bluuebunny/crossref_metadata_2025 huggingface dataset:
Is low birthweight associated with dental caries in permanent dentition?
Authors: Saraiva Maria C. P. , Chiga Sandra , Bettiol Heloisa , Silva Antônio A. , Barbieri Marco A.
Published: January 2007

The aim of this study was to test the hypothesis of association between low birthweight and dental caries. This study used data from the Third National Health and Nutritional Examination Survey, 1988–94 (NHANES III) including 7‐ to 11‐year‐old children with complete dental caries information (n = 2439). Two case definitions for dental caries were used: presence of the disease in more than one tooth, and more than 10% of teeth with dental caries. Low birthweight was defined as those children born weighing <2500 g. Other covariates used in the analysis were sex, age, poverty level, race/ethnicity, frequency of dental visit, education of head of household, daily sucrose intake, blood lead level and blood cotinine level. A separate analysis was conducted for each case definition of dental caries. Bivariable and stratified analysis was performed followed by multivariable Poisson regression. The Stata 8.0 statistical package was used to take into consideration the multistage complex sample.

For the definition of more than one tooth with dental caries, the prevalence ratios (PRs) for bivariable and multivariable analyses were 1.28 [95% confidence interval (CI): 0.48, 3.42] and 1.01 [95% CI: 0.41, 2.49] respectively. For the definition of >10% of teeth with dental caries, the PRs for bivariable and multivariable analyses were 1.33 [95% CI: 0.60, 2.96] and 1.32 [95% CI: 0.75, 2.30] respectively. This study could not demonstrate an association between low birthweight and dental caries in permanent teeth of 7‐ to 11‐year‐old American children.
Non‐steady‐state, non‐uniform transpiration rate and leaf anatomy effects on the progressive stable isotope enrichment of leaf water along monocot leaves
Authors: OGÉE J. , CUNTZ M. , PEYLIN P. , BARIAC T.
Published: January 2007

This study focuses on the spatial patterns of transpiration‐driven water isotope enrichment (Δlw) along monocot leaves. It has been suggested that these spatial patterns are the result of competing effects of advection and (back‐)diffusion of water isotopes along leaf veins and in the mesophyll, but also reflect leaf geometry (e.g. leaf length, interveinal distance) and non‐uniform gas‐exchange parameters. We therefore developed a two‐dimensional model of isotopic leaf water enrichment that incorporates new features, compared with previous models, such as radial diffusion in the xylem, longitudinal diffusion in the mesophyll, non‐uniform gas‐exchange parameters and non‐steady‐state effects. The model reproduces well all published measurements of Δlw along monocot leaf blades, except at the leaf tip and given the uncertainties on measurements and model parameters. We show that the longitudinal diffusion in the mesophyll cannot explain the observed reduction in the isotope gradient at the leaf tip. Our results also suggest that the observed differences in Δlw between C3 and C4 plants reflect more differences in mesophyll tortuosity rather than in leaf length or interveinal distance. Mesophyll tortuosity is by far the most sensitive parameter and different values are required for different experiments on the same plant species. Finally, using new measurements of non‐steady‐state, spatially varying leaf water enrichment we show that spatial patterns are in steady state around midday only, just as observed for bulk leaf water enrichment, but can be easily upscaled to the whole leaf level, regardless of their degree of heterogeneity along the leaf.
The ecophysiology of early angiosperms
Authors: FEILD TAYLOR S. , ARENS NAN CRYSTAL
Published: January 2007

Angiosperms first appeared during the Early Cretaceous, and within 30 million years they reigned over many floras worldwide. Associated with this rise to prominence, angiosperms produced a spectrum of reproductive and vegetative innovations, which produced a cascade of ecological consequences that altered the ecology and biogeochemistry of the planet. The pace, pattern and phylogenetic systematics of the Cretaceous angiosperm diversification are broadly sketched out. However, the ecophysiology and environmental interactions that energized the early angiosperm radiation remain unresolved. This constrains our ability to diagnose the selective pressures and habitat contexts responsible for the evolution of fundamental angiosperm features, such as flowers, rapid growth, xylem vessels and net‐veined leaves, which in association with environmental opportunities, drove waves of phylogenetic and ecological diversification. Here, we consider our current understanding of early angiosperm ecophysiology. We focus on comparative patterns of ecophysiological evolution, emphasizing carbon‐ and water‐use traits, by merging recent molecular phylogenetic studies with physiological studies focused on extant basal angiosperms. In doing so, we discuss how early angiosperms established a roothold in pre‐existing Mesozoic plant communities, and how these events canalized subsequent bursts of angiosperm diversification during the Aptian–Albian.
Variegation mutants and mechanisms of chloroplast biogenesis
Authors: YU FEI , FU AIGEN , ALURU MANEESHA , PARK SUNGSOON , XU YANG , LIU HUIYING , LIU XIAYAN , FOUDREE ANDREW , NAMBOGGA MILLY , RODERMEL STEVEN
Published: January 2007

