bluuebunny/crossref_metadata_2025 huggingface dataset:
A randomized controlled trial of strapping to prevent post-stroke shoulder pain
Authors: Hanger H C , Whitewood P , Brown G , Ball M C , Harper J , Cox R , Sainsbury R
Published: August 2005

Objective: To determine whether strapping the shoulder in hemiplegic stroke patients: (1) prevents the development, or reduces the severity, of shoulder pain, (2) preserves range of movement in the shoulder, and (3) improves the functional outcomes for the arm and patient overall.

Design: A prospective, randomized, single-blind controlled trial of shoulder strapping versus no strapping.

Setting: Care of the elderly wards in a teaching hospital, Christchurch, New Zealand.

Subjects: All patients admitted with an acute hemiplegic stroke, who had persisting weakness of shoulder abduction.

Intervention: The treatment group had their affected shoulder strapped for six weeks from randomization in addition to standard physiotherapy.

Main outcome measures: All subjects were assessed at entry (week 0), at end of the treatment phase (week 6) and two months later (week 14). A visual analogue scale (VAS) was used to assess shoulder pain severity whereas shoulder range of movement to the point of pain (SROMP) assessed passive range of movement and pain. Functional Independence Measure (FIM), Motor Assessment Scale (MAS) and Rankin Disability Index measured functional outcomes.

Results: Ninety-eight subjects participated (49 strapped, 49 controls). Intention to treat analysis showed no significant difference in pain, range of movement or functional outcomes after the intervention phase or at the final assessment. However there were trends for less pain at six weeks (VAS, p = 0.11) and better final upper limb function (MAS, p = 0.16) in strapped patients. Skin reactions were uncommon (6.1%). The presence of neglect or sensory loss, but not subluxation, at baseline was independently associated with poor outcome. Range of movement was lost early (mean difference SROMP between hemiplegic and contralateral shoulders at baseline = 15.2° (95% CI 10.9–19.5)) and continued throughout the study. Shoulder strapping did not alter the rate at which range of movement was lost.

Conclusions: No significant benefit with shoulder strapping was demonstrated and reasons for this are discussed. Range of movement in the hemiplegic shoulder is lost very early and any preventive treatments need to begin within the first 1–2 days after a stroke.
What is balance?
Authors: Pollock Alexandra S , Durward Brian R , Rowe Philip J , Paul John P
Published: August 2005

Balance is a term frequently used by health professionals working in a wide variety of clinical specialities. There is no universally accepted definition of human balance, or related terms. This article identifies mechanical definitions of balance and introduces clinical definitions of balance and postural control. Postural control is defined as the act of maintaining, achieving or restoring a state of balance during any posture or activity. Postural control strategies may be either predictive or reactive, and may involve either a fixed-support or a change-in-support response. Clinical tests of balance assess different components of balance ability. Health professionals should select clinical assessments based on a sound knowledge and understanding of the classification of balance and postural control strategies.
Computer recording of standard tests of visual neglect in stroke patients
Authors: Potter Jonathan , Deighton Tony , Patel Mehool , Fairhurst Michael , Guest Richard , Donnelly Nick
Published: August 2005

Objective: To determine whether a computer-based method for recording standardized assessment of neglect identifies abnormalities in the ‘process’ as well as in the ‘outcome’ of such tasks.

Design: Prospective sequential assessment of patients admitted to a stroke rehabilitation unit.

Subjects: All consecutive patients with right-sided cerebrovascular accident confirmed on computerized tomography (CT) scan including 30 patients with neglect, 57 patients without neglect. An age-matched control group of 13 subjects.

Intervention: All patients were tested using the standard Rivermead Behavioural Inattention Test (BIT) and by computer recording of two standard tests for assessing neglect (line bisection and Albert's test). Age-matched controls were tested using computer recording of the two standard tests.

Main outcome measures: Neglect was defined using the BIT with a cut-off score of 129. Computer recording measured the ‘outcome’ of tasks, i.e. the deviation from midline and omissions in cancellation, as well as the ‘process’ of tasks, i.e. time between cancellations, components of cancellation time including premovement, movement and drawing time, and the starting point for cancellation.

Results: The computer recording identified significant differences in ‘outcome’ and ‘process’ which distinguished neglect from non-neglect patients. There were significant differences between non-neglect patients and age-matched controls with regard to ‘process’ measures but not with regard to ‘outcome’ measures.

Conclusions: Computer recording of standard tests for assessing neglect identifies novel impairments with regard to the process of carrying out tasks. These impairments may be used to investigate changes in neglect with time, the response of neglect to treatment and to explore further the neuropsychological changes associated with neglect in stroke patients.
The Relationship between Parity and Bone Mineral Density in Women Characterized by a Homogeneous Lifestyle and High Parity
Authors: Streeten Elizabeth A. , Ryan Kathleen A. , McBride Daniel J. , Pollin Toni I. , Shuldiner Alan R. , Mitchell Braxton D.
Published: August 2005

Context: We reported previously that Old Order Amish (OOA) women have fewer hip fractures and higher bone mineral density (BMD) than non-Amish Caucasian women.

Objective: The objective of this study was to determine whether the high parity characteristic of OOA women contributes to their relative bone health. Previous data on the long-term effects of parity on BMD have yielded conflicting results with few data from very high parity populations. This observational study included participants in the Amish Family Osteoporosis Study, begun in 1997 to identify genetic and clinical determinants of osteoporosis in the OOA. We measured BMD by dual-energy x-ray absorptiometry at the spine, hip, and distal radius in 424 parous OOA women aged 40 and older (mean age, 57.7 ± 12 yr; mean parity, 7.6 ± 2.9).

