bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence, Diagnosis, and Treatment of Impaired Fasting Glucose and Impaired Glucose Tolerance in Nondiabetic U.S. Adults
Authors: Karve Amrita , Hayward Rodney A.
Published: August 2010

OBJECTIVE

To estimate the rates of prevalence, diagnosis, and treatment of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT).

RESEARCH DESIGN AND METHODS

A representative sample of the U.S. population (the National Health and Nutrition Examination Survey [NHANES]) from 2005–2006 including 1,547 nondiabetic adults (>18 years of age) without a history of myocardial infarction was assessed to determine the proportion of adults who met the criteria for IFG/IGT, and the proportion of IFG/IGT subjects who: 1) reported receiving a diagnosis from their physicians; 2) were prescribed lifestyle modification or an antihyperglycemic agent; and 3) were currently on therapy. We used multivariable regression analysis to identify predictors of diagnosis and treatment.

RESULTS

Of the 1,547 subjects, 34.6% (CI 30.3–38.9%) had pre-diabetes; 19.4% had IFG only; 5.4% had IGT only, and 9.8% had both IFG and IGT. Only 4.8% of those with pre-diabetes reported having received a formal diagnosis from their physicians. No subjects with pre-diabetes received oral antihyperglycemics, and the rates of recommendation for exercise or diet were 31.7% and 33.5%, respectively. Among the 47.7% pre-diabetic subjects who exercised, 49.4% reported exercising for at least 30 min daily.

CONCLUSIONS

Three years after a major clinical trial demonstrated that interventions could greatly reduce progression from IFG/IGT to type 2 diabetes, the majority of the U.S. population with IFG/IGT was undiagnosed and untreated with interventions. Whether this is due to physicians being unaware of the evidence, unconvinced by the evidence, or clinical inertia is unclear.
Prognostic Value of Gated Myocardial Perfusion Imaging for Asymptomatic Patients With Type 2 Diabetes
Authors: Yamasaki Yoshimitsu , Nakajima Kenichi , Kusuoka Hideo , Izumi Tohru , Kashiwagi Atsunori , Kawamori Ryuzo , Shimamoto Kazuaki , Yamada Nobuhiro , Nishimura Tsunehiko
Published: August 2010

OBJECTIVE

Individuals with type 2 diabetes are at high risk for cardiovascular events. We evaluated the prognostic value of gated myocardial perfusion single-photon computed tomography (SPECT) for asymptomatic diabetic patients in a Japanese population.

RESEARCH DESIGN AND METHODS

Asymptomatic patients (n = 485) aged ≥50 years with either a maximal carotid artery intima-media thickness of ≥1.1 mm, or a urinary albumin ≥30 mg/g creatinine or who had at least two of the following, abdominal obesity, low HDL cholesterol, high triglyceride levels, and hypertension, were enrolled at 50 institutions. The patients were evaluated using gated SPECT with the stress-rest protocol and followed up for 3 years.

RESULTS

During the follow-up period, 62 (13%) events occurred, including 5 cardiac deaths and 57 cardiovascular events. Patients with summed stress scores (SSS) of ≥9 had a significantly higher incidence (of either death or cardiovascular events) than those with SSS scores of <9 (23 vs. 12%; P = 0.009). Multivariate Cox regression analysis showed that significant variables were SSS ≥9, a low estimated glomerular filtration rate, and being a current smoker. Univariate Cox regression analysis showed that ticlopidine and insulin use are potent medical modulators of cardiovascular events.

CONCLUSIONS

The incidences of cardiovascular events and death were significantly high in a select population of type 2 diabetic patients with SPECT abnormalities. A targeted treatment strategy is required for asymptomatic but potentially high-risk patients with type 2 diabetes.
Initial Combination Therapy With Alogliptin and Pioglitazone in Drug-Naïve Patients With Type 2 Diabetes
Authors: Rosenstock Julio , Inzucchi Silvio E. , Seufert Jochen , Fleck Penny R. , Wilson Craig A. , Mekki Qais
Published: August 2010

OBJECTIVE

To assess the efficacy and tolerability of alogliptin plus pioglitazone for initial combination therapy in drug-naïve type 2 diabetic patients.

RESEARCH DESIGN AND METHODS

This 26-week, double-blind, parallel-group study randomized 655 patients with inadequately controlled type 2 diabetes to four arms: 25 mg alogliptin (A25) q.d. monotherapy, 30 mg pioglitazone (P30) q.d. monotherapy, or 12.5 (A12.5) or 25 mg alogliptin q.d. plus pioglitazone (P30) q.d. combination therapy. Primary efficacy was A1C change from baseline with the high-dose combination (A25 + P30) versus each monotherapy.

RESULTS

Combination therapy with A25 + P30 resulted in greater reductions in A1C (−1.7 ± 0.1% from an 8.8% mean baseline) vs. A25 (−1.0 ± 0.1%, P < 0.001) or P30 (−1.2 ± 0.1%, P < 0.001) and in fasting plasma glucose (−2.8 ± 0.2 mmol/l) vs. A25 (−1.4 ± 0.2 mmol/l, P < 0.001) or P30 (−2.1 ± 0.2 mmol/l, P = 0.006). The A25 + P30 safety profile was consistent with those of its component monotherapies.