Variegated plants typically have green‐ and white‐sectored leaves. Cells in the green sectors contain normal‐appearing chloroplasts, whereas cells in the white sectors lack pigments and appear to be blocked at various stages of chloroplast biogenesis. Variegations can be caused by mutations in nuclear, chloroplast or mitochondrial genes. In some plants, the green and white sectors have different genotypes, but in others they have the same (mutant) genotype. One advantage of variegations is that they provide a means of studying genes for proteins that are important for chloroplast development, but for which mutant analysis is difficult, either because mutations in a gene of interest are lethal or because they do not show a readily distinguishable phenotype. This paper focuses on Arabidopsis variegations, for which the most information is available at the molecular level. Perhaps the most interesting of these are variegations caused by defective nuclear gene products in which the cells of the mutant have a uniform genotype. Two questions are of paramount interest: (1) What is the gene product and how does it function in chloroplast biogenesis? (2) What is the mechanism of variegation and why do green sectors arise in plants with a uniform (mutant) genotype? Two paradigms of variegation mechanism are described: immutans (im) and variegated2 (var2). Both mechanisms emphasize compensating activities and the notion of plastid autonomy, but redundant gene products are proposed to play a role in var2, but not in im. It is hypothesized that threshold levels of certain activities are necessary for normal chloroplast development.
Monitoring of peri‐operative fluid administration by individualized goal‐directed therapy
Authors: Bundgaard‐Nielsen M. , Holte K. , Secher N. H. , Kehlet H.
Published: January 2007

Background:  In order to avoid peri‐operative hypovolaemia or fluid overload, goal‐directed therapy with individual maximization of flow‐related haemodynamic parameters has been introduced. The objectives of this review are to update research in the area, evaluate the effects on outcome and assess the use of strategies, parameters and monitors for goal‐directed therapy.

Methods:  A MEDLINE search (1966 to 2 October 2006) was performed to identify studies in which a goal‐directed therapeutic strategy was used to maximize flow‐related haemodynamic parameters in surgical patients, as well as studies referenced from these papers. Furthermore, methods applied in these studies and other monitors with a potential for goal‐directed therapy are described.

Results:  Nine studies were identified pertaining to fluid optimization during the intra‐ and post‐operative period with goal‐directed therapy. Seven studies (n= 725) found a reduced hospital stay. Post‐operative nausea and vomiting (PONV) and ileus were reduced in three studies and complications were reduced in four studies. Of the monitors that may be applied for goal‐directed therapy, only oesophageal Doppler has been tested adequately; however, several other options exist.

Conclusion:  Goal‐directed therapy with the maximization of flow‐related haemodynamic variables reduces hospital stay, PONV and complications, and facilitates faster gastrointestinal functional recovery. So far, oesophageal Doppler is recommended, but other monitors are available and call for evaluation.
Comparison of inpatient bed rest and home convalescence following split thickness skin grafting to the lower leg
Authors: Tallon Ben G , Oliver G Fergus
Published: January 2007

There has been a substantial move towards care of patients in an outpatient setting. This study was performed to determine if discharge home following split thickness skin grafting to the lower leg compromised graft results or morbidity compared with admission to hospital. Cases were reviewed retrospectively from the dermatology department’s surgical records. All split thickness skin grafts to the lower legs over a 12‐month period were included. All clinical notes were reviewed and phone calls made to patients and relatives. A total of 61 cases were included: 31 admitted as inpatients, 30 discharged home. There was no significant difference between the two groups’ age, sex or comorbidities. A trend was seen in inpatients towards increased infection (P = 0.19) and venous thrombosis (P = 0.34). There is a lack of significant difference between admitted and discharged patients in all outcomes including bleeding, number of dressing clinic follow ups and graft loss. These results suggest that home convalescence after split thickness skin grafting to the lower legs compares favourably with inpatient care.
Retrospective review of primary melanomas excised at Waikato Hospital, New Zealand, 2002–2003
Authors: Barker Scott , Oakley Amanda , Rademaker Marius
Published: January 2007

The aim of this study was to review and compare melanomas referred by general practitioners and melanomas identified at specialist clinics. The medical records relating to 113 primary melanomas excised at Waikato Hospital (a specialist regional base hospital) during 2002 and 2003 were reviewed retrospectively. Forty‐seven melanomas (41%) were detected when patients attended specialist clinics (mainly plastic surgery and dermatology), and 66 melanomas (59%) were specifically referred by general practitioners. The melanomas detected at specialist clinics had a lower mean Breslow thickness than those referred by general practitioners (0.57 mm compared with 1.45 mm). Patients referred by general practitioners waited a mean of 26.5 days (range 0–94 days) for first specialist assessment. Following specialist assessment, patients waited a mean of 24.2 days (0–81 days) before excision biopsy.
Diffuse cutaneous leishmaniasis in an HIV‐positive patient in western Africa
Authors: Niamba Pascal , Goumbri‐Lompo Olga , Traoré Adama , Barro‐Traoré Fatou , Soudré Robert T
Published: January 2007

A 36‐year‐old HIV1‐positive woman presented with a 6‐month history of a progressive papular and nodular eruption of the face and subsequent extensive spread to the rest of the skin. The diagnosis of diffuse cutaneous leishmaniasis was established by direct examination and skin biopsy. This atypical form had a dramatic improvement after a 21‐day treatment with meglumine antimoniate. This clinical form may be confused with other endemic diseases in western Africa, especially leprosy.
A 30‐year history of CD4+ vesiculo‐bullous mycosis fungoides and multiple visceral malignancies
Authors: Pearce Annette , Reid Catherine , Gramp Amanda , Sidhu Shireen
Published: January 2007

