bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence, Interpretation, and Qualification From Multiple Reports of Long-Term Outcomes in the Multimodal Treatment Study of Children With ADHD (MTA)
Authors: Swanson James , Arnold L. Eugene , Kraemer Helena , Hechtman Lily , Molina Brooke , Hinshaw Stephen , Vitiello Benedetto , Jensen Peter , Steinhoff Ken , Lerner Marc , Greenhill Laurence , Abikoff Howard , Wells Karen , Epstein Jeffery , Elliott Glen , Newcorn Jeffrey , Hoza Betsy , Wigal Timothy
Published: June 2008

Objective: To review the primary and secondary findings from the Multimodal Treatment study of ADHD (MTA) published over the past decade as three sets of articles. Method: In a two-part article—Part I: Executive Summary (without distracting details) and Part II: Supporting Details (with additional background and detail required by the complexity of the MTA)—we address confusion and controversy about the findings. Results: We discuss the basic features of the gold standard used to produce scientific evidence, the randomized clinical trial, for which was used to contrast four treatment conditions: medication management alone (MedMgt), behavior therapy alone (Beh), the combination of these two (Comb), and a community comparison of treatment “as usual” (CC). For each of the three assessment points we review three areas that we believe are important for appreciation of the findings: definition of evidence from the MTA, interpretation of the serial presentations of findings at each assessment point with a different definition of long-term, and qualification of the interim conclusions about long-term effects of treatments for ADHD. Conclusion: We discuss the possible clinical relevance of the MTA and present some practical suggestions based on current knowledge and uncertainties facing families, clinicians, and investigators regarding the long-term use of stimulant medication and behavioral therapy in the treatment of children with ADHD. (J. of Att. Dis. 2008; 12(1) 4-14)
Minor salivary gland inflammation in Devic’s disease and longitudinally extensive myelitis
Authors: Javed A , Balabanov R , Arnason BGW , Kelly TJ , Sweiss NJ , Pytel P , Walsh R , Blair EA , Stemer A , Lazzaro M , Reder AT
Published: June 2008

Devic’s disease is often considered as a variant of multiple sclerosis (MS). However, evidence suggests that Devic’s disease may be distinct from MS. Devic’s disease can coexist with connective tissue diseases, particularly Sjögren’s disease, but this association is rare with MS. Diagnosis of Sjögren’s disease in patients with neurological symptoms is often difficult. During early stages of Sjögren’s disease, patients may not fulfill all criteria for Sjögren’s disease. A high percentage of patients with Sjögren’s disease have inflammatory infiltrates in minor salivary glands, and this may be a reliable indicator of early or subclinical disease. We show high prevalence (80%) of salivary gland inflammation in Devic’s disease and longitudinally extensive transverse myelitis (LETM). We diagnosed 16 patients with Devic’s disease, and 2 of these satisfied criteria for Sjögren’s disease as did 2 of 9 patients with LETM. Anti-SSA/B titers were infrequently elevated. Although most did not satisfy criteria for Sjögren’s disease. 9 of 12 Devic’s disease patients and 7 of 8 LETM patients had severe salivary gland inflammation. Thus: (1) patients with Devic’s disease or with LETM who have positive labial biopsies but do not satisfy criteria for Sjögren’s disease could have subclinical Sjögren’s diseases. Alternatively, (2) as patients with Devic’s disease have elevated titers of several autoantibodies, so there may exist a set of antibodies that react with antigens in minor salivary glands and cause inflammation. Minor salivary gland biopsy is more sensitive than anti-SSA/B serology in providing histological evidence for possible Sjögren’s disease with CNS lesions.
Contribution of incidence to increasing prevalence of multiple sclerosis in Alberta, Canada
Authors: Warren SA , Svenson LW , Warren KG
Published: June 2008

Alberta Health Care Insurance Plan (AHCIP) data were used to calculate prevalence and incidence rates for multiple sclerosis (MS) in the general population of Alberta from 1990 to 2004. Multiple sclerosis prevalence rose steadily each year over this time period, from 217.6/100,000 individuals in 1990 to 357.6/100,000 in 2004. Multiple sclerosis incidence fluctuated with a slight increase from 1990 to 2004, at 20.9/100,000 and 23.9/100,000, respectively. Age-specific prevalence rates were higher between ages 30 and 60 in 2004 than in 1990. The pattern of age-specific incidence rates was similar in 1990 and 2004, with a slight shift toward diagnosis in younger years. Gender-specific prevalence rates were higher for females in both 1990 and 2004, with a greater increase in females (43%) than males (29%). Gender-specific incidence rates were higher for females than males in both years, but there was no differential increase in incidence by gender from 1990 to 2004. The 2004 Alberta MS prevalence rate remains among the highest reported worldwide. Both increasing incidence and longer duration have likely contributed to increasing MS prevalence in the province.
Efficiency of cognitive control recruitment in the very early stage of multiple sclerosis: a one-year fMRI follow-up study
Authors: Audoin B , Reuter F , Duong MVA , Malikova I , Confort-Gouny S , Cherif AA , Cozzone PJ , Pelletier J , Ranjeva JP
Published: June 2008