Results: Increasing parity was associated with later menopause (P = 0.001) and modestly, but not significantly, higher body mass index (BMI) (P = 0.09). Increasing parity was associated with higher BMD at the total hip and trochanter (age-adjusted P = 0.02 and 0.03), no longer statistically significant after accounting for BMI. Among women aged 50–59 yr, parity was strongly associated with BMD even after accounting for age and BMI (age-adjusted P = 0.02), although this was not true for women younger than 50 or at least 60 yr old.

Conclusions: We conclude that high parity is associated with increased hip BMD in OOA women, largely mediated by higher BMI. The parity-hip BMD association remained statistically significant after accounting for age and BMI only in women aged 50–59 yr, partially explained by a later menopausal age with high parity. The benefit of high parity on BMD appeared to be lost soon after the menopausal transition, and, therefore, these data provide evidence of neither a detrimental nor beneficial effect of high parity on long-term bone health.
Mutation at Cleavage Site of Insulin-Like Growth Factor Receptor in a Short-Stature Child Born with Intrauterine Growth Retardation
Authors: Kawashima Yuki , Kanzaki Susumu , Yang Fan , Kinoshita Tomoe , Hanaki Keiichi , Nagaishi Jun-ichi , Ohtsuka Yoshihiko , Hisatome Ichirou , Ninomoya Haruaki , Nanba Eiji , Fukushima Toshiaki , Takahashi Shin-Ichiro
Published: August 2005

Context: Mouse knockout models have clearly demonstrated the critical importance of IGF-I and IGF receptor type 1 (IGF-IR) for embryonic growth as well as postnatal growth.

Objective: We hypothesized that mutations of IGF-IR gene might predispose to short stature in children born with intrauterine growth retardation (IUGR).

Patients: Twenty-four children with unexplained IUGR (birth weight < −1.5 sd) and short stature (<−2.0 sd) were screened for abnormalities of the IGF-IR gene.

Methods: Direct DNA sequencing was used to identify IGF-IR gene mutations. Unprocessed IGF-IR proreceptor in fibroblasts was detected by immunoblot analysis. Functions of mutated IGF-IR in fibroblasts were evaluated by IGF-I binding, and IGF-I-stimulated DNA synthesis and β-subunit autophosphorylation.

Results: We found the following results: 1) a heterozygous mutation (R709Q) changing the cleavage site from Arg-Lys-Arg-Arg to Arg-Lys-Gln-Arg was identified in a 6-yr-old Japanese girl (case 1) and her mother who also had IUGR with short stature (case 2); 2) fibroblasts from case 2 contained more IGF-IR proreceptor protein (189 ± 26% of normal) and less mature β-subunit protein (63 ± 12%); 3) [125I]IGF-I binding to fibroblasts from case 2 was reduced, compared with normal control (0.61 ± 0.16 × 106vs. 1.14 ± 0.12 × 106 sites per cell; P < 0.05); and 4) both IGF-I-stimulated [3H]thymidine incorporation and IGF-IR β-subunit autophosphorylation were low in fibroblasts from case 2, compared with those of control (P < 0.05).

Conclusions: These findings strongly suggest that this mutation leads to failure of processing of the IGF-IR proreceptor to mature IGF-IR and causes short stature and IUGR.
l-Folic Acid Supplementation in Healthy Postmenopausal Women: Effect on Homocysteine and Glycolipid Metabolism
Authors: Villa Paola , Perri Concetta , Suriano Rosanna , Cucinelli Francesco , Panunzi Simona , Ranieri Micaela , Mele Cristina , Lanzone Antonio
Published: August 2005

Context: Hyperhomocysteinemia as well as alterations of glycemic and lipidic metabolism are recognized as risk factors for cardiovascular diseases.

Objective: The aim of this study was to examine the effect of l-folic acid supplementation on homocysteine (Hcy) and related thiols, such as cysteine (Cys) and Cys-glycine (Cys-Glyc) pathways and their relationship to glucose, insulin, and lipidic metabolism in normoinsulinemic postmenopausal women.

Design: This study was a randomized placebo, not double-blind, trial.

Setting: The study was performed in an academic research center.

Patients or Other Participants: Twenty healthy postmenopausal women were selected. No patient was taking drugs known to affect lipid or glucose metabolism.

Intervention(s): Patients underwent two hospitalizations before and after 8 wk of l-acid folic (7.5 mg/d) or placebo administration. The glycemic metabolism was studied by an oral glucose tolerance test and a hyperinsulinemic euglycemic clamp. Hcy metabolism was studied by a standardized oral methionine-loading test.

Main Outcome Measure(s): Hcy, Cys, and Cys-Glyc, basally and after a methionine loading test, were measured. Basal insulin, glucose, and peptide C levels as well as area under the curve for insulin, area under the curve for peptide, hepatic insulin extraction, and metabolic index were assayed. The total cholesterol, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol levels and the cholesterol/HDL and LDL/HDL ratios were also measured.

Results: The total basal Hcy concentration and the plasma postmethionine loading Hcy values were significantly decreased (P < 0.01) in l-folic acid-treated patients, whereas postmethionine loading Cys-Glyc levels were markedly increased (P < 0.02). Furthermore, l-folic acid intake induced a significant improvement in carbohydrate metabolism through an increase in fractional hepatic insulin extraction (P < 0.05) and peripheral insulin sensitivity (P < 0.02) in normoinsulinemic women. HDL levels considerably increased, inducing an improvement in other atherosclerotic indexes, such as cholesterol/HDL and LDL/HDL ratios (P < 0.03).

