bluuebunny/crossref_metadata_2025 huggingface dataset:
Periodontal status of adult patients treated with fixed buccal appliances and removable aligners over one year of active orthodontic therapy
Authors: Karkhanechi Marzieh , Chow Denise , Sipkin Jennifer , Sherman David , Boylan Robert J. , Norman Robert G. , Craig Ronald G. , Cisneros George J.
Published: June 2012

Objective:

To compare the periodontal status of adults treated with fixed buccal orthodontic appliances vs removable orthodontic aligners over 1 year of active therapy.

Materials and Methods:

The study population consisted of 42 subjects; 22 treated with fixed buccal orthodontic appliances and 20 treated with removable aligners. Clinical indices recorded included: plaque index (PI), gingival index (GI), bleeding on probing (BOP), and probing pocket depth (PPD). Plaque samples were assessed for hydrolysis of N-benzoyl-DL-arginine-naphthylamide (BANA test). Indices and BANA scores were recorded before treatment and at 6 weeks, 6 months, and 12 months after initiation of orthodontic therapy.

Results:

After 6 weeks, only mean PPD was greater in the fixed buccal orthodontic appliance group. However, after 6 months, the fixed buccal orthodontic appliance group had significantly greater mean PI, PPD, and GI scores and was 5.739 times more likely to have a higher BANA score. After 12 months, the fixed buccal orthodontic appliance group continued to have greater mean PI, GI, and PPD, while a trend was noted for higher BANA scores and BOP.

Conclusions:

These results suggest treatment with fixed buccal orthodontic appliances is associated with decreased periodontal status and increased levels of periodontopathic bacteria when compared to treatment with removable aligners over the 12-month study duration.
Nutrient Excess Stimulates β-Cell Neogenesis in Zebrafish
Authors: Maddison Lisette A. , Chen Wenbiao
Published: June 2012

Persistent nutrient excess results in a compensatory increase in the β-cell number in mammals. It is unknown whether this response occurs in nonmammalian vertebrates, including zebrafish, a model for genetics and chemical genetics. We investigated the response of zebrafish β-cells to nutrient excess and the underlying mechanisms by culturing transgenic zebrafish larvae in solutions of different nutrient composition. The number of β-cells rapidly increases after persistent, but not intermittent, exposure to glucose or a lipid-rich diet. The response to glucose, but not the lipid-rich diet, required mammalian target of rapamycin activity. In contrast, inhibition of insulin/IGF-1 signaling in β-cells blocked the response to the lipid-rich diet, but not to glucose. Lineage tracing and marker expression analyses indicated that the new β-cells were not from self-replication but arose through differentiation of postmitotic precursor cells. On the basis of transgenic markers, we identified two groups of newly formed β-cells: one with nkx2.2 promoter activity and the other with mnx1 promoter activity. Thus, nutrient excess in zebrafish induces a rapid increase in β-cells though differentiation of two subpopulations of postmitotic precursor cells. This occurs through different mechanisms depending on the nutrient type and likely involves paracrine signaling between the differentiated β-cells and the precursor cells.
Rapamycin/IL-2 Combination Therapy in Patients With Type 1 Diabetes Augments Tregs yet Transiently Impairs β-Cell Function
Authors: Long S. Alice , Rieck Mary , Sanda Srinath , Bollyky Jennifer B. , Samuels Peter L. , Goland Robin , Ahmann Andrew , Rabinovitch Alex , Aggarwal Sudeepta , Phippard Deborah , Turka Laurence A. , Ehlers Mario R. , Bianchine Peter J. , Boyle Karen D. , Adah Steven A. , Bluestone Jeffrey A. , Buckner Jane H. , Greenbaum Carla J.
Published: June 2012

Rapamycin/interleukin-2 (IL-2) combination treatment of NOD mice effectively treats autoimmune diabetes. We performed a phase 1 clinical trial to test the safety and immunologic effects of rapamycin/IL-2 combination therapy in type 1 diabetic (T1D) patients. Nine T1D subjects were treated with 2–4 mg/day rapamycin orally for 3 months and 4.5 × 106 IU IL-2 s.c. three times per week for 1 month. β-Cell function was monitored by measuring C-peptide. Immunologic changes were monitored using flow cytometry and serum analyses. Regulatory T cells (Tregs) increased within the first month of therapy, yet clinical and metabolic data demonstrated a transient worsening in all subjects. The increase in Tregs was transient, paralleling IL-2 treatment, whereas the response of Tregs to IL-2, as measured by STAT5 phosphorylation, increased and persisted after treatment. No differences were observed in effector T-cell subset frequencies, but an increase in natural killer cells and eosinophils occurred with IL-2 therapy. Rapamycin/IL-2 therapy, as given in this phase 1 study, resulted in transient β-cell dysfunction despite an increase in Tregs. Such results highlight the difficulties in translating therapies to the clinic and emphasize the importance of broadly interrogating the immune system to evaluate the effects of therapy.
Association of Diabetes and Hemodialysis With Ankle Pressure and Ankle-Brachial Index in Japanese Patients With Critical Limb Ischemia
Authors: Takahara Mitsuyoshi , Kaneto Hideaki , Iida Osamu , Katakami Naoto , Matsuoka Taka-aki , Ikeda Masahiko , Shimomura Iichiro
Published: June 2012

OBJECTIVE

To investigate whether diabetes and regular hemodialysis are associated with false elevation of ankle systolic blood pressure and ankle-brachial systolic pressure index (ABI) because of their arterial calcification in patients with critical limb ischemia (CLI).