Functional magnetic resonance imaging (FMRI) studies have established that patients with multiple sclerosis show stronger activation in the lateral prefrontal cortices (LPFC) than healthy control subjects during effortful cognitive tasks. The aim of the present study was to assess the impact of these activation changes on cognitive performances. In addition to 19 controls, who were tested at a single time-point to define a standard pattern of fMRI activation during the performance of the Paced Auditory Serial Addition Task (PASAT), 13 patients with clinically isolated syndrome underwent a longitudinal fMRI examination while performing the PASAT at the beginning of the study (M0) and one year later (M12). Relative to the M0 scores, PASAT performances improved in eight patients (group A) and either decreased ( n = 4) or remained unchanged ( n = 1) (group B) in five patients at M12. Random effect analyses (SPM2; Wellcome Institute, London, England) were performed to compare intra-group time-related effects on brain activation (paired t-test between M0 and M12), and inter-group differences were also compared between the two groups of patients (analysis of covariance with PASAT performances as the covariate). Relative to group B, group A showed larger increase in activation between M0 and M12 in the right LPFC. In the whole group of patients, interaction analyses showed that the differences in the PASAT scores between M0 and M12 were correlated with the differences in activation observed in the right LPFC. This longitudinal study shows that in patients with early multiple sclerosis, the increased levels of activation in the right LPFC was associated with improved individual working memory and processing speed performances.
Increasing prevalence and incidence of multiple sclerosis in northern Japan
Authors: Houzen H , Niino M , Hata D , Nakano F , Kikuchi S , Fukazawa T , Sasaki H
Published: June 2008

Background

We previously reported that prevalence of multiple sclerosis (MS) in Japan was 8.6/100,000 individuals in 2001. This was much higher than prevalence previously reported from Asian countries. A second epidemiologic survey was conducted to assess changes in MS prevalence and incidence over the last 30 years in Tokachi province of Hokkaido, the northernmost island of Japan.

Methods

The authors studied the frequency of MS in the community of Tokachi Province, where the population has stabilized between 350,000 and 360,000 over the last 30 years. The survey was conducted at the same institutions using the same methods as the first survey in 2001.

Results

On March 31, 2006, 47 subjects satisfied Poser’s criteria for MS. The prevalence rate increased from 8.6 to 13.1/100,000 individuals between 2001 and 2006. The prevalence of conventional MS (C-MS) increased in five years although the prevalence of optic-spinal MS (OS-MS) did not increase. The mean annual incidence increased from 0.15 (1975–1989) to 0.68 (1990–2004).

Conclusions

The results show the highest MS prevalence in Asia; the increase in MS prevalence in Tokachi Province may be due to increased incidence after 1990.
Timing of birth and disease progression in multiple sclerosis
Authors: Koch M , De Keyser J , Tremlett H
Published: June 2008

Background

The timing of birth has recently been associated with the risk of developing multiple sclerosis (MS) in later life. Whether the timing of birth also influences the disease course of MS is unknown.

Objective

To investigate whether the season or month of birth influences the timing of secondary progression or the time to landmark disability outcomes in MS.

Methods

To allow confirmation of findings, all analyses were performed in duplicate in two large natural history cohorts from geographically distinct but seasonally similar locations in Europe and North America. Kaplan–Meier survival analyses were used to investigate the influence of month and season of birth on 1) the time to and age at the development of secondary progression in patients with a relapsing disease onset and 2) the time to reach an Expanded Disability Status Scale (EDSS) score of 6.0 in patients with primary progressive and relapsing MS.

Results

No association between the month or season of birth and disease progression could be found, which was reproducible in both natural history cohorts. A seasonal trend was observed for the time to and age at secondary progression in Groningen, with March babies exhibiting a shorter time to and younger age at secondary progression. The birth month affected time to EDSS 6 for those with relapsing MS in British Columbia, with January babies exhibiting a longer time to EDSS 6. Neither finding could be reciprocated in the other natural history cohort.

Conclusion

The season or month of birth does not appear to influence disease progression of MS.
Neuromyelitis optica immunoglobulins as a marker of disease activity and response to therapy in patients with neuromyelitis optica
Authors: Weinstock-Guttman B , Miller C , Yeh EA , Stosic M , Umhauer M , Batra N , Munschauer F , Zivadinov R , Ramanathan M
Published: June 2008

Objective

To determine whether neuromyelitis optica (NMO) immunoglobulin (IgG) antibody status in NMO/Devic’s disease patients followed prospectively is persistent or can change relative to the clinical status and/or response to therapy.

Design

A cross-sectional group of patients with NMO, relapsing extensive longitudinal transverse myelitis (RLETM) or optico-spinal multiple sclerosis (OSMS) were evaluated for the presence of NMO IgG antibodies. Repeated evaluation was made in all NMO/RLETM patients and in a subgroup of OSMS patients.

Setting

Baird Multiple Sclerosis Center, Buffalo, New York, an academic multiple sclerosis center.

Results

Out of a consecutive cohort of 38 patients evaluated for the presence of NMO IgG, 12 had NMO and 26 had OSMS. Five of the 12 NMO/RLETM patients were NMO IgG positive at the time of their initial evaluation. Four of these patients were repeatedly tested for NMO IgG: two of these became negative and two remained positive. One patient who was initially negative became positive during an acute event and again became negative during the stable disease phase following treatment. A positive test result was associated with active disease, whereas a negative NMO IgG result was consistently found in stable, long-term treated patients. None of the OSMS patients were positive for NMO IgG even during acute attacks.