Conclusions: These results show that folic acid supplementation lowers plasma Hcy levels and improves insulin and lipid metabolism, reducing the risk of cardiovascular disease.
Soluble fms-Like Tyrosine Kinase 1 Is Increased in Preeclampsia But Not in Normotensive Pregnancies with Small-for-Gestational-Age Neonates: Relationship to Circulating Placental Growth Factor
Authors: Shibata Eiji , Rajakumar Augustine , Powers Robert W. , Larkin Robert W. , Gilmour Carol , Bodnar Lisa M. , Crombleholme William R. , Ness Roberta B. , Roberts James M. , Hubel Carl A.
Published: August 2005

Context: An excess of the soluble receptor, fms-like tyrosine kinase 1 (sFlt-1) may contribute to maternal vascular dysfunction in women with preeclampsia by binding and thereby reducing concentrations of free vascular endothelial growth factor and placental growth factor (PlGF) in the circulation. The putative stimulus for increased sFlt-1 during preeclampsia, placental hypoxia due to poor perfusion, is common to both preeclampsia and idiopathic intrauterine growth restriction. However, the latter condition occurs without maternal vascular disease.

Objective: We asked whether, as with preeclampsia, sFlt-1 is increased and free PlGF is decreased in villous placenta and maternal serum of normotensive women with small-for-gestational-age (SGA) neonates.

Study Design: This was a case-control study using banked samples. Groups of women with SGA neonates (birth weight centile < 10th) and women with preeclampsia were matched to separate sets of normal pregnancy controls based on gestational age at blood sampling (serum) or gestational age at delivery (placenta).

Results: sFlt-1 levels were higher in preeclamptics than controls (serum, P < 0.0001; placental protein, P = 0.03; placental mRNA, P = 0.007) but not increased in SGA pregnancies. PlGF was lower in both preeclampsia (serum, P < 0.0001; placental protein, P = 0.05) and SGA (serum, P = 0.0008; placental protein, P = 0.03) compared with their controls. PlGF in preeclampsia and SGA groups did not differ.

Conclusions: These data are consistent with a role for sFlt-1 in the maternal manifestations of preeclampsia. In contrast to preeclampsia, sFlt-1 does not appear to contribute substantially to decreased circulating free PlGF in SGA pregnancies in the absence of a maternal syndrome.
Mitogenic Effects of the Up-Regulation of Minichromosome Maintenance Proteins in Anaplastic Thyroid Carcinoma
Authors: Guida Teresa , Salvatore Giuliana , Faviana Pinuccia , Giannini Riccardo , Garcia-Rostan Ginesa , Provitera Livia , Basolo Fulvio , Fusco Alfredo , Carlomagno Francesca , Santoro Massimo
Published: August 2005

Context: Anaplastic thyroid carcinomas (ATC) are among the most aggressive human malignancies and are characterized by high mitotic activity. Minichromosome maintenance proteins (MCM) 2–7 are required to initiate eukaryotic DNA replication, and their overexpression has been associated with dysplasia and malignancy.

Objective: In an attempt to cast light on the mechanisms governing ATC, we evaluated MCM5 and MCM7 expression in human normal, papillary (PTC), and anaplastic thyroid samples, as well as in primary culture cells and transgenic mouse models.

Results: MCM5 and MCM7 expression was high in 65% of ATC and negligible in normal thyroid tissue and papillary thyroid carcinomas. In ATC, high MCM5 and MCM7 expression was paralleled by high levels of MCM2 and MCM6. An analysis of human ATC primary cell cultures and of a transgenic mouse model of ATC confirmed these findings. An increased transcription rate accounted for MCM7 up-regulation, because the activity of the MCM7 promoter was more than 10-fold higher in ATC cells compared with normal thyroid cells. Adoptive overexpression of wild-type p53, but not of its inactive (R248W and R273H) mutants, strongly down-regulated transcription from the MCM7 promoter, suggesting that p53 knock-out contributes to MCM7 up-regulation in ATC. Treatment with small inhibitory duplex RNAs, which decrease MCM7 protein levels, reduced the rate of DNA synthesis in ATC cells.

Conclusion: MCM proteins are overexpressed in ATC and sustain the high proliferative capacity of ATC cells.
Urocortin 1, Urocortin 3/Stresscopin, and Corticotropin-Releasing Factor Receptors in Human Adrenal and Its Disorders
Authors: Fukuda Tsuyoshi , Takahashi Kazuhiro , Suzuki Takashi , Saruta Masayuki , Watanabe Mika , Nakata Taisuke , Sasano Hironobu
Published: August 2005

Context: Urocortin 1 (Ucn1) and urocortin 3 (Ucn3)/stresscopin are new members of the corticotropin-releasing factor (CRF) neuropeptide family. Ucn1 binds to both CRF type 1 (CRF1) and type 2 receptors (CRF2), whereas Ucn3 is a specific agonist for CRF2. Recently, direct involvement of the locally synthesized CRF family in adrenocortical function has been proposed.

Objective, Design, and Setting: We examined in situ expression of Ucn and CRF receptors in nonpathological human adrenal gland and its disorders using immunohistochemistry and mRNA in situ hybridization.

Results: Ucn immunoreactivity was localized in the cortex and medulla of nonpathological adrenal glands. Ucn1 immunoreactivity was marked in the medulla, whereas Ucn3 was immunostained mostly in the cortex. Both CRF type 1 and CRF2 were expressed in the cortex, particularly in the zonae fasciculata and reticularis but very weakly or undetectably in the medulla. Immunohistochemistry in serial tissue sections with mirror images revealed that both Ucn3 and CRF2 were colocalized in more than 85% of the adrenocortical cells. mRNA in situ hybridization confirmed these findings above. In fetal adrenals, Ucn and CRF receptors were expressed in both fetal and definitive zones of the cortex. Ucn and CRF receptors were all expressed in the tumor cells of pheochromocytomas, adrenocortical adenomas, and carcinomas, but its positivity was less than that in nonpathological adrenal glands, suggesting that Ucn1, Ucn3, and CRF receptors were down-regulated in these adrenal neoplasms.