An 83‐year‐old Caucasian woman presented with a 25‐year history of an itchy, eczematous blistering eruption affecting her trunk and acral sites. She had a past history of adenocarcinoma of the lung, colorectal carcinoma and bladder carcinoma. Several skin biopsies consistently showed features of a spongiotic process. Direct and indirect immunofluorescence studies were repeatedly negative, excluding the possibility of an autoimmune blistering disorder. A skin biopsy several years later, however, showed histological and immunophenotypic features of mycosis fungoides. The literature on this rare phenotype of cutaneous T‐cell lymphoma generally portrays a negative prognosis. Our case illustrates an excellent prognosis with stable disease 30 years after onset.
Assessing the evidence for an association between circumferential tumour clearance and local recurrence after resection of rectal cancer
Authors: Dent O. F. , Haboubi N. , Chapuis P. H. , Chan C. , Lin B. P. C. , Wong S. K C. , Bokey E. L.
Published: January 2007

Objective  Circumferential resection margin involvement (CRMI) after resection of rectal cancer is regarded as a risk factor for local recurrence. We have been able to identify only nine peer‐reviewed English‐language publications which focus primarily on this association, and they report widely differing rates of local recurrence. The aims of this study were to review possible reasons for this variability and to assess the evidence for the micrometrically measured threshold defining CRMI.

Method  Methodological and statistical evaluation of relevant literature.

Results  Several factors which could account for this variability are discussed including the nature of the patient series, surgical technique, curative vs palliative resections, pathology technique, the definition of CRMI, adjuvant therapy, tumour stage, definition and ascertainment of local recurrence, length of follow‐up and method of analysis. The objective evidence for the conventional definition of CRMI as tumour 1 mm or less from a circumferential margin is considered along with the evidence supporting a recent proposal that the margin be extended to 2 mm or less. The evidence is numerically weak in both cases and we believe that neither definition should be set in concrete at this stage.

Conclusion  Pending further research, we recommend that routine pathology reports should record frank tumour transection, if present, or otherwise report the histological width of the margin between the tumour and the nearest circumferential line of resection in millimetres. The definition of CRMI should be simply histological evidence of tumour in a line of resection, that is, a margin of 0 mm. The definition of CRMI as a margin of 1 mm should not be adopted as a basis for assessing the quality of surgery.
Risk of second primary colorectal cancer with particular reference to age at diagnosis
Authors: O’Dwyer S. T. , Renehan A. G. , Zwahlen M. , Egger M.
Published: January 2007

Objective:  Patients with a history of colorectal cancer are considered at increased risk of second metachronous colorectal cancer (SM‐CRC), for which they frequently receive intensive colonoscopic surveillance. In view of the ambiguous nature of the existing evidence and the growing interest in targeted surveillance, we sought to quantify long‐term risk with particular reference to age at diagnosis.

Method:  The surveillance epidemiology and end results (SEER) database was used to estimate risk of SM‐CRC after first incident colorectal cancer diagnosed between 1975 and 1999. We calculated time‐dependent rates using Kaplan‐Meier estimates and relative risk compared with the US general population.

Results:  From 311, 689 eligible patients, there were 6387 SM‐CRCs. At 15 years following initial diagnosis, the SM‐CRC rate was 6.3% (95% CI: 6.1–6.5). For patients with synchronous primary cancers (n = 9936: 3.2%), the 15‐year SM‐CRC rate increased to 10.5% (95% CI: 9.1–12.2). Younger age predicted for increased relative risks but absolute cumulative rates at 15 years were low (Table).

Age groups (years)
20–29
30–39
40–49
50–59
60–69
70–79
80+

Relative risk–men
60.4
15.1
4.52
1.87
1.34
1.28
1.15

Relative risk–women
18.4
9.63
4.08
2.29
1.72
1.46
1.24

Absolute risk–both sexes
3.53
3.74
4.29
4.70
6.15
7.59
7.26

Conclusion:  The long‐term cumulative risk of SM‐CRCs after first colorectal cancer is low, even among younger age patients. These data do not support the routine use of high‐frequency colonoscopy surveillance in patients with a history of colorectal cancer.
Local recurrence after curative resection for rectal cancer – role of the multi – disciplinary team
Authors: Khera G. , Walsh C. J. , Anderson J. A. , El‐Sayed T. Y. , Haylock B. J. , Myint A. S. , Smith D. B. , Makin C. A.
Published: January 2007

Objective:  We believe optimal management of rectal cancer should be tailored to the individual patient. This is achieved by close liaison within a well established multidisciplinary team (MDT). Patients also benefit from the unusual alliance between our district general hospital (DGH) and regional oncology centre with expertise in radiotherapy for rectal cancer. To test our beliefs we reviewed the incidence of local recurrence following curative resection for rectal cancer.

Method:  A total of 201 consecutive cases of rectal cancer treated from 01/04/1999 to 31/03/2002 were reviewed by one author (GK). 100% case note retrieval was achieved of which 122 curative resections were identified (122/201 = 60.7%). Mean follow up 4½ years.