Conclusions

NMO IgG antibodies are associated with active NMO/RLETM. A well-controlled stable disease usually under effective immunosuppressive therapy can transform the NMO IgG to a negative status. Repeated NMO IgG testing should be considered as a useful biological marker for monitoring NMO/RLETM disease and or response to therapy.
Thinking skills in England's National Curriculum
Authors: Glevey Kwame E.
Published: June 2008

This article sets out to explore some of the issues raised by the introduction of a number of particular skills in the English National Curriculum known collectively as thinking skills. These skills are now embedded in the National Curriculum and teachers are required to address them as part of their daily duties. This article argues that presenting such a limited selection of skills as the foundation for effective thinking may lead to an inadequate approach to enhancing pupils' thinking. Although creative thinking is emphasized in addition to the considerable focus on reasoning in the list of thinking skills presented in the National Curriculum, silence prevails on other types of thinking of equal significance, such as contemplation and sign-cognition (a form of pre-verbal and pre-imaginal form of cognition). The article attempts to highlight the need for the awareness of the complex nature of thinking and concludes by highlighting the opportunities that the introduction thinking skills offer teachers.
Are Individualistic Orientations Collectively Valuable in Group Negotiations?
Authors: Schei Vidar , Rognes Jørn K. , De Dreu Carsten K. W.
Published: June 2008

This experiment examines how members' individualistic or cooperative motivational orientations affect the processes and outcomes of negotiating groups. A total of 228 students participated in a three-person negotiation simulation where motivational orientations were induced through written instructions and members were aware of each other's orientations. Results showed that groups with only cooperative members were more satisfied with their negotiations than were groups with other member compositions. Conversely, groups with only individualistic members achieved higher joint gains than did groups with other member compositions. Process analyses indicated that individualistic groups increased their integrative activities and decreased their distributive activities toward the end of their negotiations. Our results challenge the dominant view that individualistic orientations are detrimental for group processes and outcomes.
Financial independence and age: Distributive justice in the case of adult education
Authors: Smith Matthew A. , Baum Sandy , Mcpherson Michael S.
Published: June 2008

Under current law, students pursuing an undergraduate degree in the United States are considered financially independent (from their parents) for the purposes of financial aid if, among other conditions, they are 24 years of age or older. When students' parents are able to pay, considering them financially independent may result in more generous financial aid allocations. Such aid allocations may in turn constitute regressive redistribution. In this article, we explore the concept of `financial independence' and argue that the age condition results in unjust financial aid allocations. We also propose replacing the age condition with a minimum income condition and argue that less regressive redistribution would result.
Educational ethics and the DESD: Considering trade-offs
Authors: Schlottmann Christopher
Published: June 2008

The United Nation's Decade of Education for Sustainable Development (DESD) aims to prepare students for pressing economic and environmental problems. In this article, I argue that an exclusive emphasis on an ambiguous goal, sustainable development, raises important questions for educational ethics. Specifically, I argue that DESD mission statements and curricula often fail to account for trade-offs that are inevitable in environmental decision-making. Further, I argue that DESD aims don't adequately focus on the development of agency, decision-making skills, and ethical empowerment. I conclude by suggesting that ESD curricula should critically and constructively recognize the inevitability of trade-offs.
Sustainability in higher education: Implications for the disciplines
Authors: Everett Jennifer
Published: June 2008

Academic disciplines have a critical role to play in higher education's response to the planetary challenges of the 21st century. Many academics have embraced the call for a fundamental reorientation of higher education around the goal of education for sustainable development. Individual faculty members who prioritize such a pedagogical goal, however, may find themselves caught between claims of social responsibility on the one hand and traditional norms of their disciplines on the other. This predicament, I suggest, does not require resolution of theoretical debates over interdisciplinarity, but does require concrete practical action on the part of academics for institutional change in the disciplines. I highlight strategies currently being adopted by academic disciplinary associations to advance the mission of the UN Decade on Education for Sustainable Development.
Implementing Effective Community-Based Prevention Programs in the Community Youth Development Study
Authors: Fagan Abigail A. , Hanson Koren , Hawkins J. David , Arthur Michael W.
Published: June 2008

There is mixed evidence regarding the extent to which communities can replicate science-based substance use and delinquency prevention programs with high implementation fidelity, that is, in close adherence to the theoretical rationale and specifications of the program. This article examines implementation of 16 tested and effective preventive interventions replicated during 2004—2006 by 12 communities participating in the Community Youth Development Study. Results revealed that across all programs the majority of required material, core components, and lessons were delivered; implementers were prepared, enthusiastic, and used a variety of teaching practices to convey material; and high levels of engagement by program participants were observed. The results indicate that, using a comprehensive system to proactively monitor implementation, community coalitions can ensure high-quality replication of effective prevention programs.
From the `Cinematic' to the `Anime-ic': Issues of Movement in Anime
Authors: Ruddell Caroline
Published: June 2008

