bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatic Safety and Antiretroviral Effectiveness in HIV‐Infected Patients Receiving Naltrexone
Authors: Tetrault Jeanette M. , Tate Janet P. , McGinnis Kathleen A. , Goulet Joseph L. , Sullivan Lynn E. , Bryant Kendall , Justice Amy C. , Fiellin David A. ,   For the Veterans Aging Cohort Study Team
Published: July 2011

Background:  We sought to determine the impact of naltrexone on hepatic enzymes and HIV biomarkers in HIV‐infected patients.

Methods:  We used data from the Veterans Aging Cohort Study‐Virtual Cohort, an electronic database of administrative, pharmacy, and laboratory data. We restricted our sample to HIV‐infected patients who received an initial oral naltrexone prescription of at least 7 days duration. We examined aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and HIV biomarker (CD4 and HIV RNA) values for the 365 days prior to, during, and for the 365 days post‐naltrexone prescription. We also examined cases of liver enzyme elevation (LEE; defined as >5 times baseline ALT or AST or >3.5 times baseline if baseline ALT or AST was >40 IU/l).

Results:  Of 114 HIV‐infected individuals, 97% were men, 45% white, 57% Hepatitis C co‐infected; median age was 49 years; 89% of the sample had a history of alcohol dependence and 32% had opioid dependence. Median duration of naltrexone prescription was 49 (interquartile range 30 to 83) days, representing 9,525 person‐days of naltrexone use. Mean ALT and AST levels remained below the upper limit of normal. Two cases of LEE occurred. Mean CD4 count remained stable and mean HIV RNA decreased after naltrexone prescription.

Conclusions:  In HIV‐infected patients, oral naltrexone is rarely associated with clinically significant ALT or AST changes and does not have a negative impact on biologic parameters. Therefore, HIV‐infected patients with alcohol or opioid dependence can be treated with naltrexone.
Association Between Higher Levels of Sexual Function, Activity, and Satisfaction and Self‐Rated Successful Aging in Older Postmenopausal Women
Authors: Thompson Wesley K. , Charo Lindsey , Vahia Ipsit V. , Depp Colin , Allison Matthew , Jeste Dilip V.
Published: July 2011

OBJECTIVES: To determine whether measures of successful aging are associated with sexual activity, satisfaction, and function in older postmenopausal women.

DESIGN: Cross‐sectional study using self‐report surveys; analyses included chi‐square and t‐tests and multiple linear regression analyses.

SETTING: Community‐dwelling older postmenopausal women in the greater San Diego region.

PARTICIPANTS: One thousand two hundred thirty‐five community‐dwelling women aged 60 to 89 participating at the San Diego site of the Women's Health Initiative.

MEASUREMENTS: Demographic information and self‐reported measures of sexual activity, function, and satisfaction and successful aging.

RESULTS: Sexual activity and functioning (desire, arousal, vaginal tightness, use of lubricants, and ability to climax) were negatively associated with age, as were physical and mental health. In contrast, sexual satisfaction and self‐rated successful aging and quality of life remained unchanged across age groups. Successful aging measures were positively associated with sexual measures, especially self‐rated quality of life and sexual satisfaction.

CONCLUSION: Self‐rated successful aging, quality of life, and sexual satisfaction appear to be stable in the face of declines in physical health, some cognitive abilities, and sexual activity and function and positively associated with each other from age 60 to 89.
A Life Course Model of Cognitive Activities, Socioeconomic Status, Education, Reading Ability, and Cognition
Authors: Jefferson Angela L. , Gibbons Laura E. , Rentz Dorene M. , Carvalho Janessa O. , Manly Jennifer , Bennett David A. , Jones Richard N.
Published: July 2011

OBJECTIVES: To cross‐sectionally quantify the contribution of proxy measures of cognitive reserve reflective of the lifespan, such as education, socioeconomic status (SES), reading ability, and cognitive activities, in explaining late‐life cognition.

DESIGN: Prospective observational cohort study of aging.

SETTING: Retirement communities across the Chicago metropolitan area.

PARTICIPANTS: Nine hundred fifty‐one older adults free of clinical dementia in the Rush Memory and Aging Project (aged 79±8, 74% female).

MEASUREMENTS: Baseline data on multiple life course factors included early‐, mid‐, and late‐life participation in cognitive activities; early‐life and adult SES; education; and reading ability (National Adult Reading Test; NART). Path analysis quantified direct and indirect standardized effects of life course factors on global cognition and five cognitive domains (episodic memory, semantic memory, working memory, visuospatial ability, perceptual speed).

RESULTS: Adjusting for age, sex, and race, education had the strongest association with global cognition, episodic memory, semantic memory, and visuospatial ability, whereas NART (followed by education) had the strongest association with working memory. Late‐life cognitive activities had the strongest association with perceptual speed, followed by education.