Conclusions: Ucn1, Ucn3, and CRF receptors are all expressed in human adrenal cortex and medulla and may play important roles in physiological adrenal functions.
Association of Cryptorchidism with a Specific Haplotype of the Estrogen Receptor α Gene: Implication for the Susceptibility to Estrogenic Environmental Endocrine Disruptors
Authors: Yoshida Rie , Fukami Maki , Sasagawa Isoji , Hasegawa Tomonobu , Kamatani Naoyuki , Ogata Tsutomu
Published: August 2005

Context: The prevalence of cryptorchidism (CO) has increased during the past few decades in several countries, and this event has primarily been ascribed to the estrogenic effects of environmental endocrine disruptors (EEDs). Little is known, however, about the role of genetic susceptibility to EEDs in this phenomenon.

Objective: The objective of this study was to determine whether CO is associated with a specific haplotype of the gene for estrogen receptor α (ESR1) that mediates the estrogenic effects of EEDs.

Design: This was a case-control study.

Setting: The study was performed at the National Research Institute and University Hospitals.

Subjects: Sixty-three cryptorchid males, aged 1–13 yr, and 47 control males, aged 4–12 yr, were studied.

Intervention: After genotyping 15 single nucleotide polymorphisms widely distributed in the greater than 300-kb genomic sequences of ESR1, haplotype analysis was performed.

Main Outcome Measure: Identification of a specific ESR1 haplotype associated with CO was the main outcome measure.

Results: A haplotype block was identified for an approximately 50-kb region encompassing single nucleotide polymorphisms 10–14 in the 3′ region of ESR1 in both groups. The frequency of the estimated AGATA haplotype within the block was higher in the patients than in the control males (34.0% vs. 21.3%; P = 0.037), and the association of this haplotype with CO phenotype was significant in a recessive mode (P = 0.0060). The homozygosity for this haplotype was identified only in the patients, and the frequency of the homozygotes was significantly different between the two groups (10 of 63 vs. zero of 47; P = 0.0042).

Conclusions: The association of CO with homozygosity for the specific ESR1 haplotype suggests the relevance of genetic susceptibility to EEDs in the development of CO.
Occupational Exposure to Ionizing Radiation Is Associated with Autoimmune Thyroid Disease
Authors: Völzke Henry , Werner André , Wallaschofski Henri , Friedrich Nele , Robinson Daniel M. , Kindler Stefan , Kraft Matthias , John Ulrich , Hoffmann Wolfgang
Published: August 2005

Context: The thyroid gland is a potential target organ for radiation-related damage.

Objective: The aim of the analysis was to investigate the association between occupational exposure to ionizing radiation and autoimmune thyroid disease (AITD).

Design: Our design was the cross-sectional Study of Health in Pomerania.

Setting: The setting was the general community.

Subjects: Analyses were performed in a population-based sample of 4299 subjects. Among them, 160 persons reported a history of occupational exposure to ionizing radiation.

Main Outcome Measure: AITD was defined as the combined presence of hypoechogenicity in thyroid ultrasound and antithyroxiperoxidase antibodies greater than 200 IU/ml.

Results: Females with occupational exposure to ionizing radiation had more often AITD than nonexposed females (10.0 vs. 3.4%; P < 0.05). This association persisted after adjustment for relevant confounders (odds ratio, 3.46; 95% confidence interval, 1.16–10.31; P < 0.05). In males, there were too few subjects who fulfilled the criteria of AITD, but the association between the exposure to radiation and hypoechogenicity of the thyroid gland barely missed statistical significance (odds ratio, 2.20; 95% confidence interval, 0.92–5.26; P = 0.08). In both females and males, subjects who reported a length of exposure of more than 5 yr exhibited the highest risk of the endpoints.

Conclusions: We conclude that occupational exposure to ionizing radiation is related to the risk of AITD. The usage of thyroid protection shields by radiation workers is strongly recommended.
Novel Mutations within the POU1F1 Gene Associated with Variable Combined Pituitary Hormone Deficiency
Authors: Turton James P. G. , Reynaud Rachel , Mehta Ameeta , Torpiano John , Saveanu Alexandru , Woods Kathryn S. , Tiulpakov Anatoly , Zdravkovic Vera , Hamilton Jill , Attard-Montalto Simon , Parascandalo Ray , Vella Cecil , Clayton Peter E. , Shalet Stephen , Barton John , Brue Thierry , Dattani Mehul T.
Published: August 2005

Context: Mutations within the gene encoding the pituitary-specific transcription factor POU1F1 are associated with combined pituitary hormone deficiency (CPHD). Most of the affected individuals manifest GH, prolactin, and TSH deficiency.

Objective: We have now screened 129 individuals with CPHD and isolated GH deficiency for mutations within POU1F1.

Results: Causative mutations were identified in 10 of 129 individuals (7.8%). Of these, five patients harbored the dominant negative R271W mutation, which is a well-recognized mutational hot spot. We have also identified a second frequently occurring mutation, E230K, which appears to be common in Maltese patients. Additionally, we describe two novel mutations within POU1F1, an insertion of a single base pair (ins778A) and a missense mutation (R172Q). Functional studies have revealed that POU1F1 (E230K) is associated with a reduction in transactivation, although DNA-binding affinity is similar to the wild-type protein. On the other hand, POU1F1 (R172Q) is associated with a reduction in DNA binding and transactivation, whereas POU1F1 (ins778A) is associated with loss of DNA binding and a reduction in transactivation.