CONCLUSIONS

Alogliptin plus pioglitazone combination treatment appears to be an efficacious initial therapeutic option for type 2 diabetes.
Assessment of High-Sensitivity C-Reactive Protein Levels as Diagnostic Discriminator of Maturity-Onset Diabetes of the Young Due to HNF1A Mutations
Authors: Owen Katharine R. , Thanabalasingham Gaya , James Timothy J. , Karpe Fredrik , Farmer Andrew J. , McCarthy Mark I. , Gloyn Anna L.
Published: August 2010

OBJECTIVE

Despite the clinical importance of an accurate diagnosis in individuals with monogenic forms of diabetes, restricted access to genetic testing leaves many patients with undiagnosed diabetes. Recently, common variation near the HNF1 homeobox A (HNF1A) gene was shown to influence C-reactive protein levels in healthy adults. We hypothesized that serum levels of high-sensitivity C-reactive protein (hs-CRP) could represent a clinically useful biomarker for the identification of HNF1A mutations causing maturity-onset diabetes of the young (MODY).

RESEARCH DESIGN AND METHODS

Serum hs-CRP was measured in subjects with HNF1A-MODY (n = 31), autoimmune diabetes (n = 316), type 2 diabetes (n = 240), and glucokinase (GCK) MODY (n = 24) and in nondiabetic individuals (n = 198). The discriminative accuracy of hs-CRP was evaluated through receiver operating characteristic (ROC) curve analysis, and performance was compared with standard diagnostic criteria. Our primary analyses excluded ∼11% of subjects in whom the single available hs-CRP measurement was >10 mg/l.

RESULTS

Geometric mean (SD range) hs-CRP levels were significantly lower (P ≤ 0.009) for HNF1A-MODY individuals, 0.20 (0.03–1.14) mg/l, than for any other group: autoimmune diabetes 0.58 (0.10–2.75) mg/l, type 2 diabetes 1.33 (0.28–6.14) mg/l, GCK-MODY 1.01 (0.19–5.33) mg/l, and nondiabetic 0.48 (0.10–2.42) mg/l. The ROC-derived C-statistic for discriminating HNF1A-MODY and type 2 diabetes was 0.8. Measurement of hs-CRP, either alone or in combination with current diagnostic criteria, was superior to current diagnostic criteria alone. Sensitivity and specificity for the combined criteria approached 80%.

CONCLUSIONS

Serum hs-CRP levels are markedly lower in HNF1A-MODY than in other forms of diabetes. hs-CRP has potential as a widely available, cost-effective screening test to support more precise targeting of MODY diagnostic testing.
Effect of Oral Sebacic Acid on Postprandial Glycemia, Insulinemia, and Glucose Rate of Appearance in Type 2 Diabetes
Authors: Iaconelli Amerigo , Gastaldelli Amalia , Chiellini Chiara , Gniuli Donatella , Favuzzi Angela , Binnert Christophe , Macé Katherine , Mingrone Geltrude
Published: August 2010

OBJECTIVE

Dicarboxylic acids are natural products with the potential of being an alternate dietary source of energy. We aimed to evaluate the effect of sebacic acid (a 10-carbon dicarboxylic acid; C10) ingestion on postprandial glycemia and glucose rate of appearance (Ra) in healthy and type 2 diabetic subjects. Furthermore, the effect of C10 on insulin-mediated glucose uptake and on GLUT4 expression was assessed in L6 muscle cells in vitro.

RESEARCH DESIGN AND METHODS

Subjects ingested a mixed meal (50% carbohydrates, 15% proteins, and 35% lipids) containing 0 g (control) or 10 g C10 in addition to the meal or 23 g C10 as a substitute of fats.

RESULTS

In type 2 diabetic subjects, the incremental glucose area under the curve (AUC) decreased by 42% (P < 0.05) and 70% (P < 0.05) in the 10 g C10 and 23 g C10 groups, respectively. At the largest amounts used, C10 reduced the glucose AUC in healthy volunteers also. When fats were substituted with 23 g C10, AUC of Ra was significantly reduced on the order of 18% (P < 0.05) in both healthy and diabetic subjects. The insulin-dependent glucose uptake by L6 cells was increased in the presence of C10 (38.7 ± 10.3 vs. 11.4 ± 5.4%; P = 0.026). This increase was associated with a 1.7-fold raise of GLUT4.

CONCLUSIONS

Sebacic acid significantly reduced hyperglycemia after a meal in type 2 diabetic subjects. This beneficial effect was associated with a reduction in glucose Ra, probably due to lowered hepatic glucose output and increased peripheral glucose disposal.
Prothrombotic State, Cardiovascular, and Metabolic Syndrome Risk Factors in Prepubertal Children Born Large for Gestational Age
Authors: Evagelidou Eleni N. , Giapros Vasileios I. , Challa Anna S. , Cholevas Vasileios K. , Vartholomatos Georgios A. , Siomou Ekaterini C. , Kolaitis Nikolaos I. , Bairaktari Eleni T. , Andronikou Styliani K.
Published: August 2010

OBJECTIVE

To evaluate metabolic syndrome and cardiovascular disease risk factors in prepubertal children born large for gestational age (LGA) to nondiabetic, nonobese mothers.

RESEARCH DESIGN AND METHODS

At 6–7 years of age, the comparison of various factors was made between 31 LGA and 34 appropriate-for-gestational-age (AGA) children: fibrinogen, antithrombin III, protein C and S, fasting insulin, glucose, homeostasis assessment model of insulin resistance (HOMA-IR) index, adiponectin, leptin, visfatin, IGF-1, IGF-binding protein (IGFBP)-1, IGFBP-3, lipids, and the genetic factors V Leiden G1691A mutation, prothrombin 20210A/G polymorphism, and mutation in the enzyme 5,10-methylenetetrahydrofolate-reductase gene (MTHFR-C677T).