RESEARCH DESIGN AND METHODS

We recruited 269 Japanese patients who underwent endovascular therapy for CLI. Ankle systolic blood pressure and ABI were assessed before endovascular therapy. Arterial stenosis and calcification were evaluated angiographically. We investigated the associations among clinical comorbidities, arterial calcification, and measurements of ankle systolic blood pressure and ABI.

RESULTS

Ankle systolic blood pressure was 85 ± 56 mmHg, and ABI was 0.59 ± 0.37. Arterial calcification was observed in 69% of the patients. The prevalence of diabetes and regular hemodialysis was 71 and 47%. Diabetes and regular hemodialysis were both significantly associated with the presence of arterial calcification; their adjusted odds ratios were 2.33 (P = 0.01) and 7.40 (P < 0.01), respectively. However, there was no significant difference in ankle systolic blood pressure or ABI level between those with and without these comorbidities. Furthermore, the presence of arterial calcification was not associated with ankle systolic blood pressure or ABI level, whereas arterial stenoses of all segments in the lower body had independent associations with reduced ankle systolic blood pressure and ABI level.

CONCLUSIONS

Diabetes and regular hemodialysis were significantly associated with arterial calcification, but not with elevated measurements of ankle systolic blood pressure or ABI, in CLI patients.
Intensive Blood Pressure Treatment Does Not Improve Cardiovascular Outcomes in Centrally Obese Hypertensive Individuals With Diabetes
Authors: Barzilay Joshua I. , Howard Annie G. , Evans Gregory W. , Fleg Jerome L. , Cohen Robert M. , Booth Gillian L. , Kimel Angela R. , Pedley Carolyn F. , Cushman William C.
Published: June 2012

OBJECTIVE

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial reported no differences in most cardiovascular disease (CVD) outcomes between intensive and standard blood pressure therapy in individuals with diabetes mellitus (DM) and hypertension. Many such individuals are centrally obese. Here we evaluate whether the trial outcomes varied by the level of central obesity.

RESEARCH DESIGN AND METHODS

The cohort included 4,687 people (47.7% women) with DM and hypertension. Mean age was 62.2, and mean follow-up was 4.7 years. Participants were randomly assigned to one of two blood pressure treatment strategies: intensive (systolic <120 mmHg) or standard (systolic <140 mmHg). Sex-specific quartiles of waist-to-height ratio were used as the measure of central obesity. The primary ACCORD outcome (a composite of nonfatal myocardial infarction [MI], nonfatal stroke, or CVD death) and three secondary outcomes (nonfatal MI, fatal or nonfatal stroke, and CVD death) were examined using proportional hazard models.

RESULTS

There was no evidence that the effect of intensively lowering blood pressure differed by quartile of waist-to-height ratio for any of the four outcomes (P > 0.25 in all cases). Controlling for waist-to-height quartile had no significant impact on previously published results for intensive blood pressure therapy. Waist-to-height ratio was significantly related to CVD mortality (hazard ratio 2.32 [95% CI 1.40–3.83], P = 0.0009 comparing the heaviest to lightest quartiles), but not to the other outcomes (P > 0.09 in all cases).

CONCLUSIONS

Intensive lowering of blood pressure versus standard treatment does not ameliorate CVD risk in individuals with DM and hypertension. These results did not vary by quartile of waist-to-height ratio.
Circadian Variation in the Response to the Glucose Challenge Test in Pregnancy
Authors: Goldberg Robert J. , Ye Chang , Sermer Mathew , Connelly Philip W. , Hanley Anthony J.G. , Zinman Bernard , Retnakaran Ravi
Published: June 2012

OBJECTIVE

A common approach to screening for gestational diabetes mellitus (GDM) is the universal testing of all pregnant women with a 1-h, 50-g glucose challenge test (GCT), followed by a diagnostic oral glucose tolerance test (OGTT) in those in whom the GCT is positive (≥7.8 mmol/L). More important, the GCT is performed at any time of day, but there has been limited study of the effect of time of day on test performance. Thus, using their subsequent OGTT (performed in the morning), we sought to characterize the metabolic function of women with positive GCTs in relation to the timing of their test.

RESEARCH DESIGN AND METHODS

A total of 927 women with positive GCTs underwent a 3-h 100-g OGTT. They were stratified into four groups by time of day (hours) of their GCT: <0900 (n = 171), 0900–1059 (n = 288), 1100–1259 (n = 189), and ≥1300 (n = 279).

RESULTS

On the OGTT, the prevalence of GDM progressively decreased across the GCT groups from <0900 h (26.9%) to 0900–1059 h (25.0%) to 1100–1259 h (21.7%) to ≥1300 h (21.5%; P = 0.0022). After adjustment for GDM risk factors, mean adjusted glucose area under the curve (AUCgluc) similarly decreased across the groups, while insulin sensitivity (Matsuda index) and β-cell function (Insulin Secretion-Sensitivity Index-2) progressively increased (all P < 0.0001). In particular, compared with the <0900- and 0900–1059-h groups, women whose positive GCT occurred after 1300 h had superior metabolic function, as evidenced by lower AUCgluc, higher insulin sensitivity, and better β-cell function (all P ≤ 0.0097).