This article explores the way that movement is formally depicted in anime. Drawing on Thomas Lamarre's concepts of the `cinematic' and the `anime-ic', the article interrogates further the differences in movement and action in anime from traditional filmic form. While often considered in terms of `flatness', anime offers spectacle, character development and, ironically, depth through the very form of movement put to use in such texts.The article questions whether the modes of address at work in anime are unique to this form of animation.Taking into account how the terms `cinematic' and `anime-ic' can be understood (and by extension the cinematic and animatic apparatus), the article also begins to explore how viewers might identify with such images.
Advances in understanding pathogenic mechanisms of thrombophilic disorders
Authors: Dahlbäck Björn
Published: June 2008

Venous thromboembolism is a major medical problem, annually affecting 1 in 1000 individuals. It is a typical multifactorial disease, involving both genetic and circumstantial risk factors that affect a delicate balance between procoagulant and anticoagulant forces. In the last 50 years, the molecular basis of blood coagulation and the anticoagulant systems that control it have been elucidated. This has laid the foundation for discoveries of both common and rare genetic traits that tip the natural balance in favor of coagulation, with a resulting lifelong increased risk of venous thrombosis. Multiple mutations in the genes for anticoagulant proteins such as antithrombin, protein C, and protein S have been identified and constitute important risk factors. Two single mutations in the genes for coagulation factor V (FV Leiden) and prothrombin (20210G>A), resulting from approximately 20 000-year-old mutations with subsequent founder effects, are common in the general population and constitute major genetic risk factors for thrombosis. In celebration of the 50-year anniversary of the American Society of Hematology, this invited review highlights discoveries that have contributed to our present understanding of the systems that control blood coagulation and the genetic factors that are involved in the pathogenesis of venous thrombosis.
Von Willebrand factor, ADAMTS13, and thrombotic thrombocytopenic purpura
Authors: Sadler J. Evan
Published: June 2008

Discoveries during the past decade have revolutionized our understanding of idiopathic thrombotic thrombocytopenic purpura (TTP). Most cases in adults are caused by acquired autoantibodies that inhibit ADAMTS13, a metalloprotease that cleaves von Willebrand factor within nascent platelet-rich thrombi to prevent hemolysis, thrombocytopenia, and tissue infarction. Although approximately 80% of patients respond to plasma exchange, which removes autoantibody and replenishes ADAMTS13, one third to one half of survivors develop refractory or relapsing disease. Intensive immunosuppressive therapy with rituximab appears to be effective as salvage therapy, and ongoing clinical trials should determine whether adjuvant rituximab with plasma exchange also is beneficial at first diagnosis. A major unanswered question is whether plasma exchange is effective for the subset of patients with idiopathic TTP who do not have severe ADAMTS13 deficiency.
Bortezomib-induced peripheral neuropathy in multiple myeloma: a comprehensive review of the literature
Authors: Argyriou Andreas A. , Iconomou Gregoris , Kalofonos Haralabos P.
Published: June 2008

Bortezomib has demonstrated significant activity in clinical trials, mainly against recurrent or newly diagnosed multiple myeloma (MM). Peripheral neuropathy is a significant toxicity of bortezomib, requiring dose modification and potential changes in the treatment plan when it occurs. The mechanism underlying bortezomib-induced peripheral neuropathy (BIPN) is unknown. Metabolic changes resulting from the accumulation of bor-tezomib in the dorsal root ganglia cells, mitochondrial-mediated disregulation of Ca++ homeostasis, and disregulation of neurotrophins may contribute to the pathogenesis of BIPN. It is increasingly recognized that BIPN may be a proteasome inhibitor class effect, producing primarily a small fiber and painful, axonal, sensory distal neuropathy. Incidence of BIPN is mainly related to various risk factors, including cumulative dose and evidence of preexisting neuropathy. Assessment of BIPN is based primarily on neurologic clinical examination and neurophysiologic methods. To date, apart from the use of dose reduction and schedule change algorithm, there is no effective treatment with neuroprotective agents for BIPN. Analgesics, tricyclic antidepressants, anticonvulsants, and vitamin supplements have been used as symptomatic treatment against bortezomib-associated neuropathic pain with some success. This review looks critically at the pathogenesis, incidence, risk factors, diagnosis, characteristics, and management of BIPN, and highlights areas for future research.
The neovasculature homing motif NGR: more than meets the eye
Authors: Corti Angelo , Curnis Flavio , Arap Wadih , Pasqualini Renata
Published: June 2008

A growing body of evidence suggests that peptides containing the Asn-Gly-Arg (NGR) motif can selectively recognize tumor neovasculature and can be used, therefore, for ligand-directed targeted delivery of various drugs and particles to tumors or to other tissues with an angiogenesis component. The neovasculature binding properties of these peptides rely on the interaction with an endothelium-associated form of aminopeptidase N (CD13), an enzyme that has been implicated in angiogenesis and tumor growth. Recent studies have shown that NGR can rapidly convert to isoaspartate-glycine-arginine (isoDGR) by asparagine deamidation, generating αvβ3 ligands capable of affecting endothelial cell functions and tumor growth. This review focuses on structural and functional properties of the NGR motif and its application in drug development for angiogenesis-dependent diseases. Furthermore, we discuss the time-dependent transition of NGR to isoDGR in natural proteins, such as fibronectins, and its potential role of as a “molecular timer” for generating new binding sites for integrins impli-cated in angiogenesis.
Complete nucleotide sequence of the Cryptomeria japonicaD. Don. chloroplast genome and comparative chloroplast genomics: diversified genomic structure of coniferous species
Authors: Hirao Tomonori , Watanabe Atsushi , Kurita Manabu , Kondo Teiji , Takata Katsuhiko
Published: June 2008