RESULTS

LGA children had higher levels of leptin (P < 0.01), fasting insulin (P < 0.01), and HOMA-IR (P < 0.01), but lower IGFBP-3 (P = 0.0001), fibrinogen (P = 0.0001), and lipoprotein(a) (P < 0.001) than AGA children. Significantly more LGA children were homozygous for the MTHFR-C677T mutation (P = 0.0016).

CONCLUSIONS

Being born LGA to nondiabetic, nonobese mothers is associated with diverse effects on cardiometabolic risk factors at prepuberty.
Core Journals That Publish Clinical Trials of Physical Therapy Interventions
Authors: Costa Leonardo Oliveira Pena , Moseley Anne M. , Sherrington Catherine , Maher Christopher G. , Herbert Robert D. , Elkins Mark R.
Published: August 2010

Objective

The objective of this study was to identify core journals in physical therapy by identifying those that publish the most randomized controlled trials of physical therapy interventions, provide the highest-quality reports of randomized controlled trials, and have the highest journal impact factors.

Design

This study was an audit of a bibliographic database.

Methods

All trials indexed in the Physiotherapy Evidence Database (PEDro) were analyzed. Journals that had published at least 80 trials were selected. The journals were ranked in 4 ways: number of trials published; mean total PEDro score of the trials published in the journal, regardless of publication year; mean total PEDro score of the trials published in the journal from 2000 to 2009; and 2008 journal impact factor.

Results

The top 5 core journals in physical therapy, ranked by the total number of trials published, were Archives of Physical Medicine and Rehabilitation, Clinical Rehabilitation, Spine, British Medical Journal (BMJ), and Chest. When the mean total PEDro score was used as the ranking criterion, the top 5 journals were Journal of Physiotherapy, Journal of the American Medical Association (JAMA), Stroke, Spine, and Clinical Rehabilitation. When the mean total PEDro score of the trials published from 2000 to 2009 was used as the ranking criterion, the top 5 journals were Journal of Physiotherapy, JAMA, Lancet, BMJ, and Pain. The most highly ranked physical therapy–specific journals were Physical Therapy (ranked eighth on the basis of the number of trials published) and Journal of Physiotherapy (ranked first on the basis of the quality of trials). Finally, when the 2008 impact factor was used for ranking, the top 5 journals were JAMA, Lancet, BMJ, American Journal of Respiratory and Critical Care Medicine, and Thorax. There were no significant relationships among the rankings on the basis of trial quality, number of trials, or journal impact factor.

Conclusions

Physical therapists who are trying to keep up-to-date by reading the best available evidence on the effects of physical therapy interventions have to read more broadly than just physical therapy–specific journals. Readers of articles on physical therapy trials should be aware that high-quality trials are not necessarily published in journals with high impact factors.
Patient safety: Prevention during care
Authors: Vaidya A
Published: August 2010

DOI: 10.3126/kumj.v8i2.3547Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 151-152
Osteosynthesis of intercondylar humerus fracture using Bryan and Morrey approach
Authors: Lakhey S , Sharma S , Pradhan RL , Pandey BK , Manandhar RR , Rijal KP
Published: August 2010

Background: The olecranon approach has been the gold standard for surgical approaches to fracture fixation of distal articular surface of humerus. Although it provides a good exposure, it also has disadvantages of delayed union, nonunion and implant related complications at the osteotomy site. Objective: The aim of this study was to determine the functional outcome of displaced intra-articular distal humerus fracture fixation using an alternative approach: the Bryan and Morrey approach. Materials and methods: Twenty patients with twenty AO type C1 and C2 intercondylar fractures of the distal humerus had bicolumnar fixation of the distal humerus with two contoured reconstruction plates and screws on the dorsal surface or various combinations of a single reconstruction plate, screws and K-wires using a Bryan and Morrey approach. Twelve of the patients were male and eight were female. The average age of the patients was 44.8 years. Eleven patients had sustained the injury as result of fall and nine of the patients had sustained it in road traffic accidents. Right elbow was involved in fifteen patients and left in five. All patients were followed up for 12 months post operatively. Results: All twenty fractures had united at 4 months follow-up. The mean fixed flexion deformity was 9.0° (range 0°-15°) and the mean arc of motion was 115.0° (range 85°-130°). All patients had grade 4 triceps strength and stable elbows at the end of 12 months follow up. One patient had deep seated wound infection resulting in necrosis of the triceps tendon requiring a second operative procedure. Conclusions: Bryan and Morrey approach is a simpler, easier and better approach as compared to the other posterior approaches to the elbow joint, and therefore, can be used as the approach of choice for fixation of fractures of the distal articular surface of humerus. Key words: Fracture; Intercondylar Humerus; Osteosynthesis DOI: 10.3126/kumj.v8i2.3549 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 154-157
Surgical abortion in second trimester: Initial experiences in Nepal
Authors: Shrivastava V , Bajracharya L , Thapa S
Published: August 2010

