bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental health problems, negative life events, perceived pressure and the frequency of acute infections among adolescents Results from a cross‐sectional, multicultural, population‐based study
Authors: Lien Lars , Rikard Haavet Ole , Thoresen Magne , Heyerdahl Sonja , Bjertness Espen
Published: April 2008

Aim: To study the association between mental health problems, negative life events, perceived pressure at school and the frequency of acute infectious illnesses in an adolescent population, and to explore whether the association differs by sex and immigration status.

Methods: A cross‐sectional study involving all tenth grade pupils in Oslo in 2000 and 2001. Of 8316 eligible pupils, 7346 participated in the study, giving a participation rate of 88%. Twenty‐four percent of participants were first‐ or second‐generation immigrants.

Results: Mental health problems and negative life events were associated with the number of acute infections in a population‐based setting, even after adjustment for possible confounding factors. For girls with an immigrant background, internalised mental health problems and own serious illness or injury had the strongest association with acute infections. For adolescents with a non‐immigrant background, experiencing sexual violence had the strongest association, and for native‐born boys the strongest association with acute infections was externalised mental health problems. Smoking was the cofactor with the strongest association to acute infections.

Conclusion: There is a relationship between acute infection, mental health problems and negative life events among adolescents in a multicultural population‐based setting.
Is the mattress important in helping babies keep warm?—Paradoxical effects of a sleeping surface with negligible thermal resistance
Authors: Arkell Sara , Blair Pete , Henderson John , Fleming Peter
Published: April 2008

Background: Heavy wrapping and head covering are risk factors for Sudden Infant Death Syndrome. A new mattress construction, PurFlo®, has extremely low thermal resistance, and when used with an infant sleeping bag minimizes the risk of head covering.

Aim: To investigate the thermal balance and metabolic rate of infants sleeping on a conventional mattress or a Purflo® mattress in infant sleeping bags.

Methods: A longitudinal study of thermal balance of infants during day‐time sleep on both mattress types in thermoneutral and cool conditions at ages 3 weeks (n = 24), 3 months (n = 22) and 5 months (n = 18).

Results: In thermoneutral conditions axillary temperatures in quiet sleep were lower on the conventional mattress than on the PurFlo® mattress (p < 0.05, Wilcoxon test). On lowering room temperature to 15–16°C axillary temperatures fell, particularly in the older babies, and at each age were lower on the conventional mattress than the Purflo® (differences 0.14–0.72°C, p < 0.05, Wilcoxon test).

Conclusion: In both thermoneutral and cool conditions, infant temperatures were higher on the PurFlo® than the conventional mattress. The more deformable surface of the PurFlo® mattress may lead to more effective insulation by the sleeping bag despite a lack of mattress insulation.
MRSA in children from foreign countries adopted to Swedish families
Authors: Gustafsson EB , Ringberg H , Johansson PJH
Published: April 2008

Aim: To determine if children adopted to Swedish families from countries with a high carrier rate of methicillin‐resistant Staphylococcus aureus (MRSA) are infected or colonized with MRSA.

Methods: From January 2000 to May 2005, 23 adopted children from 6 countries were examined for MRSA at the University hospital in Lund after their arrival in Sweden.

Results: Thirteen of the 23 children (57%) were MRSA positive with a median age of the children at the time MRSA was detected of 6 (range 3–16) months. All MRSA positive children had a history of hospitalization in their native country before arriving in Sweden. The throat was the most frequent and persistent site where MRSA was seen while in sites such as the anterior nares and perineum, MRSA was found more intermittently. The MRSA‐positive children were adopted into 13 Swedish families and in 3 families, 6 of 10 family members became MRSA positive.

Conclusion: Children adopted from foreign countries to Swedish families and with a history of hospitalization in their native country were commonly colonized with MRSA. The throat was the most frequent site colonized and transmission of MRSA from adopted children to other family members occurred.
Apgar score predicts short‐term outcome in infants born at 25 gestational weeks
Authors: Forsblad Kristina , Källén Karin , Maršál Karel , Hellström‐Westas Lena
Published: April 2008

Aim: To identify early predictors of outcome in infants born at 25 gestational weeks.

Material and Methods: Data from a regional perinatal database (time‐period 1995–2001, total n = 108 000 births) were used. Apgar scores were available in 92 preterm infants, born at 25 + 0 to 25 + 6 gestational weeks, and analyzed in relation to short‐term outcome (180‐day survival with, or without, severe brain damage defined as intraventricular hemorrhage grade 3–4 or cystic periventricular leukomalacia). Based on multiple logistic regression analyses we constructed graphs of the estimated chance of survival.

Results: Apgar scores at 1, 5 and 10 min correlated with survival without severe brain damage (p = 0.02, 0.006 and 0.006, respectively). Survival without severe brain damage was higher in singleton than in multiple births (p = 0.03); there was no association with infant gender or mode of delivery. The strongest model for prediction of survival without severe brain damage was based on 5‐min Apgar score and the Clinical Risk Index for Babies (CRIB), (p < 0.001).

Conclusion: Apgar score predicts short‐term outcome in extremely preterm infants at 25 gestational weeks. The precision for prediction of outcome increases when Apgar score is combined with CRIB.
Dieting in children: a population‐based study in children aged between 9 and 12 years
Authors: Dousma Mieke , Wierdsma Nienke , Van Ede Jaap , Van Buuren Stef , Heijmans Hugo S A , De Vries Tjalling W.
Published: April 2008

Aim: Dieting can be a burden for the child and can have side effects. Insight into dieting is therefore important. A recent study showed that 13.7% (95% CI 11.5–15.9%) of the children referred to a general paediatric outpatient clinic were or had been on a diet. However, it is unknown how many children in a random population are or have been on a diet.