Conclusion:  The incidence of local recurrence was 2.5% (3/122). All occurred in patients having Hartmann's operation. There were no local recurrences following anterior resection or abdomino–perineal resection.

Number (%)
Average distance from anal verge (cm)
Number (%) receiving preoperative radiotherapy

Anterior resection
76/122 (62.3)
11.2
13/76 (17.3)

Hartmanns
9/122 (7.4)
8
4/9 (44.4)

Abdomino–perineal Resection
27/122 (22.1)
4.7
11/27 (40.7)

Discussion:  Data support our belief that, combining modern surgical techniques with radiotherapy +/‐ chemotherapy, high quality outcomes are achievable when care is tailored to individuals by a functional MDT.
Abdominal aortic aneurysm repair and colonic infarction: a risk factor appraisal
Authors: Neary P. , Hurson C. , Briain D. O. , Brabazon A. , Mehigan D. , Keaveny T. V. , Sheehan S.
Published: January 2007

Objective  Colonic infarction is a recognized complication of abdominal aortic aneurysm (AAA) surgery. The clinical difficulty in establishing the diagnosis combined with the patient's poor physiological status is usually associated with a fatal outcome. We assessed our experience with this problem to identify a possible risk factor profile for these patients.

Method  Patients records were identified from the operative logs, intensive care unit, Hospital Inpatient Enquiry system and vascular unit databases over a 6‐year period.

Results  A total of 405 patients underwent AAA repair during this period; 140 as emergency ruptures. Nine patients were identified from the databases with known colonic infarction (2.2%). One was a woman. The mean age was 70 years. Seven patients had emergency ruptures (5%). Twenty independent risk factors were analysed using univariate and multivariate logistic regression models. Significant risk factors identified by using a multivariate analysis included the nature of the presenting patient, preoperative hypotension, prolonged cross‐clamp time, intra‐operative ischaemia and postoperative acidosis. Confirmatory diagnosis was made by colonoscopy in eight patients. One patient survived following the salvage surgery. The mean duration of survival was 10.5 days. The overall mortality was 89% of patients.

Conclusion  In our unit infrarenal AAA repair has a 2.2% rate of colonic infarction. A definitive diagnosis is best made by colonoscopy. A risk factor profile for the development of colonic infarction may be constructed on the basis of specific clinical parameters. Earlier intervention on the basis of this profile may ultimately reduce the current excessive mortality.
Management of duodenal involvement in locally advanced colonic carcinoma
Authors: Biyani D. K. , Speake D. , Siriwardena A. , Watson A. J. M.
Published: January 2007

Removal of locally advanced right‐sided colonic carcinoma involving the duodenum can be challenging. There are few data on the optimal surgical approach. Adjacent organ involvement is associated with a poor prognosis and may be classified as inoperable with patients having palliative bypass procedures rather than primary resection. Survival is however improved after en bloc resection of adjoining viscera compared with intestinal bypass. We present a variety of surgical options depending on the extent of local invasion and the debility of the patient.
A novel procedure to assess anismus using three‐dimensional dynamic anal ultrasonography
Authors: Murad‐Regadas S. M. , Regadas F. S. P. , Rodrigues L. V. , Souza M. H. L. P. , Lima D. M. R. , Silva F. R. S. , Filho F. S. P. R.
Published: January 2007

Objective  This study aimed to determine the value of three‐dimensional (3D) dynamic endosonography in the assessment of anismus.

Method  Sixty‐one women submitted to anorectal manometry were enrolled including 40 healthy women and 21 patients with anismus diagnosed by manometry. Patients were submitted to 3D endosonography. Images were acquired at rest and during straining and analysed in axial and midline longitudinal planes. Sphincter integrity was quantified. The angle between the internal edge of the puborectalis with a vertical line according to the anal canal axis was calculated at rest and during straining.

Results  The angle increased in 39 of the 40 normal individuals and decreased in all patients with anismus during straining compared with the angle at rest (88.36°) and straining (98.65°) in normal individuals. In the anismus group, the angle decreased at rest (90.91°) and straining (84.89°). The difference between angle sizes in normal and anismus patients during straining was statistically significant (P < 0.5).

Conclusion  Three‐dimensional endosonography is a useful method to assess patients with anismus confirming the anorectal manometric results.
Magnetic resonance imaging in the evaluation of pelvi‐ureteric junction obstruction: an all‐in‐one approach
Authors: El‐Nahas Ahmed R. , Abou El‐Ghar Mohamed E. , Refae Huda F. , Gad Hossam M. , El‐Diasty Tarek A.
Published: January 2007

Authors from Egypt carried out comprehensive MRI in several patients with PUJ obstruction. This included MR urography, dynamic MRI, and MR angiography. They found this method of analysis to be valuable and accurate as a single‐imaging method for evaluating patients with this condition.

OBJECTIVE

To study the ability of comprehensive magnetic resonance imaging (MRI) to replace multiple imaging methods in the evaluation of patients with pelvi‐ureteric junction obstruction (PUJO).

PATIENTS AND METHODS

Between May 2003 and November 2005, 46 consecutive patients (22 male and 24 females; mean age 31.6 years) with symptomatic primary PUJO were included. All had comprehensive MRI, including MR urography (MRU), dynamic MRI and MR angiography (MRA). Morphological results of MRU were compared with that of renal ultrasonography or intravenous urography, while the anatomical results of MRA were compared with the operative findings. A correlation between MR clearance and radioisotope clearance was done using linear regression analysis.