Introduction: In spite of legalising abortion and making safe abortion available at affordable price at accessible distance to almost everyone, unsafe abortion especially second trimester abortion is still a big health problem in Nepal. Objective: The objective of the study is to find the demographic profile, reasons for seeking abortion and to see the effectiveness of Misoprostol in preparing the cervix. Materials and methods: A prospective study was done in the two second trimester abortion trainings conducted in Maternity hospital, Kathmandu. Total 57 clients had second trimester abortion performed. Information was collected from structured questionnaire and then data was analysed. Results: Commonest reason for seeking abortion was, multiparity (61.4%). Common reasons for second trimester abortion were, completed family size with unwanted pregnancy (61.4%), unwanted pregnancy in married (10.52%) unwanted pregnancy in unmarried (5.26%). Conclusions: Second trimester abortion is one of the most common procedures performed in reproductive-aged women and when performed by a skilled provider in the appropriate setting, it is one of the safest surgeries, if it is well supported by change in policy of the country and acceptability of the people. Key words: Maternal death; Safe abortion; Second trimester abortion DOI: 10.3126/kumj.v8i2.3552 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 169-172
Comparison of single versus multiple doses of antibiotic prophylaxis in reducing post-elective Caesarean section infectious morbidity
Authors: Shakya A , Sharma J
Published: August 2010

Background: Puerperal sepsis is frequently in Caesarean section. Antibiotic prophylaxis may have significant impact in reduction of infections and thus the need to study its role in sepsis prevention systematically. Objective: The aim of this study is to compare the efficacy of single dose versus multiple doses of a first generation cephalosporin (with Metronidazole), to reduce postoperative infectious morbidity in elective caesarean section. Materials and methods: It was prospective clinical trial of hundred women undergoing elective caesarean section who received either a single prophylactic dose of Cefazolin with Metronidazole post-cord clamping, or multiple postoperative doses of antibiotics based on the standard protocol of the hospital. Duration of the study was seven months and twentytwo days (11th November 2004 to 30th June 2005).Women were compared on the basis of development of postoperative febrile morbidity, endometritis, urinary tract infection, wound infection and other infections. Results: There were no significant differences among the patients in single and multiple dose groups in terms of their age distribution, gravida, period of gestation, smoking status, body mass index, indications for elective caesarean section or operation characteristics. There were 4% and 6% febrile morbidity, 2 (4%) and 0 (0%) urinary tract infection, in the single dose and multiple dose groups respectively. But none of the differences were statistically significant. Conclusion: A single prophylactic dose of Cefazolin plus Metronidazole given post-umbilical cord clamping gives as much protection as multiple postoperative doses of Cefazolin/Cefalexin plus Metronidazole in preventing postoperative infectious morbidity in elective caesarean section. Key words: Antibiotic prophylaxis; Caesarean section DOI: 10.3126/kumj.v8i2.3554 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 179-184
Successes rate of endoscopic dacryocystorhinostomy at KMC
Authors: Shrestha S , Kafle PK , Pokhrel S , Maharjan M , Toran KC
Published: August 2010

Background: Nasolacrimal duct obstruction is a common problem which can be corrected by dacryocystorhinostomy (DCR). The gold standard treatment for this is DCR operation through an external approach. Development of endoscopic sinus surgery and endoscopic DCR performed through intranasal route is a major recent development in this field. Objectives: The aim of this study is to find out the success rate of endoscopic dacryocystorhinostomy without silicon stent intubation within the period of six month following surgery. Materials and methods: A prospective study was done on 26 patients with obstruction of the nasolacrimal duct referred from eye out-patient department to ENT OPD during one year period from 2008 to 2009. All the cases had undergone endoscopic DCR operation which was regularly followed up for a period of six months. Postoperative patency of ostium was checked by sac syringing and endoscopic visualisation of ostium in the nasal cavity. The success of surgery was categorised as: complete cure, partial cure and no improvement depending upon symptomatic relief and clinical examination such as sac syringing and endoscopic examination following surgery. Result: In six months' follow-up, 22 (84.5%) out of 26 patients had achieved the complete cure and 4 patients (15.5%) continued to have persistent epiphora. Conclusion: Endoscopic DCR is a beneficial procedure for nasolacrimal duct obstruction with no external scar on face and less bleeding. The success rate is as good as external DCR. Key words: Nasolacrimal duct; Epiphora; Rigid nasal endoscope; Endoscopic Dacryocystorhinostomy DOI: 10.3126/kumj.v8i2.3557 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 195-198
Effect of preloading on haemodynamic of the patient undergoing surgery under spinal anaesthesia
Authors: Singh J , Ranjit S , Shrestha S , Sharma R , Marahatta SB
Published: August 2010

Background: Hypotension and bradycardia after conduction of spinal anaesthesia are common side effects because of sympathetic blockade. Efforts to prevent these complications have been attempted like preloading with crystalloids, colloids or use of vasopressors. The role of volume preloading to prevent haemodynamic changes associated with spinal anaesthesia has been recently questioned. Objective: The objective of the study was to investigate the effects of volume preload on changes of patient's hemodynamic. Materials and methods: A Quasi- experimental design was used to conduct the study. Taking written informed consent, 40 patients of age group 18-45 years and ASA grade I and II undergoing surgery under spinal anaesthesia in operation theatre of Dhulikhel Hospital were selected as the sample of the study and allocated randomly to 2 groups. Group I did not receive volume preload and Group II received preload of 1000 ml of Ringer's lactate solution within 30 minutes immediately before giving the spinal anaesthesia. An observational checklist was used to collect demographic, intraoperative and post-operative records of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR). Results: The findings revealed that the haemodynamic changes occurred in all patients. The decrease in SBP, MBP and DBP from baseline was statistically significant at all points of time (p=0.000). The decrease in HR from baseline was not statistically significant at all points of time (p>0.05). The overall incidence of hypotension was 50%, among which 9 (45%) were from without preload group and 11 (55%) were from with preload group. The incidence of hypotension was similar in groups, sexes and surgical conditions (General Surgery, Gynae/Obs and Orthopaedics). There were no significant differences in haemodynamic changes among groups. Conclusion: On the basis of findings, it is concluded that volume preloading had no effect on the incidence of hypotension and bradycardia after spinal anaesthesia. Key words: Preload; Haemodynamics; Spinal Anaesthesia; Crystalloid DOI: 10.3126/kumj.v8i2.3562 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 216-221
Spigelian hernia
Authors: Bhatia TP , Ghimire P , Panhani ML
Published: August 2010

