bluuebunny/crossref_metadata_2025 huggingface dataset:
Minimally Invasive Reconstruction of Lateral Ligaments of the Ankle Using Semitendinosus Autograft
Authors: Wang Bibo , Xu Xiang-Yang
Published: February 2013

Background:

Multiple techniques have been described for reconstruction of the lateral ligaments of the ankle. Most require extensive exposure and dissection, which may lead to potential problems with wound healing, higher risk of nerve injury, fibrosis, and stiffness. This study reports on the results of a minimally invasive method to reconstruct the ligaments using a semitendinosus tendon autograft and achieve a stable ankle while avoiding these problems.

Materials and Methods:

From September 2006 to May 2010, 25 patients (14 males, 11 females) with chronic ankle instability underwent lateral ligament reconstruction. The average age was 32.4 (range, 17 to 62) years old. A semitendinosus autograft was harvested through 2 small knee incisions. For the ankle reconstruction, 4 small incisions of 5 mm each were made at the medial and lateral side of the fibular tip, the talar neck, and the middle of the calcaneus. Anatomical reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) was then performed through these small incisions. The mean final follow-up was 32.3 (range, 12 to 56) months. AOFAS questionnaires were used to measure clinical outcomes and donor site morbidity and patient satisfaction are also reported. Preoperative and postoperative stress tests were performed and radiographic parameters were measured.

Results:

The mean AOFAS score increased on average from 71.1 to 95.1 ( P < .001). Two patients reported residual instability on uneven ground. No patient reported weakness or disability from the donor site. The satisfaction level was excellent in 20 patients and good in 5 patients. Significant improvement in stress radiographic parameters was noted for the talar tilt angle, with reduction from a mean of 14.0 to 3.8 degrees ( P < .001); anterior talar displacement reduced from a mean of 12.3 to 4.6 mm ( P < .001).

Conclusion:

Reconstruction of the lateral ankle ligaments using a semitendinosus tendon autograft and a minimally invasive approach can achieve a stable ankle while avoiding extensive exposure and risk of nerve injury.

Level of Evidence:

Level IV, retrospective case series.
Use of Collagen Conduits in Management of Painful Neuromas of the Foot and Ankle
Authors: Gould John S. , Naranje Sameer M. , McGwin Gerald , Florence Mason , Cheppalli Suresh
Published: February 2013

Background:

Painful neuromas of the foot and ankle frequently pose a treatment dilemma due to persistent pain or recurrence after resection. The purpose of this survey was to evaluate the clinical and functional outcomes in patients in which collagen nerve conduits were used as an adjunct to the resection of a painful neuroma. Our prior experience with vein conduits for this purpose suggested that we might have similar success with the use of these devices.

Materials and Methods:

Chart reviews and telephone surveys were performed on patients operated by the senior surgeon (JSG) at our medical center from June 2006 to June 2011. A total of 50 patients underwent excision of painful single or multiple neuromas with the end of the resected nerve sutured into the collagen conduit. Each patient preoperatively was asked to describe the amount of pain he or she was experiencing on a scale from 1 to 10, with 10 indicating the most severe pain. In the telephone interview conducted during this study, the same question was asked of each patient following revision. Patient ages ranged from 16 to 77 years, with a mean of 54 years. In all, 30 right and 20 left sides were operated, and 1 patient had bilateral involvement. Mean follow-up was 36 months (6-55 months). There were a total of 69 nerves that underwent conduit procedures.

Results:

Of 69 nerve conduit constructs, 30 (43%) were painless at final outcome, 23 (33%) had pain scores of 1 to 4, 6 (9%) had pain scores of 5 to 7, and 10 (15%) had severe symptoms with pain scores of 8 to 10. Satisfactory outcomes in which patients stated that they were significantly improved with the procedure and now functional occurred in 59/69 (85%). In all, 24 (48%) patients were completely symptom free, 13 (26%) had a pain score of 1 to 4, 6 (12%) had scores of 5 to 7, and 10 (15%) had severe pain with scores of 8 to 10. Three patients had superficial infections (stitch abscesses): 2 resolved with oral antibiotics and 1 resolved spontaneously. Three patients developed complex regional pain syndrome. One patient responded to a dorsal column stimulator and 2 responded to sympathetic blocks. No other complications were reported.

Conclusion:

Collagen conduits were safe and generally successful adjuncts to simple excision in the management of painful neuromas of the foot and ankle.