CONCLUSIONS

Among women with a positive GCT, those tested in the afternoon have better metabolic function and a lower risk of GDM on subsequent OGTT.
Modest Levels of Physical Activity Are Associated With a Lower Incidence of Diabetes in a Population With a High Rate of Obesity
Authors: Fretts Amanda M. , Howard Barbara V. , McKnight Barbara , Duncan Glen E. , Beresford Shirley A.A. , Calhoun Darren , Kriska Andrea M. , Storti Kristi L. , Siscovick David S.
Published: June 2012

OBJECTIVE

To examine the association of objectively measured participation in low levels of physical activity with incident type 2 diabetes.

RESEARCH DESIGN AND METHODS

The study population included participants free of diabetes and cardiovascular disease at baseline (n = 1,826) who participated in a follow-up examination. Generalized estimating equations were used to examine the association of steps per day with incident diabetes.

RESULTS

During 5 years of follow-up, 243 incident cases of diabetes were identified. When compared with participants in the lowest quartile of steps per day (<3,500 steps), participants in the upper three quartiles of steps per day had lower odds for diabetes, consistent with a threshold effect. Contrasting the three upper quartiles with the lowest quartile, the odds ratio of diabetes was 0.71 (95% CI 0.51–0.98).

CONCLUSIONS

Modest levels of physical activity are associated with a lower risk of incident diabetes, compared with lower levels of activity.
Indexing Severity of Diabetic Foot Infection With 99mTc-WBC SPECT/CT Hybrid Imaging
Authors: Erdman William A. , Buethe Ji , Bhore Rafia , Ghayee Hans K. , Thompson Chiarra , Maewal Param , Anderson Jon , Klemow Steve , Oz Orhan K.
Published: June 2012

OBJECTIVE

Management of diabetic foot infection (DFI) has been hampered by limited means of accurately classifying disease severity. New hybrid nuclear/computed tomography (CT) imaging techniques elucidate a combination of wound infection parameters not previously evaluated as outcome prognosticators. Our aim is to determine if a novel standardized hybrid image–based scoring system, Composite Severity Index (CSI), has prognostic value in DFI.

RESEARCH DESIGN AND METHODS

Masked retrospective 99mTc-white blood cell (WBC) single photon emission CT (SPECT)/CT image interpretation and independent chart review of 77 patients (101 feet) suspected of DFI-associated osteomyelitis at a large municipal hospital between January 2007 and July 2009. CSI scores were correlated with probability of favorable outcome (no subsequent amputation/readmission after therapeutic intervention) during median 342-day follow-up.

RESULTS

CSI ranged from 0–13. Receiver operating characteristic accuracy for predicting favorable outcome was 0.79 (optimal cutoff CSI, ≤2; odds ratio of therapeutic failure for CSI >2, 15.1 [95% CI 4.4–51.5]). CSI of 0 had a 92% chance of favorable outcome, which fell progressively to 25% as indices rose to ≥7. Image-based osteomyelitis versus no osteomyelitis assessment was less accurate than CSI at predicting outcome (P = 0.016). In patients with intermediate severity (CSI 3–6), treatment failure decreased from 68 to 36% when antibiotic duration was extended to ≥42 days (P = 0.026).

CONCLUSIONS

99mTc-WBC SPECT/CT hybrid image–derived wound infection parameters incorporated into a standardized scoring system, CSI, has prognostic value in DFI.
Genotoxicity of Metal Nanoparticles: Focus on In Vivo Studies
Authors: Klien Katharina , Godnić-Cvar Jasminka
Published: June 2012

Genotoxicity of Metal Nanoparticles: Focus on In Vivo Studies

With increasing production and application of a variety of nanomaterials (NMs), research on their cytotoxic and genotoxic potential grows, as the exposure to these nano-sized materials may potentially result in adverse health effects. In large part, indications for potential DNA damaging effects of nanoparticles (NPs) originate from inconsistent in vitro studies. To clarify these effects, the implementation of in vivo studies has been emphasised. This paper summarises study results of genotoxic effects of NPs, which are available in the recent literature. They provide indications that some NP types cause both DNA strand breaks and chromosomal damages in experimental animals. Their genotoxic effects, however, do not depend only on particle size, surface modification (particle coating), and exposure route, but also on exposure duration. Currently available animal studies may suggest differing mechanisms (depending on the duration of exposure) by which living organisms react to NP contact. Nevertheless, due to considerable inconsistencies in the recent literature and the lack of standardised test methods - a reliable hazard assessment of NMs is still limited. Therefore, international organisations (e.g. NIOSH) suggest utmost caution when potential exposure of humans to NMs occurs, as long as evidence of their toxicological and genotoxic effect(s) is limited.
City Shape and the Fractality of Street Patterns
Authors: Mohajeri Nahid , Longley Paul , Batty Michael
Published: June 2012

City Shape and the Fractality of Street Patterns

This paper discusses, first, the concepts of fractals and power laws in relation to the street patterns of the city of Dundee, East Scotland and, second, the results of the measurement of 6,004 street segments in the city. The trends of the street segments are presented through rose diagrams and show that there are two main street trends in the city: one is parallel with the coast, the other is roughly perpendicular to the coast. It is clear that the coastline largely regulates the street trend, because both the main street trends change along the city so as to be nearly coast-perpendicular and coast-parallel everywhere. The lengths of the street segments follow power laws. When presented on log-log plots, however, the result is not a single straight line but two straight lines. At the break in line slope, the fractal dimension changes from 0.88 to 2.20. The change occurs at the step length of about 100 m, indicating that the short streets belong to a population that is different from that of the longer streets.
Quality of Life in an Urban Environment: A Typology of Urban Units of Olomouc
Authors: Kladivo Petr , Halás Marián
Published: June 2012