Conclusions: Our data suggest that the phenotype associated with POU1F1 mutations may be more variable, with the occasional preservation of TSH secretion. Additionally, our data revealed POU1F1 mutations in three patients who were diagnosed as having ACTH deficiency but who, on further evaluation, were found to have normal cortisol secretion. Hence, elucidation of the genotype led to further evaluation of the phenotype, with the cessation of cortisol replacement that had been commenced unnecessarily. These data reflect the importance of mutational analysis in patients with CPHD.
Serial Single-photon Emission Computed Tomographic and Transcranial Doppler Measurements for Evaluation of Vasospasm after Aneurysmal Subarachnoid Hemorrhage
Authors: Egge Arild , Sjøholm Hans , Waterloo Knut , Solberg Tore , Ingebrigtsen Tor , Romner Bertil
Published: August 2005

OBJECTIVE:

To assess the clinical value of serial single photon-emission computed tomographic (SPECT) measurements after aneurysmal subarachnoid hemorrhage (SAH).

METHODS:

Thirty-two patients were studied prospectively during the first 26 days after SAH with repeated SPECT measurements, clinical examinations, and transcranial Doppler recordings. Time trends were analyzed with a general linear model. A final SPECT measurement was performed after 1 year.

RESULTS:

A mean of 2.6 (range, 1–5) SPECT measurements revealed a significant (P = 0.001) quadratic curve consistent with initial hypoperfusion and then with hyperperfusion during the acute stage. SPECT findings were significantly associated with transcranial Doppler recordings (P = 0.016) and clinical assessments (P = 0.008). Patients fulfilling clinical and transcranial Doppler criteria for vasospasm demonstrated a more pronounced relative hypoperfusion-hyperperfusion time course. A multivariate logistic regression analysis identified SPECT measurements obtained during Days 7 to 14 after the SAH as the only independent predictor (β = 0.042, P = 0.02) for impaired perfusion after 1 year.

CONCLUSION:

Serial SPECT measurements after aneurysmal SAH demonstrate that regional changes in cerebral perfusion follow a nonlinear time trend, and repeated measurements are necessary. This observation, as well as the low feasibility of SPECT, restricts the clinical value of such measurements.
Stereotactic Radiosurgery for Vestibular Schwannomas: Analysis of 317 Patients Followed More Than 5 Years
Authors: Hasegawa Toshinori , Fujitani Shigeru , Katsumata Shun , Kida Yoshihisa , Yoshimoto Masayuki , Koike Joji
Published: August 2005

OBJECTIVE:

Many investigators have reported successful treatment of vestibular schwannomas with gamma knife radiosurgery (GKRS). However, long-term outcomes should be evaluated before concluding that GKRS is truly safe and effective for the treatment of vestibular schwannomas.

METHODS:

Between May 1991 and December 1998, 346 consecutive patients (excluding those presenting with neurofibromatosis Type 2) were treated with GKRS. Of these, 317 patients were assessed. Twenty-nine patients were lost to follow-up within 5 years.

RESULTS:

The median follow-up period was 7.8 years. Of 301 patients who underwent serial follow-up imaging, two (1%) experienced complete remission, 184 (61%) experienced partial remission, 93 (31%) had stable tumors, and 22 (7%) experienced treatment failure. The actuarial 5- or 10-year progression-free survival (PFS) rate was 93 and 92%, respectively. Tumors less than 15 cm3 in volume (10-yr PFS, 96%; P < 0.001) or which did not compress the brainstem and deviate the fourth ventricle (10-yr PFS, 97%; P = 0.008) resulted in significantly better PFS rates. Failure of treatment usually occurred within 3 years. When the tumor was treated with a marginal dose of 13 Gy or less, the hearing preservation rate was 68%, transient facial palsy developed at a rate of 1%, and facial numbness developed at a rate of 2%.

CONCLUSION:

GKRS proved to be a safe and effective treatment for patients followed longer than 5 years who presented with tumors with a volume of less than 15 cm3 and who did not have significant fourth ventricle deviation. Good functional outcomes were observed in this group of patients.
Cushing's Disease in Children and Adolescents: 20 Years of Experience in a Single Neurosurgical Center
Authors: Joshi Shabin M. , Hewitt Richard Jonathan David , Storr Helen L. , Rezajooi Kia , Ellamushi Habib , Grossman Ashley B. , Savage Martin O. , Afshar Fary
Published: August 2005

OBJECTIVE:

This is a retrospective analysis of 25 consecutive pediatric patients with Cushing's disease who underwent transsphenoidal surgery performed by a single neurosurgeon in a specialist center during a 20-year period. This article discusses the presentation of Cushing's disease, the endocrinological investigation with particular reference to bilateral inferior petrosal sinus sampling (BIPSS), the operative management with reference to specific pediatric difficulties of the transsphenoidal approach and the use of intraoperative image guidance, and the analysis of these cases as regards postoperative complications and outcomes of this rare condition in young patients.

METHODS:

All patients underwent detailed endocrine investigation and imaging in the form of computed tomography and/or magnetic resonance imaging. BIPSS was performed in 19 patients (76%), with successful lateralization of the side of the microadenoma in 14 (74%) and prediction of a central tumor in four (94% total prediction rate). Surgical removal was via the sublabial, paraseptal, transsphenoidal route.

RESULTS:

There were 15 male and 10 female patients, with a mean age of 13.4 years (range, 6.6–17.8 yr). Weight gain was the most common presentation (100%), and then growth impairment (96%), fatigue and skin changes (64%), and hypertension (32%). Postoperative complications included growth hormone deficiency (36%), transient diabetes insipidus (12%), panhypopituitarism (4%), and transient cerebrospinal fluid rhinorrhea (4%). The median follow-up period was 59.5 months (range, 6–126 mo). Overall, 15 patients (60%) achieved surgical cure or remission, of which 14 outcomes were obtained using the results of BIPSS. Ten patients (40%) required postoperative radiotherapy to achieve “remission.” There were no cases of meningitis, no neurological deficits, no reoperations, and no mortality.