Level of Evidence:

Level IV, retrospective case series.
Building a Larger Tent for Public Health
Authors: Goodman Robert Mark
Published: February 2013

The unification of the American Association for Health Education (AAHE) and the Society for Public Health Education (SOPHE) generates a long-desired synergy, a ramping up of our leadership influence in promoting health. It also serves as an ongoing opportunity to reflect on how we synergize the distinct philosophic, scientific, and practical approaches that our AAHE colleagues bring in constructing a larger tent for public health education. Running parallel to our union with AAHE is the undertaking by several schools of health, physical education, and recreation (HPER) to become schools of public health. The unification between AAHE and SOPHE can be of enormous benefit to such a process. Just as the harmonious integration of two organizations with similar but distinct perspectives depends on compromise and transcendence, the schools that they embody—both public health and HPER—might consider ways to engage in continued dialogue to assure a more expansive paradigm for public health. SOPHE has an important role to play in this process, and with the additional insight and influence that our AAHE colleagues bring, we can become more instrumental as a boundary spanner. Mechanisms for such integration are discussed.
Content analysis of students’ journals in a percussion methods course
Authors: Knowlton Dave S.
Published: February 2013

This article presents an empirical investigation of music education students’ journals within a percussion methods course at a Midwestern university in the United States. The findings of this investigation raise issues about music education students’ sense of self-awareness, specificity within the journals, and the predominance of discussions about concrete (e.g., technique) over abstract (e.g., musicianship) aspects of the course. The issues are discussed from a variety of perspectives, including a discussion of the potential shortcomings of verbal thinking within a music education course. Implications are offered regarding the design and pedagogy of music education courses.
Mixing methods to explore appearance in dementia care
Authors: Ward Richard , Campbell Sarah
Published: February 2013

This paper considers approaches to investigating appearance and the work invested in maintaining it within dementia care. Our focus is upon methodological and methods-related issues associated with the challenge of generating knowledge of the embodied worlds of people with dementia. We begin with a brief overview of the literature on appearance and dementia, and consider what it teaches us about the nature of appearance and ways of understanding it. We describe and discuss the mixing of methods for an on-going investigation into hairdressing in dementia care: The Hair and Care project. Based upon the experience of research in care-based hair salons, we argue for a creative use of methods in dementia studies as an avenue to better engaging with the embodied experiences of people with dementia and, as a result, understanding how people use their bodies and senses to create meaningful worlds.
Elastic Rubber Strips to Heal Large Wounds of the Body Wall
Authors: Petroianu Andy
Published: February 2013

Background/Purpose. Closure of large wounds is a difficult surgical challenge. This article reports on the effective closure of large surgical wounds using elastic rubber strips. Methods. One to 3 circular elastic rubber strips were sutured by applying moderate tension to the opposite edges of 30 large wounds in 28 patients. The strips were sutured in a successive “X” fashion by crossing one over the other. These rubber strips were replaced when they ruptured or after their tension had reduced because of the closure of the wounds. Results. Complete closure of the wounds was achieved with no further need for any surgical procedure or device. One patient with laparostomy and colostomy presented with difficulty on adapting the colostomic bag, and the rubber strips were removed. The rubber strip had little effect on a large wound of the skull. In the late postoperative follow-up, 3 of the 15 closed laparostomies developed incisional hernias, and all these patients were subjected to hernioplasties with good results. Conclusion. The use of circular elastic rubber strips maintained at moderate tension is a simple, effective, and inexpensive surgical option for healing large wounds. It is readily available at any hospital and requires no extensive surgical experience.
A Critique of Private Sessions in Family Mediation
Authors: Bowen Don
Published: February 2013

This study represents a critical examination of private sessions (caucuses), seen as a sub-process within the core family mediation process and defined as involving separate and confidential conversations between mediator(s) and each disputant during the main session. In the study, the views of family mediators were explored revealing that considerable support for the use of the tool was juxtaposed with a range of fundamental ethical concerns. Emerging from the study is strong evidence of coercive practice as an inherent component of caucusing thus posing a challenge to the positive benefits.
The calcineurin-NFAT pathway negatively regulates megakaryopoiesis
Authors: Zaslavsky Alexander , Chou Stella T. , Schadler Keri , Lieberman Allyson , Pimkin Maxim , Kim Yeo Jung , Baek Kwan-Hyuck , Aird William C. , Weiss Mitchell J. , Ryeom Sandra
Published: February 2013

Key Points

Inhibition of calcineurin-NFAT signaling increases megakaryocyte and platelet counts. Inhibition of calcineurin-NFAT signaling increases proliferation of megakaryocyte progenitors.
The brain-in-motion study: effect of a 6-month aerobic exercise intervention on cerebrovascular regulation and cognitive function in older adults
Authors: Tyndall Amanda V , Davenport Margie H , Wilson Ben J , Burek Grazyna M , Arsenault-Lapierre Genevieve , Haley Eryka , Eskes Gail A , Friedenreich Christine M , Hill Michael D , Hogan David B , Longman R Stewart , Anderson Todd J , Leigh Richard , Smith Eric E , Poulin Marc J
Published: February 2013

Background

Aging and physical inactivity are associated with declines in some cognitive domains and cerebrovascular function, as well as an elevated risk of cerebrovascular disease and other morbidities. With the increase in the number of sedentary older Canadians, promoting healthy brain aging is becoming an increasingly important population health issue. Emerging research suggests that higher levels of physical fitness at any age are associated with better cognitive functioning and this may be mediated, at least in part, by improvements in cerebrovascular reserve. We are currently conducting a study to determine: if a structured 6-month aerobic exercise program is associated with improvements or maintenance of both cerebrovascular function and cognitive abilities in older individuals; and, the extent to which any changes seen persist 6 months after the completion of the structured exercise program.