Methods: Parents of children in the fifth grade of primary schools in the Dutch province of Friesland were asked to complete a structured questionnaire.

Results: From 2500 questionnaires 90% were returned. Two hundred and thirty‐one children aged between 9 and 12 years had been on a diet (10.3%, 95% CI 9.0%–11.6%). A cow's milk free diet was used most frequently (50% of the dieting children). Other diets were: diets excluding additives (16%), peanuts (16%), sugar (15%) and lactose (11%).

Conclusion: The use of diets by children in a general population is widespread: one in every ten children was or had been on a diet. Due to the known health risks associated with diets excluding one or more foods, such diets should only be advised by healthcare professionals.
Perceived pubertal timing, pubertal status and the prevalence of alcohol drinking and cigarette smoking in early and late adolescence: a population based study of 8950 Norwegian boys and girls
Authors: Bratberg Grete H. , Nilsen Tom I L , Holmen Turid L , Vatten Lars J
Published: April 2008

Aim: To study whether perceived pubertal timing is related to the prevalence of alcohol drinking and cigarette smoking among adolescent boys and girls.

Methods: The Young‐HUNT study (95–97), conducted in Nord‐Trøndelag County in Norway, comprises information from 8950 students, aged 13–19 years. Odds ratios (OR) with 95% confidence intervals (CI) related to alcohol drinking and cigarette smoking were estimated by logistic regression analyses.

Results: Boys and girls who perceived themselves as early matured were more likely to report more risky drinking than those who perceived themselves as being on time, both in middle school and high school. A nearly identical pattern was found for smoking. However, boys in middle school, who perceived themselves as late, were more likely to smoke than those who were on time.

Conclusion: In both genders, perceived early maturation was associated with increased risk behaviour involvement. Perceptions of being early in combination with high pubertal status yielded the highest prevalence of alcohol and tobacco use.
Is serum troponin T a useful marker of myocardial damage in newborn infants with perinatal asphyxia?
Authors: Costa S. , Zecca E , De Rosa G , De Luca D , Barbato G , Pardeo M , Romagnoli C
Published: April 2008

Aim: To assess the correlation of echocardiographic signs of myocardial damage to serum cardiac troponin T (cTnT) concentrations in newborn infants with perinatal asphyxia.

Methods: Electocardiograms (ECG) and echocardiograms (Echo) were obtained during the first 24 h of life from 29 asphyxiated and 30 control infants and correlated with cTnT concentrations. The echocardiographic parameters included systolic ventricular performance, preload, afterload, diastolic function, stroke volume (SV), left ventricular output (LVO), hyperechogenity of the papillary muscles and insufficiency of the atrioventricular valves.

Results: LVO and SV were lower but CTnT were significantly higher in asphyxiated than in control infants: 0.15 (010–0.23) vs. 0.05 (0.02–0.13), p < 0.001). Asphyxiated infants with signs of myocardial damage were associated with significantly higher cTnT than those without, 0.20 (0.11–0.28) and 0.11 (0.05–0.14 ug/L), p = 0.04.

Conclusion: Cardiac troponin may prove to be valuable in evaluating myocardial damage in birth asphyxia. However, the degree of prematurity may complicate the assessment.
Successful therapy of paediatric ethylene glycol poisoning: a case report and annual survey by a regional poison centre
Authors: Schwerk Nicolaus , Desel Herbert , Schulz Manuela , Schwerk Christina , Kiess Wieland , Siekmeyer Werner
Published: April 2008

Severe poisoning with ethylene glycol, often used as antifreeze, is a rare, life‐threatening event. Neurological symptoms are accompanied by metabolic acidosis with elevated anion gap and osmotic gap.

We report on a 7‐year‐old boy suffering from severe ethylene glycol intoxication. Early diagnosis based on typical clinical signs and rapid initiation of specific therapy with ethanol resulted in complete and rapid recovery without haemodialysis becoming necessary. While one laboratory initially had not been able to detect ethylene glycol in the patient's blood, an ethylene glycol serum level of 3900 mg/L was measured by a second laboratory, the highest value ever reported in the scientific literature for paediatric cases. Ethylene glycol poisoning is verified by quantitative glycol analysis in serum, but only few laboratories are able to perform this investigation in emergency cases. Therefore, in the beginning diagnosis has to be based on patient's history and clinical signs. Every substantial suspicion of ethylene glycol poisoning has to be treated with an antidote (fomepizole or ethanol) immediately.

Conclusion: Ethylene glycol poisoning is rare in the paediatric age group in our series of glycol poisonings. One should keep in mind, that early diagnosis and treatment due to clinical signs is important and haemodialysis usually is not necessary.
Nutritional state of Polish prepubertal children assessed by population‐specific and international standards
Authors: Matusik P. , Malecka‐Tendera E. , Klimek K ,   Polish Childhood Obesity Study Group
Published: April 2008

Objective: To assess the frequency of obesity, overweight and underweight (thinness) in Polish 7–9‐year‐old children using a population specific definition as compared to the French, US and IOTF references based on body mass index (BMI).