A Spigelian hernia (or lateral ventral hernia) is a hernia through the spigelian fascia, which is the aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally. So far, about 1000 cases have been reported worldwide. These hernias are diffi cult to diagnose as they do not present with a subcutaneous swelling and have high risk of going for strangulation. We discuss the case of a 36 year old female who presented with history of pain and lumpiness in left lower abdomen, both of which decreased on lying down. She presented to emergency with an episode severe pain at same site which subsided spontaneously. Diagnosis was confirmed on C T scan, plication and onlay prolene mesh repair performed. Spigelian hernias are rare, interparietal type of hernias which have high risk undergoing strangulation. Knowledge of symptoms and signs is vital to diagnosis and treatment of these rare type of hernias. Key words: Spigelian hernia; Interparietal hernia; Rare hernias DOI: 10.3126/kumj.v8i2.3567 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 241-243
Multiple intracranial tubercular abscesses in a child
Authors: Narang M , Gomber S , Upreti L , Dua S
Published: August 2010

2 year old girl presented with fever and cough for 4 months. Neurological examination revealed right sided hemiplegia. Contrast enhanced computed tomography of brain showed multiple hypodense ring enhancing lesions. Pus on aspiration of intracranial abscess showed positive polymerase chain reaction for Mycobacterium tuberculosis. A possibility of tuberculosis though not commonly recognised may be considered in any child presenting with prolonged fever and multiple intracranial abscesses. DOI: 10.3126/kumj.v8i2.3568 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 244-246
Halitosis: Much beyond oral malodor
Authors: Ongole R , Shenoy N
Published: August 2010

Oral malodor one of the most common complaints with which patients approaches us thinking it can be detrimental to his self-image and confidence. Even though majority of oral malodor is of oral origin, there are multiple other systemic causes that have to be addressed while we diagnose and treat this condition. Most of these patients look up to oral care physicians for expert advice, it is critical for us to have the knowledge base and communication techniques to provide quality clinical assessment and implement effective intervention programs. This article reviews the various causes and the diagnostic modalities which will help us treat this multifaceted condition. Key words: Halitosis; Oral malodor; Systemic diseases; Diagnosis DOI: 10.3126/kumj.v8i2.3574 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 269-275
A-Z of Practical Paediatrics
Authors: Dixit Hemang
Published: August 2010

A-Z of Practical Paediatrics Second Edition By Prof. Dr. Manindra R BaralPublisher: Educational Publishing House Jamal, KathmanduPrice: Rs. 600/- DOI: 10.3126/kumj.v8i2.3577 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 285
Prima la musica, poi le parole? Operatic Challenges to Word–Music Relations
Authors: Hutcheon Linda , Hutcheon Michael
Published: August 2010

The relationship between words and music in opera has been a contested one right from the very start. Over the history of this form of musical drama, the relative importance of each component has shifted radically, often provoking operatic ‘reforms’ aimed at righting what was intended, at opera's birth, to be a balance of the two. But to complicate matters further, opera does not consist only of words and music; unlike the lied or lyric poem, opera aims to tell, or rather to show, a more extensive story. It does this not only through the words, but also, in complex ways, through the music itself (which ‘speaks’ directly to and is heard by the audience, not the characters on stage). But one further complication: the interaction of words with music is not alone in communicating the narrative of opera: through its dramatic performance, opera deploys multiple semiotic systems – visual (lighting, costumes, sets), gestural, auditory, etc. – to enact its story. Using examples from the past and present of opera, this study investigates these multiple complications and their consequences for theorizing the relationship of words to music more generally.
Reading at the Opera
Authors: Germano William
Published: August 2010

Opera is a musical-theatrical form dependent upon language, but access to that language is mediated by texts and technologies. The singing body alone cannot disclose the sung text. The earliest surviving libretti demonstrate that reading played an important role in the audience's engagement with the new form, and over the ensuing four centuries reading has been opera's complicated but open secret. From seventeenth-century printed libretti to electronically delivered titles, reading has been a central component of performance practice and reception. This essay examines the history of reading at the opera – in the audience and within the diegesis – not as a prop for but as a function of operatic expression.
Swinging Modernism: Porter and Sinatra beneath the Skin
Authors: Wells Ira
Published: August 2010

Since it was first performed in the 1936 film Born to Dance, Cole Porter's “I've Got You under My Skin” has proven to be an important pop standard for a wide range of artists, not the least of whom is Frank Sinatra. When polled, Sinatra's fans and critics frequently rank “Under My Skin” among the greatest ever Sinatra recordings. Commentators have tried to explain the song's immense appeal in terms of its supposedly straightforward, if feverish, sexuality. This essay suggests that a turn back to Porter's lyrics reveals a more complicated picture. “Under My Skin” is less about achieving heterosexual unity than it is about probing and confronting an interior multiplicity – much as the textual surface of Sinatra's recording reveals two constitutive but finally discrete and irresolvable American musical selves. This essay returns Porter's lyrics to their historical and literary context to argue that “Under My Skin” represents a popular expression of the modernist anxiety over the split self – a trope that characterizes many of Porter's great songs, which contain the high and the low, the bottom and the top, beneath the same shining skin.
Image-guided frameless stereotactic needle biopsy in awake patients without the use of rigid head fixation
Authors: Amin Devin V. , Lozanne Karl , Parry Phillip V. , Engh Johnathan A. , Seelman Kathleen , Mintz Arlan
Published: August 2010

Object

Image-guided frameless stereotactic techniques provide an alternative to traditional head-frame fixation in the performance of fine-needle biopsies. However, these techniques still require rigid head fixation, usually in the form of a head holder. The authors report on a series of fine-needle biopsies and brain abscess aspirations in which a frameless technique was used with a patient's head supported on a horseshoe headholder. To validate this technique, they performed an in vitro accuracy study.