Quality of Life in an Urban Environment: A Typology of Urban Units of Olomouc

Studying the internal structure of cities is one of the traditional topics of geographical research. The aim of this article is to show a possible approach to the study of an objective dimension of the quality of life in an intra-urban environment focusing on detailed studies of selected indicators of the quality of life. There exist many approaches to evaluating the quality of life because it is an interdisciplinary term; we are going to focus on this issue in terms of the quality of living conditions. Using multivariate statistical methods, we are going to try a typology of an urban area in just those terms, and the results will be confronted with the perception of the quality of life by residents themselves. The area studied will be the city of Olomouc.
Urban Nature Between Modern and Postmodern Aesthetics: Reflections Based on the Social Constructivist Approach
Authors: Kühne Olaf
Published: June 2012

Urban Nature Between Modern and Postmodern Aesthetics: Reflections Based on the Social Constructivist Approach

The article deals with the question of the social construction and assessment of physical urban objects (such as trees, gardens, parks) which are perceived as natural. The society perceives nature ambivalently. Nature describes "the primary and the good (…) that contrasts with society as the artificial and even the destructive". Nevertheless nature means "the wild and the threatening which is domesticated to protect society" (Groß 2006: 5). In the city, nature exists in a domesticated form (e.g. as a park) or in a less domesticated condition (e.g. as sparse flora). Modernity and postmodernity have different implications in the perception and assessment of urban nature. Especially the less domesticated nature contradicts the modern aesthetic scheme. It is assumed that the antagonism of legitimated and trivial culture is a substantial characteristic of modernity, which incorporates itself in a series of fundamental dichotomies like nature and culture (Fuller 1992). A typical characteristic of the modern dichotomy is the construction of order and disorder. By contrast, postmodern aesthetics challenges and deconstructs these dichotomies (Sloterdijk 1987, 1988). Unlike modernity, postmodernity tolerates the less domesticated nature in cities which includes new possibilities of the composition of the cityscape, especially for ruined buildings and areas. Postmodern landscape planning and architecture do not mean ‘anything goes’, but rather including the pluralism of citizens' interests, belongings and needs, especially because they are the sovereigns in democratic societies. In consequence, the postmodern perspective on planning can be an integral part of the sustainable development of cities.
Structural Changes in the Industry of Poland Aagainst the Background of Eastern European Union States
Authors: Gierańczyk Wiesława , Rachwał Tomasz
Published: June 2012

Structural Changes in the Industry of Poland Aagainst the Background of Eastern European Union States

Industrial restructuring processes associated with the transformation of the system taking place in Poland and other countries of Central and Eastern Europe bring about structural changes in manufacturing intended to develop intellectually-intensive industries based on the implementation of the latest research and development (R&D) results. The purpose of this article is therefore to present changes in the role of industry in the economy of Poland based on its share in employment and gross value added in comparison with other eastern EU countries, as well as structural changes in the industrial sectors (NACE divisions). The comparison will assess the competitive position of Polish industry on international markets, particularly against the other states transforming their economies. The analysis will seek to establish to what extent the structural changes in Polish industry indicate positive effects of the country's economic transformation.
Search for Immortality in Ancient and Modern Sport
Authors: Pisk Jernej
Published: June 2012

Search for Immortality in Ancient and Modern Sport

There is only one real problem each human being faces: death. Nobody lives eternally. In essence, humans are mortal beings; beings-unto-death, as framed by Heidegger. But human beings are never reconciled with this fact. Since ancient times, humans have been searching for ways to become immortal and to somehow stay alive eternally. In this paper we will focus on one specific common understanding of immortality among people - immortality in memory. Since ancient Greece, success and fame have meant not only different privileges in the community but also achieving symbolic immortality. Artists, politicians, and athletes - all of them were trying to become well known. So other people would remember them after their death, praise them, and keep them in their memory. In times when transcendental immortality was not known (or accepted), this was the only means to becoming immortal. To this day, lists and statues of ancient Greek Olympic champions have survived. So in a way champions are still alive - they achieved immortality. With the rise of metaphysics in philosophy and the also the Christian understanding of transcendental immortality, the need to be famous, to stay alive in memory, has declined. But nowadays, when the faith in transcendental immortality is weak, once again the ancient notion of immortality is becoming more and more powerful. Being famous, recognized among others, staying in the memory of others - this can be one of the important motives in striving to become a champion in the field of sport.
Localised Exoticism: Developments and Features of Belly Dance in Taiwan
Authors: Chang Yu-Chi
Published: June 2012

Localised Exoticism: Developments and Features of Belly Dance in Taiwan

Belly dance has become one of the most popular dances in Taiwan today, with women of various ages participating in this imported dance. With respect to this speedy expansion, the purpose of this study is to investigate current developments, and to distinguish features of Taiwanese belly dance. The method adopted is literature analysis: a large number of Internet news items were collected to capture the trend of belly dancing in Taiwan. This study concludes that belly dance in Taiwan is primarily presented as: an exercise that is beneficial for health; widely accessible and partially embedded in local life; an exercise for all age groups and genders; a blend of multiple cultural elements; outstanding dancers acclaimed as the pride of Taiwan. The representation showed that the development of belly dance was influenced by the Taiwanese social background. Within the Taiwanese cultural landscape of meanings, belly dance moves between the exotic and the local. This study argues that belly dance is better described as "localised-exoticism" in Taiwan.
From Double Iron to Double Deca Iron Ultra-Triathlon - A Retrospective Data Analysis from 1985 to 2011
Authors: Lenherr Reto , Knechtle Beat , Rüst Christoph , Rosemann Thomas , Lepers Romuald
Published: June 2012