CONCLUSIONS: These cross‐sectional findings suggest that education and reading ability are the most‐robust proxy measures of cognitive reserve in relation to late‐life cognition. Additional research leveraging path analysis is warranted to better understand how these life course factors, reflecting the latent construct of cognitive reserve, affect abnormal cognitive aging.
Retooling for an Aging America: Building the Healthcare Workforce
Authors:   Section for Enhancing Geriatric Understanding and Expertise Among Surgical and Medical Specialists (SEGUE), American Geriatrics Society
Published: July 2011

In Chicago, Illinois, on May 7, 2009, a group of 53 medical educators representing many U.S. certification boards, residency review committees, and medical societies met to review and approve a white paper intended to promote Recommendation 4.2 of the Institute of Medicine report of April 14, 2008, “Retooling for an Aging America: Building the Healthcare Workforce.” This recommendation is one of 14 and states: “All licensure, certification and maintenance of certification for healthcare professionals should include demonstration of competence in care of older adults as a criterion.” Background information given included the growing numbers of older adults, review of a 15‐year initiative by a section of the American Geriatrics Society (AGS) to include geriatric education in all surgical and some related medical specialties, a recent announcement of 26 elder care competencies to be expected of graduating medical students from Association of American Medical Colleges (AAMC) affiliated schools, and the American Board of Medical Specialties (ABMS) approach to “Reinforcing Geriatric Competencies through Licensure and Certification Examinations.” Nine points involved in the implementation of this recommendation received discussion, and approaches to realization were presented. In conclusion, this white paper, which those listed as being in attendance approved, proposes that all ABMS member boards whose diplomates participate in the care of older adults select the floor competencies enumerated by the AAMC that apply to their specialty and add or subtract those completed during their trainees' initial (intern) year and then define those needed in subsequent years of residency and ultimate practice. This would fulfill the requirements of Recommendation 4.2 above.
Anxiety, Depression, and 1‐Year Incident Cognitive Impairment in Community‐Dwelling Older Adults
Authors: Potvin Olivier , Forget Hélène , Grenier Sébastien , Préville Michel , Hudon Carol
Published: July 2011

OBJECTIVES: To examine in men and women the independent associations between anxiety and depression and 1‐year incident cognitive impairment and to examine the association of cognitive impairment, no dementia (CIND) and incident cognitive impairment with 1‐year incident anxiety or depression.

DESIGN: Prospective cohort study.

SETTING: General community.

PARTICIPANTS: Population‐based sample of 1,942 individuals aged 65 to 96.

MEASUREMENTS: Two structured interviews 12 months apart evaluated anxiety and mood symptoms and disorders according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Incident cognitive impairment was defined as no CIND at baseline and a follow‐up Mini‐Mental State Examination score at least 2 points below baseline and below the 15th percentile according to normative data. The associations between cognitive impairment and anxiety or depression were assessed using logistic regression adjusted for potential confounders.

RESULTS: Incident cognitive impairment was, independently of depression, associated with baseline anxiety disorders in men (odds ratio (OR)=6.27, 95% confidence interval (CI)=1.39–28.29) and anxiety symptoms in women (OR=2.14, 95%=1.06–4.34). Moreover, the results indicated that depression disorders in men (OR=8.87, 95%=2.13–36.96) and anxiety symptoms in women (OR=4.31, 95%=1.74–10.67) were particularly linked to incident amnestic cognitive impairment, whereas anxiety disorders in men (OR=12.01, 95%=1.73–83.26) were especially associated with incident nonamnestic cognitive impairment. CIND at baseline and incident cognitive impairment were not associated with incident anxiety or depression.

CONCLUSION: Anxiety and depression appear to have different relationships with incident cognitive impairment according to sex and the nature of cognitive impairment. Clinicians should pay particular attention to anxiety in older adults because it may shortly be followed by incident cognitive treatment.
Visual Sequence Learning in Infancy: Domain‐General and Domain‐Specific Associations With Language
Authors: Shafto Carissa L. , Conway Christopher M. , Field Suzanne L. , Houston Derek M.
Published: July 2011

Research suggests that nonlinguistic sequence learning abilities are an important contributor to language development (Conway, Bauernschmidt, Huang, & Pisoni, 2010). The current study investigated visual sequence learning (VSL) as a possible predictor of vocabulary development in infants. Fifty‐eight 8.5‐month‐old infants were presented with a three‐location spatiotemporal sequence of multicolored geometric shapes. Early language skills were assessed using the MacArthur‐Bates CDI. Analyses of children’s reaction times to the stimuli suggest that the extent to which infants demonstrated learning was significantly correlated with their vocabulary comprehension at the time of test and with their gestural comprehension abilities 5 months later. These findings suggest that VSL may have both domain‐general and domain‐specific associations with language learning.
Measuring the Development of Social Attention Using Free‐Viewing
Authors: Frank Michael C. , Vul Edward , Saxe Rebecca
Published: July 2011

How do young children direct their attention to other people in the natural world? Although many studies have examined the perception of faces and of goal‐directed actions, relatively little work has focused on what children will look at in complex and unconstrained viewing environments. To address this question, we showed videos of objects, faces, children playing with toys, and complex social scenes to a large sample of infants and toddlers between 3 and 30 months old. We found systematic developmental changes in what children looked at. When viewing faces alone, younger children looked more at eyes and older children more at mouths, especially when the faces were making expressions or talking. In the more complex videos, older children looked more at hands than younger children, especially when the hands were performing actions. Our results suggest that as children develop they become better able to direct their attention to the parts of complex scenes that are most interesting socially.
Control Combinations in New Product Development Projects*
Authors: Rijsdijk Serge A. , van den Ende Jan
Published: July 2011