CONCLUSION:

Cushing's disease in children and adolescents is a rare illness. The accurate preoperative localization of the adenoma is essential for achieving good results. In this series, BIPSS was far more accurate in localizing the adenoma than computed tomography or magnetic resonance imaging. Imaging, however, is useful for the exclusion of other intracranial problems. Transsphenoidal surgery was safe and efficacious in achieving cure in the majority of cases. The challenge of transsphenoidal surgery in this age group is the small pituitary fossa and the absence of sphenoid sinus aeration in some cases. We found the use of intraoperative neuronavigation to be an excellent aid in overcoming such anatomic difficulties.
Herniation Secondary to Critical Postcraniotomy Cerebrospinal Fluid Hypovolemia
Authors: Komotar Ricardo J. , Mocco J , Ransom Evan R. , Mack William J. , Zacharia Brad E. , Wilson David A. , Naidech Andrew M. , McKhann Guy M. , Mayer Stephan A. , Fitzsimmons Brian-Fred M. , Connolly E Sander
Published: August 2005

OBJECTIVE:

Cerebrospinal fluid hypovolemia resulting in postural headaches is a well-known clinical entity, but severe forms of cerebrospinal fluid hypovolemia with altered mental status and signs of transtentorial herniation (“brain sag”) have rarely been reported. This article describes the clinical features of brain sag after craniotomy in an attempt to increase recognition of this syndrome.

METHODS:

Between April 2001 and January 2003, 220 consecutive patients with subarachnoid hemorrhage were prospectively enrolled in the Columbia Subarachnoid Hemorrhage Outcomes Project; 137 underwent craniotomy for aneurysm clipping. Among these patients, the diagnosis of brain sag was made when all three of the following criteria were present: clinical signs of transtentorial herniation, head computed tomographic scans revealing effacement of the basal cisterns with an oblong brainstem, and improvement of symptoms after placement of the patient in the Trendelenburg position (–15 to –30 degrees). For each patient, the symptoms, clinical course, and subsequent response to treatment were characterized. In addition, brainstem dimensions were measured on computed tomographic scans taken before, during, and after resolution of brain sag. A “sag ratio” was generated for these time points by dividing the maximum anteroposterior distance by the maximum bipeduncular distance.

RESULTS:

Eleven (8.0%) of 137 aneurysmal subarachnoid hemorrhage patients treated by craniotomy and an intraoperative spinal drain met the criteria for brain sag. Signs of transtentorial herniation developed most commonly between 2 and 4 days postoperatively. Pupillary asymmetry was noted in 10 (91.0%) of 11 patients, whereas the other patient demonstrated extensor posturing. The Trendelenburg position reversed the symptoms in all patients. The mean sag ratios before, during, and after resolution of brain sag were 0.91 ± 0.03 (mean ± standard error), 1.18 ± 0.03, and 0.91 ± 0.03, respectively. This represented a 30.9% elongation of the brainstem during sag (P < 0.001) and a 23.6% change back to baseline after resolution of the syndrome (P < 0.002). There was no significant difference between the presag and postsag ratios.

CONCLUSION:

Severe cerebrospinal fluid hypovolemia after craniotomy may produce a dramatic herniation syndrome that is completely reversed by the Trendelenburg position. Brain sag should be included in the differential diagnosis for acute postoperative clinical deterioration in this patient population.
Cervical Spondylotic Myelopathy, Depression, and Anxiety: A Cohort Analysis of 89 Patients
Authors: Stoffman Michael R. , Roberts Mark S. , King Joseph T.
Published: August 2005

OBJECTIVE:

To determine the prevalence of depressed and anxious mood states in patients with cervical spondylotic myelopathy (CSM), a degenerative spine condition with symptoms of neck pain, numb clumsy hands, gait difficulties, sphincter dysfunction, and impotence. To examine the relation between mood and functional deficits produced by CSM.

METHODS:

We surveyed a cohort of 89 patients with CSM recruited during 1 year from a neurosurgery clinic. Patients underwent a structured interview to collect information on demographics, personal habits, CSM symptoms, comorbid diseases, and symptoms of depression and anxiety. Patients self-completed the Hospital Anxiety and Depression scale and were scored on the Nurick, Cooper, Harsh, and modified Japanese Orthopaedic Association (mJOA) scales.

RESULTS:

According to the Hospital Anxiety and Depression scale threshold value of 11, 29% of the cohort had a depressed mood and 38% had an anxious mood. Higher depression scores were associated with worse myelopathy, as measured by the Nurick scale (P = 0.01), the Cooper leg subscale (P = 0.006), the Harsh scale (P = 0.02), the mJOA arm subscale (P = 0.006), and the mJOA leg subscale (P = 0.004). There was no relation between depression scores and the Cooper arm subscale, Harsh sphincter scale, mJOA sensory subscale, or mJOA bladder subscale. Similar patterns were seen in the relations between myelopathy and anxiety.

CONCLUSION:

More than one-third of patients with CSM have a depressed or anxious mood. In patients with CSM, depression and anxiety scores are strongly associated with decreased mobility, inconsistently associated with arm dysfunction, and not associated with sensory deficits or sphincter dysfunction, suggesting that ambulatory dysfunction may cause or exacerbate the symptoms of depression and anxiety in patients with CSM.
The Anteroinferior Cerebellar Artery Embedded in the Subarcuate Fossa: A Rare Anomaly and Its Clinical Significance
Authors: Tanriover Necmettin , Rhoton Albert L.
Published: August 2005

OBJECTIVE:

The purpose of this study is to call attention to an anomaly in which a segment of the anteroinferior cerebellar artery (AICA) is embedded in the dura or bone surrounding the subarcuate fossa, a small depression in the bone posterior to the internal acoustic meatus (IAM), through which the subarcuate artery enters the bone. This anomaly places the artery at risk in removing the posterior wall of the IAM.