RESULTS

MRU showed the morphology of the collecting system in all patients, and the ureter below the PUJ in 31 of 46 (67%), but renal stones were missed in three of 10 patients. MRA showed crossing vessels in 22 patients (48%). There was a strong correlation between MR clearance and radioisotope clearance (r = 0.823, P < 0.001). From the MRI results, 35 patients (19 with crossing vessels and 16 with marked hydronephrosis) had pyeloplasty and 11 had an endopyelotomy. Findings during pyeloplasty showed one false‐negative and one false‐positive result of the preoperative MRI. Therefore, the sensitivity, specificity and accuracy of MRA were 95%, 94% and 94%, respectively. The outcome was successful in 44 (96%) patients. One failure after pyeloplasty was managed with endopyelotomy and the other was treated with pyeloplasty after endopyelotomy.

CONCLUSION

Comprehensive MRI is a valuable and accurate single‐imaging method for evaluating patients with PUJO.
Laparoscopic distal ureterectomy and anastomosis for management of low‐risk upper urinary tract transitional cell carcinoma: preliminary results
Authors: Rouprêt Morgan , Harmon Justin D. , Sanderson Kristin M. , Barret Eric , Cathelineau Xavier , Vallancien Guy , Rozet François
Published: January 2007

Associate Editor

Ash Tewari

Editorial Board

Ralph Clayman, USA

Inderbir Gill, USA

Roger Kirby, UK

Mani Menon, USA

OBJECTIVE

To determine the surgical feasibility and early oncological outcomes of laparoscopic distal ureterectomy in patients with low‐grade upper urinary tract transitional cell carcinoma (UUT‐TCC).

PATIENTS AND METHODS

We retrospectively reviewed patients treated laparoscopically with conservative management for a UUT‐TCC between 2001 and 2005. We collected data on gender, age, mode of diagnosis, smoking, history of bladder cancer, complications, tumour site, size, stage, grade, hospital stay, recurrence and progression.

RESULTS

Data were analysed for six patients with a mean (range) age of 68.5 (54–76) years. Four patients had a diagnostic ureteroscopy with biopsy. The operative duration was 173.3 (120–240) min, the estimated blood loss was 75 (50–200) mL and the length of ureteric resection was 5.23 cm. Two patients required a psoas hitch. JJ stents were maintained for 25.8 (15–30) days. The hospital stay was 6 (5–8) days. There were minor complications in three patients after surgery. The follow‐up was 32 (17–46) months. The tumour size was 1.7 (0.8–2.6) cm. There were low‐grade tumours in four patients and pTa in five. All patients are alive and free of disease; there were no anastomotic strictures. Two patients developed a recurrence, one in the ipsilateral renal pelvis and one in the bladder.

CONCLUSION

Laparoscopic distal ureterectomy with direct re‐implantation is technically feasible for low‐risk UUT‐TCC (i.e. low‐grade, noninvasive), in the properly selected patient. Early oncological outcomes are promising but strict surveillance protocols must be followed.
A critical appraisal of logistic regression‐based nomograms, artificial neural networks, classification and regression‐tree models, look‐up tables and risk‐group stratification models for prostate cancer
Authors: Chun Felix K.‐H. , Karakiewicz Pierre I. , Briganti Alberto , Walz Jochen , Kattan Michael W. , Huland Hartwig , Graefen Markus
Published: January 2007

OBJECTIVE

To evaluate several methods of predicting prostate cancer‐related outcomes, i.e. nomograms, look‐up tables, artificial neural networks (ANN), classification and regression tree (CART) analyses and risk‐group stratification (RGS) models, all of which represent valid alternatives.

METHODS

We present four direct comparisons, where a nomogram was compared to either an ANN, a look‐up table, a CART model or a RGS model. In all comparisons we assessed the predictive accuracy and performance characteristics of both models.

RESULTS

Nomograms have several advantages over ANN, look‐up tables, CART and RGS models, the most fundamental being a higher predictive accuracy and better performance characteristics.

CONCLUSION

These results suggest that nomograms are more accurate and have better performance characteristics than their alternatives. However, ANN, look‐up tables, CART analyses and RGS models all rely on methodologically sound and valid alternatives, which should not be abandoned.
Common Adiponectin Gene Variants Show Different Effects on Risk of Cardiovascular Disease and Type 2 Diabetes in European Subjects
Authors: Gable D. R. , Matin J. , Whittall R. , Cakmak H. , Li Ka Wah , Cooper J. , Miller G. J. , Humphries S. E. ,   on behalf of the HIFMECH investigators
Published: January 2007

