportion below the 5th percentile was 4.4% (PCN), 5.1% (NCHS), 2.9% (CDC), and 2.3% (WHO). When using the CDC curves, the proportion above the 95th percentile increased from 0.2% for children younger than 2 weeks to 11.8% for children 12 months old. When using the WHO curves, the proportion above the 95th percentile was >5% at all ages, with a maximum of 18.0% for children older than 24 months.

CONCLUSIONS:

The CDC and WHO head-circumference curves describe different distributions than the clinical measurements in our PCN population, especially for children with larger heads. The resulting percentile misclassification may delay diagnosis in children with intracranial pathology in very young infants and spur unnecessary evaluation of healthy children older than 6 months.
Fetal Growth Retardation and Risk of Febrile Seizures
Authors: Visser Annemarie M. , Jaddoe Vincent W. V. , Hofman Albert , Moll Henriette A. , Steegers Eric A. P. , Tiemeier Henning , Raat Hein , Breteler Monique M. B. , Arts Willem Frans M.
Published: September 2010

OBJECTIVE:

The goal was to examine the associations between fetal growth characteristics in different trimesters of pregnancy and the occurrence of febrile seizures in early childhood.

METHODS:

This study was embedded in a population-based, prospective, cohort study from early fetal life onward. Fetal growth characteristics (femur length, abdominal circumference, estimated fetal weight, head circumference, biparietal diameter, and transverse cerebellar diameter [TCD]) were measured with ultrasonography in the second and third trimesters of pregnancy. Information on the occurrence of febrile seizures was collected with questionnaires at the ages of 12 and 24 months. Analyses were based on data for 3372 subjects.

RESULTS:

In the second trimester, children in the lowest tertile of TCDs were at increased risk of developing febrile seizures, compared with children in the highest tertile (odds ratio 2.87 [95% confidence interval: 1.31–6.28]). In the third trimester, children in the lowest tertile of all general growth characteristics (femur length, abdominal circumference, and estimated fetal weight) were at increased risk of developing febrile seizures. This association was strongest for children in the lowest tertile of estimated fetal weight (odds ratio: 2.57 [95% confidence interval: 1.34–4.96]). Children in the lowest tertile of biparietal diameter in the third trimester also were at increased risk of febrile seizures. Similar but not statistically significant tendencies were observed for head circumference and TCD.

CONCLUSIONS:

Fetal growth retardation is associated with increased risk of febrile seizures in the first 2 years of life. Adverse environmental and genetic factors during pregnancy may be important in the development of febrile seizures.
Concepciones culturales del VIH/Sida de adolescentes de Bolivia, Chile y México
Authors: Torres López Teresa Margarita , Reynaldos Quinteros Carolina , Lozano González Aldo Favio , Munguía Cortés Jazmín Aranzazú
Published: September 2010

OBJETIVO: Comprender las dimensiones culturales del VIH/Sida de estudiantes adolescentes. MÉTODOS: Estudio antropológico cognitivo. Realizado en Cochabamba (Bolivia), Talca (Chile) y Guadalajara (México) entre 2007 y 2008. Un total de 184 jóvenes (de 14 y 19 años de edad) fueron seleccionados por muestreo propositivo en centros de estudios de educación media superior de cada país. Fueron utilizadas las técnicas de listados libres y el sorteo de montones. Se indagaron términos asociados al concepto VIH/Sida y grupos de dimensiones conceptuales. Posteriormente se aplicó análisis de consenso mediante factorización de componentes principales y análisis dimensional mediante conglomerados jerárquicos y escalas multidimensionales. RESULTADOS: Las diferencias entre los contextos fueron en el grado de consenso en relación al término de VIH/Sida, ya que fue mayor en Cochabamba. En Talca y Guadalajara los jóvenes mencionaron metáforas de lucha frente a la enfermedad, mientras en Cochabamba se refirieron a la ayuda, apoyo y amor que las personas infectadas deberían recibir. Las coincidencias entre las conceptualizaciones de los jóvenes de los tres países fueron: los riesgos (las prácticas sexuales desprotegidas y el contacto con algunos grupos poblacionales específicos), las consecuencias (muerte física y social, entendida ésta última como el rechazo de la sociedad hacia los enfermos) y la prevención de la enfermedad (con base en la información así como uso del condón). CONCLUSIONES: Para los estudiantes adolescentes el VIH/Sida es una enfermedad causada por prácticas sexuales y consumo de drogas que implica daño, dolor y muerte. Los programas preventivos del VIH/Sida para los adolescentes deben promover la búsqueda de información sobre el tema con bases científicas, y no centrarse en las consecuencias emocionales y sociales de la enfermedad.
Validação da versão brasileira do Youth Risk Behavior Survey 2007
Authors: Guedes Dartagnan Pinto , Lopes Cynthia Correa
Published: September 2010