Design: Height and weight were measured and BMI was calculated in a randomly selected representative sample of 7–9‐year‐old Polish children (N = 2916; 1445 girls; 1471 boys) to define their nutritional status. Overweight (including obesity) was estimated according to four and underweight (thinness) according to three definitions Polish national references; French references; United States references and International Obesity Task Force references.

Results: According to Polish, French, U.S. and IOTF references overweight (including obesity) was found in 12.1, 14.3, 20.7 and 15.4% of children, respectively; 3.5, 9.4 and 3.6% of children were obese according to national, U.S. and IOTF references, respectively while underweight (thinness) was present in 6.9, 2.6 and 4.2% of children according to Polish, French and U.S. references, respectively. A trend of decreasing overweight and increasing underweight through age classes was observed.

Conclusion: The rates of underweight (thinness), overweight and obesity in Polish 7–9‐year‐old children calculated according to the national, French, U.S. and IOTF references were significantly different. Therefore even if the IOTF reference is considered superior for international epidemiological studies, population specific standards should probably coexist for clinical practice.
Childhood deaths due to electrocution in Adana, Turkey
Authors: Akçan R , Hilal A , Gülmen MK , Çekin N
Published: April 2008

Aim: This retrospective study was conducted to determine the general features of childhood deaths due to electrocution, and draw the attention of community to these preventable deaths.

Methods: The autopsy records of the Morgue of the Adana Branch of the Turkish Forensic Medicine Council were used. Thirty‐seven cases of childhood (under 18) electrocution during the period 1999–2004 were analyzed.

Results: Electrocution deaths comprised 0.8% of all the medico‐legal autopsy cases (4515) during these 6 years. Thirty‐one (83.8%) of the victims were male and only six (16.2%) were female. They were between 18 months and 18 years of age, and the mean age was 11.35, and all deaths were recorded as accidental.

Conclusion: Medical units, and paramedical and educational centres should play important roles in formulating public health strategies to tackle preventable deaths such as electrocution.
MRI and ultrasound for hepatic fat quantification:relationships to clinical and metabolic characteristics of pediatric nonalcoholic fatty liver disease
Authors: Pacifico Lucia , Celestre Michela , Anania Caterina , Paolantonio Pasquale , Chiesa Claudio , Laghi Andrea
Published: April 2008

Objective: The aims of this study were to evaluate hepatic steatosis severity in a series of obese children through both magnetic resonance imaging (MRI) and ultrasound, and to correlate imaging findings to clinical and metabolic characteristics of the study population.

Methods: Fifty obese children presenting hepatomegaly and/or elevated aminotransferases were candidates for assessment of hepatic fat fraction (HFF) by MRI. All subjects underwent dual energy X‐ray absorptiometry scan measurement, and liver ultrasound scanning. Fasting blood samples were taken for the estimation of serum concentrations of glucose, insulin, leptin, aminotransferases and serum lipid profile.

Results: A diagnosis of fatty liver was established by MRI in 20 (40%) children; of these, 12 had HFF of 9–18%, while the remaining ones had HFF of 19% or higher. HFF was not correlated to age, SDS‐BMI, pubertal status and fat mass. HFF was positively associated with serum concentrations of alanine aminotransferase (ALT; r = 0.62; p < 0.0001) and AST (r = 0.39; p = 0.006), as well as with insulin (r = 0.44; p = 0.001) and insulin resistance (r = 0.49; p < 0.0001). Overall, ultrasound correlated well with MRI (p < 0.0001). However, HFF ranged greatly in subjects with moderate (2–37%) as well as with severe (11–25%) degree of ultrasound hepatic steatosis. In fact, the mean hepatic fat fraction in children with severe steatosis was not statistically different from that found in patients with moderate steatosis (p = 0.98). In multiple regression analysis, the most powerful predictors of elevated ALT, after correction for age, gender, BMI and pubertal status, were insulin resistance (p < 0.01) and MRI HFF (p < 0.0001).

Conclusions: Unlike sonography, an operator‐dependent procedure, MRI is not subject to interpretation or inter‐observer variation, and may be more useful than ultrasound for the monitoring of young patients with hepatic steatosis.
Transmission of cytomegalovirus to extremely preterm infants through breast milk
Authors: Omarsdottir Soley , Casper Charlotte , Zweygberg Wirgart Benita , Grillner Lena , Vanpée Mireille
Published: April 2008

Aim: To evaluate the rate and clinical expression of postnatal cytomegalovirus (CMV) infection transmitted through breast milk in extremely preterm infants.

Methods: Ten extremely preterm infants and their six mothers were included. Maternal CMV serology was determined. Breast milk samples and urine samples from the infants were screened for CMV. Symptoms and laboratory findings of CMV infected infants were documented. All infants received partly fresh and/or defrosted breast milk.

Results: CMV‐DNA was found in breast milk in four of five CMV‐seropositive mothers. Two infants were infected by CMV. They were the only infants fed with breast milk positive for viral culture. One infant developed hepatic affection concurrent with viral excretion in urine. This infant was later diagnosed with cystic fibrosis.

Conclusion: This study supports that CMV transmission through breast milk can aggravate the clinical course in extremely preterm infants with preexisting hepatic conditions.
Acute and recurrent pancreatitis in children: etiological factors
Authors: Sánchez‐Ramírez Carmen A , Larrosa‐Haro Alfredo , Flores‐Martínez Silvia , Sánchez‐Corona José , Villa‐Gómez Alejandra , Macías‐Rosales Rocío
Published: April 2008

Objectives: To describe the clinical picture and outcome, and to assess the etiological factors of acute and recurrent pancreatitis in children.