Methods/design

Two hundred and fifty men and women aged 55–80 years are being enrolled into an 18-month combined quasi-experimental and prospective cohort study. Participants are eligible for enrollment into the study if they are inactive (i.e., not participating in regular physical activity), non-smokers, have a body mass index <35.0 kg/m2, are free of significant cognitive impairment (defined as a Montreal Cognitive Assessment score of 24 or more), and do not have clinically significant cardiovascular, cerebrovascular disease, or chronic obstructive pulmonary airway disease. Repeated measurements are done during three sequential six-month phases: 1) pre-intervention; 2) aerobic exercise intervention; and 3) post-intervention. These outcomes include: cardiorespiratory fitness, resting cerebral blood flow, cerebrovascular reserve, and cognitive function.

Discussion

This is the first study to our knowledge that will examine contemporaneously the effect of an exercise intervention on both cerebrovascular reserve and cognition in an older population. This study will further our understanding of whether cerebrovascular mechanisms might explain how exercise promotes healthy brain aging. In addition our study will address the potential of increasing physical activity to prevent age-associated cognitive decline.
A functional genomics screen for microRNA regulators of NF-kappaB signaling
Authors: Olarerin-George Anthony O , Anton Lauren , Hwang Yih-Chii , Elovitz Michal A , Hogenesch John B
Published: February 2013

Background

The nuclear factor-KappaB (NF-κB) pathway is conserved from fruit flies to humans and is a key mediator of inflammatory signaling. Aberrant regulation of NF-κB is associated with several disorders including autoimmune disease, chronic inflammation, and cancer, making the NF-κB pathway an attractive therapeutic target. Many regulatory components of the NF-κB pathway have been identified, including microRNAs (miRNAs). miRNAs are small non-coding RNAs and are common components of signal transduction pathways. Here we present a cell-based functional genomics screen to systematically identify miRNAs that regulate NF-κB signaling.

Results

We screened a library of miRNA mimics using a NF-κB reporter cell line in the presence and absence of tumor necrosis factor (+/- TNF). There were 9 and 15 hits in the -TNF and +TNF screens, respectively. We identified putative functional targets of these hits by integrating computational predictions with NF-κB modulators identified in a previous genome-wide cDNA screen. miR-517a and miR-517c were the top hits, activating the reporter 86- and 126-fold, respectively. Consistent with these results, miR-517a/c induced the expression of endogenous NF-κB targets and promoted the nuclear localization of p65 and the degradation of IκB. We identified TNFAIP3 interacting protein1 (TNIP1) as a target and characterized a functional SNP in the miR-517a/c binding site. Lastly, miR-517a/c induced apoptosis in vitro, which was phenocopied by knockdown of TNIP1.

Conclusions

Our study suggests that miRNAs are common components of NF-κB signaling and miR-517a/c may play an important role in linking NF-κB signaling with cell survival through TNIP1.
Assimilation's Racializing Sensibilities: Colonized Koreans as Yobos and the “Yobo-ization” of Expatriate Japanese
Authors: Henry Todd A.
Published: February 2013

Recent approaches to the study of Euro-American empires have increasingly highlighted the importance of what the anthropologist and historian Ann Stoler calls “cultural sensibilities” (rather than skin color) as the de facto criterion by which national membership was assigned. Such critical interventions have succeeded in calling into question the seeming immutability of “black-and-white” racial distinctions, which most scholars have conventionally understood as the most important justificatory and operational logic of colonial rule. However, when viewed from a historical perspective anchored in (East) Asia, these debates have curiously failed to consider the case of Japanese colonialism, where deeper physiognomic similarities between colonizer and colonized made it even more important to create, mark, and patrol the shifting boundaries between the diverse members of the multiethnic national community. As a way of dialoguing with and thereby enriching Euro-centric debates on the place of racialized culture in the study of empire, this paper will show how attention to colonial sensibilities figured centrally in the government-general's avowed goal to “assimilate” colonized Koreans into the larger emperor-centered community. However, as I will argue, this elusive project of cultural incorporation revolved around mutually constitutive definitions of Japanese-ness and Korean-ness that the colonial state was seriously invested in managing but, in practice, could hardly control. On the one hand, essentialized discourses of Korean-ness as commonly expressed by the racialized epithet yobo demonstrate how Japanese settlers aimed to distance themselves from native inhabitants and thereby justify their privileges over them. While challenging the homogenizing initiatives of the colonial state, these discourses also helped to create equally idealized notions of Japanese-ness, sensibilities the government-general could appropriate to measure the degree to which Koreans had been incorporated into the imperial community. On the other hand, inevitable encounters between Japanese settlers and the local population—elaborate efforts to insulate themselves from the “contaminating” sensibilities of Koreans notwithstanding—also produced anxious debates on the so-called yobo-ization of Japanese settlers. Charges of having embodied attributes of Korean others not only suggests that some settlers had failed to become sufficiently “Japanese,” but also underscores how the project of colonial assimilation relied upon a multidirectional flow of practical sensibilities which often transversed and transgressed the carefully constructed, discursive boundaries of ethnicity.
UV-induced G2 checkpoint depends on p38 MAPK and minimal activation of ATR-Chk1 pathway
Authors: Warmerdam Daniël O. , Brinkman Eva K. , Marteijn Jurgen A. , Medema René H. , Kanaar Roland , Smits Veronique A. J.
Published: February 2013