METHODS:

An anomalous AICA having a segment that was embedded in the dura covering on the bone surrounding the subarcuate fossa was found during a microsurgical dissection course. The senior author (ALR) has observed this anomaly in four patients during surgery for acoustic neuromas and in three specimens in microsurgery dissection courses. To define the microsurgical anatomy of the anomalous artery further, the latex-injected specimen was dissected in a stepwise manner using ×3 to ×40 magnification.

RESULTS:

The anomalous AICA described in this report bifurcated into a rostral trunk and a caudal trunk near the facial-vestibulocochlear nerve complex. The caudal trunk formed a sharp lateral loop that was embedded in the dura covering the subarcuate fossa. The involved trunk continued to supply the suboccipital area normally supplied by the posteroinferior cerebellar artery, which was hypoplastic. The dura surrounding the anomalous loop was opened, and the adjacent bone was removed to free the anomalous loop from the subarcuate fossa so that the artery could be displaced medially to remove the posterior wall of the IAM. Although it has been reported that the AICA may occasionally be adherent to the dura over the subarcuate fossa, this study is the first to demonstrate an AICA that is embedded in the dura and bone of the subarcuate fossa.

CONCLUSION:

Mobilizing the AICA loop that is embedded in the subarcuate fossa posterior to the IAM places the involved AICA at significant risk in exposing the contents of the IAM.
Myxopapillary Ependymoma and Fatty Filum in an Adult with Tethered Cord Syndrome: A Shared Embryological Lesion? Case Report
Authors: Adamson D Cory , Cummings Thomas J. , Friedman Allan H.
Published: August 2005

OBJECTIVE AND IMPORTANCE:

Myxopapillary ependymoma and fatty fila are traditionally thought to arise via completely different pathophysiologies. Recognition of these distinct pathologies in the same patient is important for appropriate treatment and prognosis.

CLINICAL PRESENTATION:

A 28-year-old woman presented with low back pain, bilateral leg radiculopathies, and mild leg weakness suggestive of tethered cord syndrome. Magnetic resonance imaging revealed lesions in the area of the conus medullaris consistent with a myxopapillary ependymoma and fatty filum.

INTERVENTION:

Under the surveillance of intraoperative electromyographic monitoring, the patient underwent an L4–S2 laminectomy for transection of the fatty filum and gross total resection of the mass. Histopathological examination confirmed the presence of these two distinct pathologies.

CONCLUSION:

We report an unusual case of a myxopapillary ependymoma coexisting with a fatty filum in an adult patient. To the best of our knowledge, this association has not yet been reported. This raises the interesting question of a possible associative or causative relationship between these distinct pathologies, which have traditionally been thought to arise from different mechanisms.
Endovascular Management of Ventricular Catheter-induced Anterior Cerebral Artery False Aneurysm: Technical Case Report
Authors: Horowitz Michael , Sharts Michael , Levy Elad , Albright A Leland , Pollack Ian
Published: August 2005

OBJECTIVE AND IMPORTANCE:

We describe the case of a 3.3-kg infant who developed an anterior cerebral artery pseudoaneurysm after ventricular catheter placement. The lesion was treated with endovascular vessel sacrifice.

CLINICAL PRESENTATION:

A 3.3-kg infant with a myelomeningocele underwent repair and ventricular catheter insertion for hydrocephalus. During shunt insertion, intracerebral arterial bleeding was encountered. Subsequent arteriography demonstrated an anterior cerebral artery pseudoaneurysm.

TECHNIQUE:

Via a transfemoral artery approach, the aneurysm and feeding vessel were catheterized with a microcatheter and wire. The aneurysm and vessel were then sacrificed with detachable platinum coils.

CONCLUSION:

Arterial injury is uncommon after ventricular catheter placement. When it does occur, however, an unstable pseudoaneurysm may form. Endovascular techniques can be used to remedy this problem, thus at times obviating the need for a standard craniotomy, which can be particularly difficult in a newborn.
Synthesis of New Green-emitting Gd2O2CO3:Tb3+ Fine Particles with High Luminescence Intensities
Authors: Masui Toshiyuki , Mayama Yuhei , Koyabu Kazuhiko , Imanaka Nobuhito
Published: August 2005

New green-emitting Gd2O2CO3:xTb3+ fine particles were synthesized by a flux method using the 0.476Li2CO3–0.270Na2CO3–0.254K2CO3 eutectic mixture. The emission intensity of the Gd2O2CO3:16.9 atom %Tb3+ phosphor was equivalent to that of the commercial LaPO4:Ce3+,Tb3+, in spite that the size was apparently smaller (ca. 1/10) than the commercial one.
Rearrangements in a hydrophobic core region mediate cAMP action in the regulatory subunit of PKA
Authors: Hahnefeld Claudia , Moll Daniela , Goette Maik , Herberg Friedrich W.
Published: August 2005