Background

The recent determination of complete chloroplast (cp) genomic sequences of various plant species has enabled numerous comparative analyses as well as advances in plant and genome evolutionary studies. In angiosperms, the complete cp genome sequences of about 70 species have been determined, whereas those of only three gymnosperm species, Cycas taitungensis, Pinus thunbergii, and Pinus koraiensis have been established. The lack of information regarding the gene content and genomic structure of gymnosperm cp genomes may severely hamper further progress of plant and cp genome evolutionary studies. To address this need, we report here the complete nucleotide sequence of the cp genome of Cryptomeria japonica, the first in the Cupressaceae sensu lato of gymnosperms, and provide a comparative analysis of their gene content and genomic structure that illustrates the unique genomic features of gymnosperms.

Results

The C. japonica cp genome is 131,810 bp in length, with 112 single copy genes and two duplicated (trnI-CAU, trnQ-UUG) genes that give a total of 116 genes. Compared to other land plant cp genomes, the C. japonica cp has lost one of the relevant large inverted repeats (IRs) found in angiosperms, fern, liverwort, and gymnosperms, such as Cycas and Gingko, and additionally has completely lost its trnR-CCG, partially lost its trnT-GGU, and shows diversification of accD. The genomic structure of the C. japonica cp genome also differs significantly from those of other plant species. For example, we estimate that a minimum of 15 inversions would be required to transform the gene organization of the Pinus thunbergii cp genome into that of C. japonica. In the C. japonica cp genome, direct repeat and inverted repeat sequences are observed at the inversion and translocation endpoints, and these sequences may be associated with the genomic rearrangements.

Conclusion

The observed differences in genomic structure between C. japonica and other land plants, including pines, strongly support the theory that the large IRs stabilize the cp genome. Furthermore, the deleted large IR and the numerous genomic rearrangements that have occurred in the C. japonica cp genome provide new insights into both the evolutionary lineage of coniferous species in gymnosperm and the evolution of the cp genome.
The Anal Fistula Plug versus the mucosal advancement flap for the treatment of Anorectal Fistula (PLUG trial)
Authors: van Koperen Paul J , Bemelman Willem A , Bossuyt Patrick MM , Gerhards Michael F , Eijsbouts Quirijn AJ , van Tets Willem F , Janssen Lucas WM , Dijkstra F Robert , van Dalsen Annette D , Slors J Frederik M
Published: June 2008

Background

Low transsphincteric fistulas less than 1/3 of the sphincter complex are easy to treat by fistulotomy with a high success rate. High transsphincteric fistulas remain a surgical challenge. Various surgical procedures are available, but recurrence rates of these techniques are disappointingly high. The mucosal flap advancement is considered the gold standard for the treatment of high perianal fistula of cryptoglandular origin by most colorectal surgeons. In the literature a recurrence rate between 0 and 63% is reported for the mucosal flap advancement. Recently Armstrong and colleagues reported on a new biologic anal fistula plug, a bioabsorbable xenograft made of lyophilized porcine intestinal submucosa. Their prospective series of 15 patients with high perianal fistula treated with the anal fistula plug showed promising results.

The anal fistula plug trial is designed to compare the anal fistula plug with the mucosal flap advancement in the treatment of high perianal fistula in terms of success rate, continence, postoperative pain, and quality of life.

Methods/design

The PLUG trial is a randomized controlled multicenter trial. Sixty patients with high perianal fistulas of cryptoglandular origin will be randomized to either the fistula plug or the mucosal advancement flap. Study parameters will be anorectal fistula closure-rate, continence, post-operative pain, and quality of life. Patients will be followed-up at two weeks, four weeks, and 16 weeks. At the final follow-up closure rate is determined by clinical examination by a surgeon blinded for the intervention.

Discussion

Before broadly implementing the anal fistula plug results of randomized trials using the plug should be awaited. This randomized controlled trial comparing the anal fistula plug and the mucosal advancement flap should provide evidence regarding the effectiveness of the anal fistula plug in the treatment of high perianal fistulas.

Trial registration

ISRCTN: 97376902
Double vs single internal thoracic artery harvesting in diabetic patients: role in perioperative infection rate
Authors: Agrifoglio Marco , Trezzi Matteo , Barili Fabio , Dainese Luca , Cheema Faisal H , Topkara Veli K , Ghislandi Chiara , Parolari Alessandro , Polvani Gianluca , Alamanni Francesco , Biglioli Paolo
Published: June 2008

Background

The aim of this prospective study is to evaluate the role in the onset of surgical site infections of bilateral internal thoracic arteries harvesting in patients with decompensated preoperative glycemia.