Methods: Thirty‐six (65.5%) patients with acute and 19 (34.5%) with recurrent pancreatitis were studied. Mean age was 126 (41.3 SD) months; 27 (49.1%) were females. Setting: a pediatric referral hospital. Period: 2000–2005. Design: cross‐sectional. Variables: clinical and laboratory data and etiological factors. Statistics: χ2‐test, Fisher test, OR, confidence interval, Student t‐test and Mann–Whitney U‐test.

Results: The most frequent symptom in acute and recurrent pancreatitis was abdominal pain, followed by vomiting and ileus. The severity of pancreatitis and complications were similar in both groups. Biliary stones, family history of pancreatitis, drug ingestion and hypercalcemia occurred in both groups. Abdominal trauma and acute hepatitis A occurred in patients with acute pancreatitis; triglyceride >5.65 mmol/L, pancreas divisum and ΔF508 mutation occurred in patients with recurrent pancreatitis. No difference was observed when frequency factors between study groups were compared.

Conclusions: The clinical picture and etiological factors were similar in both groups. Since one out of every three children with acute pancreatitis in this series presented recurrences, it was not considered to be a ‘benign disease'. Fifteen different etiological factors were identified in two‐thirds of the cases.
Recurrent abdominal pain in school children: effect of obesity and diet
Authors: Malaty Hoda M. , Abudayyeh Suhaib , Fraley Ken , Graham David Y. , Gilger Mark A. , Hollier David R.
Published: April 2008

Aims: To study the epidemiology and some of the risk factors of childhood recurrent abdominal pain (RAP) in school age children.

Methods: We used a questionnaire concerning socioeconomic parameters, intensity, frequency, duration, nature of RAP and anthropometric measures. We used several criteria to identify RAP and the Wong‐Baker FACES scale for pain intensity and calculated the gender/age‐specific body mass index (BMI) Z‐score using NCHS standards. Obesity was defined as a BMI ≥95th percentile for age and gender.

Results: A total of 925 children mean age of 9.5 years completed and returned the questionnaires. The prevalence of RAP was 24%; 22% among boys versus 26% among girls (p = 0.28) and reached its peak among children aged 7–9 (29%) years. Children with BMI ≥95% percentile reported more RAP compared to those not obese (33.3% vs. 22.5%) (OR = 1.8, p = 0.01). There was an inverse correlation between fruit consumption and RAP prevalence with 20% among children reporting more than three serving of fruit per week compared to 40% of those who did not consume any fruits (p < 0.002). Logistic regression analysis confirmed BMI ≥95th percentile and low consumption of fruits are significant risk factors for RAP.

Conclusions: There is a significant association between RAP and obesity and both conditions are prevalent among children in this population. Understanding more about the co‐morbidity between RAP and obesity could have important implications on RAP management and treatment.
Practicing Women: The Matter of Women in Medieval English Literature
Authors: Robertson Elizabeth Ann
Published: April 2008

This essay provides a survey of women in medieval English literature through the lens of the various ways matter signifies for an understanding of the representation of women in literature of the period and their identity as authors. The Aristotelian cultural assumption that women are associated with matter rather than form profoundly influences the ways in which women are represented in medieval literary works. That cultural assumption is unsettled by the changing material conditions of women in late medieval England and even further complicated when women become authorial subjects. Finally, textual representations are materially influenced by the increasingly prominent role women play in the production and consumption of texts.
Postmastectomy reconstruction with extended latissimus dorsi myocutaneous flap for Hong Kong Chinese
Authors: Chow Tam‐Lin , Chan Tony Tung‐Fei , Chan Sharon Wing‐Wai , Lam Siu‐Ho
Published: April 2008

Objective:  Because of the smaller breast size of Chinese women, postmastectomy reconstruction without prosthesis by extended latissimus dorsi (LD) flap is potentially more applicable in the Chinese population.

Methods:  Patients who had undergone immediate postmastectomy breast reconstruction by extended latissimus dorsi flap without prosthesis were retrospectively studied. Surgical complications, aesthetic result and patient satisfaction were evaluated.

Results:  Ten Asian patients (nine Chinese and one Filipino) underwent extended LD flap for breast reconstruction after mastectomy. There was no total or partial flap failure. Operative complications included seroma in one patient and minor wound edge slough at back wounds in two patients. Simultaneous seroma and minor donor wound slough occurred in another patient. Aesthetic outcome was excellent (n = 5), good (n = 4) and poor (n = 1). Patient satisfaction with the procedure was very satisfied in four, satisfied in four and dissatisfied in two, respectively. All but two patients would recommend the same procedure to their friends or relatives.