Methods

Forty-eight patients underwent fine-needle biopsy of intracranial lesions that ranged in size from 0.9 to more than 107.7 ml; a fiducial-less, frameless, image-guided technique was used without rigid head fixation. In 1 of the 48 patients a cerebral abscess was drained. The accuracy study was performed with a skull phantom that was imaged with a CT scanner and tracked with a registration mask containing light-emitting diodes. The objective was a skin fiducial marker with a 4-mm circular target to accommodate the 2.5-mm biopsy needle. A series of 50 trials was conducted.

Results

Diagnostic tissue was obtained on the first attempt in 47 of 48 brain biopsy cases. In 2 cases small hemorrhages at the biopsy site were noted as a complication on the postoperative CT scan. One of these hemorrhages resulted in hand and arm weakness. The accuracy study demonstrated a 98% success rate of the biopsy needle passing through the 4-mm circular target using the registration mask as the registration and tracking device. This demonstrates a ± 0.75-mm tolerance on the targeting method.

Conclusions

The accuracy study demonstrated the ability of the mask to actively track the target and allow navigation to a 4-mm-diameter circular target with a 98% success rate. The frameless, pinless, fiducial-less technique described herein will likely be another safe, fast alternative to frame-based stereotactic techniques for fine-needle biopsy that avoids the potential morbidity of rigid head-pin fixation. Furthermore, it should lend itself to other image-guided applications such as the placement of ventricular catheters for shunting or Ommaya reservoirs.
Vascular recovery promoted by atorvastatin and simvastatin after experimental intracerebral hemorrhage: magnetic resonance imaging and histological study
Authors: Yang Dongmei , Knight Robert A. , Han Yuxia , Karki Kishor , Zhang Jianfeng , Ding Christopher , Chopp Michael , Seyfried Donald M.
Published: August 2010

Object

Longitudinal multiparametric MR imaging and histological studies were performed on simvastatin- or atorvastatin-treated rats to evaluate vascular repair mechanisms after experimental intracerebral hemorrhage (ICH).

Methods

. Primary ICH was induced in adult Wistar rats by direct infusion of 100 μl of autologous blood into the striatal region adjacent to the subventricular zone. Atorvastatin (2 mg/kg), simvastatin (2 mg/kg), or phosphate-buffered saline was given orally at 24 hours post-ICH and continued daily for 7 days. The temporal evolution of ICH in each group was assessed by MR imaging measurements of T2, T1sat, and cerebral blood flow in brain areas corresponding to the bulk of the hemorrhage (core) and edematous border (rim). Rats were killed after the final MR imaging examination at 28 days, and histological studies were performed. A small group of sham-operated animals was also studied. Neurobehavioral testing was performed in all animals. Analysis of variance methods were used to compare results from the treatment and control groups, with significance inferred at p ≤ 0.05.

Results

. Using histological indices, animals treated with simvastatin and atorvastatin had significantly increased angiogenesis and synaptogenesis in the hematoma rim compared with the control group (p ≤ 0.05). The statin-treated animals exhibited significantly increased cerebral blood flow in the hematoma rim at 4 weeks, while blood-brain barrier permeability (T1sat) and edema (T2) in the corresponding regions were reduced. Both statin-treated groups showed significant neurological improvement from 2 weeks post-ICH onward.

Conclusions

The results of the present study demonstrate that simvastatin and atorvastatin significantly improve the recovery of rats from ICH, possibly via angiogenesis and synaptic plasticity. In addition, in vivo multiparametric MR imaging measurements over time can be effectively applied to the experimental ICH model for longitudinal assessment of the therapeutic intervention.
The use of diffusion tensor tractography to measure the distance between the anterior tip of the Meyer loop and the temporal pole in a cohort from Southern China
Authors: Wang Yi-Xiang J. , Zhu Xian-Lun , Deng Min , Siu Deyond Y. W. , Leung Jason C. S. , Chan Queenie , Chan Danny T. M. , Mak Calvin Hoi Kwan , Poon Wai S.
Published: August 2010

Object

Anterior temporal lobe resection plus amygdalohippocampectomy can cause damage to the anterior portion of the optic radiation, also known as the Meyer loop, resulting in homonymous superior quadrantanopia. Magnetic resonance diffusion tensor tractography (DTT) of the Meyer loop can help in surgical planning. In this study, the distance of the anterior tip of the Meyer loop to the temporal lobe pole (ML-TP) in the Southern Chinese population was assessed.

Methods

The authors studied 16 Southern Chinese individuals (8 men and 8 women; mean age 45.6 years, range 21–60 years). Diffusion tensor images were obtained with a 3-T MR imaging system using a single-shot spin echo echo planar imaging sequence. Two trained operators, one neurosurgeon (Operator A) and one radiologist (Operator B), carried out the DTT analysis with software iPlan (BrainLAB) and FiberTrak (Philips).