OBJETIVO: Validar as propriedades psicométricas da versão brasileira do questionário Youth Risk Behavior Survey (YRBS), versão 2007. MÉTODOS: Foram realizadas tradução para o português da versão original do YRBS2007 e retrotradução para o inglês. As versões do questionário foram analisadas por comitê de juízes. O comitê utilizou como critério de análise as equivalências semântica, idiomática, cultural e conceitual. Para identificação das propriedades psicométricas, a versão final do questionário YRBS2007 traduzida foi administrada em duas ocasiões com intervalo de duas semanas em amostra de 873 estudantes de ambos os sexos, do ensino médio, em Londrina, PR, em 2007. A confiabilidade teste-reteste foi analisada pelo cálculo do índice de concordância Kappa e da taxa de prevalência de cada comportamento de risco nas réplicas de aplicação. Teste de qui-quadrado foi empregado para identificar diferenças estatísticas entre a primeira e a segunda aplicações do questionário. RESULTADOS: Após discretas modificações apontadas nos processos de tradução, o comitê de juízes considerou que a versão para o idioma português do YRBS2007 apresentou equivalências semântica, idiomática, cultural e conceitual. Diferenças significativas entre as taxas de prevalências de ambas as aplicações foram observadas em 23,4% dos itens. A identificação de 91% dos itens com índice de concordância Kappa entre moderado a substancial e valor médio desse índice de 68,6% indicou a qualidade das propriedades psicométricas do YRBS2007 traduzido para o idioma português. CONCLUSÕES: A tradução, a adaptação transcultural e as qualidades psicométricas do questionário YRBS2007 foram satisfatórias, o que viabiliza sua aplicação em estudos epidemiológicos no Brasil.
Association of dental enamel lead levels with risk factors for environmental exposure
Authors: Olympio Kelly Polido Kaneshiro , Naozuka Juliana , Oliveira Pedro Vitoriano , Cardoso Maria Regina Alves , Bechara Etelvino José Henriques , Günther Wanda Maria Risso
Published: September 2010

OBJECTIVE: To analyze household risk factors associated with high lead levels in surface dental enamel. METHODS: A cross-sectional study was conducted with 160 Brazilian adolescents aged 14-18 years living in poor neighborhoods in the city of Bauru, southeastern Brazil, from August to December 2008. Body lead concentrations were assessed in surface dental enamel acid-etch microbiopsies. Dental enamel lead levels were measured by graphite furnace atomic absorption spectrometry and phosphorus levels were measured by inductively coupled plasma optical emission spectrometry. The parents answered a questionnaire about their children's potential early (05 years old) exposure to well-known lead sources. Logistic regression was used to identify associations between dental enamel lead levels and each environmental risk factor studied. Social and familial covariables were included in the models. RESULTS: The results suggest that the adolescents studied were exposed to lead sources during their first years of life. Risk factors associated with high dental enamel lead levels were living in or close to a contaminated area (OR = 4.49; 95% CI: 1.69;11.97); and member of the household worked in the manufacturing of paints, paint pigments, ceramics or batteries (OR = 3.43; 95% CI: 1.31;9.00). Home-based use of lead-glazed ceramics, low-quality pirated toys, anticorrosive paint on gates and/or sale of used car batteries (OR = 1.31; 95% CI: 0.56;3.03) and smoking (OR = 1.66; 95% CI: 0.52;5.28) were not found to be associated with high dental enamel lead levels. CONCLUSIONS: Surface dental enamel can be used as a marker of past environmental exposure to lead and lead concentrations detected are associated to well-known sources of lead contamination.
Impacto do incentivo ao aleitamento materno entre mulheres trabalhadoras formais
Authors: Brasileiro Aline Alves , Possobon Rosana de Fátima , Carrascoza Karina Camilo , Ambrosano Gláucia Maria Bovi , Moraes Antônio Bento Alves de
Published: September 2010