Conclusion:  Extended LD flap can reliably achieve pleasing results with low morbidity. It has more potential to become a competitive alternative to transverse abdominis myocutaneous flap in most Chinese women for postmastectomy reconstruction.
Ischaemic colitis in an ironman triathlete: A case report and review of the literature
Authors: O'Neill Christine J. , Gan John
Published: April 2008

Participation in endurance sports is growing and gastrointestinal complaints including abdominal pain and rectal bleeding are common. The most severe lower gastrointestinal complication of endurance sport is ischaemic colitis. Only a few cases have been reported, all in amateur long distance runners. The majority of cases involve the right colon and, if diagnosed early and managed appropriately, few patients require operative intervention. A 51‐year‐old male presented 24 h after completing an ironman triathlon with severe right‐sided abdominal pain and bloody diarrhoea. Computed tomography confirmed right‐sided ischaemic colitis. Conservative management with intravenous rehydration and antibiotics led to the complete resolution of his symptoms over a 72 h period. Participation in endurance sport is increasing and awareness of its complications is important. In the case of ischaemic colitis related to extreme exertion, early recognition and appropriate management will decrease the risk of potentially life‐threatening complications.
Recurrence and survival for hepatocellular carcinoma after curative resection: Tertiary centre experience
Authors: Li Wing‐Hong , Cheung Moon‐Tong
Published: April 2008

Aim:  The aim of the present paper was to determine the pattern of recurrence and prediction for survival after primary curative surgical resection of hepatocellular carcinoma (HCC).

Methods:  This was a retrospective single institutional review. During 2002–2005, 197 patients had hepatectomies at Queen Elizabeth Hospital The total number of patients with primary curative liver resection was 113, and 103 patients were included in this survival analysis.

Results:  The recurrence rate was 49/103 (47.6%). The operative mortality rate was 4/113 (3.5%). The median time for recurrence was 13.5 months (range, 1–60 months). The mean follow‐up period was 26.03 months (range, 1–60 months).Overall survival was 90%, 72% and 50%, at 1, 3 and 5 years, respectively, and disease‐free survival was 55%, 48% and 42%, at 1, 3 and 5 years, respectively. On univariate analysis, tumour > 10 cm, close (≤ 1 mm)/focally involved/involved resection margin, operative blood loss > 2500 mL, presence of satellite tumour nodules, vascular invasion and poor tumour differentiation were found to be associated with recurrence. On multivariate analysis presence of multiple satellite tumour nodules and presence of vascular invasion predicted poor disease‐free survival whereas vascular invasion was the only predictor for overall survival.

Conclusion:  Patients who had curative surgical resection for HCC should be considered for adjuvant therapy when these high‐risk factors are present.
Intrahepatic cholangiocarcinoma: A diagnostic and therapeutic challenge
Authors: Lee Kit‐Fai , Cheung Yue‐Sun , Tsang Yvonne Yee‐Yan , Ng Wilson Wing‐Chi , Wong John , Lai Paul Bo‐San
Published: April 2008

Objectives:  Intrahepatic cholangiocarcinoma (ICC) is a rare tumor of the liver. The diagnosis and treatment of it are difficult. The present study reviewed the diagnostic pathways and operative results for ICC.

Methods:  A retrospective analysis was made of the clinical presentation, diagnostic pathways, and operative results of 20 patients with ICC who underwent hepatectomy from 1997 to 2004 in our institute.

Results:  The patients were predominantly female (female : male = 15:5), and ranged in age from 41 to 74 years (median 59.8). Abdominal pain was the main presenting symptom, and hepatomegaly was the commonest physical sign. Diagnosis relied mainly on ultrasound or computed tomography. Without biopsy, only two patients were correctly diagnosed with ICC before surgery. The median size of the tumor was 6 cm (range 1.6–12 cm). Major hepatectomy was carried out in 80% of patients. The operative mortality and morbidity were 15% and 40%, respectively. The median follow up was 18.3 months. Thirteen patients (65%) had recurrences at one or more sites, including, in decreasing frequency, the liver, abdominal lymph node, lung, bone, or skin. The median survival was 17.3 months and the 1‐year, 3‐year, and 5‐year survival rates were 60%, 45%, and 10%, respectively.

Conclusions:  The poor survival of patients with ICC was mainly due to the delay in diagnosis and the aggressive nature of the disease. The diagnosis of ICC relies on a high index of suspicion as there is no reliable tumor marker and imaging results are usually inconclusive. Radical hepatectomy remains the only chance of cure for ICC. The role of lymph node dissection, liver transplantation, and adjunctive chemotherapy in the treatment of patients with ICC remains to be determined.
Arterial stiffness acutely decreases after whole‐body vibration in humans
Authors: Otsuki T. , Takanami Y. , Aoi W. , Kawai Y. , Ichikawa H. , Yoshikawa T.
Published: April 2008

Background:  Increased arterial stiffness is a well‐established cardiovascular risk factor. Mechanical stimuli to artery, such as compression, elicit vasodilation and acutely decrease arterial stiffness. As whole‐body vibration (WBV)‐induced oscillation is propagated at least to lumbar spine, WBV mechanically stimulates abdominal and leg arteries and may decrease arterial stiffness. WBV is feasible in vulnerable and immobilized humans. Therefore, it is worthwhile to explore the possibility of WBV as a valuable adjunct to exercise training.

Aim:  The aim of this study was to investigate the acute effects of WBV on arterial stiffness.

Methods:  Ten healthy men performed WBV and control (CON) trials on separate days. The WBV session consisted of 10 sets of vibration (frequency, 26 Hz) for 60 s with an inter‐set rest period of 60 s. Subjects maintained a static squat position with knees bent on a platform. In the CON trial, WBV stimulation was not imposed. Blood pressure, heart rate and brachial‐ankle pulse wave velocity (baPWV), an index of arterial stiffness, were measured before and 20, 40 and 60 min after both trials.