In response to UV light single-stranded DNA intermediates coated by RPA are generated, which trigger the ATR-Chk1 checkpoint pathway. Recruitment/activation of several checkpoint proteins at the damaged sites is important for the subsequent cell cycle arrest. Surprisingly, upon UV irradiation, Rad9 and RPA only minimally accumulate at DNA lesions in G2 phase, suggesting that only few single-stranded DNA intermediates are generated. Also, little phosphorylated Chk1 is observed in G2 phase after UV-irradiation, and UV light fails to elicit efficient accumulation of typical DNA damage response proteins at sites of damage in this phase. In contrast, p38 MAPK is phosphorylated in G2 phase cells after UV damage. Interestingly, despite the lack of an obvious activation of the ATR-Chk1 pathway, only the combined inhibition of the ATR- and p38-dependent pathways results in a complete abrogation of the UV-induced G2/M arrest. This suggests that UV light induces less hazardous lesions in G2 phase or lesions created in this phase are less efficiently processed resulting in a low activation of the ATR-Chk1 pathway. UV-induced G2 checkpoint activation in this situation therefore relies on signalling via the p38 MAPK and ATR-Chk1 signalling cascades.
A complex containing LPP and α-Actinin mediates TGFβ-induced migration and invasion of ErbB2-expressing breast cancer cells
Authors: Ngan Elaine , Northey Jason J. , Brown Claire M. , Ursini-Siegel Josie , Siegel Peter M.
Published: February 2013

Transforming Growth Factor β is a potent modifier of the malignant phenotype in ErbB2-expressing breast cancers. We demonstrate that epithelial-derived breast cancer cells, which undergo a TGFβ-induced EMT, engage signaling molecules that normally facilitate cellular migration and invasion of mesenchymal cells. We identify Lipoma Preferred Partner (LPP) as an indispensable regulator of TGFβ-induced migration and invasion of ErbB2-expressing breast cancer cells. We show that LPP re-localizes to focal adhesion complexes upon TGFβ stimulation and is a critical determinant in TGFβ-mediated focal adhesion turnover. Finally, we have determined that the interaction between LPP and α-Actinin, an actin cross-linking protein, is necessary for TGFβ-induced migration and invasion of ErbB2-expressing breast cancer cells. Thus, our data reveals that LPP, which is normally operative in cells of mesenchymal origin, can be co-opted by breast cancer cells during an EMT to promote their migration and invasion.
Deregulated G1/S control and energy stress contribute to the synthetic lethal interactions between inactivation ofRBandTSC1/TSC2
Authors: Gordon Gabriel M. , Zhang Tianyi , Zhao Jiong , Du Wei
Published: February 2013

Synthetic lethality is a potential strategy for cancer treatment by specifically promoting the death of cancer cells with particular defects such as the loss of the RB tumor suppressor. We previously showed that inactivation of both RB and TSC2 induces synergistic apoptosis during Drosophila melanogaster development and in cancer cells. However, the in vivo mechanism of this synthetic lethal interaction is not clear. In this manuscript we show that synergistic cell death in tissues which have lost the RB and TSC1/TSC2 orthologs rbf and dtsc1/gig, or overexpress Rheb and dE2F1, are correlated with synergistic defects in G1/S control, which causes cells to accumulate DNA damage. Coexpression of the G1/S inhibitor Dap, but not the G2/M inhibitor dWee1, decreases DNA damage and reduces cell death. In addition, we show that rbf and dtsc1 mutant cells are under energy stress, are sensitive to decreased energy levels and depend on the cellular energy stress response pathway for survival. Decreasing mitochondrial ATP synthesis by inactivating cova or abrogating the energy stress response by removing the metabolic regulator LKB1 both enhance the elimination of cells lacking either rbf or dtsc1. These observations, in conjunction with the finding that deregulation of TORC1 induces JNK activation, indicate that multiple cellular stresses are induced and contribute to the synthetic lethal interactions between RB and TSC1/TSC2 inactivation. The insights gained from this study suggest new approaches targeting RB-deficient cancers.
Membrane and actin reorganization in electropulse-induced cell fusion
Authors: Gerisch Günther , Ecke Mary , Neujahr Ralph , Prassler Jana , Stengl Andreas , Hoffmann Max , Schwarz Ulrich S. , Neumann Eberhard
Published: February 2013

When cells of Dictyostelium discoideum are exposed to electric pulses they are induced to fuse, yielding motile polykaryotic cells. By combining electron microscopy and direct recording of fluorescent cells, we have studied the emergence of fusion pores in the membranes and the localization of actin to the cell cortex. In response to electric pulsing, the plasma membranes of two contiguous cells are turned into tangles of highly bent and interdigitated membranes. Live-imaging of cells double-labeled for membranes and filamentous actin revealed that actin is induced to polymerize in the fusion zone to temporally bridge the gaps in the vesiculating membrane. The diffusion of green fluorescent protein (GFP) from one fusion partner to the other was scored using spinning disc confocal microscopy. Fusion pores that allowed intercellular exchange of GFP were formed after a delay, which may last up to 24 seconds after exposure of the cells to the electric field. These data indicate that the membranes persist in a fusogenic state before pores of about 3 nm diameter are formed.
A Gaussian Kernel-Based Approach for Modeling Vehicle Headway Distributions
Authors: Zhang Guohui , Wang Yinhai
Published: February 2013