Alterations in the secretion of adipokines may explain the link between obesity, type 2 diabetes (T2DM) and coronary artery disease (CAD). These conditions have been associated with variation in the adiponectin gene, although evidence for this relationship has been variable, with differences found even in similar samples. This study aims to clarify these inconsistencies by determining the impact of identified adiponectin gene (ADIPOQ) variants (−11391G>A,−1377C>G[promoter] and +45T>G[exon 2] and +276G>T[intron 2]) on the prospective risk of CAD and T2DM in healthy men, and on adverse metabolic markers, in myocardial infarct survivors and controls from different parts of Europe. The hazard ratio for cardiovascular disease varied across the −11391GG/GA/AA(p = 0.03) and −11371CC/CG/GG(p = 0.05) genotypes only. In contrast, only the +45T>G variant (3.80[1.76‐8.24]) was associated with T2DM, while two haplotypes GCTT/GCGG (p < 0.05) and +276G>T(p = 0.01) increased risk in interaction with obesity. The variants were associated with a number of biomarkers in Southern but not Northern Europe (p = 0.01), despite no significant differences in allele or haplotype frequencies (p > 0.44). A risk haplotype could not be identified in either sample. Adiponectin gene variants are hence currently poor markers for the development of T2DM and CAD. Their influence on risk depends significantly on interactions that are not currently understood with either genetic variation elsewhere or the environment of the sample studied.
Visual function and visual perception in cerebral palsied children
Authors: Kozeis Nikos , Anogeianaki Antonia , Mitova Daniela Tosheva , Anogianakis George , Mitov Tosho , Klisarova Anelia
Published: January 2007

Purpose:  To investigate visual function and perception in cerebral palsied (CP) children.

Methods:  A total of 105 congenitally CP children (aged 6–15 years), without severe mental retardation, were classified into three groups: those with spastic quadriplegia, spastic diplegia and spastic hemiplegia. Data collected included patient history, IQ, refraction, far and near visual acuity, position of the eyes and eye movements, visual fields, colour perception, stereoacuity, slit lamp and fundoscopic examinations, and evaluation of visual perception. The results were compared with a control group from the general paediatric population.

Results:  The IQ of the CP children ranged between 70 and 100. A total of 59% of them had best corrected distance visual acuity <6/6, with 25.5% <6/9. Near visual acuity was also reduced (70.1% scored <6/6 and 38.4% scored <6/9). Incidence of refractive errors was higher than in the control group (hypermetropia in 43.8% of the eyes, myopia 16.19% and astigmatism 40.9%) as was the incidence of strabismus (26.7% esotropic and 27.6% exotropic). In visual field testing, 80.95% of CP children were normal. A total of 94.28% had normal colour perception and 89.52% were free of ocular pathology. Stereopsis was abnormal or absent in 85.71% of the cases. Visual perception was markedly reduced: in 57.14% of the cases it was less than or equal to that of 6‐year‐old children; in 26.66% equal to that of 6‐ to 7.5‐year‐old children, and in 16.2% of the cases greater than or equal to that of 7.5‐year‐old children.

Conclusions:  In the absence of severe mental retardation, CP children have deficient visual skills. It is suggested that the poor visual skills of CP children are a separate, identifiable factor compounding the adverse effects of mental retardation.
Influence of target type and RAF rule on the measurement of near point of convergence
Authors: Adler Paul M. , Cregg Mary , Viollier Ann‐Julie , Margaret Woodhouse J.
Published: January 2007

Purpose:  This study was designed to investigate if the use of different target types or the RAF rule affected the measurement of near point of convergence (NPC).

Methods:  The subjects comprised three groups: (1) 20 children aged 6–9 years (2) 17 children aged 11–13 years (3) 14 adults aged 20–30 years. Five targets were used to measure the NPC: (1) pencil tip, (2) fingertip, (3) penlight, (4) N5 letter and (5) vertical line target on the RAF rule.

Results:  There was no significant difference in NPC measurements between the pencil tip, fingertip and N5 target in free space. The penlight resulted in significantly more remote NPC break and recovery points compared with the fingertip and pencil tip (p < 0.05). The RAF rule influences the NPC obtained (p < 0.001). The greatest difference in NPC measurements was observed when comparing the RAF line target and the finger in free space; the former resulted in NPC values of 1.9 times (95% CI 1.6–2.2 times) as much as those obtained with the finger.

Conclusions:  Use of the penlight and RAF rule resulted in a more distant NPC break point compared with other targets. The effect of the RAF rule was more apparent for more receded NPC points.
Influence of eyelid position on wavefront aberrations
Authors: Han Wei , Kwan William , Wang Jing , Yip Shea Ping , Yap Maurice
Published: January 2007

Purpose:  To investigate the influence of eyelid position on wavefront aberrations.

Methods:  In study 1, the right eyes of 43 non‐cyclopleged subjects were evaluated using the Complete Ophthalmic Analysis System (COAS) aberrometer. In study 2, the right eyes of the 23 cyclopleged subjects were evaluated using the Optical Pathway Difference Scan aberrometer. Measurements were made with wide‐open and deliberately narrowed palpebral apertures in these subjects. In study 3, the influence of eyelashes on the COAS output was investigated in 20 subjects by placing artificial eyelashes in front of the eye, in close proximity to the natural eyelashes.

Results:  For study 1, the total root mean square (RMS) of the third‐ and fourth‐order aberrations with the wide‐open lids was significantly different from the narrowed lid position after the correction for multiple comparisons. There was a difference in the Zernike coefficient of the defocus (C4), 90/180 astigmatism (C5), vertical coma (C7) and spherical aberration terms (C12) between the narrowed and wide‐open positions. For study 2, changes were observed with the narrowed lid position in the overall RMS of the third and fourth orders, and total coma aberrations, as well as the specific Zernike coefficients of the C5 and C7 terms. However, none of these changes were significant after the multiple comparison correction. The corneal topography also showed remarkable changes in the superior corneal zone. Placing artificial eyelashes in front of the eye significantly affected some Zernike terms and the RMS of the second and fourth orders, and total coma aberrations, for particular pupil sizes.