Results and conclusion:  Heart rate and blood pressure did not change from baseline after both trials. Although baPWV did not change in the CON trial (baseline vs. after 20, 40 and 60 min; 1144 ± 35 vs. 1164 ± 41, 1142 ± 39, and 1148 ± 34 cm s−1), baPWV decreased 20 and 40 min after the WBV trial and recovered to baseline 60 min after the trial (1137 ± 28 vs. 1107 ± 30, 1108 ± 28, and 1128 ± 25 cm s−1). These results suggest that WBV acutely decreases arterial stiffness.
Quality Characterization of Pasta Enriched with Mustard Protein Isolate
Authors: Alireza Sadeghi M. , Bhagya S.
Published: April 2008

ABSTRACT:  Mustard protein isolate (MPI) prepared by steam injection heating for removal of antinutritional factors was used at different levels, including 0%, 2.5%, 5%, and 10%, for supplementation of pasta products. The effects of supplementation levels on rheological properties of pasta dough and chemical composition, and cooking, nutritional, and color characteristics of dried samples were evaluated. The results showed that as the supplementation level increased, the dough development time (DDT) increased from 3.5 min in the control to 13.8 min in 10% supplementation level. Maximum consistency (MC) increased from 351 farinograph units (FU) in the control to 371 and 386 FU in 2.5% and 5% supplementation levels, respectively, but decreased to 346 FU in 10% supplementation level. Mixing tolerance index (MTI) decreased as the supplementation increased. The most pronounced effect of enrichment on chemical composition was the increase in protein content; the increase was around 4.5% with supplementation of each 5% MPI in pasta formulation. Study of cooking characteristics of enriched pasta samples showed that cooked weight, cooking loss, protein loss, and stickiness decreased and firmness increased as the supplementation level increased. The nutritional properties of sample showed that enrichment of semolina with MPI had a pronounced effect on lysine, cysteine, arginine, and histidine contents. All computed nutritional indices were higher in enriched samples compared to the control. Color measurement of sample showed that a and b values increased and L value decreased as the supplementation level increased. The SEM of different samples shows that enrichment of pasta with MPI increases the matrix around starch granules.
Clinical and dosimetric experience with MammoSite‐based brachytherapy under the RTOG 0413 protocol
Authors: Wojcicka Jadwiga B. , Lasher Donette E. , Malcom Ronald , Fortier Gregory
Published: April 2008

MammoSite balloon brachytherapy is a relatively new technique for partial breast irradiation. The present paper focuses on the treatment planning, dosimetry, and quality assurance aspects of that treatment, based on the Radiation Therapy Oncology Group 0413 randomized prospective trial (RTOG 0413) protocol. We investigate the usefulness of evaluating implants for treatment appropriateness according to the full set of RTOG criteria as compared with the manufacturer's guidelines. We describe our methods to improve MammoSite balloon implants that would otherwise not comply with the protocol. The initially acquired computed tomography (CT) images are evaluated for tissue conformance, balloon surface–to–skin distance, and balloon symmetry. If the implant fails to meet the foregoing criteria, corrective action such as delay in the CT scan, balloon manipulation, or fluid volume adjustment is taken, and the patient is re‐scanned. If the corrective action appears to be successful, three dimensional treatment planning and dose–volume histogram analysis is performed to evaluate the geometric and dosimetric parameters with regard to the RTOG 0413 protocol. The evaluated parameters include

• volume ratio of the lumpectomy cavity to the ipsilateral breast,

• target volume coverage,

• tissue–balloon conformance,

• balloon symmetry,

• minimal balloon surface–to–skin distance,

• maximum skin dose, and

• normal breast tissue dose–volume parameters V150 and V200.

Among our implants, 21.7% did not initially meet the RTOG 0413 acceptance criteria. Asymmetry and poor conformance values reduce the target volume coverage, and so an implant with moderate conformance and asymmetry can be within the manufacturer's guidelines, but still not meet the RTOG criteria. Our intervention corrected all but one of the implants that failed to meet the criteria. Manipulating the cavity and adjusting the balloon volume may salvage an implant and meet the strict geometric and dosimetric criteria imposed by the RTOG 0413 protocol.

PACS number: 7.53.Jw
Verification procedure for isocentric alignment of proton beams
Authors: Ciangaru George , Yang James N. , Oliver Patrick J. , Bues Martin , Zhu Mengping , Nakagawa Fumio , Chiba Hitoshi , Nakamura Shin , Yoshino Hirofumi , Umezawa Mosumi , Smith Alfred R.
Published: April 2008

We present a technique—based on the Lutz, Winston, and Maleki test used in stereotactic linear accelerator radiosurgery—for verifying whether proton beams are being delivered within the required spatial coincidence with the gantry mechanical isocenter. Our procedure uses a proton beam that is collimated by a circular aperture at its central axis and is then intercepted by a small steel sphere rigidly supported by the patient couch. A laser tracker measurement system and a correction algorithm for couch position assures precise positioning of the steel sphere at the mechanical isocenter of the gantry. A film‐based radiation dosimetry technique, chosen for the good spatial resolution it achieves, records the proton dose distribution for optical image analysis. The optical image obtained presents a circular high‐dose region surrounding a lower‐dose area corresponding to the proton beam absorption by the steel sphere, thereby providing a measure of the beam alignment with the mechanical isocenter. We found the self‐developing Gafchromic EBT film (International Specialty Products, Wayne, NJ) and commercial Epson 10000 XL flatbed scanner (Epson America, Long Beach, CA) to be accurate and efficient tools. The positions of the gantry mechanical and proton beam isocenters, as recorded on film, were clearly identifiable within the scanning resolution used for routine alignment testing (0.17 mm per pixel). The mean displacement of the collimated proton beam from the gantry mechanical isocenter was for the gantry positions tested, which was well within the maximum deviation of 0.50 mm accepted at the Proton Therapy Center in Houston.