From Double Iron to Double Deca Iron Ultra-Triathlon - A Retrospective Data Analysis from 1985 to 2011

Participation in ultra-endurance performance is of increasing popularity. We analyzed the historic development of the ultra-triathlon scene from 1985 to 2011 focusing on a) worldwide distribution of competition, b) participation, c) gender, and d) athlete nationality. We examined the participation trends of 3,579 athletes, involving 3,297 men (92.1%) and 300 women (7.9%), using linear regression analyses. Between 1985 and 2011, a total of 96 Double Iron ultra-triathlons (7.6km swimming, 360km cycling, and 84.4km running), 51 Triple Iron ultra-triathlons (11.6km swimming, 540km cycling, and 126.6km running), five Quadruple Iron ultra-triathlons (15.2km swimming, 720km cycling, and 168.8km running), five Quintuple Iron ultra-triathlons (19km swimming, 900km cycling, and 211km running), 11 Deca Iron ultra-triathlons (38km swimming, 1,800km cycling, and 422km running), and two Double Deca Iron ultra-triathlons (76km swimming, 3,600km cycling, and 844km running) were held. In total, 56.7% of the races were in Europe, 37.4% in North America, 5.3% in South America, and less than 1% in Asia. Europeans comprised 80% of the athletes. The number of male participants in Double (r2 = .56; P < .001) and Triple Iron ultra-triathlon (r2 = .47; P < .001) and the number of female participants in Double Iron ultra-triathlon (r2 = .66; P < .001) increased significantly. Less than 8% of the athletes total participated in an ultra-triathlon longer than a Triple Iron ultra-triathlon. Europeans won by far the most competitions in every distance. In conclusion, ultra-triathlon popularity is mainly limited to a) European and North American men and b) Double and Triple Iron ultra-triathlons. Future studies need to investigate the motivation of these ultra-endurance athletes to compete in these extreme races.
Perceived Effort of Walking: Relationship With Gait, Physical Function and Activity, Fear of Falling, and Confidence in Walking in Older Adults With Mobility Limitations
Authors: Julius Leslie M. , Brach Jennifer S. , Wert David M. , VanSwearingen Jessie M.
Published: June 2012

Background

Although clinicians have a number of measures to use to describe walking performance, few, if any, of the measures capture a person's perceived effort in walking. Perceived effort of walking may be a factor in what a person does versus what he or she is able to do.

Objective

The objective of this study was to examine the relationship of perceived effort of walking with gait, function, activity, fear of falling, and confidence in walking in older adults with mobility limitations.

Design

This investigation was a cross-sectional, descriptive, relational study.

Methods

The study took place at a clinical research training center. The participants were 50 older adults (mean age=76.8 years, SD=5.5) with mobility limitations. The measurements used were the Rating of Perceived Exertion (RPE) for walking; gait speed; the Modified Gait Abnormality Rating Scale; energy cost of walking; Late Life Function and Disability Instrument (LLFDI) for total, basic, and advanced lower-extremity function and for disability limitations; activity and restriction subscales of the Survey of Activities and Fear of Falling in the Elderly (SAFFE); activity counts; SAFFE fear subscale; and Gait Efficacy Scale (GES). The relationship of the RPE of walking with gait, function, activity, fear, and confidence was determined by using Spearman rank order coefficients and an analysis of variance (adjusted for age and sex) for mean differences between groups defined by no exertion during walking and some exertion during walking.

Results

The RPE was related to confidence in walking (GES, R=−.326, P=.021) and activity (activity counts, R=.295, P=.044). The RPE groups (no exertion versus some exertion) differed in LLFDI scores for total (57.9 versus 53.2), basic (68.6 versus 61.4), and advanced (49.1 versus 42.6) lower-extremity function; LLFDI scores for disability limitations (74.9 versus 67.5); SAFFE fear subscale scores (0.346 versus 0.643); and GES scores (80.1 versus 67.8) (all P<.05).

Limitations

The range of RPE scores for the participants studied was narrow. Thus, the real correlations between RPE and gait, physical function, and psychological aspects of walking may be greater than the relationships reported.

Conclusions

The perceived effort of walking was associated with physical activity and confidence in walking. Reducing the perceived effort of walking may be an important target of interventions to slow the decline in function of older adults with mobility limitations.
Discours libertin et argument national dans le triptyque (Haywood, Crébillon-fils et Kimber) des heureux orphelins
Authors: Vanacker Beatrijs
Published: June 2012

Dans cette étude, sera examinée la mise en scène du libertin en tant que véhicule et figure d'un discours sur les nations dans un cycle de trois fictions romanesques du xviiie siècle. L'original anglais, The Fortunate Foundlings (1744) d'Eliza Haywood, forme la base d'une «imitation de l'anglais» de Crébillon-fils, Les Heureux Orphelins (1754), avant d'être remanié une seconde fois par le romancier anglais Edward Kimber, The Happy Orphans (1759). Dans cette suite d'adaptations romanesques, nous nous focalisons sur le parcours d'un seul personnage, le libertin, dont la caractérisation varie également selon l'approche—culturellement déterminée—des auteurs. Cette attention exclusive pour le (discours) libertin nous permettra d'aborder le triptyque des «heureux orphelins» par le biais d'une lecture imagologique—c'est-à-dire une étude de la mise en scène fictionnelle d'images nationales—qui prend en outre une portée morale. Comme il s'avérera, à travers la figure du libertin, les images nationales sont souvent, sinon subordonnées, du moins mises au service d'un discours sur la séduction de l'Autre.
Complex Chiari malformations in children: an analysis of preoperative risk factors for occipitocervical fusion
Authors: Bollo Robert J. , Riva-Cambrin Jay , Brockmeyer Meghan M. , Brockmeyer Douglas L.
Published: June 2012