This article investigates the effects of and interactions among the three prototypical control mechanisms of outcome control, process control, and clan control. Outcome control refers to the specification and evaluation of desired outputs that employees should deliver. Process control concerns mechanisms that specify which behaviors are appropriate, and clan control relies on socialization processes among organizational members. The authors argue that, whereas previous research has generally treated the control mechanisms in isolation, the different control mechanisms are interdependent and act as complements or substitutes in their influence on process performance, product concept effectiveness, and financial performance. The authors collected data through an online survey on 148 new product development projects conducted by high‐tech companies located in the Netherlands. The results show that the combination of different controls may lead to synergistic or conflicting effects for the different new product development project outcomes. Outcome controls and clan controls synergistically increase process performance. This implies that the benefit of increasing goal clarity and project team autonomy through outcome controls can be strengthened by supporting it with social cohesion. In contrast, process controls hamper the effectiveness of clan controls in their positive effect on process performance. Potentially, the combination of these relatively information‐intensive controls leads to a redundancy in communication that decreases process efficiency. In contrast to expectations, outcome and clan control only independently affect product concept effectiveness. Finally, the results show that outcome control and process control negatively interact in their impact on financial performance. This suggests that the installation of highly strict control systems that combine high levels of both outcome and process controls may lead to lower financial performance. The authors conclude that neglecting the interdependencies between different controls may lead to an incomplete insight into how firms can most effectively manage their new product development processes.
Conveying Effective Message Content When Launching New Industrial Products
Authors: Talke Katrin , Colarelli O'Connor Gina
Published: July 2011

This paper seeks to uncover the specific message content that facilitates the diffusion of industrial innovations. Diffusion theory specifies that innovation adoption is only likely to occur when a potential customer has positive perceptions of the new product's attributes. Hence, it seems intuitive that firms should use these attributes as message content when launching a new industrial product. But the question of which message content is actually used by firms, and how this impacts new product performance has not been addressed in the literature. Referring to this gap, the authors propose a model of three message content types: usability information, technical information, and financial information. Each of these information types is designed to mitigate a set of perceived risks that consumers may experience in the decision to adopt a new industrial product. Level of product innovativeness is considered as well, given its likely differential impact on the effectiveness of the specific message content used. The model is tested with 112 new industrial products using a multiple informant approach. Generally, the findings support the suggestion that using innovation attributes as message content can be effective when launching a new industrial product, but they behave differently from one another and differently in the moderated context. While usability information and financial information were found to be effective in impacting performance, technical information was found to be counter‐effective. Concerning the moderating influence of product innovativeness, results indicate that usability information is of specific importance when launching a highly innovative product. Financial details, however, become less important.
Impact of Defibrillation Test Protocol and Test Repetition on the Probability of Meeting Implant Criteria
Authors: SMITS KAREL , VIRAG NATHALIE
Published: July 2011

Background: Defibrillation testing is a common procedure at defibrillator implant, with the purpose to ensure that each patient receives a device‐lead system with a sufficient shock efficacy. The objective of this paper was to study the influence of defibrillation test protocols on the probability of passing implant testing.

Methods: Defibrillation shock efficacy as a function of shock energy was modeled by a dose‐response relationship estimated from the clinical data of the PainFREE Rx II study on 564 patients. A Monte Carlo method was used to simulate the outcomes of 12 commonly used defibrillation efficacy test protocols: four safety margin tests and eight protocols estimating the defibrillation threshold (DFT).

Results: The probabilities of failing 20‐J and 25‐J implant criteria for the different protocols ranged from 0.9% to 6.3% for 20 J and 0.3% to 3.4% for 25 J. Large variations in consecutively measured DFT values in the same patients were observed. Best results in the identification of “high risk” patients were obtained with the 2/2 safety margin protocol with an implant criterion of 20 J. The study also showed that the probability of patients inappropriately passing the implant criterion increased when the defibrillation test was repeated after initial failure.

Conclusion: The defibrillation test protocol greatly influences the probability of meeting implant criterion. Therefore, these test protocols should be standardized. The model developed in this study, could be used to further understand their impact and to derive recommendations. (PACE 2011; 34:1515–1526)
Clinical History in the Diagnosis of the Cardiac Syncope–The Predictive Scoring System
Authors: MITRO PETER , KIRSCH PETER , VALOČIK GABRIEL , MURíN PAVOL
Published: July 2011

Background:
 Cardiac syncope represents clinical situation with serious prognosis. The aim of the present study was to develop the diagnostic scoring system based on the clinical history allowing to distinguish between cardiac and noncardiac syncope.

Methods:
 Clinical history was obtained in the form of the structured questionnaire in 60 patients with cardiac syncope (mean age 70 ± 10 years, 33 men) an in 140 patients with noncardiac syncope (mean age 45 ± 20 years, 44 men). Multivariate regression analysis identified seven variables that were included in the final regression model.

Results:
 The age above 55 years, presence of structural heart disease, syncope in supine position, absence of prodromal symptoms, and chest pain before syncope were predictive of cardiac syncope. Predictors of noncardiac syncope were recovery duration of more than 1 minute and syncope occurring immediately after standing up. A diagnostic point score was derived from the regression coefficients. The sum of the points identified patients with cardiac syncope if the diagnostic point score was ≤2. Diagnostic performance of the score was assessed on the validation group of 67 patients with syncope (21 patients with cardiac syncope and 46 patients with noncardiac syncope). Sensitivity was 81%, specificity 84.8%, positive predictive value 70.8%, and negative predictive value 90.7%.