PACS numbers: 87.53.Xd, 87.53.Oc, 87.56.‐v, 87.66.‐a, 87.56.Fc
The use of LiF (TLD‐100) as an out‐of‐field dosimeter
Authors: Kry Stephen F. , Price Michael , Followill David , Mourtada Firas , Salehpour Mohammad
Published: April 2008

The commonly used thermoluminescent dosimeter TLD‐100 (Harshaw Chemical Company, Solon, OH) responds not only to photons and electrons, but also to neutrons that are produced during high‐energy therapies. As a result, TLD‐100 measurements outside of the treatment field are suspect when high‐energy radiation is used. Although alternatives such as TLD‐700 do not respond to neutrons, specialty dosimeters of this kind are expensive and are not routinely used in most clinics. In the current study, we examined the accuracy of TLD‐100 in measuring the out‐of‐field photon dose as a function of treatment energy.

To determine the accuracy of TLD‐100 as compared with TLD‐700, TLD‐100 was irradiated outside of the treatment field by medical accelerators operated at 6, 10, 15, and 18 MV. In an effort to eliminate the response of TLD‐100 to neutrons, TLD capsules were encased in varying thicknesses of cadmium foil (0.25 – 0.75 mm) before being irradiated at 18 MV. The out‐of‐field TLD‐100 was found to be accurate at 6 MV and 10 MV, but to be substantially over‐responsive at 15 MV and 18 MV (by up to 1063% relative to TLD‐700). By wrapping the TLD‐100 in up to 0.75 mm of cadmium, it was possible to drastically reduce (down to 39% on average) the over‐response of the TLD‐100; however, total removal of the over‐responsiveness was not possible. Although TLD‐100 is well suited for measuring out‐of‐field dose at energies as high as 10 MV, at higher energies (15 MV or greater), this dosimeter over‐responds substantially and should not be used. Although encasing the TLD in cadmium minimized over‐response to a degree, the reduction was not sufficient to make TLD‐100 viable for measuring out‐of‐field dose at high treatment energies.

PACS numbers: 87.52.‐g, 87.53.‐j, 87.53.‐Dq
Quality assurance device for four‐dimensional IMRT or SBRT and respiratory gating using patient‐specific intrafraction motion kernels
Authors: Nelms Benjamin E. , Ehler Eric , Bragg Henry , Tomé Wolfgang A.
Published: April 2008

Emerging technologies such as four‐dimensional computed tomography (4D CT) and implanted beacons are expected to allow clinicians to accurately model intrafraction motion and to quantitatively estimate internal target volumes (ITVs) for radiation therapy involving moving targets. In the case of intensity‐modulated (IMRT) and stereotactic body radiation therapy (SBRT) delivery, clinicians must consider the interplay between the temporal nature of the modulation and the target motion within the ITV. A need exists for a 4D IMRT/SBRT quality assurance (QA) device that can incorporate and analyze customized intrafraction motion as it relates to dose delivery and respiratory gating. We built a 4D IMRT/SBRT prototype device and entered (X, Y, Z)(T) coordinates representing a motion kernel into a software application that

transformed the kernel into beam‐specific two‐dimensional (2D) motion “projections,”

previewed the motion in real time, and

drove a precision X–Y motorized device that had, atop it, a mounted planar IMRT QA measurement device.

The detectors that intersected the target in the beam's‐eye‐view of any single phase of the breathing cycle (a small subset of all the detectors) were defined as “target detectors” to be analyzed for dose uniformity between multiple fractions. Data regarding the use of this device to quantify dose variation fraction‐to‐fraction resulting from target motion (for several delivery modalities and with and without gating) have been recently published. A combined software and hardware solution for patient‐customized 4D IMRT/ SBRT QA is an effective tool for assessing IMRT delivery under conditions of intrafraction motion. The 4D IMRT QA device accurately reproduced the projected motion kernels for all beam's‐eye‐view motion kernels. This device has been proved to

• effectively quantify the degradation in dose uniformity resulting from a moving target within a static planning target volume, and

• integrate with a commercial respiratory gating system to ensure that the system is working effectively.

Such a device is discussed as a potential tool to optimize the gating duty cycle to maximize delivery efficiency while minimizing dose variability.

PACS numbers: 87.50.Gi, 87.53.Dq, 87.53.Kn, 87.53.Mr, 87.53.Tf, 87.56.Fc, 87.58.Sp
Study of the uncertainty in the determination of the absorbed dose to water during external beam radiotherapy calibration
Authors: Castro Pablo , García‐Vicente Feliciano , Mínguez Cristina , Floriano Alejandro , Sevillano David , Pérez Leopoldo , Torres Juan J.
Published: April 2008

To achieve a good clinical outcome in radiotherapy treatment, a certain accuracy in the dose delivered to the patient is required. Therefore, it is necessary to keep the uncertainty in each of the steps of the process inside some acceptable values, which implies as low a global uncertainty as possible. The work reported here focused on the uncertainty evaluation of absorbed dose to water in the routine calibration for clinical beams in the range of energies used in external‐beam radiotherapy. With this aim, we considered various uncertainty components (corrected electrometer reading, calibration factor, beam quality correction factor, and reference conditions) associated with beam calibration. Results show a typical uncertainty in the determination of absorbed dose to water during beam calibration of approximately 1.3% for photon beams and 1.5% for electron beams ( in both cases) when the formalism is used and is calculated theoretically. These values may vary depending on the uncertainty provided by the standards laboratory for calibration factor, which is shown in the work. For primary standards based on clinical linear accelerator beam energies, the uncertainty in this step of the process could be placed close to 1.0%. We also discuss the possibility of an uncertainty reduction with the adoption of the absorbed dose to water formalism as compared with the air kerma formalism.