Investigar se programas de incentivo ao aleitamento materno ajudam a prevenir o desmame precoce entre filhos de mães trabalhadoras. Foi realizado um estudo de intervenção não randomizado, por meio de inquérito entre mães que voltaram a trabalhar após o parto, participantes e não-participantes de um programa de incentivo ao aleitamento. A amostra consistiu de 200 mães de filhos com idades entre 6 e 10 meses. Para avaliar fatores associados ao desmame precoce, os resultados foram analisados por meio dos testes estatísticos de qui-quadrado, exato de Fisher e análise de regressão logística múltipla (α = 0,05). Os resultados mostraram que houve diferença estatística nas taxas de aleitamento materno exclusivo (p < 0,0001) e de aleitamento materno (p < 0,0001) entre os grupos. Apresentou diferença estatística (p = 0,0056) em relação à época de retorno ao trabalho entre os grupos. Não houve diferença entre o fim da licença-maternidade e a época de desmame. As mães que não conseguem amamentar seus filhos durante a jornada de trabalho têm 4,98 (IC95%: 1,27-19,61) vezes mais chances de desmamá-los antes do quarto mês.
Gestão do trabalho, da educação, da informação e comunicação na atenção básica à saúde de municípios das regiões Sul e Nordeste do Brasil
Authors: Silveira Denise Silva da , Facchini Luiz Augusto , Siqueira Fernando Vinholes , Piccini Roberto Xavier , Tomasi Elaine , Thumé Elaine , Silva Suele Manjourany , Dilélio Alitéia Santiago , Maia Maria de Fátima dos Santos
Published: September 2010

A descentralização das ações no Sistema Único de Saúde requer competências específicas para a gestão municipal. As demandas incluem o gerenciamento de equipes de trabalho, estrutura física e tecnológica, e organização de insumos e estratégias. Por meio de inquérito epidemiológico estudou-se a gestão do trabalho, da educação, da informação e da comunicação na atenção básica à saúde de 41 municípios com mais de 100 mil habitantes das regiões Sul e Nordeste do Brasil. Evidenciou-se uma escassa profissionalização dos gestores e limitações importantes das estruturas e instrumentos de gestão. A precarização do trabalho é um problema relevante na atenção básica. A supervisão do trabalho está pouco direcionada ao planejamento e às práticas de saúde. A educação permanente de trabalhadores se limita a particularidades das ações de saúde. Geralmente, a informação em saúde no âmbito municipal se restringe à coleta e transferência de dados às esferas estadual e federal. Já a comunicação não se constitui em uma estratégia efetiva de vinculação entre gestores, trabalhadores, população e controle social.
Prevalência de excesso de peso e obesidade abdominal, segundo parâmetros antropométricos, e associação com maturação sexual em adolescentes escolares
Authors: Pinto Isabel Carolina da Silva , Arruda Ilma Kruze Grande de , Diniz Alcides da Silva , Cavalcanti Ana Márcia Tenório de Souza
Published: September 2010