Conclusion:
 Predictive model based on parameters form clinical history of the patients may help to distinguish between cardiac and other causes of syncope. (PACE 2011; 34:1480–1485)
Pregnant Women with Complete Atrioventricular Block: Perinatal Risks and Review of Management
Authors: HIDAKA NOBUHIRO , CHIBA YOSHIHIDE , FUKUSHIMA KOTARO , WAKE NORIO
Published: July 2011

We have summarized the care management of pregnant women with complete atrioventricular block (CAVB) by reviewing data from the published literature as well as our own experience in 32 pregnancies. Obstetrical management of women with a permanent pacemaker implanted prior to conception has been sufficiently reported thus far, and the management of such patients is considered to be of low risk. Since CAVB usually does not cause any specific obstetrical problems during pregnancy, prepregnancy prophylactic placement of a permanent pacemaker is not indicated in all asymptomatic patients. However, when asymptomatic women without pacemakers become pregnant, there is a subset that ultimately develops heart failure during pregnancy. Therefore, close surveillance of pregnant patients with CAVB is warranted. The current increase in the use of permanent pacemakers in young women with symptomatic CAVB will certainly limit the need for intrapartum temporary pacing in patients who do not require a pacemaker before pregnancy. In fact, most women with CAVB, who do not require a permanent pacemaker before delivery, can be safely managed during labor without temporary pacing. However, the clinical symptoms and cardiac function of patients should be carefully followed after delivery, even when pregnancy and delivery are uneventful. (PACE 2011; 34:1161–1176)
Renal Artery Thrombosis Following an Inappropriate Implantable Cardioverter Defibrillator Shock
Authors: ARIAS MIGUEL A. , DE LA ROSA CRISTINA , PUCHOL ALBERTO , RODRÍGUEZ‐PADIAL LUIS
Published: July 2011

In spite of technological advances, the incidence of inappropriate therapies continues being high. Usually, the most direct consequence of inappropriate shocks is impairment on quality of life parameters, but in some cases the consequences may be unpredictable. We report on a case of renal artery thrombosis, following an inappropriate implantable cardioverter defibrillator shock. (PACE 2012; 35:e263–e264)
Acute Hemodynamic Effects of Right and Left Ventricular Lead Positions during the Implantation of Cardiac Resynchronization Therapy Defibrillators
Authors: STOCKINGER JOCHEM , STAIER KLAUS , SCHIEBELING‐RÖMER JOCHEN , KEYL CORNELIUS
Published: July 2011

Background: To evaluate the acute hemodynamic effects of different right (RV) and left ventricular (LV) pacing sites in patients undergoing the implantation of a cardiac resynchronization therapy defibrillator (CRT‐D).

Methods: Stroke volume index (SVI), assessed via pulse contour analysis, and dp/dt max, obtained in the abdominal aorta, were analyzed in 21 patients with New York Heart Association class III heart failure and left bundle branch block (mean ejection fraction of 24 ± 6%), scheduled for CRT‐D implantation under general anesthesia. We compared the hemodynamic effects of RV apical (A), RV septal (B), and biventricular pacing using the worst (lowest SVI; C) and best (highest SVI; D) coronary sinus lead positions.

Results: Mean arterial pressure, SVI, and dp/dt max did not differ significantly between RV apical and septal pacing. Dp/dt max and SVI increased significantly during biventricular pacing (dp/dt max: B, 588 ± 160 mmHg/s; C, 651 ± 218 mmHg/s, P = 0.03 vs B; D, 690 ± 220 mmHg/s, P = 0.02 vs C; SVI: B, 33.6 ± 5.5 mL/m2, C, 34.8 ± 6.1 mL/m2, P = 0.08 vs B, D 36.0 ± 6.0 mL/m2, P < 0.001 vs C). The best hemodynamic response was associated with lateral or inferior lead positions in 15 patients. Other LV lead positions were most effective in six patients.

Conclusions: The optimal LV lead position varies significantly among patients and should be individually determined during CRT‐D implantation. The impact of the RV stimulation site in patients with intraventricular conduction delay, undergoing CRT‐D implantation, has to be investigated in further studies. (PACE 2011; 34:1537–1543)
True Bipolar and Integrated Bipolar Sensing and Detection by Implantable Defibrillators
Authors: VERGA TREVOR A. , GILLBERG JEFFREY M. , GREENBERG RICHARD M. , DEGER FLORIN T.
Published: July 2011

Introduction:
 Sensing and detection can be performed in true bipolar or integrated bipolar configuration by implantable defibrillators. New Medtronic generators (Medtronic Inc., Minneapolis, MN, USA) can be configured so that the sensing function of the device can be either true bipolar or integrated bipolar. We compared the sinus rhythm R‐wave amplitude and detection time of induced ventricular fibrillation (VF) at implant (acute phase), and sinus rhythm R‐wave amplitude 3 months or more after the implant (chronic phase) in these two configurations.

Methods:
 Twenty‐eight patients were studied in the acute phase, and a subgroup of 15 patients was tested in the chronic phase. The generators were Medtronic model numbers D224VRC, D224TRK, D224DRG, D284VRC, D284TRK, and D284DRG. The leads were Medtronic 6947 or 6935. Sensing was evaluated by recording the electrogram and measuring the R‐wave peak‐to‐peak amplitude in the two configurations. Detection was evaluated by measuring the detection time in the two configurations in two consecutive inductions. The detection time was measured on programmer paper from the marker of the T shock to the marker of VF.