PACS numbers: 87.53.Dq, 87.53.Hv
Verifying monitor unit calculations for tangential whole‐breast fields in three‐dimensional planning
Authors: Kay Ian , Meyer Tyler
Published: April 2008

Verification of the accuracy of monitor unit calculations is an essential component of quality assurance in radiation therapy. For tangential breast fields, monitor unit differences between primary calculations and second checks are usually larger than would be considered acceptable at other anatomic sites. Here, we present a simple model to reconcile the differences between sophisticated and simple algorithms, based on estimating the volume irradiated by the field, replacing the breast contour with a rectangular block having an equal volume, but using a new field width that provides almost equivalent scatter to the prescription point. This analysis can also assist the treatment planning physicist in selecting a tolerance window for verifying monitor unit calculations for tangential breast fields.

PACS numbers: 87.53.Kn, 87.53.Tf, 87.53.Xd
Use of three‐dimensional (3D) optical flow method in mapping 3D anatomic structure and tumor contours across four‐dimensional computed tomography data
Authors: Zhang Geoffrey , Huang Tzung‐Chi , Guerrero Thomas , Lin Kang‐Ping , Stevens Craig , Starkschall George , Forster Ken
Published: April 2008

A three‐dimensional (3D) optical flow program that includes a multi‐resolution feature has been developed and applied to 3D anatomic structure and gross tumor volume (GTV) contour mapping for four‐dimensional computed tomography (4D CT) data. The present study includes contour mapping for actual CT data sets from 3 patients and also for a thoracic phantom in which the displacement for each voxel was known. Of the CT data sets for the actual patients, one set was used to map lung and GTV contours over all respiration phases, and the other two were studied using only the end inspiration and end expiration phases, in which the displacements between phases were the largest. Including the residual motion in the 4D CT data and motion from table shaking, the optical flow calculation agrees with the known displacement to within 1 mm. Excluding errors not introduced by the optical flow algorithm, agreement for a displacement magnitude of 24 mm can be within 0.1 mm. The mapped contours in 4D CT images of lungs, liver, esophagus, GTV, and other structures for actual patients were acceptable to clinicians. The 3D optical flow program is a good tool for contour mapping of anatomic structure and tumor volume across 4D CT scans.

PACS numbers: 87.55.D‐, 87.59.bd
Status of healthcare studies submitted to UK research ethics committees for approval in 2004–5
Authors: Arshad A , Arkwright P D
Published: April 2008

Background:

In view of the increasing complexity of research ethics committee (REC) applications and thus the time and expense involved in completing the forms, continual monitoring of outcome of clinical research studies for which ethics applications have been submitted is essential in determining whether resources are being effectively used, or alternatively whether significant numbers of research proposals are abandoned because of lack of funding or manpower. Previously published surveys for which data are available examined outcome of studies receiving REC approval 10 or more years ago.

Methods:

A prospective questionnaire-based survey sent out in July 2006 to all 506 principal investigators who submitted research ethics applications to nine Greater Manchester RECs between April 2004 and March 2005. Data on the outcome of REC applications, and the status of the research study were collected and analysed.

Results:

288 of the 506 (57%) questionnaires were returned. 97% of REC applications were approved, and 87% of studies were in progress or had been completed 1–2 years after approval had been granted. Researchers employed by universities (51%), healthcare (43%) and the pharmaceutical industry (6%) had similar rates of success in initiating research studies.

Conclusions:

This survey suggests that most research studies submitted to RECs in Manchester, UK are approved and initiated.
The Ashley treatment: a step too far, or not far enough?
Authors: Edwards S D
Published: April 2008

This “current controversies” contribution describes the recent case of a severely disabled six year old girl who has been subjected to a range of medical interventions at the request of her parents and with the permission of a hospital clinical ethics committee. The interventions prescribed have become known as “the Ashley treatment” and involve the performance of invasive medical procedures (eg, hysterectomy) and oestrogen treatment. A central aim of the treatment is to restrict the growth of the child and thus make it easier for her parents to care for her at home. The paper below discusses the main objections to the treatment. It concludes that the most serious concern raised by the case is that it may set a worrying precedent if the moral principle employed in justification of the treatment is applied again to endorse it in similar circumstances. Finally, it raises the possibility that that same moral principle may even be invoked to justify more radical interventions than those that were actually performed in the Ashley treatment.
The religious beliefs of students and the teaching of medical ethics: a comment on Brassington
Authors: McLachlan H V
Published: April 2008

It has recently been suggested by Brassington that, when students in classes in medical ethics announce that some view that they wish to express is related to their religious convictions, the teacher is obliged to question them explicitly about the suggested link. Here, a different conclusion is reached. The view is upheld that, although the stratagem recommended by Brassington is permissible and might sometimes be desirable, it is not obligatory nor is it, in general, likely to be optimal.