cAMP-dependent protein kinase (PKA) forms an inactive heterotetramer of two regulatory (R; with two cAMP-binding domains A and B each) and two catalytic (C) subunits. Upon the binding of four cAMP molecules to the R dimer, the monomeric C subunits dissociate. Based on sequence analysis of cyclic nucleotide-binding domains in prokaryotes and eukaryotes and on crystal structures of cAMP-bound R subunit and cyclic nucleotide-free Epac (exchange protein directly activated by cAMP), four amino acids were identified (Leu203, Tyr229, Arg239 and Arg241) and probed for cAMP binding to the R subunits and for R/C interaction. Arg239 and Arg241 (mutated to Ala and Glu) displayed no differences in the parameters investigated. In contrast, Leu203 (mutated to Ala and Trp) and Tyr229 (mutated to Ala and Thr) exhibited up to 30-fold reduced binding affinity for the C subunit and up to 120-fold reduced binding affinity for cAMP. Tyr229Asp showed the most severe effects, with 350-fold reduced affinity for cAMP and no detectable binding to the C subunit. Based on these results and structural data in the cAMP-binding domain, a switch mechanism via a hydrophobic core region is postulated that is comparable to an activation model proposed for Epac.
Earlywood and latewood elastic properties in loblolly pine
Authors: Cramer Steven , Kretschmann David , Lakes Roderic , Schmidt Troy
Published: August 2005

The elastic properties of earlywood and latewood and their variability were measured in 388 specimens from six loblolly pine trees in a commercial plantation. Properties measured included longitudinal modulus of elasticity, shear modulus, specific gravity, microfibril angle and presence of compression wood. Novel testing procedures were developed to measure properties from specimens of 1 mm×1 mm×30 mm from earlywood or latewood. The elastic properties varied substantially circumferentially around a given ring and this variation was nearly as large as the variation across rings. The elastic properties varied by ring and height, but while the modulus of elasticity increased with height, the shear modulus decreased with height. A strong correlation was found between modulus of elasticity and shear modulus, but only at low heights and inner rings. Specific gravity and microfibril angle were the strongest predictors of elastic properties and explained 75% of the variation in modulus of elasticity for latewood. Despite being the best predictors in this study, these parameters accounted for less than half of the variability of earlywood modulus of elasticity, earlywood shear modulus and latewood shear modulus.
Advances in understanding bioactivity of chitosan and chitosan oligomers against selected wood-inhabiting fungi
Authors: Torr Kirk M. , Chittenden Colleen , Franich Robert A. , Kreber Bernhard
Published: August 2005

Nitrous acid deaminative depolymerisation was used to prepare three chitosan oligomer (CO) mixtures from high-molecular weight chitosan. These mixtures of chitosan oligosaccharides were analysed by electrospray ionisation mass spectroscopy, potentiometric titration and gel permeation chromatography. A method based on potentiometric titration of the amino groups of the oligomers gave an average degree of polymerisation (DP) for the three preparations of 5 (CODP5), 9 (CODP9) and 14 (CODP14). Chitosan acetate and the chitosan oligomer mixtures were assayed against Leptographium procerum, Sphaeropsis sapinea and Trichoderma harzianum on nutrient media. Leptographium procerum and S. sapinea growth was prevented by chitosan acetate and chitosan oligomers at concentrations of 0.3–0.4% (w/v), whereas T. harzianum was able to overcome the fungistatic action of these compounds. The oligomer preparation CODP14 exhibited superior specific activity to both CODP5 and chitosan acetate, suggesting an optimum molecular weight for bioactivity. All oligomer preparations were more effective at pH 4 than at pH 6. This result, in combination with the inactivity of N-acetylated CODP14, indicated that amino group protonation was an important factor for fungistatic activity. The CODP14 preparation was reduced with sodium borohydride and fractionated by alkali precipitation and ion exchange chromatography. Bioassays of these fractions pointed towards DP and degree of deacetylation (DD) as key factors in chito-oligosaccharide bioactivity. Conversely, the terminal aldehyde groups generated by depolymerisation did not contribute to the activity observed.
Comparison of quantitative real-time PCR, chitin and ergosterol assays for monitoring colonization of Trametes versicolor in birch wood
Authors: Eikenes Morten , Hietala Ari M. , Alfredsen Gry , Gunnar Fossdal Carl , Solheim Halvor
Published: August 2005

This paper describes the use of quantitative real-time PCR for monitoring colonization of birch wood (Betula pubescens) by the white-rot fungusTrametes versicolorin an EN113 decay experiment. The wood samples were harvested after 4, 8, 12, 16 and 20 weeks of incubation. The mass loss was in the range of 4–40%. Chitin and ergosterol assays were conducted for comparison. Second-order polynomial fits of the mass loss of decayed wood versus chitin, ergosterol and DNA gave correlations (r2) of 0.87, 0.61 and 0.84, respectively. Compared to the other two assays employed, real-time PCR data correlated best with the relative mass loss of decayed samples 4–8 weeks after inoculation, while the saturation and decline of DNA-based estimates for fungal colonization 16–20 weeks after inoculation indicated that the DNA assay is not suited for quantification purposes in the late stages of decay. The impact of conversion factors, extraction efficiency, inhibitory compounds and background levels in relation to the three detection assays used is discussed.
Rekursiver Entwurf stabiler Regelkreise durch sukzessive Berücksichtigung von Integratoren und quasi-statische Rückführungen (Recursive Design of Stable Control Loops by Integrator Backstepping and Quasi-static Feedback)
Authors: Rudolph Joachim
Published: August 2005

Die in der englischsprachigen Literatur unter der Bezeichnung integrator backstepping bekannte Methode zum Entwurf stabiler Regelkreise wird für die differentiell flachen Systeme diskutiert. Die Verwendung von Brunovsky-Zuständen und quasi-statischen Rückführungen ermöglicht eine systematische Behandlung von Systemen mit mehreren Eingangsgrößen unabhängig von der Systemdarstellung. Die Anwendung der Methode für die Trajektorienfolgeregelung wird am Beispiel eines Brückenkrans illustriert.