Results:
 The acute‐phase values were: R wave in true bipolar configuration 13.9 ± 7.1 mV, R wave in integrated bipolar configuration 13.6 ± 6.9 mV (p = 0.38),VF detection time in true bipolar configuration 3.12 ± 0.39 seconds, and VF detection time in integrated bipolar configuration 3.17 ± 0.39 seconds (p = 0.52).

Conclusions:
 Sensing and detection at implant were not significantly different between the true bipolar and the integrated bipolar configurations for the tested leads and generators. (PACE 2011; 34:1561–1568)
Relationship between Ventricular Dyssynchrony and T‐wave Alternans in Patients with Coronary Artery Disease
Authors: YAN GUO‐HUI , WANG MEI , YUE WEN‐SHENG , YIU KAI‐HANG , ZHI GUANG , LAU CHU‐PAK , WL LEE STEPHEN , SIU CHUNG‐WAH , TSE HUNG‐FAT
Published: July 2011

Introduction: Coronary artery disease (CAD) is associated with increased dispersion of repolarization and sudden cardiac death. We sought to investigate whether ventricular dyssynchrony is associated with proarrhythmic repolarization dispersion as measured by T‐wave alternans (TWA) in patients with CAD.

Methods and Results: We evaluated 154 patients (67 ± 9 years, 123 men) with documented CAD, who underwent exercise treadmill testing and echocardiographic examination. TWA was analyzed continuously during treadmill testing in all standard precordial leads by time‐domain method. Tissue Doppler imaging was performed to measure inter‐ and intraventricular dyssynchrony. Increased TWA ≥ 60μV was observed in 42 (27%) patients. There was higher prevalence of females (31 vs 16%, P = 0.04) and greater body mass index (25.7 ± 2.6 vs 24.6 ± 3.0 kg/m2, P = 0.04) in the TWA ≥ 60μV group of patients than the TWA < 60μV group. The index of interventricular dyssynchrony, Ts‐RL, was significantly increased (75.6 ± 37.8 vs 59.9 ± 35.9 ms, P = 0.03) but not intraventricular dyssynchrony (all P > 0.05) in patients with TWA ≥ 60 μV compared with those with TWA < 60 μV. In addition, a weak but significant positive correlation was observed between TWA and Ts‐RL (r = 0.25, P = 0.003). Multivariate analysis revealed that only Ts‐RL (odds ratio 1.02, 95% confidence interval 1.00–1.03, P = 0.013) was independent predictor for increased TWA.

Conclusions: Our results demonstrated that interventricular dyssynchrony in patients with CAD is associated with increased TWA. This suggests that interventricular dyssynchrony may contribute to proarrhythmic repolarization dispersion. (PACE 2011; 34:1503–1510)
Impact of medico‐legal findings on charge filing in cases of rape in adult women
Authors: HAGEMANN CECILIE T. , STENE LISE E. , MYHRE ARNE K. , ORMSTAD KARI , SCHEI BERIT
Published: July 2011

Objective. To assess the impact of the medical documentation and biological trace evidence in rape cases on the legal process. Design. Retrospective descriptive study. Setting and sample. Police‐reported cases of rape of women ≥16 years old in the Norwegian county of Sør‐Trøndelag from January 1997 to June 2003. Methods. Police data were merged with data from the Sexual Assault Center at St Olav's Hospital. Charged and non‐charged cases were compared. Main Outcome Measures. Medico‐legal findings and legal outcome. Results. A total of 185 police‐reported cases were identified. Of the 101 cases examined at Sexual Assault Center, charges were filed in 18 cases. Extragenital injuries were documented in 49 women; five were life threatening. Anogenital injuries were documented in 14 women; eight had multiple anogenital injuries. Documentation of injuries was not associated with charge filing. In only 33% of the cases were swabs collected from women's genitals used as trace evidence by the police. When used, this increased the likelihood for charge filing. A DNA profile matching the suspect was identified in four of the 18 charged cases and in only one among the 54 non‐charged cases. Conclusions. Half of the women had one or more documented injury. Only one‐third of the trace evidence kits collected from the women's anogenital area were analyzed. The analysis of swabs was associated with charge filing, regardless of test results. Increased use of such medical evidence, especially in cases of stranger rape, may ensure women's rights and increase available information to the legal system.
Long‐term follow up of posterior vestibulectomy for treating vulvar vestibulitis
Authors: TOMMOLA PÄIVI , UNKILA‐KALLIO LEILA , PAAVONEN JORMA
Published: July 2011

Objective. To evaluate the safety and the effectiveness of posterior vestibulectomy in the treatment of vulvar vestibulitis syndrome. Design. A retrospective cohort study. Setting. University Hospital, tertiary referral center. Population. Seventy women treated by posterior vestibulectomy for severe vulvar vestibulitis syndrome during 1995–2007 at the Department of Obstetrics and Gynecology, University Hospital, Helsinki. Methods. All operated women were invited to a long‐term follow‐up study. Patient characteristics, baseline visual analog scale (VAS) for dyspareunia and data from the postoperative period were collected. Of the 70 women, 57 attended the follow‐up visit including face‐to‐face interview, gynecological examination with swab‐touch test for vestibular tenderness, current VAS score for dyspareunia and McCoy questionnaire for sexual problems. Main Outcome Measures. Short‐term and long‐term complication rates, dyspareunia by VAS score, vestibular tenderness, sexual problem index and overall patient satisfaction. Results. Ninety‐one per cent were satisfied with the outcome. The VAS for dyspareunia decreased from a median of 9 to 3 (66.7% decrease; p<0.001). Posterior vestibular tenderness was absent in 34 patients (64.2%). Six (8.6%) patients developed postoperative bleeding and 11 (15.7%) mild wound infection. Bartholin's cysts occurred in four (5.7%) patients. Conclusions. Posterior vestibulectomy is effective and safe in the treatment of severe vulvar vestibulitis syndrome and provides long‐term patient satisfaction.
Maternal mortality in Ghana: a hospital‐based review
Authors: LEE QIN YI , ODOI ALEXANDER T. , OPARE‐ADDO HENRY , DASSAH EDWARD T.
Published: July 2011