Conclusions:  Deliberate narrowing of the palpebral aperture can influence the wavefront aberrations significantly. The corneal curvature distortion in response to eyelid pressure may account for some of the effect on aberration change. Eyelashes interfering with the light path within the pupil zone distort the output from the COAS, causing significant errors.
Reading performance with various lamps in age‐related macular degeneration
Authors: Eperjesi F. , Maiz‐Fernandez C. , Bartlett H. E.
Published: January 2007

The purpose of this study was to determine if there was an objective difference in reading between four commonly available lamps, of varying spectral radiance, for 13 subjects with age‐related maculopathy (ARM) or non‐exudative age‐related macular degeneration (AMD) – logMAR visual acuity between 0.04 and 0.68. At a constant illuminance of 2000 lux, there was no interaction between ARM and AMD subgroups and no statistically significant difference between the lamps: standard (clear envelope) incandescent, daylight simulation (blue tint envelope) incandescent, compact fluorescent and halogen incandescent, for any reading outcome measure (threshold print size p = 0.67, critical print size p = 0.74, acuity reserve p = 0.84 and mean reading rate p = 0.78). For lamps typically used in low‐vision rehabilitation, a clinically significant effect of spectral radiance on reading for people with ARM or non‐exudative AMD is unlikely.
Acuity measurements in adult subjects using a preferential looking test
Authors: Woodhouse J. Margaret , Morjaria Shreya A. , Adler Paul M.
Published: January 2007

Preferential looking (PL), as a technique for assessing visual acuity, was designed for use with young infants. There are occasions when a practitioner may need to use a PL test with an adult who is unable to participate in acuity measures with conventional optotype tests (such as an adult with learning disabilities, stroke damage or dementia). In preparation for the development of an adult‐appropriate PL test, this study compared scores with the Cardiff Acuity Test (CAT, which was designed as a PL test) and a standard LogMAR‐based test, the Lea chart. One hundred and one adults with learning disabilities, attending vision screening at Special Olympics, took part in acuity measures with both tests. Athletes subsequently found to have uncorrected refractive errors were excluded and analysis was confined to 72 athletes. There was no significant difference in mean acuity with the two tests, but CAT tended to overestimate scores for poorer acuities. CAT was less sensitive than the Lea chart to interocular acuity differences. Although CAT may be a successful way to assess acuity in patients unable to participate in conventional acuity tests, the practitioner should be cautious in interpreting results. There is the potential with CAT to overestimate acuity and to miss small interocular differences, so criteria for determining ‘abnormality’ may need to be adjusted.
Review of the Pharmacology and Clinical Profile of Bupropion, an Antidepressant and Tobacco Use Cessation Agent
Authors: Dwoskin Linda P. , Rauhut Anthony S. , King‐Pospisil Kelley A. , Bardo Michael T.
Published: January 2007

Bupropion hydrochloride ((±)‐2‐tert‐butylamino)‐3′‐chloropropiophenone · HCl) is a nonselective inhibitor of the dopamine transporter (DAT) and the norepinephrine transporter (NET) and is also an antagonist at neuronal nicotinic acetylcholine receptors (nAChRs). In animal models used commonly to screen for antidepressant activity, bupropion shows a positive response. Also using animal models, bupropion has been shown to attenuate nicotine‐induced unconditioned behaviors, to share or enhance discriminative stimulus properties of nicotine and to have a complex effect on nicotine self‐administration, i.e., low doses augmenting nicotine self‐administration and high doses attenuating self‐administration. Current studies show that bupropion facilitates the acquisition of nicotine conditioned place preference in rats, further suggesting that bupropion enhances the rewarding properties of nicotine. Bupropion has been shown to attenuate the expression of nicotine withdrawal symptoms in both animal models and human subjects. With respect to relapse, current studies show that bupropion attenuates nicotine‐induced reinstatement in rats, but large individual differences are apparent. Clinically, bupropion is used as a treatment for two indications, as an antidepressant, the indication for which it was developed, and as a tobacco use cessation agent. In clinical trials, bupropion is being tested as a candidate treatment for psychostimulant drug abuse, attention‐deficit hyperactivity disorder (ADHD) and obesity. Bupropion is available in three bioequivalent oral formulations, immediate release (IR), sustained release (SR), and extended release (XL). Extensive hepatic metabolism of bupropion produces three pharmacologically active metabolites, which may contribute to its clinical profile.
Augmentation Treatment of Psychotherapy for Anxiety Disorders with D‐Cycloserine
Authors: Hofmann Stefan G. , Pollack Mark H. , Otto Michael W.
Published: January 2007