Results

For the 32 temporal lobes, the intraclass correlation coefficient (ICC) of the 2 operators' results using iPlan was 0.96, while that of Operator A using iPlan and Operator B using FiberTrak was 0.75. The ICC of Operator B using iPlan and FiberTrak was 0.81. The ML-TP distance of normal lobes (30 lobes [2 lobes that previously underwent surgery were excluded]) was 36.3 ± 5.5 mm (range 26.6–48.9 mm), 36.3 ± 5.3 mm (range 26.8–48.2 mm), and 35.9 ± 6.4 mm (range 20.8–48.4 mm) for Operator A using iPlan, Operator B using iPlan, and Operator B using FiberTrak, respectively (p > 0.05).

Conclusions

The 2 operators reached good agreement on ML-TP distance measurement using DTT. The DDT results can be more software dependent than operator dependent. The measurement with FiberTrak demonstrated larger range and standard deviation than measurement with iPlan.
Evaluation of the production characteristics of the Jamunapari goat and its adaptability to farm conditions in Bangladesh
Authors: Hassan MR , Talukder MAI , Sultana S
Published: August 2010

The growth rate, milk yield, milk composition and reproductive efficiency ofJamunapari goats were studied under semi-intensive conditions. Animals were allowedto graze for 6-7 hours and concentrate (17% CP, 11 MJ/kg DM) at 400g/head/day wasoffered twice daily. No body measurement was different in male and female goats. Theudder was capacious but pendulous. Testis length, breadth and scrotal circumferencewere 17.3 ± 1.5, 11.5 ± 1.7 and 42.4 ± 2.0 cm, respectively. The mean body weight at birthand at 12 months was 1.6 and 21.4 kg, respectively. The average growth rates of male andfemale kids were 59.4 and 48.2g/day, respectively. The overall rate of weight gain washighest in second month and lowest in 11th month. Highest milk yield was in secondmonth and lowest in the fifth month after kidding. Lactation length was 135.4 ± 14.9 and143.9 ± 13.2 days for does suckling one and two kids, respectively. Milk intake to growthratio was 15.6 ± 0.2 and 12.5 ± 0.3 for the litter size of one and two, respectively. Highestmilk fat, lactose and solids not fat (SNF) were in the later stage of lactation, whereasprotein and minerals were similar throughout the lactation. The average age at firstoestrus, age at first pregnancy and age at first kidding were 354.8 ± 17.1, 395.4 ± 29.6 and548.6 ± 68.1 days, respectively. The average number of services per pregnancy was 1.4.The gestation length was 152.8 ± 17.6 days. The average body weight just after kiddingand placenta weight were 26.7 kg and 342.4g, respectively. The overall litter size was 1.8and 32.9, 58.2 and 8.9% of kidding produced single, twins and triplets, respectively. Sexratio was 53.3 male to 46.7% female. Average onset of post-partum oestrus was 51 andinterval from parturition to pregnancy 69.3 days. Production of Jamunapari goats wascomparable with that of the Bengal goats.(Bangl. vet. 2010. Vol. 27, No. 1, 26 – 35)DOI: 10.3329/bvet.v27i1.5912
Evaluation of quality of mozzarella cheese
Authors: Mijan MA , Haque MA , Habib MA , Wadud MA
Published: August 2010

The physical and chemical qualities of mozzarella cheese prepared from cow andbuffalo milk were evaluated by a panel of judges (flavour and taste, body and texture,finish and colour) and by chemical tests (acidity, pH, fat, protein, lactose and ash). Theflavour and taste, finish and colour of cow cheese were not significantly different fromthose of buffalo cheese. Fat, protein, lactose and ash content of cow cheese weresignificantly higher than those of buffalo cheese. (Bangl. vet. 2010. Vol. 27, No. 1, 36 – 42)DOI: 10.3329/bvet.v27i1.5913
A Characterization of Local LOINC Mapping for Laboratory Tests in Three Large Institutions
Authors: Lin M. C. , Vreeman D. J. , McDonald C. J. , Huff S. M.
Published: August 2010

Objectives: We characterized the use of laboratory LOINC® codes in three large institutions, focused on the following questions: 1) How many local codes had been voluntarily mapped to LOINC codes by each institution? 2) Could additional mappings be found by expert manual review for any local codes that were not initially mapped to LOINC codes by the local institution? and 3) Are there any common characteristics of unmapped local codes that might explain why some local codes were not mapped to LOINC codes by the local institution?

Methods: With Institutional Review Board (IRB) approval, we obtained deidentified data from three large institutions. We calculated the percentage of local codes that have been mapped to LOINC by personnel at each of the institutions. We also analyzed a sample of un-mapped local codes to determine whether any additional LOINC mappings could be made and identify common characteristics that might explain why some local codes did not have mappings.

Results: Concept type coverage and concept token coverage (volume of instance data covered) of local codes mapped to LOINC codes were 0.44/0.59, 0.78/0.78 and 0.79/ -0.88 for ARUP, Intermountain, and Regenstrief, respectively. After additional expert manual mapping, the results showed mapping rates of 0.63/0.72, 0.83/0.80 and 0.88/0.90, respectively. After excluding local codes which were not useful for inter-institutional data exchange, the mapping rates became 0.73/0.79, 0.90/0.99 and 0.93/0.997, respectively.