Objective. This study examines the leading causes of maternal mortality in Ghana, classifies the main causes of maternal deaths and suggests how maternal care can be improved. Design. Retrospective review. Setting. Komfo Anokye Teaching Hospital, Ghana. Sample. Three hundred and twenty‐two maternal deaths with 30 269 live births in the period 1 January 2008 to 30 June 2010. Methods. Data on maternal mortality and morbidity were retrieved from the Biostatistics Unit of the hospital. Main Outcome Measures. Maternal mortality ratio (MMR), case fatality rate, leading causes of maternal deaths, duration of admission and staff/patient ratio. Results. The MMR was calculated to be 1 004 per 100 000 live births (95% confidence interval 895.0–1113.2). Of these, 71.1% were direct deaths, 22.4% were indirect deaths and 6.5% were unclassified. Hypertensive states of pregnancy were the leading cause of mortality (26.4%) and, together with hemorrhage, genital tract sepsis and early pregnancy deaths, accounted for 62.2% of all‐cause maternal deaths and 87.3% of direct deaths. Infection and sickle cell disease accounted for 13.7% of all‐cause maternal deaths and 61.1% of indirect deaths. Conclusions. Hypertensive states of pregnancy were the current leading cause of maternal mortality. Adopting a multi‐pronged approach through reducing delays in access to emergency obstetric care, promoting contraceptive use, encouraging early, regular antenatal attendance and shared antenatal care with the medical team is essential to tackle the situation.
Long‐term sequential receptor activator of NF‐κB ligand (RANKL) and osteoprotegrin (OPG) expression in lipopolysaccharide‐induced rat periapical lesions
Authors: Chuang Fu‐Hsiung , Tsai Chi‐Cheng , Chen Jeng‐Huey , Chen Ker‐Kong , Chen Yuk‐Kwan , Lin Ying‐Chu
Published: July 2011

J Oral Pathol Med (2012) 41: 186–193

Background:  Long‐term sequential expression of receptor activator of NF‐κB ligand (RANKL) and osteoprotegrin (OPG) in lipopolysaccharide (LPS)‐induced rat periapical lesions has not been studied.

Materials:  Seventy‐two 4‐week‐old Wistar rats were divided into eight experimental groups and one control group (eight animals in each).

Methods:  Lipopolysaccharide‐induced periapical lesions were produced in rats by occlusal exposure of the pulp of their lower first molars in all experimental groups but not the control group. The extent of periapical destruction was measured by radiographic imaging. RANKL and OPG mRNA were measured in all tissue sections containing the periapical lesions as well as the control group every week from week 1 to week 8 by real‐time quantitative reverse transcription polymerase chain reaction. RANKL and OPG protein were determined by immunohistochemistry. Osteoclasts were identified by enzyme histochemistry.

Results:  The sequential changes in the mRNA and protein expression of RANKL and OPG were largely compatible with the occurrence of osteoclasts histologically and enzymes histochemically, as well as the mean areas of the periapical lesions radiographically during long‐term observation of the LPS‐induced rat periapical lesions.

Conclusion:  This study may be the first to demonstrate the long‐term RANKL and OPG expression every week from week 1 to week 8 using LPS to produce periapical infection in a Wistar rat model. The long‐term findings of high expressions of RANKL and OPG further extend the potential application of the Wistar rat model for future experimental trials using RANKL inhibitor to evaluate the treatment outcome for LPS‐induced rat periapical lesions.
The expression and significance of MRP1, LRP, TOPOIIβ, and BCL2 in tongue squamous cell carcinoma
Authors: Zhang Bin , Liu Mo , Tang Hai‐kuo , Ma Hui‐bin , Wang Cheng , Chen Xiaohua , Huang Hong‐zhang
Published: July 2011

J Oral Pathol Med (2012) 41: 141–148

Background:  Multiple drug resistance protein 1 (MRP1), lung resistance protein (LRP), topoisomerase IIβ (TOPOIIβ) and B‐cell lymphoma 2 (BCL2) are well known in the development of drug resistance in cancer cells. The aim of this study was to evaluate the relationship between them and the clinicopathological features, their expression differences between tumor tissue and experimental drug‐resistant model in tongue carcinoma.

Materials and methods:  Multiple drug resistance protein 1, LRP, TOPOIIβ, and BCL2 expression was examined by immunohistochemistry in specimens from radical surgeries of 65 patients with tongue carcinoma. A cisplatin‐resistance cell line, SCC‐15/cisplatin, was established from a cisplatin‐sensitive cell line, SCC‐15. A MTT‐based method was used to analyze drug potencies. Immunofluorescence was used to detect protein expression in both cell lines. Western blot was used to compare the protein expressions in specimens and SCC‐15/cisplatin cells.