Methods

81 consecutive patients with uncontrolled diabetes mellitus underwent elective CABG harvesting single or double internal thoracic arteries. Single left ITA was harvested in 41 patients (Group 1, 50.6%), BITAs were harvested in 40 (Group 2, 49.4%). The major clinical end points analyzed in this study were infection rate, type of infection, duration of infection, infection relapse rate and total hospital length of stay.

Results

Five patients developed sternal SSI in the perioperative period, 2 in group 1 and 3 in group 2 without significant difference. All sternal SSIs were superficial with no sternal dehiscence. The development of infection from the time of surgery took 18.5 ± 2.1 and 7.3 ± 3.0 days for Groups 1 and 2 respectively. The infections were treated with wound irrigation and debridement, and with VAC therapy as well as with antibiotics. The VAC system was removed after a mean of 12.8 ± 5.1 days, when sterilization was achieved. The overall survival estimate at 1 year was 98.7%. Only BMI was a significant predictor of SSI using multivariate stepwise logistic regression analysis (Odds Ratio: 1.34; 95%Conficdence Interval: 1.02–1.83; p value: 0.04). In the model, the use of BITA was not an independent predictor of SSI.

Conclusion

CABG with bilateral pedicled ITAs grafting could be performed safely even in diabetics with poor preoperative glycaemic control.
Modeling elastic wave velocities and attenuation in rocks saturated with heavy oil
Authors: Gurevich Boris , Osypov Konstantin , Ciz Radim , Makarynska Dina
Published: June 2008

Although properties of bulk heavy oil can be approximated by an appropriate viscoelastic model, only a few attempts to model properties of rocks saturated with heavy oil have been reported. Rock-physics models used for rocks saturated with conventional fluids are inapplicable to those saturated with heavy oil because its viscoelastic rheology invalidates the main assumptions of the Gassmann and Biot theories. We estimate viscoelastic properties of mixtures of rock and heavy oil by considering (1) a system of layers of a solid and a viscoelastic medium and (2) by computing Hashin-Shtrikman (HS) bounds for this system. These two methods give approximate bounds for the frequency- and temperature-dependent velocities and attenuation coefficients in rocks saturated with heavy oil. We also propose a method to compute a realistic estimate of these properties that lie between those bounds. This estimate is based on a self-consistent equivalent-medium approach known as coherent-potential approximation. In a more general form, this approximation can be used for approximate fluid substitution for heavy oil. This approach gives frequency-dependent velocities and attenuation values that are qualitatively consistent with experimental observa-tions.
Continuous and simultaneous measurement of reflector depth and average soil-water content with multichannel ground-penetrating radar
Authors: Gerhards Holger , Wollschläger Ute , Yu Qihao , Schiwek Philip , Pan Xicai , Roth Kurt
Published: June 2008

Ground-penetrating radar is a fast noninvasive technique that can monitor subsurface structure and water-content distribution. To interpret traveltime information from single common-offset measurements, additional assumptions, such as constant permittivity, usually are required. We present a fast ground-penetrating-radar measurement technique using a multiple transmitter-and-receiver setup to measure simultaneously the reflector depth and average soil-water content. It can be considered a moving minicommon-midpoint measurement. For a simple analysis, we use a straightforward evaluation procedure that includes two traveltimes to the same reflector, obtained from different antenna separations. For a more accurate approach, an inverse evaluation procedure is added, using traveltimes obtained from all antenna separations at one position and its neighboring measurement locations. The evaluation of a synthetic data set with a lateral variability in reflector depth and an experimental example with a large variability in soil-water content are introduced to demonstrate the applicability for field-scale measurements. The crucial point for this application is the access to absolute traveltimes, which are difficult to determine accurately from common-offset measurements.
Premature Ovarian “Failure” in the Adolescent
Authors: Rebar Robert W.
Published: June 2008

Premature ovarian “failure” (POF) is an enigmatic and heterogeneous disorder characterized by amenorrhea, hypoestrogenism, and hypergonadotropinism that occurs in women under the age of 40 years. The predominant causes are different in the adolescent, and more of these causes are associated with permanent cessation of ovarian function. It would seem that the more common causes of POF in adolescents include cytogenetic abnormalities involving the X chromosome, ovarian dysfunction occurring in association with other autoimmune endocrine disturbances, and chemotherapy and/or radiation therapy given for any of a number of malignancies. Special challenges in the adolescent beyond establishing the diagnosis include counseling the young woman and her family and discussing the possibility of future pregnancy. Lifelong therapy must be addressed as well. Any discussion of POF raises numerous unanswered questions that should be the focus of future research.
The Menstrual Cycle and Adolescent Health
Authors: Barsom Susannah Heyer , Dillaway Heather E. , Koch Patricia Barthalow , Ostrowski Mona L. , Mansfield Phyllis Kernoff
Published: June 2008