Headway distribution models are essential for studying traffic flow theory, roadway accidents, and microscopic traffic simulations. Previous work has focused on parametric models. Vehicle headways were considered to follow some known parametric distributions based on certain assumptions. However, these assumptions are not universally acceptable and, consequently, the reliability of those headway distribution models varies significantly when applied to different flow conditions. In this study, a nonparametric distribution model with Gaussian kernel functions is introduced and assessed for vehicle headways on urban multilane freeways. Without any assumptions, Gaussian kernel models can extract intrinsic patterns from observed headway data to describe the distributing attributes of headways. Experiments were conducted to evaluate the accuracy of Gaussian kernel models for modeling vehicle headways. Results from the experiments indicated that the proposed models outperformed traditional parametric methods in a wide range of flow rates. Furthermore, transferability tests of the nonparametric model were performed, and the results showed that the proposed models can be generalized for applications at other locations with similar traffic flow patterns.
Factors affecting late displacement following volar locking plate fixation for distal radial fractures in elderly female patients
Authors: Rhee S. H. , Kim J. , Lee Y. H. , Gong H. S. , Lee H. J. , Baek G. H.
Published: February 2013

The purpose of this study was to evaluate the risk of late displacement after the treatment of distal radial fractures with a locking volar plate, and to investigate the clinical and radiological factors that might correlate with re-displacement. From March 2007 to October 2009, 120 of an original cohort of 132 female patients with unstable fractures of the distal radius were treated with a volar locking plate, and were studied over a follow-up period of six months. In the immediate post-operative and final follow-up radiographs, late displacement was evaluated as judged by ulnar variance, radial inclination, and dorsal angulation. We also analysed the correlation of a variety of clinical and radiological factors with re-displacement. Ulnar variance was significantly overcorrected (p < 0.001) while radial inclination and dorsal angulation were undercorrected when compared statistically (p <  0.001) with the unaffected side in the immediate post-operative stage. During follow-up, radial shortening and dorsal angulation progressed statistically, but none had a value beyond the acceptable range. Bone mineral density measured at the proximal femur and the position of the screws in the subchondral region, correlated with slight progressive radial shortening, which was not clinically relevant.

Volar locking plating of distal radial fractures is a reliable form of treatment without substantial late displacement.

Cite this article: Bone Joint J 2013;95-B:396–400.
Residual pain due to soft-tissue impingement after uncomplicated total ankle replacement
Authors: Kim B. S. , Choi W. J. , Kim J. , Lee J. W.
Published: February 2013

We report the incidence and intensity of persistent pain in patients with an otherwise uncomplicated total ankle replacement (TAR). Arthroscopic debridement was performed in selected cases and the clinical outcome was analysed.

Among 120 uncomplicated TARs, there was persistent pain with a mean visual analogue scale (VAS) of 2.7 (0 to 8). The intensity of pain decreased in 115 ankles (95.8%). Exercise or walking for more than 30 minutes was the most common aggravating factor (62 ankles, 68.1%). The character of the pain was most commonly described as dull (50 ankles, 54.9%) and located on the medial aspect of the joint (43 ankles, 47.3%).

A total of seven ankles (5.8%) underwent subsequent arthroscopy. These patients had local symptoms and a VAS for pain ≥ 7 on exertion. Impingement with fibrosis and synovitis was confirmed. After debridement, the median VAS decreased from 7 to 3 and six patients were satisfied. The median VAS for pain and the American Orthopaedic Foot and Ankle Society score of the ankles after debridement was similar to that of the uncomplicated TARs (p = 0.496 and p = 0.066, respectively).

Although TAR reduces the intensity of pain, residual pain is not infrequent even in otherwise uncomplicated TARs and soft-tissue impingement is the possible cause.

Cite this article: Bone Joint J 2013;95-B:378–83.
Azithromycin for the Treatment of Gastroparesis
Authors: Potter Teresa G , Snider Kenneth R
Published: February 2013

OBJECTIVE

To evaluate the use of azithromycin for the treatment of gastroparesis.

DATA SOURCES

Literature was accessed through PubMed/MEDLINE and Web of Science (both 1966-October 2012) using the terms gastroparesis, diabetic gastroparesis, and azithromycin. Literature was limited to English-language publications. In addition, references from publications identified were reviewed.

STUDY SELECTION AND DATA EXTRACTION

All articles published in English identified from the data sources were evaluated.