Results:  We found higher expression of MRP1, LRP, and BCL2 and lower expression of TOPOIIβ in tongue carcinoma compared with adjacent non‐neoplastic tongue tissues (P < 0.05). In addition, MRP1 and TopoIIβ expression were significantly associated with clinical stage, lymph node metastasis and histologic grade, and LRP was significantly associated with histologic grade in the samples (P < 0.05). Finally, Western blot showed that higher expressions of MRP1, LRP, and BCL2 and lower expression of TopoIIβ were observed in SCC‐15/cisplatin cells than in clinical samples.

Conclusion:  Our results suggest that the high expressions of MRP1, LRP, and BCL2 and low expression of TOPOIIβ in patients with tongue carcinoma indicates that intrinsic drug resistance may exist in tongue carcinoma, and is associated with tumor differentiation and cisplatin resistance in tongue carcinoma.
Prevotella nigrescens and Porphyromonas gingivalis are associated with signs of carotid atherosclerosis in subjects with and without periodontitis
Authors: Yakob M. , Söder B. , Meurman J. H. , Jogestrand T. , Nowak J. , Söder P.‐Ö.
Published: July 2011

Yakob M, Söder B, Meurman JH, Jogestrand T, Nowak J, Söder P.‐Ö. Prevotella nigrescens and Porphyromonas gingivalis are associated with signs of carotid atherosclerosis in subjects with and without periodontitis. J Periodont Res 2011; 46: 749–755. ©2011 John Wiley & Sons A/S

Background and Objective:  Oral microorganisms may be involved in the development of cardiovascular diseases, and Porphyromonas gingivalis is one of the periodontal microorganisms that has been found in carotid atheroma. The aim of this work was to study subgingival microorganisms and early carotid lesions in subjects with and without periodontitis.

Material and Methods:  Eighty‐eight subjects with periodontitis and 40 subjects without periodontitis underwent dental examinations in 2003. The presence of the periodontal microorganisms Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens and Tannerella forsythia was analyzed from subgingival plaque using PCR amplification. The common carotid artery was scanned using ultrasound and the calculated intima‐media area (cIMA) was measured. The association between periodontitis, the cIMA value and the presence of periodontal microorganisms, together with several confounders, was studied in a multiple logistic regression model.

Results:  Smoking [odds ratio (OR) = 5.64; p = 0.001), level of education (OR = 5.02; p < 0.05) and the presence of P. gingivalis (OR = 6.50; p < 0.05) were associated with periodontitis. Explanatory factors for the increased cIMA were periodontitis (OR = 4.22; p < 0.05), hypertension (OR = 4.81; p < 0.05), high body mass index (OR = 5.78; p < 0.01), male gender (OR = 3.30; p < 0.05) and poor socioeconomic status (OR = 4.34; p < 0.05). P. nigrescens (OR 4.08; p < 0.05) and P. gingivalis (OR 7.63; p < 0.01) also appeared as explanatory variables associated with increased cIMA values.

Conclusion:  This cross‐sectional study showed that P. nigrescens and P. gingivalis were significantly associated with increased cIMA values.
Actin is Involved in Pollen Tube Tropism Through Redefining the Spatial Targeting of Secretory Vesicles
Authors: Bou Daher Firas , Geitmann Anja
Published: July 2011

In order to accurately target the embryo sac and deliver the sperm cells, the pollen tube has to find an efficient path through the pistil and respond to precise directional cues produced by the female tissues. Although many chemical and proteic signals have been identified to guide pollen tube growth, the mechanism by which the tube changes direction in response to these signals is poorly understood. We designed an experimental setup using a microscope‐mounted galvanotropic chamber that allowed us to induce the redirection ofin vitropollen tube growth through a precisely timed and calibrated external signal. Actin destabilization, reduced calcium concentration in the growth medium and inhibition of calcium channel activity decreased the responsiveness of the pollen tube to a tropic trigger. An increased calcium concentration in the medium enhanced this response and was able to rescue the effect of actin depolymerization. Time‐lapse imaging revealed that the motion pattern of vesicles and the dynamics of the subapical actin array undergo spatial reorientation prior to the onset of a tropic response. Together these results suggest that the precise targeting of the delivery of new wall material represents a key component in the growth machinery that determines directional elongation in pollen tubes.
Traumatic dental injuries and their association with malocclusion in the primary dentition of Irish children
Authors: Norton Eimear , O’Connell Anne C.
Published: July 2011

Abstract –  Aims:  This study sought to establish the prevalence of traumatic dental injuries in the primary dentition of Irish children and to investigate the relationship between dental trauma and non‐nutritive sucking habits.

Materials and methods:  Following ethical approval, a variety of schools and crèches in an urban setting were identified and parents of over 1000 children were contacted. Consent was obtained, and parental questionnaires were completed prior to a clinical examination of the children by one operator in a non‐dental setting. Signs of previous dental trauma were noted, and overbite and overjet were measured.

Results:  Eight hundred and thirty‐nine children were examined. The prevalence of dental trauma was 25.6%, with boys more frequently affected. The most commonly observed dental injury was fracture of enamel (39.4%), followed by crown discolouration (20.2%). Only 38.8% of the children with a reported history of trauma sought dental care. Non‐nutritive sucking habits were reported in 63.5% of the sample, and these habits, if prolonged, were significantly associated with anterior open bites and increased overjet (P < 0.001). Using regression analysis, it was established that the risk of dental injury is 2.99 times greater if the child has an overjet >6 mm and 2.02 times greater if the child has an anterior open bite.