Object

Chiari malformation Type I (CM-I) is a congenital anomaly often treated by decompressive surgery. Patients who fail to respond to standard surgical management often have complex anomalies of the craniovertebral junction and brainstem compression, requiring reduction and occipitocervical fusion. The authors hypothesized that a subgroup of “complex” patients defined by specific radiographic risk factors may have a higher rate of requiring occipitocervical fusion.

Methods

A retrospective review was conducted of clinical and radiographic data in pediatric patients undergoing surgery for CM-I between 1995 and 2010. The following radiographic criteria were identified: scoliosis, syringomyelia, CM Type 1.5, medullary kinking, basilar invagination, tonsillar descent, craniocervical angulation (clivoaxial angle [CXA] < 125°), and ventral brainstem compression (pB–C2 ≥ 9 mm). A multivariate Cox regression analysis was used to determine the independent association between occipitocervical fusion and each variable.

Results

Of the 206 patients who underwent CM decompression with or without occipitocervical fusion during the study period, 101 had preoperative imaging available for review and formed the study population. Mean age at surgery was 9.1 years, and mean follow-up was 2.3 years. Eighty-two patients underwent suboccipital decompression alone (mean age 8.7 years). Nineteen patients underwent occipitocervical fusion (mean age 11.1 years), either as part of the initial surgical procedure or in a delayed fashion. Factors demonstrating a significantly increased risk of requiring fusion were basilar invagination (HR 9.8, 95% CI 2.2–44.2), CM 1.5 (HR 14.7, 95% CI 1.8–122.5), and CXA < 125° (HR 3.9, 95% CI 1.2–12.6).

Conclusions

Patients presenting with basilar invagination, CM 1.5, and CXA < 125° are at increased risk of requiring an occipitocervical fusion procedure either as an adjunct to initial surgical decompression or in a delayed fashion. Patients and their families should be counseled in regard to these findings as part of a preoperative CM evaluation.
Intracranial hypotension producing reversible coma: a systematic review, including three new cases
Authors: Loya Joshua J. , Mindea Stefan A. , Yu Hong , Venkatasubramanian Chitra , Chang Steven D. , Burns Terry C.
Published: June 2012

Intracranial hypotension is a disorder of CSF hypovolemia due to iatrogenic or spontaneous spinal CSF leakage. Rarely, positional headaches may progress to coma, with frequent misdiagnosis. The authors review reported cases of verified intracranial hypotension–associated coma, including 3 previously unpublished cases, totaling 29. Most patients presented with headache prior to neurological deterioration, with positional symptoms elicited in almost half. Eight patients had recently undergone a spinal procedure such as lumbar drainage. Diagnostic workup almost always began with a head CT scan. Subdural collections were present in 86%; however, intracranial hypotension was frequently unrecognized as the underlying cause. Twelve patients underwent one or more procedures to evacuate the collections, sometimes with transiently improved mental status. However, no patient experienced lasting neurological improvement after subdural fluid evacuation alone, and some deteriorated further. Intracranial hypotension was diagnosed in most patients via MRI studies, which were often obtained due to failure to improve after subdural hematoma (SDH) evacuation. Once the diagnosis of intracranial hypotension was made, placement of epidural blood patches was curative in 85% of patients. Twenty-seven patients (93%) experienced favorable outcomes after diagnosis and treatment; 1 patient died, and 1 patient had a morbid outcome secondary to duret hemorrhages. The literature review revealed that numerous additional patients with clinical histories consistent with intracranial hypotension but no radiological confirmation developed SDH following a spinal procedure. Several such patients experienced poor outcomes, and there were multiple deaths. To facilitate recognition of this treatable but potentially life-threatening condition, the authors propose criteria that should prompt intracranial hypotension workup in the comatose patient and present a stepwise management algorithm to guide the appropriate diagnosis and treatment of these patients.
Successful treatment with azathioprine of relapsing Rosai-Dorfman disease of the central nervous system
Authors: Le Guenno Guillaume , Galicier Lionel , Uro-Coste Emmanuelle , Petitcolin Virginie , Rieu Virginie , Ruivard Marc
Published: June 2012

Rosai-Dorfman disease (RDD) is a rare non-Langerhans histiocytosis that usually presents with lymphadenopathy. Although isolated involvement of the CNS was considered to be uncommon, numerous cases have been reported in recent years. For RDD of the CNS, the treatment consists, in general, of surgery. In cases of partial resection or relapse, chemotherapy regimens, corticosteroids, and/or radiotherapy have yielded negative results. The authors describe the case of a 57-year-old man with a history of chronic Q fever who presented with aphasia and partial seizure. Computed tomography of the brain revealed a left frontotemporal lesion that was suggestive of a meningioma. The lesion was partially resected and histopathological evaluation revealed the presence of RDD. Nineteen months later, a Jacksonian seizure prompted MRI evaluation, which disclosed a local recurrence of the tumor. Computed tomography and FDG-PET demonstrated that the RDD involved no other site, but the presence of ileitis, noted on ileoscopy, led to the diagnosis of Crohn disease. Treatment with the purine analog azathioprine was initiated, leading to an objective and sustained response in both the RDD tumor and ileitis over 35 months of follow-up. This case report highlights the potential use of a purine analog in cases of relapsing RDD of the CNS and a possible common defect of macrophage regulation in RDD, Crohn disease, and Q fever.
Leucine-Rich Repeat (LRR) Domains Containing Intervening Motifs in Plants
Authors: Matsushima Norio , Miyashita Hiroki
Published: June 2012