DATA SYNTHESIS

The treatment of gastroparesis depends on the severity of the symptoms, but generally includes dietary modifications, prokinetic medications, and antiemetics. The initial treatment for gastroparesis is a prokinetic agent, and because erythromycin has the greatest effect on gastric emptying, it is often used. Limitations to erythromycin include adverse reactions (nausea, vomiting, and abdominal pain), QTc interval prolongation, CYP3A-associated drug interactions, and tachyphylaxis. Azithromycin, another macrolide, has been shown to increase gastrointestinal motility and may have fewer limitations to its use. Azithromycin has fewer drug interactions, less incidence of QTc interval prolongation, a longer half-life, and fewer gastrointestinal adverse effects. Use of azithromycin may be beneficial in patients with gastric and small bowel dysmotility. Two observational studies have supported its use in gastroparesis, but there have been no controlled studies. All studies published have been performed during testing procedures for gastroparesis; thus, longer-term treatment effects and symptom control need to be studied. There is one ongoing prospective controlled trial with preliminary data available only in abstract form.

CONCLUSIONS

Azithromycin may prove to be an alternative prokinetic agent in gastroparesis, but further study is needed before it can be recommended.
Tranexamic Acid–Induced Toxic Epidermal Necrolysis
Authors: Irazabal Maider Pretel , Martin Laura Marques , Gil Leyre Aguado , Gastearena Miguel Angel Idoate
Published: February 2013

OBJECTIVE

To report a case of toxic epidermal necrolysis (TEN) induced by orally administered tranexamic acid in a patient with liver cirrhosis and acute rectal bleeding.

CASE SUMMARY

A 67-year-old male with a history of liver cirrhosis due to alcohol consumption with ascitic decompensation, esophageal varices, and multifactorial renal insufficiency presented with rectal bleeding. The patient was prescribed oral tranexamic acid (1000 mg every 8 hours), with partial resolution of symptoms. Te n days after treatment with tranexamic acid began, a purplish macular rash appeared over the patient's trunk. The dose of tranexamic acid was reduced to 1000 mg every 12 hours, adjusting for renal function. In the following days the lesions extended and became confluent with blisters and epidermal necrosis. Multiple mucosal surfaces were also affected. He denied allergies to any medications and had no history of tranexamic acid exposure. Treatment with tranexamic acid was suspended and fluid replacement therapy, oral prednisone therapy (0.4 mg/kg per day), and N-acetylcysteine 2 g every 6 hours was started, with the empiric diagnosis of TEN. Results of a skin biopsy were compatible with TEN. Resolution of the skin lesions was favorable, but after 2 weeks the patient died secondary to acute renal failure, respiratory infection, and multiorgan failure.

DISCUSSION

TEN is a rare, severe mucocutaneous adverse reaction. Although infrequent, TEN has a significant impact on public health because of its high mortality. Its pathogenesis is unclear, but it seems to be a form of delayed hypersensitivity. To our knowledge, a well-documented case of TEN following tranexamic acid use has not been reported (MEDLINE search to June 2012). There have been recent reports of skin hypersensitivity reactions through different mechanisms (immunologic and nonimmunologic). The Naranjo probability scale indicates a probable relationship between the development of TEN and tranexamic acid use in our patient.

CONCLUSIONS

This appears to be the first report of a case of TEN that occurred in a patient being treated with oral tranexamic acid. Clinicians should be made aware of this potential severe cutaneous adverse reaction that may be caused by tranexamic acid administration.
The Effect of In-Store Travel Distance on Unplanned Spending: Applications to Mobile Promotion Strategies
Authors: Hui Sam K. , Inman J. Jeffrey , Huang Yanliu , Suher Jacob
Published: February 2013

Typically, shoppers’ paths only cover less than half of the areas in a grocery store. Given that shoppers often use physical products in the store as external memory cues, encouraging shoppers to travel more of the store may increase unplanned spending. Estimating the direct effect of in-store travel distance on unplanned spending, however, is complicated by the difficulty of collecting in-store path data and the endogeneity of in-store travel distance. To address both issues, the authors collect a novel data set using in-store radio frequency identification tracking and develop an instrumental variable approach to account for endogeneity. Their analysis reveals that the elasticity of unplanned spending on travel distance is 57% higher than the uncorrected ordinary least squares estimate. Simulations based on the authors’ estimates suggest that strategically promoting three product categories through mobile promotion could increase unplanned spending by 16.1%, compared with the estimated effect of a benchmark strategy based on relocating three destination categories (7.2%). Furthermore, the authors conduct a field experiment to assess the effectiveness of mobile promotions and find that a coupon that required shoppers to travel farther from their planned path resulted in a substantial increase in unplanned spending ($21.29) over a coupon for an unplanned category near their planned path ($13.83). The results suggest that targeted mobile promotions aimed at increasing in-store path length can increase unplanned spending.
Health and educational performance among young migrants
Authors: Kirkcaldy Bruce David , Furnham Adrian , Siefen Rainer Georg
Published: February 2013

This study is a part replication of an earlier study by on health efficacy, educational attainment and well-being among 30 nations. It includes, however, data from these nations, as well as the latest Pisa results and update socioeconomic data and sociological variables which include divorce rate, number of persons/household, employment rates, and measures of physical and mental health (including new scales of well-being, e.g., mental health index, life satisfaction, suicide rates). More importantly, it includes measures of migrant rates among children and adults in each country, the focus of attention of this article. New material on health and educational expenditure are provided.
Adolescent suicide: characterizing the need and identifying the predictive factors for preventive consultation or hospitalization in a rural community setting
Authors: Nair Muttathu K.C. , Russell Paul S.S. , Shankar Satya R. , Subramaniam Vinod S. , Nazeema Suma , Mammen Priya , Chembagam Neethu
Published: February 2013

Background: Studies from India consistently document the highest suicide rates in the world, and the majority of completed suicides had been within adolescents.