Early reproductive characteristics, including menarcheal age, may have significant effects on later health outcomes. While early exposure to ovarian hormones may influence the risk for certain diseases, the degree to which this exposure is mediated by other factors is not well understood. Research on secular trends in age at menarche and subsequent outcomes in women's health across the lifespan can help to clarify the importance of age at menarche. Since 1934, the TREMIN Research Program on Women's Health has collected longitudinal data on menstruation and reproductive health. Recently we examined the age at menarche across the entire population of TREMIN participants, across the two major cohorts of this research program (participants initially enrolled in the 1930s and in the 1960s), and within families where mothers and daughters participated in the study. Our results indicated that age at menarche among the 4,444 mainly European American girls in our sample decreased in the first part of the twentieth century, and then began to increase in the late 1940s. The comparison of age at menarche across the two major cohorts reinforced this analysis: age at menarche was slightly but significantly lower (P < .001) in the second cohort (12.66), most of whom were born in the 1940s, than in the first cohort (12.89), those women born before 1920. In analyzing data from 380 mother–daughter pairs, there was no significant difference between mothers' and daughters' mean age at menarche and no significant correlation between them.
Polycystic Ovary Syndrome in Adolescence
Authors: Blank Susan K. , Helm Kristin D. , McCartney Christopher R. , Marshall John C.
Published: June 2008

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive‐aged women and is characterized by hyperandrogenemia, menstrual dysfunction, and polycystic ovarian morphology. The hormonal abnormalities inherent in PCOS often begin in adolescence and include hyperinsulinemia and rapid luteinizing hormone (LH) pulse frequency, both of which mediate ovarian and adrenal overproduction of androgens. Although differences exist regarding the diagnostic criteria for PCOS, we believe that hyperandrogenemia is the final common pathway for the development of adolescent PCOS, and we propose a hypothesis to illustrate such. Recognizing and reducing androgen levels in adolescence is critical given their association with the metabolic syndrome (MBS), diabetes, and infertility in adulthood.
Dysmenorrhea in Adolescents
Authors: Harel Zeev
Published: June 2008

Dysmenorrhea is the most common gynecologic complaint among adolescent females. Dysmenorrhea in adolescents is usually primary, and is associated with normal ovulatory cycles and with no pelvic pathology. In approximately 10% of adolescents with severe dysmenorrheic symptoms, pelvic abnormalities such as endometriosis or uterine anomalies may be found. Potent prostaglandins and leukotrienes play an important role in generating the symptoms of dysmenorrhea. Nonsteroidal anti‐inflammatory drugs (NSAIDs) are the most common pharmacologic treatment for dysmenorrhea. A loading dose of NSAIDs (typically twice the regular dose) should be used as initial treatment for dysmenorrhea in adolescents, followed by a regular dose until symptoms abate. Adolescents with symptoms that do not respond to treatment with NSAIDs for three menstrual periods should be offered hormonal treatment such as combined estrogen/progestin oral contraceptive pills for three menstrual cycles. Adolescents with dysmenorrhea who do not respond to this treatment should be evaluated for secondary causes of dysmenorrhea. The adolescent care provider's role is to explain the pathophysiology of dysmenorrhea to every adolescent female, address any concern that the patient has about her menstrual period, and review effective treatment options for dysmenorrhea with the patient.
Eating Disorders and Menstrual Dysfunction in Adolescents
Authors: Vyver Ellie , Steinegger Cathleen , Katzman Debra K.
Published: June 2008

Menstrual dysfunction is a common feature of all eating disorders and results in significant medical complications. The etiology of menstrual dysfunction is multifaceted and the result of a complex interplay of many factors including weight loss, decreased body fat, hypoleptinemia, abnormal eating attitudes and behaviors, exercise, and psychological stressors. This chapter will review the prevalence of menstrual dysfunction in adolescents with eating disorders, its multifactorial etiology, the evidence‐based pathophysiology, and the resulting complications to linear growth, pubertal development, bone mineral accretion, and cognitive function. Future research directions are identified that suggest opportunities to gain new insights into our understanding of the mechanisms and treatment of menstrual dysfunction in adolescents with eating disorders.
The Psychology of Antecedents to Adult Reproductive Disorders in Adolescent Girls
Authors: Covington Sharon N. , Martinez Pedro E. , Popat Vaishali , Nandagopal Radha , Ryan Mary , Nelson Lawrence M.
Published: June 2008

The normal developmental tasks and roles of adolescence are altered by a diagnosis of a reproductive disorder. The crisis of impaired fertility affects both parent and child, stressing the family system. For the adolescent girl, a reproductive disorder has an impact on her developing sense of self, body‐image, and sexuality, which, in turn, can affect her self‐esteem and relationships with others. Because of the sexual nature of a reproductive disorder, feelings of embarrassment or protectiveness are often engendered that can make it difficult for families to discuss. Nonetheless, families do best with openness and honesty regarding the condition and should be discouraged from keeping the diagnosis a secret. Adolescence encompasses a broad spectrum of emotional maturity, which needs to be considered by parents and clinicians when communicating information. Understanding that the family is an emotional unit, a family systems approach to deal with health issues is most appropriate. In this context, parents need to first deal with their own feelings about the diagnosis, before they can help their child. Secondly, parents must be provided with tools to build an ongoing conversation with their child that will avoid stigmatizing her condition and handicapping her growth into healthy adulthood. The goal for parent and clinician is to help the adolescent girl formulate positive self‐esteem and body image, despite impaired fertility.
Menstrual Issues in Adolescents with Physical and Developmental Disabilities
Authors: Quint Elisabeth H.
Published: June 2008