LRRs (leucine rich repeats) are present in over 14,000 proteins. Non-LRR, island regions (IRs) interrupting LRRs are widely distributed. The present article reviews 19 families of LRR proteins having non-LRR IRs (LRR@IR proteins) from various plant species. The LRR@IR proteins are LRR-containing receptor-like kinases (LRR-RLKs), LRR-containing receptor-like proteins (LRR-RLPs), TONSOKU/BRUSHY1, and MJK13.7; the LRR-RLKs are homologs of TMK1/Rhg4, BRI1, PSKR, PSYR1, Arabidopsis At1g74360, and RPK2, while the LRR-RLPs are those of Cf-9/Cf-4, Cf-2/Cf-5, Ve, HcrVf, RPP27, EIX1, clavata 2, fascinated ear2, RLP2, rice Os10g0479700, and putative soybean disease resistance protein. The LRRs are intersected by single, non-LRR IRs; only the RPK2 homologs have two IRs. In most of the LRR-RLKs and LRR-RLPs, the number of repeat units in the preceding LRR block (N1) is greater than the number of the following block (N2); N1 » N2 in which N1 is variable in the homologs of individual families, while N2 is highly conserved. The five families of the LRR-RLKs except for the RPK2 family show N1 = 8 − 18 and N2 = 3 − 5. The nine families of the LRR-RLPs show N1 = 12 − 33 and N2 = 4; while N1 = 6 and N2 = 4 for the rice Os10g0479700 family and the N1 = 4 − 28 and N2 = 4 for the soybean protein family. The rule of N1 » N2 might play a common, significant role in ligand interaction, dimerization, and/or signal transduction of the LRR-RLKs and the LRR-RLPs. The structure and evolution of the LRR domains with non-LRR IRs and their proteins are also discussed.
Parallel and four-step synthesis of natural-product-inspired scaffolds through modular assembly and divergent cyclization
Authors: Oguri Hiroki , Mizoguchi Haruki , Oikawa Hideaki , Ishiyama Aki , Iwatsuki Masato , Otoguro Kazuhiko , Ōmura Satoshi
Published: June 2012

By emulating the universal biosynthetic strategy, which employs modular assembly and divergent cyclizations, we have developed a four-step synthetic process to yield a collection of natural-product-inspired scaffolds. Modular assembly of building blocks onto a piperidine-based manifold 6, having a carboxylic acid group, was achieved through Ugi condensation, N-acetoacetylation and diazotransfer, leading to cyclization precursors. The rhodium-catalyzed tandem cyclization and divergent cycloaddition gave rise to tetracyclic and hexacyclic scaffolds by the appropriate choice of dipolarophiles installed at modules 3 and 4. A different piperidine-based manifold 15 bearing an amino group was successfully applied to demonstrate the flexibility and scope of the unified four-step process for the generation of structural diversity in the fused scaffolds. Evaluation of in vitro antitrypanosomal activities of the collections and preliminary structure–activity relationship (SAR) studies were also undertaken.
Severe Dyslipidaemia after the Addition of Raltegravir to a Lopinavir/Ritonavir-Containing Regimen
Authors: Huesgen Emily , Burgos Rodrigo , Goldstein Debra A , Max Blake , Jarrett Olamide D
Published: June 2012

We describe a 55-year-old HIV-1-infected male who developed severe dyslipidaemia (total cholesterol 600 mg/dl, triglycerides >5,000 mg/dl, high density lipoprotein <5 mg/dl) after raltegravir was added to his lopinavir/ ritonavir-containing regimen. To our knowledge, this is the first reported case of severe dyslipidaemia associated with the addition of raltegravir to a lopinavir/ritonavir-based regimen, suggestive of a possible drug interaction. The lipid profile quickly normalized following discontinuation of lopinavir/ritonavir and continuation of raltegravir, suggesting that lopinavir/ritonavir was the primary driver for the adverse event. With increasing interest in nucleoside-sparing regimens, knowledge of clinically significant adverse events such as this is important for HIV clinicians when selecting regimens for patients with highly resistant virus or drug tolerability issues.
Réflexivité et identité : à propos des « souvenirs-écrans »
Authors: Perron-Borelli Michèle
Published: June 2012

Résumé La réflexivité, fondatrice de la représentation de l’image de soi et de ses transformations, est à l’œuvre dans la construction des souvenirs-écrans. Ceux-ci peuvent être compris et analysés dans la cure comme des jalons identitaires. Loin de se limiter à une simple fonction de « couverture », ils sont révélateurs de fonctions organisatrices dont la valence narcissique doit être reconnue.
De l'autoanalyse à l'auto-organisation
Authors: Pragier Georges
Published: June 2012