Objective: To characterize the need and identify the predictive factors for preventive consultation or hospitalization for adolescent suicide in a community setting.

Subjects: We prospectively collected data from 500 adolescents in a rural South Indian community with independent, trained raters.

Methods: The need for suicide prevention was measured with the SAD PERSONS scale, socio-economic status with the Modified Kuppusamy Scale, depression and anxiety disorders with the Beck Depression Inventory and the Screen for Child Anxiety Related Emotional Disorders, respectively. The relationship between predictors and the need for preventive action was analyzed with univariate and multivariate regression analyses and a predictive model was built.

Results: Of those investigated, 2% and 0.6% required emergency consultation and hospitalization, respectively. Males needed more preventive action (p=0.04). Age (OR=3.40, p=0.07), gender (OR=3.13, p=0.05), presence of anxiety (OR=16.35, p=0.001), or depressive (OR=42.59, p=0.001) disorder independently predicted a need for protective action and, together, contributed to a parsimonious predictive model.

Conclusions: The majority of adolescents in the community do not require preventive steps to address suicide risk. These predictors could identify the high-risk adolescents for suicide prevention and reduce the burden of care in the community.
Developmental outcomes of economically disadvantaged adolescents in Hong Kong: a replication
Authors: Shek Daniel T.L. , Tsui Pik-fong
Published: February 2013

The purpose of this study is to examine the relationships between economic disadvantage and adolescent and developmental outcomes as well as perceived family qualities in 3580 Secondary 2 students in Hong Kong. Developmental outcomes include positive youth development constructs, problem behavior and drug taking behavior, whereas perceived family qualities include perceived family interaction and parental parenting. Generally speaking, poor and non-poor adolescents differ in terms of overall positive youth development and family life quality. Although adolescents experiencing poverty do not display significant differences from non-poor adolescents in terms of risk behavior and psychosocial competencies, adolescents with economic disadvantage show lower levels of positive identity, family interaction, and perceived paternal parenting than do those without economic disadvantage.
Impact of GH replacement therapy on sleep in adult patients with GH deficiency of pituitary origin
Authors: Morselli Lisa L , Nedeltcheva Arlet , Leproult Rachel , Spiegel Karine , Martino Enio , Legros Jean-Jacques , Weiss Roy E , Mockel Jean , Van Cauter Eve , Copinschi Georges
Published: February 2013

Objectives

We previously reported that adult patients with GH deficiency (GHD) due to a confirmed or likely pituitary defect, compared with healthy controls individually matched for age, gender, and BMI, have more slow-wave sleep (SWS) and higher delta activity (a marker of SWS intensity). Here, we examined the impact of recombinant human GH (rhGH) therapy, compared with placebo, on objective sleep quality in a subset of patients from the same cohort.

Design

Single-blind, randomized, crossover design study.

Methods

Fourteen patients with untreated GHD of confirmed or likely pituitary origin, aged 22–74 years, participated in the study. Patients with associated hormonal deficiencies were on appropriate replacement therapy. Polygraphic sleep recordings, with bedtimes individually tailored to habitual sleep times, were performed after 4 months on rhGH or placebo.

Results

Valid data were obtained in 13 patients. At the end of the rhGH treatment period, patients had a shorter sleep period time than at the end of the placebo period (479±11 vs 431±19 min respectively;P=0.005), primarily due to an earlier wake-up time, and a decrease in the intensity of SWS (delta activity) (559±125 vs 794±219 μV2respectively;P=0.048).

Conclusions

Four months of rhGH replacement therapy partly reversed sleep disturbances previously observed in untreated patients. The decrease in delta activity associated with rhGH treatment adds further evidence to the hypothesis that the excess of high-intensity SWS observed in untreated pituitary GHD patients is likely to result from overactivity of the hypothalamic GHRH system due to the lack of negative feedback inhibition by GH.
Imprinted genes in mouse placental development and the regulation of fetal energy stores
Authors: Tunster S J , Jensen A B , John R M
Published: February 2013

Imprinted genes, which are preferentially expressed from one or other parental chromosome as a consequence of epigenetic events in the germline, are known to functionally converge on biological processes that enablein uterodevelopment in mammals. Over 100 imprinted genes have been identified in the mouse, the majority of which are both expressed and imprinted in the placenta. The purpose of this review is to provide a summary of the current knowledge regarding imprinted gene function in the mouse placenta. Few imprinted genes have been assessed with respect to their dosage-related action in the placenta. Nonetheless, current data indicate that imprinted genes converge on two key functions of the placenta, nutrient transport and placental signalling. Murine studies may provide a greater understanding of certain human pathologies, including low birth weight and the programming of metabolic diseases in the adult, and complications of pregnancy, such as pre-eclampsia and gestational diabetes, resulting from fetuses carrying abnormal imprints.
Polineuropatias determinadas por tuberculostaticos: estudo da condução nervosa motora em 29 pacientes
Authors: Werneck Lineu Cesar
Published: February 2013