Este estudo objetivou estimar a prevalência de excesso de peso e obesidade abdominal em escolares segundo antropometria e maturação sexual. Foi um estudo transversal, incluindo 1.405 escolares de 10-14 anos, de ambos os sexos, residentes no Recife, Pernambuco, Brasil, em 2007. Foi avaliado o índice de massa corporal (IMC), a circunferência da cintura (CC) e razão da cintura-estatura (RCEst). A maturação sexual foi auto-avaliada, definindo-se como precoce quando o escolar apresentava idade cronológica inferior à mediana de idade para o referido estágio. A prevalência de excesso de peso foi de 20,4% (IC95%: 18,3-22,6) e a de obesidade abdominal foi de 14,9% (IC95%: 13,1-16,9) para CC e 12,6% (IC95%: 10,9-14,4) para RCE. O IMC, a CC e a RCEst apresentaram uma forte correlação positiva (rho ≅ 0,8; p < 0,001). A prevalência de excesso de peso e de obesidade abdominal foi maior (p < 0,05) nos estágios finais de maturação sexual em ambos os sexos. A alta prevalência de excesso de peso requer medidas urgentes de prevenção e controle desse distúrbio, sendo recomendada a inclusão da maturação sexual na avaliação do estado nutricional.
Prevalência de fraturas vertebrais e fatores de risco em mulheres com mais de 60 anos de idade na cidade de Chapecó, Santa Catarina, Brasil
Authors: Oliveira Patricia Pereira de , Marinheiro Lizanka Paola Figueiredo , Wender Maria Celeste Osório , Roisenberg Felipe , Lacativa Paulo Gustavo Sampaio
Published: September 2010

Fraturas são o principal agravo relacionado à fragilidade óssea na pós-menopausa, representando aumento de risco de novas fraturas, mortalidade e custos. Nosso objetivo foi verificar a ocorrência de fratura vertebral por fragilidade e relacioná-la com fatores demográficos, comportamentais e clínicos em uma população brasileira. Foi feito um estudo transversal com seleção por amostragem aleatória estratificada de mulheres idosas residentes em Chapecó, Santa Catarina, Brasil. A amostra foi constituída por 186 mulheres brancas com idade acima de 60 anos. Destas, 48,9% tinham fraturas vertebrais assintomáticas, com maiores prevalências em T11-12 e L4-5. Na análise ajustada, observa-se que existe gradiente entre idade e fratura vertebral, chegando a ser 2,3 vezes maior a prevalência de fraturas entre as mulheres com idade superior a 80 anos. As sedentárias apresentaram prevalência de fratura 1,44 vez maior do que as não sedentárias. Devido à alta prevalência de fraturas vertebrais encontrada, sugerimos a realização de radiografia de coluna para mulheres idosas para rastreamento e prevenção de agravos.
Adesão ao pré-natal de mulheres HIV+ que não fizeram profilaxia da transmissão vertical: um estudo sócio-comportamental e de acesso ao sistema de saúde
Authors: Darmont Mariana de Queiroz Rocha , Martins Helena Santos , Calvet Guilherme Amaral , Deslandes Suely Ferreira , Menezes Jacqueline Anita de
Published: September 2010

Objetivamos compreender os fatores sócio-comportamentais e do Sistema Único de Saúde (SUS) que, na visão de mulheres identificadas como HIV+ por teste rápido no parto, dificultaram ou impediram a adesão ao pré-natal. Foram incluídas 40 mulheres, das quais apenas oito tinham tido seis consultas ou mais. Foi utilizada a abordagem qualitativa, com entrevistas semi-estruturadas. Os dados foram analisados seguindo os preceitos da análise temática. Os resultados foram agrupados em dois blocos: os que dificultaram a adesão ao pré-natal: não aceitação da gestação, falta de apoio familiar, conhecimento prévio da soropositividade, contexto social adverso, experiências negativas de atendimento e práticas e concepções de descrédito em relação ao pré-natal, e os que favoreceram a adesão: apoio familiar, discurso de valorização do cuidado com a saúde, desejo de laqueadura tubária, acolhimento pela equipe de saúde e experiências positivas de assistência. Uma compreensão melhor do contexto sociocultural deveria permitir a construção de estratégias capazes de resgatar essas mulheres para um sistema de saúde mais acolhedor.