Conclusions: Local codes for two institutions could be mapped to LOINC codes with 99% or better concept token coverage, but mapping for a third institution (a reference laboratory) only achieved 79% concept token coverage. Our research supports the conclusions of others that not all local codes should be assigned LOINC codes. There should also be public discussions to develop more precise rules for when LOINC codes should be assigned
Novel multi-responsive P2VP-block-PNIPAAm block copolymers via nitroxide-mediated radical polymerization
Authors: Corten Cathrin , Kretschmer Katja , Kuckling Dirk
Published: August 2010

Linear soluble multi-responsive block copolymers are able to form so called schizophrenic micelles in aqueous solution. Here, such polymers are prepared via nitroxide-mediated radical polymerization (NMRP). In a first step nitroxide-terminated poly(2-vinylpyridine) (P2VP) was prepared with different molecular weights and narrow molecular weight distributions. The best reaction conditions, optimized by kinetic studies, were bulk polymerization at 110 °C. Using P2VP as a macroinitiator, the synthesis of new soluble linear block copolymers of P2VP and poly(N-isopropylacrylamide) (PNIPAAm) (P2VP-block-PNIPAAm) was possible. The nitroxide terminated polymers were characterized by nuclear magnetic resonance (NMR) spectroscopy, size exclusion chromatography (SEC) and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Thermal properties were investigated by the differential scanning calorimetry (DSC). Block copolymers showed pH- and temperature-responsive solubility in aqueous media. By increasing the P2VP content, the phase transition temperature shifted to lower temperatures (e.g. 26 °C for P2VP114-block-PNIPAAm180). Depending on the resulting block length, temperature and pH value of aqueous solution, the block copolymers form so called schizophrenic micelles. The hydrodynamic radius Rh of these micelles associated with pH values and temperature was analyzed by dynamic light scattering (DLS). Such kind of block copolymers has potential for many applications, such as controlled drug delivery systems.
Quarante ans de politique environnementale en France : évolutions, avancées, constante
Authors: Lacroix Valérie , Zaccai Edwin
Published: August 2010

Cette contribution passe en revue la politique française de l’environnement sur quarante années, en la replaçant dans ses contextes historiques, tant international et européen, que politique et sociologique. Trois perspectives – enjeux, institutions, pollutions – servent de fil conducteur à une étude pluridisciplinaire articulant analyses politiques et données empiriques. L’article permet de suivre les modifications intervenues dans ces différents registres, et de mettre en évidence une série de constantes qui transcendent les périodes. Les rapports entre préoccupations environnementales, économiques et sectorielles apparaissent comme des facteurs décisifs.
La continuité de la gestion des forêts françaises de l'ancien régime à nos jours, ou comment l'Etat a-t-il pris en compte le long terme
Authors: Morin Georges-André
Published: August 2010

Par nature, la gestion des forêts engage le long terme. Dès le XIV e siècle sont apparus deux principes spécifiques qui ont fondé les législations forestières françaises : la protection de l’affectation forestière par la règle de l’inaliénabilité du domaine forestier de la Couronne, et une planification raisonnée des coupes en vue d’un « rendement soutenu ». Ces principes ont traversé près de sept siècles dans des formulations très tôt stabilisées. L’extension des forêts françaises depuis le XIX e siècle traduit l’efficacité de leur mise en œuvre. Ce cadre juridique a été complété à la Libération par la création d’un Fonds forestier national, compte d’affectation spéciale du Trésor, supprimé depuis.
Du ministère de l'impossible au ministère d'Etat
Authors: Laville Bettina
Published: August 2010

L’article offre une présentation historique de la création, sous forme de ministère, d’une administration en charge des questions d’environnement puis de développement durable en France à partir de 1971. Il s’attache particulièrement à montrer comment l’organisation administrative de cette structure a reflété le changement majeur de politique publique dans le domaine en question : d’une protection de l’environnement limitée à la sanctuarisation de certaines zones et à la lutte contre les pollutions majeures à une politique de développement durable qui cherche à faire intégrer les objectifs environnementaux dans l’exercice de la plupart des activités industrielles et même économiques en général.
Le Grenelle de l'environnement : une novation politique ?
Authors: Boy Daniel
Published: August 2010

Cet article analyse comment la politique publique de l’environnement a connu à partir de 2007 une étape très importante, celle du « Grenelle de l’environnement ». L’auteur aborde tout d’abord en quoi le Grenelle a constitué une manière inédite, de définir la politique de l’environnement grâce à la mise en place de structures originales et ouvertes sans pour autant constituer des nouveautés radicales et en faisant remarquer que l’État gardait globalement la main mise sur le processus.
La conférence de Copenhague : la négociation, mode d'emploi
Authors: Barbéris Jean-Jacques
Published: August 2010

Cet article se veut d’abord un témoignage de deux années de négociations climatiques internationales et européennes. Il a aussi pour ambition de fournir un éclairage sur la manière dont la négociation climatique avance, tant bien que mal, et comment une administration tente de s’organiser pour y faire face, dans un contexte international et européen.
La gestion des aménités et le développement durable
Authors: Ribière Georges
Published: August 2010

Les aménités constituent un ensemble de valeurs matérielles et immatérielles dont la gestion territoriale illustre la problématique du développement durable. Quoique prises en compte depuis longtemps dans les politiques nationales et locales, leur valorisation n’évite pas les conflits d’usage territorial. La comptabilité patrimoniale, les études d’impact, l’évaluation environnementale et le débat public permettent d’aider à rendre des arbitrages et de qualifier les mesures compensatoires. Toutefois, le débat reste ouvert sur les irréversibilités, la recherche de projets alternatifs et la « variante zéro ».