Résumé Dans l’histoire de la psychanalyse, la réflexivité a été exploitée comme la métaphore du retour sur soi-même d’un processus psychique. L’autoanalyse de Freud et Le Journal clinique de Ferenczi illustrent cliniquement cette notion. Elle est enrichie par une autre métaphore, la réfraction, qui permet de mieux saisir comment la présence d’un autre favorise une transformation. Avec l’importance croissante accordée à l’analyse du contre-transfert, l’intérêt pour l’autoanalyse s’épuise progressivement en dépit de quelques écrits importants. Au-delà de ces représentations linéaires, l’auteur estime que le dispositif analytique engendre plutôt un système capable d’auto-organisation. L’émergence du nouveau favorise la complexité si bien que le travail « auto » a changé de nature.
La naissance du « Je » dans un autoportrait de Dürer
Authors: Lamblin Berlende
Published: June 2012

Résumé L’ Autoportrait de 1500 de Dürer signe la prise de conscience de l’être humain en tant qu’il est considéré pour lui-même. La succession de coupures à différents niveaux va marquer la famille de Dürer tout comme elle va scander son Autoportrait. La répétition est l’axe du symbolique, l’axe du réel impossible. Du narcissisme primaire à l’idéal du moi, Dürer, par la sublimation, parcourt le chemin qui le mène au symbolique : la perte de l’objet primordial dans la mélancolie, le manque ici « présentifié » par la main absente, la signature. Dans une analyse rigoureuse du tableau l’auteure nous amène, pas à pas, à découvrir, à travers le regard de l’Autoportrait, ce que Dürer ne peut pas voir, la scène primitive originelle. Avec l’acceptation de la castration, de l’autre différent, c’est l’accession au « Je » du sujet désirant, la naissance du « Je ».
« La Purge » : une expertise juridico-médicale de la lèpre en Auvergne au Moyen Âge
Authors: Picot Johan
Published: June 2012

Résumé Dès le début du xii e  siècle, l’Auvergne est témoin du retour d’une maladie absente depuis plusieurs siècles : la lèpre. L’endémie contraint les autorités locales à réagir pour diminuer la propagation du mal avec notamment l’installation de plusieurs léproseries. Cependant, ce sont les Montferrandais les plus organisés avec un tribunal unique en France : « la Purge ». Les origines de cette juridiction sont obscures et il faut attendre le début du xiv e  siècle pour en saisir l’existence et le fonctionnement, c’est-à-dire lorsque la juridiction est créée ou officialisée sous la forme d’un tribunal royal. Détenue et présidée par le consulat de Montferrand, la Purge a pour but la convocation, l’examen, le jugement, puis la mise à l’écart des lépreux résidant en Auvergne, mais aussi dans les pays voisins. Le fonctionnement de cet organe juridico-médical est assuré par un organigramme précis composé de notaires, d’huissiers, de greffiers, de sergents, de procureurs, de juges, mais surtout de médecins et de chirurgiens experts en matière de lèpre. En effet, la procédure repose sur un élément capital : la visite médicale et le procès-verbal dressé par les experts médicaux. Le déroulement de cette procédure illustre la place centrale détenue par ces savants puisque c’est à eux que revient le soin de déterminer la présence ou non du mal de lèpre sur l’inculpé. Ce jury d’experts est donc indispensable à la Purge qui ne peut rendre ses sentences ni fonctionner sans lui. Si dans certaines régions l’examen des lépreux peut repousser les praticiens, en Auvergne il n’en est rien. L’office offert par la cour royale de Montferrand attire les cliniciens sur le long terme. La charge est visiblement porteuse de considération, mais apporte surtout des rémunérations considérables à ceux qui visitent les suspects de lèpre. Enfin, pour s’assurer l’entière disponibilité de ses experts, la Purge n’hésite pas à inquiéter les imprudents médecins qui exercent sans sa licence ce qui prouve encore l’utilité de ces conseillers particuliers, mais attestent également de l’émergence d’un système médico-légal en Auvergne à la fin du Moyen Âge.
L'économie espagnole en débat. L'œuvre d'Accarias de Sérionne et sa réfutation par Campomanes
Authors: Astigarraga Jesús
Published: June 2012

Résumé En 1773 fut publié un petit livre intitulé Impugnación de diferentes máximas perjudiciales a España, que se encuentran en la obra titulada Historia, o Descripción general de los intereses de Comercio (Réfutation de nombreuses maximes préjudiciables pour l’Espagne, se trouvant dans l’œuvre intitulée Histoire, ou Description générale des Intérêts du Commerce) . Ce texte anonyme possède une portée historique non négligeable parce qu’on peut en attribuer sa paternité au puissant membre du Conseil de Castille, le comte de Campomanes. Le livre avait pour but de contester un ensemble d’idées sur l’Espagne contenues dans le traité de l’économiste français Jacques Accarias de Sérionne Les Intérêts des nations de l’Europe (1766). Campomanes prenait la défense des intérêts économiques et impériaux espagnols, de son point de vue insuffisamment défendus dans la traduction espagnole du traité d’Accarias de Serionne. Dans le même temps, avec son Impugnación , il prétendait démontrer l’importance qu’avait la diffusion des « écrits publics » dans la stratégie des Lumières. Dans ce cas précis, il s’agissait de mobiliser l’opinion publique espagnole contre un courant intellectuel d’envergure européenne qui prétendait que l’Espagne était inadaptée aux projets des Lumières. Cette Impugnación trouve donc sa place dans le champ d’une littérature européenne de type polémique qui constitue l’une des expressions du processus de création de la sphère publique dans la majorité des pays européens.