Conclusions:  Non‐nutritive sucking habits are associated with the establishment of anterior open bite and increased overjet in the primary dentition. These malocclusions are, in turn, significantly associated with an increased prevalence of dental trauma in the primary dentition.
Recommendations for using regenerative endodontic procedures in permanent immature traumatized teeth
Authors: Garcia‐Godoy Franklin , Murray Peter E.
Published: July 2011

Abstract –  The regeneration of immature permanent teeth following trauma could be beneficial to reduce the risk of fracture and loss of millions of teeth each year. Regenerative endodontic procedures include revascularization, partial pulpotomy, and apexogenesis. Several case reports give these procedures a good prognosis as an alternative to apexification. Care is needed to deliver regenerative endodontic procedures that maintain or restore the vitality of teeth, but which also disinfect and remove necrotic tissues. Regeneration can be accomplished through the activity of the cells from the pulp, periodontium, vascular, and immune system. Most therapies use the host’s own pulp or vascular cells for regeneration, but other types of dental stem cell therapies are under development. There are no standardized treatment protocols for endodontic regeneration. The purpose of this article is to review the recent literature and suggest guidelines for using regenerative endodontic procedures for the treatment of permanent immature traumatized teeth. Recommendations for the selection of regenerative and conventional procedures based on the type of tooth injury, fracture type, presence of necrosis or infection, periodontal status, presence of periapical lesions, stage of tooth development, vitality status, patient age, and patient health status will be reviewed. Because of the lack of long‐term evidence to support the use of regenerative endodontic procedures in traumatized teeth with open apices, revascularization regeneration procedures should only be attempted if the tooth is not suitable for root canal obturation, and after apexogenesis, apexification, or partial pulpotomy treatments have already been attempted and have a poor prognosis.
Outcomes of Crural Ligation Surgery for Isolated Crural Venous Leak
Authors: Flores Stefan , Tal Raanan , O’Brien Keith , Mulhall John P.
Published: July 2011

Introduction

Venous ligation surgery results for diffuse venous leak have been disappointing, although in isolated crural venous leak (ICVL) cases, efficacy for crural ligation surgery (CLS) has been demonstrated.

Aim

The purpose of this study was to present our experience with treatment of ICVL with CLS.

Methods

All patients underwent preoperative cavernosometry. Cavernosography (CG) or perineal compression (PC) was used to define the diagnosis of ICVL. If CG demonstrated ICVL or flow-to-maintain values normalized with PC, the patient was counseled regarding CLS. Baseline and postoperative erectile function (EF) was assessed by the International Index of Erectile Function (IIEF) questionnaire.

Main Outcome Measures

EF, using the EF domain (EFD) score of the IIEF, a domain with six questions with a maximum score of 30 and a minimum score of 6 in the sexually active male. All patients completed the questionnaire preoperatively and in a serial fashion after surgery at a time point after 12 months postoperatively.

Results

14 patients underwent CLS. Mean age was 29 ± 7 years. Also, 64% had primary erectile dysfunction. Mean baseline IIEF-EF score was 18 ± 6. Furthermore, 71% of patients had failed phosphodiesterase type 5 (PDE5) inhibitors and 6/10 (60%) failed intracavernosal injections (ICI). Mean postoperative EFD score was 24 ± 3 representing a mean change of 6.5 points per patient. No patient needed ICI after CLS; however, 4/14 patients needed PDE5 inhibitors, all of whom had been using ICI preoperatively. In addition, 71% experienced unassisted sexual intercourse after CLS.

Conclusions

In a highly selected population of young men with ICVL, CLS cures 70% and improves EF in more than 90% of men. Surgical treatment of ICVL by CLS can be performed safely and with sufficient efficacy that larger and longer term studies should be undertaken.
Women's Clitoris, Vagina, and Cervix Mapped on the Sensory Cortex: fMRI Evidence
Authors: Komisaruk B. R. , Wise N. , Frangos E. , Liu W. , Allen K. , Brody S.
Published: July 2011

Introduction

The projection of vagina, uterine cervix, and nipple to the sensory cortex in humans has not been reported.

Aims

The aim of this study was to map the sensory cortical fields of the clitoris, vagina, cervix, and nipple, toward an elucidation of the neural systems underlying sexual response.

Methods

Using functional magnetic resonance imaging (fMRI), we mapped sensory cortical responses to clitoral, vaginal, cervical, and nipple self-stimulation. For points of reference on the homunculus, we also mapped responses to the thumb and great toe (hallux) stimulation.

Main Outcome Measures

The main outcome measures used for this study were the fMRI of brain regions activated by the various sensory stimuli.

Results

Clitoral, vaginal, and cervical self-stimulation activated differentiable sensory cortical regions, all clustered in the medial cortex (medial paracentral lobule). Nipple self-stimulation activated the genital sensory cortex (as well as the thoracic) region of the homuncular map.

Conclusion

The genital sensory cortex, identified in the classical Penfield homunculus based on electrical stimulation of the brain only in men, was confirmed for the first time in the literature by the present study in women applying clitoral, vaginal, and cervical self-stimulation, and observing their regional brain responses using fMRI. Vaginal, clitoral, and cervical regions of activation were differentiable, consistent with innervation by different afferent nerves and different behavioral correlates. Activation of the genital sensory cortex by nipple self-stimulation was unexpected, but suggests a neurological basis for women's reports of its erotogenic quality.