Anxiety disorders are among the most common mental disorders. One of the most effective strategies to treat anxiety disorders is exposure therapy with or without cognitive intervention. Fear reduction in exposure therapy is similar to extinction learning. Preclinical studies suggest that extinction learning can be blocked by antagonists at the glutamatergic N‐methyl‐D‐aspartate (NMDA) receptor, and facilitated with D‐cycloserine (DCS), a partial agonist at the glycine recognition site of the NMDA receptor in the amygdala. DCS is an established antibiotic drug for the chronic treatment of tuberculosis in humans, but has only recently been investigated as an augmentation therapy for psychological treatment procedures. The review of the literature provides preliminary support for the use of acute dosing of DCS as an adjunctive intervention to exposure therapy for anxiety disorders, including specific phobia and social anxiety disorder. Negative results have recently been reported in the treatment of subclinical fears of animals. These studies suggest that DCS needs to be administered on an acute rather than a chronic dosing schedule, include sufficient time for memory consolidation, and be administered together with psychological treatment that leaves sufficient room for further improvement. It remains to be seen whether these highly promising findings represent reliable pharmacological strategies to enhance exposure therapy of anxiety disorders.
Silperisone: A Centrally Acting Muscle Relaxant
Authors: Farkas Sándor
Published: January 2007

Silperisone is a tolperisone like organosilicon compound with centrally acting muscle relaxant properties. Studies in mice showed that silperisone may have less propensity to cause CNS depressant or motor side effects than tolperisone or other antispastic drugs. In cats and rats, silperisone was an effective suppressant of monosynaptic and polysynaptic spinal reflexes and decerebrate rigidity. Its suppressant effect on the spinal reflexes was also demonstrated in the isolated hemisected rat spinal cord in vitro. The in vivo potency and efficacy of silperisone by i.v administration were similar to those of tolperisone and eperisone. However, in cats by intraduodenal administration and in mice by oral administration its duration of action was much longer and its functional bioavailability much higher than of the other two drugs. With regard to its profile of actions silperisone was similar to tolperisone with minor differences. The most striking difference was in pontine facilitation and bulbar inhibition of the patellar reflex. Tolperisone depressed both, whereas silperisone inhibited only the former. The mechanism underlying the spinal reflex depressant effects of silperisone involves the blockade of voltage gated neuronal sodium and calcium channels leading to a decreased release of excitatory transmitter and reduced neuronal excitability. In addition, silperisone has potassium channel blocking effect, which is stronger than that of tolperisone. Silperisone is absorbed rapidly and is extensively metabolized in rats. However, its metabolism in dogs and particularly in humans is much less extensive. The elimination half‐life of silperisone in humans is 12 to 16 h, so that it can be administered once or twice daily. Phase I clinical studies with silperisone at doses up to 150 mg/day failed to detect any adverse effects at plasma concentrations considered to be effective in the preclinical tests. These findings suggested that silperisone might be a useful antispastic drug. However, findings in chronic animal toxicity studies led to the discontinuation of silperisone's development.

image
[ Chemical structure of silperisone. ]
A New Look at the Respiratory Stimulant Doxapram
Authors: Yost C. Spencer
Published: January 2007

A number of life‐threatening clinical disorders may be amenable to treatment with a drug that can stimulate respiratory drive. These include acute respiratory failure secondary to chronic obstructive pulmonary disease, post‐anesthetic respiratory depression, and apnea of prematurity. Doxapram has been available for over forty years for the treatment of these conditions and it has a low side effect profile compared to other available agents. Generally though, the use of doxapram has been limited to these clinical niches involving patients in the intensive care, post‐anesthesia care and neonatal intensive care units. Recent basic science studies have made considerable progress in understanding the molecular mechanism of doxapram's respiratory stimulant action. Although it is unlikely that doxapram will undergo a clinical renaissance based on this new understanding, it represents a significant advance in our knowledge of the control of breathing.
The Effects of Abutment Wall Height, Platform Size, and Screw Access Channel Filling Method on Resistance to Dislodgement of Cement‐Retained, Implant‐Supported Restorations
Authors: Emms Mark , Tredwin Christopher J. , Setchell Derrick J. , Moles David R.
Published: January 2007

Purpose: Factors affecting the retention of fixed prostheses to natural abutments are well understood. In contrast, little is known concerning factors influencing the retention of fixed prostheses cemented to implant abutments. The purpose of this study was to investigate the effect that varying implant abutment wall height, platform size, and screw access channel filling method has on the retention of castings cemented to implant abutments using TempBond.

Materials and Methods: Four 15° preangled abutments (Nobel Biocare Replace Select Esthetic) of each platform size—narrow (NP), regular (RP), and wide (WP)—were used. In each group of abutments the screw access axial wall was either unadjusted, one‐third removed, two‐thirds removed, or completely removed. The screw access channels were either fully or partially filled with Memosil, a vinyl polysiloxane impression material. For each abutment a casting was constructed that incorporated an attachment to allow removal. Castings were cemented to abutments with TempBond. The tensile force required to separate the cemented castings from the abutments was measured using an Instron Universal load‐testing machine.

Results: The mean peak removal force for comparable abutments was significantly different ( p < 0.05): (1) where the screw access channel was completely filled with Memosil compared with those partially filled with Memosil; (2) with platform sizes—WP > RP > NP; (3) with alteration of axial wall height—1/3 removed > unadjusted = 2/3 removed > total wall removal.

Conclusions: The retention of castings cemented to implant abutments with TempBond is influenced by the wall height, platform size, and the filling modality of the screw access channel.