É relatado o estudo eletrográfico realizado durante tratamento com hidrazida, em 29 pacientes, cujas idades variaram entre 16 e 70 anos, abrangendo um período de 12 meses. Foi verificada a condução nervosa motora nos nervos mediano, ulnar e peroneiro lateral. A análise estatística não forneceu dados signiciantes no período de 6 meses, nos nervos mediano e peroneiro lateral, com p > 0,05, embora tenha ocorrido diminuição da velocidade de condução nervosa motora no período de 12 meses. Este último fato também ocorreu com o nervo ulnar, sendo que p < 0,01, portanto significante, mas de difícil valorização. Não foi possível correlacionar os achados clínicos e os valores obtidos na determinação da condução nervosa motora. O autor acredita que a determinação da condução nervosa motora não é útil para detectar precocemente neuropatias nos pacientes em tratamento com hidrazida.
Craniotomia descompressiva no edema cerebral grave: a propósito de 30 casos operados
Authors: Silva José A. Gonçalves da , Silva Cláudio E. Gonçalves da , Sousa Maricélia B. Rodrigues
Published: February 2013

Craniotomia descompressiva uni ou bilateral foi empregada como tratamento paliativo em 30 casos de edema cerebral grave de etiologia predominantemente traumática. Coma, midríase e descerebração caracterizaram o quadro clínico na maioria dos casos. A sobrevida foi de 46,6%.
Consideraciones sobre el hidrocefalo de baja presion
Authors: Herskovits E. , Matera Jr. R. , Matera R.
Published: February 2013

Se analizan las condiciones fisiopatológicas del sindrome de hidrocéfalo de presión normal. De un grupo de 21 pacientes con sintomatologia clínica correspondiente a esta entidad, se seleccionan 10 que presentan un diagnóstico clínico, radiológico y cisternográfico indudable de la entidad en estudio. Se observó que, a pesar de esta selección solamente un 50% de ellos se vió beneficiado con la colocación de una válvula de baja presión. Surge entonces la hipotésis de que este cuadro es un sindrome multicausal; que por un proceso fisiopatogenico común produce un cuadro clínico, radiológico y cisternográfico similar y que serían beneficiados únicamente aquellos enfermos en los que se soluciona el problema mecánico.
Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients
Authors: Oki Gláucia Celeste Rossatto , Pavin Elizabeth João , Coelho Otávio Rizzi , Parisi Maria Cândida R. , Almeida Raitany C. , Etchebehere Elba Cristina Sá de Camargo , Camargo Edwaldo Eduardo , Ramos Celso Dario
Published: February 2013

OBJECTIVE: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. MATERIALS AND METHODS: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with 99mTc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. RESULTS: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). CONCLUSION: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia.
Prevalência de pielonefrite aguda e incidência de cicatriz renal em crianças menores de dois anos de idade com infecção do trato urinário avaliadas por cintilografia renal com 99mTc-DMSA: a experiência de um hospital universitário
Authors: Berdichevski Eduardo Herz , Mattos Silvia Gelpi , Bezerra Sofia , Vilas Eduardo Rosito de , Baldisserotto Matteo
Published: February 2013

OBJETIVO: Calcular as frequências de pielonefrite aguda e cicatriz renal em pacientes menores de dois anos com cintilografia renal com 99mTc-DMSA com primeiro quadro de infecção do trato urinário em hospital universitário brasileiro, comparando com dados da literatura internacional. MATERIAIS E MÉTODOS: Foram revisados laudos cintilográficos de crianças menores de dois anos de idade que realizaram cintilografia renal com 99mTc-DMSA em um hospital universitário no Rio Grande do Sul, entre 2006 e 2009, para pesquisa de pielonefrite aguda/cicatriz renal. Revisaram-se a presença de refluxo vesicoureteral, o uso precoce de antibiótico, e a presença de comorbidades que constassem nos prontuários eletrônicos. Calculou-se a amostra com base num estudo de revisão sistemática e obteve-se um mínimo de 147 pacientes. Excluíram-se pacientes sem registro eletrônico. RESULTADOS: Cento e cinquenta e sete crianças preencheram critérios de inclusão do estudo, 48 tiveram pielonefrite aguda e 8 destas apresentaram cicatriz renal. Nem a idade nem o gênero dos pacientes apresentaram associação significativa com pielonefrite aguda (p = 0,405 e p = 0,124, respectivamente). Não houve diferença estatística nas associações de refluxo vesicoureteral e pielonefrite aguda (p = 1,0) e outras comorbidades (p = 0,470) e em relação ao uso precoce de antibiótico com pielonefrite aguda (p = 0,130) e cicatriz renal (p = 0,720). CONCLUSÃO: As frequências de pielonefrite aguda e cicatriz renal obtidas concordam com os resultados da maioria dos estudos publicados.