Puberty and menstruation are difficult issues for teens with disabilities and for their families as well. Irregular bleeding, mood swings, and problems with hygiene often complicate the delicate balance in the lives of these adolescents. The care provider is asked to help with the pubertal transition and the issues surrounding menstruation and reproductive health. This review will concentrate on the issues concerning menstruation that need special focus in teens with developmental disability (DD). The impact of the menstrual cycle on these teenagers, including hygiene issues, menstrual irregularities due to specific clinical circumstances, and treatment dilemmas associated with the use of hormonal medication will be discussed for this special group of teens.
Congenital Adrenal Hyperplasia in Adolescents
Authors: Lin‐Su Karen , Nimkarn Saroj , New Maria I.
Published: June 2008

Adolescent females who have irregular menstrual periods may have the nonclassical form of congenital adrenal hyperplasia due to a mild deficiency of steroid 21‐hydroxylase (NC 21‐OHD). Hyperandrogenic signs such as acne, frontal hair loss, hirsutism, and irregular menstrual periods should alert the physician to the diagnosis of NC 21‐OHD. An ACTH stimulation test in which serum hormone concentrations of 17‐OHP, Δ4‐androstenedione, and testosterone are determined will assist in the diagnosis of NC 21‐OHD, but the definitive diagnostic test is an analysis of the mutations in the CYP21A2 gene. Typical mutations in the CYP21A2 gene in patients with NC 21‐OHD are an exon 7 or an exon 1 mutation. Once the genotype establishes the diagnosis of NC 21‐OHD, treatment should be initiated. Typical treatment is dexamethasone, 0.25 mg HS, which generally reverses the hyperandrogenic signs.
Menstrual Health and the Metabolic Syndrome in Adolescents
Authors: Tfayli Hala , Arslanian Silva
Published: June 2008

The metabolic syndrome, a constellation of interrelated risk factors for cardiovascular disease and type 2 diabetes mellitus, has become a major public health concern against the backdrop of increasing rates of obesity. Insulin resistance plays a pivotal role as the underlying pathophysiological linchpin of the various components of the syndrome. The metabolic syndrome is well recognized in adults, and there is convincing evidence that it starts in childhood, with progressive clustering of the various components over time and tracking through adulthood. Adult women and adolescents with polycystic ovary syndrome (PCOS) have higher prevalence rates of the metabolic syndrome compared with the general population. Several anthropometric (obesity, particularly abdominal obesity), metabolic (insulin resistance/hyperinsulinemia, dyslipidemia) and hormonal (low IGFBP1, IGFBP2 and low sex hormone binding globulin) features of adolescents with PCOS are also features of the metabolic syndrome. Insulin resistance, believed to be a key pathogenic factor in both PCOS and the metabolic syndrome, may be the thread that links the two conditions. Menstrual health in adolescents could be viewed as yet another component in the evaluation of the metabolic syndrome. Careful assessment of menstrual history and appropriate laboratory work‐up could reveal the presence of PCOS in obese at‐risk adolescent girls with a family history of the metabolic syndrome.
Exercise‐Induced Amenorrhea and Bone Health in the Adolescent Athlete
Authors: Warren Michelle P. , Chua Abigail T.
Published: June 2008

Female participation in high school athletics has increased 800% in the last 30 years. The problem of exercise‐induced amenorrhea was initially thought to be analogous to hypoestrogenism, but recent studies suggest that nutritional issues underlie most of the pathophysiology and that the mechanism is different from that seen in the primary hypogonadal state. Exercise‐induced amenorrhea can be an indicator of an energy drain, and the presence of the other components of the female athlete triad—bone density loss and eating disorders—must be determined as well. Addressing skeletal problems related to nutritional and hormonal deficiencies in this population is of very high priority.
Pubertal Development and Menarche
Authors: DiVall Sara A. , Radovick Sally
Published: June 2008

Puberty is the developmental process that culminates in reproductive capability and is the result of a complex series of molecular and physiological events. The release of gonadotropin‐releasing hormone from specialized neurons of the hypothalamus begins the hormonal cascade that causes gonadal activation and the physical changes of puberty. Several factors have been proposed to influence the activation of the hypothalamus to trigger puberty, but the involved pathways have not been fully elucidated. The recent observations that the age of pubertal onset may be lowering in American girls calls attention to the lack of knowledge of modulating factors that affect the pubertal process. Genes necessary for puberty have been found by studying persons who do not achieve puberty; such studies have provided insights into the pathways necessary for pubertal development. A multidisciplinary focus is required to elucidate the complex mechanisms involved in the initiation and progression of puberty.
Stress‐Associated or Functional Hypothalamic Amenorrhea in the Adolescent
Authors: Liu James H. , Bill Arthur H.
Published: June 2008

Stress‐associated amenorrhea in the adolescent is likely similar to the disorder found in young reproductive‐aged adults and is termed hypothalamic amenorrhea. The key defect is an abnormality in the secretion of gonadotropin‐releasing hormone. This review examines the current studies that characterize the disorder and the plausible factor(s) that may account for the disturbances in gonadotropin‐releasing hormone, and identifies directions for future research in this group of disorders.