bluuebunny/crossref_metadata_2025 huggingface dataset:
QUANTUM PHASE TRANSITIONS IN MESOSCOPIC SYSTEMS
Authors: IACHELLO F.
Published: August 2006

Shape phase transitions in nuclei, an example of quantum phase transitions in mesoscopic systems, are briefly reviewed. Spectral signatures of critical points in finite quantal systems are discussed and experimental examples are shown.
MATTER AT EXTREME DENSITY AND ITS ROLE IN NEUTRON STARS AND SUPERNOVA
Authors: REDDY SANJAY
Published: August 2006

We discuss observable aspects of neutron stars and supernova that are influenced by the properties of matter at extreme density. In particular, we explore the possible role phase transitions to quark matter phases at supra nuclear density. The competition between the strange quark mass and the pairing energy in quark matter, and show that it leads to a rich phase structure at densities of relevance to neutron stars. The equation of state and transport properties of quark matter is shown to be strongly influenced by pairing correlations at the Fermi surface.
GROUND STATE OF MANY-BODY LATTICE SYSTEMS VIA A CENTRAL LIMIT THEOREM
Authors: PRESILLA CARLO , OSTILLI MASSIMO
Published: August 2006

We review a novel approach to evaluate the ground-state properties of many-body lattice systems based on an exact probabilistic representation of the dynamics and its long time approximation via a central limit theorem. The choice of the asymptotic density probability used in the calculation is discussed in detail.
SPIN TEXTURES AND RANDOM FIELDS IN DIRTY QUANTUM HALL FERROMAGNETS
Authors: CHALKER J. T.
Published: August 2006

Dirty quantum Hall ferromagnets (QHFMs) provide a setting both for new problems in the theory of magnetism with quenched disorder, and for new realisations of old problems. In the first category, the fact that spin textures in Heisenberg QHFMs carry charge leads to a coupling between charged impurities and magnetic order. This coupling drives a zero-temperature transition between a ferromagnet at low disorder and a spin glass at strong disorder, and controls screening and the nature of excitations in the disorder-dominated ground state. In the second category, random fields coupling linearly to the order parameter appear in some Ising QHFMs, and transport measurements appear to indicate field-induced domain states at low temperature.
POSSIBLY EXACT SOLUTION FOR THE MULTICRITICAL POINT OF FINITE-DIMENSIONAL SPIN GLASSES
Authors: NISHIMORI HIDETOSHI , TAKEDA KOUJIN , SASAMOTO TOMOHIRO
Published: August 2006

After briefly describing the present status of the spin glass theory, we present a conjecture on the exact location of the multicritical point in the phase diagram of finite-dimensional spin glasses. The theory enables us to understand in a unified way many numerical results for two-, three- and four-dimensional models including the ±J Ising model, random Potts model, random lattice gauge theory, and random Zq model. It is also suggested from the same theoretical framework that models with symmetric distribution of randomness in exchange interaction have no finite-temperature transition on the square lattice.
FROM STATISTICAL PHYSICS METHODS TO ALGORITHMS
Authors: BATTAGLIA DEMIAN , KOLÁŘ MICHAL , ZECCHINA RICCARDO
Published: August 2006

After a brief review of the Survey Propagation equations defined over single instances of complex glassy-like Hamiltonians, we discuss their application to the search for minimum energy configurations in difficult combinatorial optimization problems. Furthermore, we show that the application of arbitrary external field is helpful in the investigation of the topology of the configuration space.
QUANTUM ERROR CORRECTION FAILS FOR HAMILTONIAN MODELS
Authors: ALICKI R.
Published: August 2006

It is argued that the existing schemes of fault-tolerant quantum computation, designed for discrete time models and based on quantum error correction, fail for continuous time Hamiltonian models, even with Markovian noise.
Modeling the effect of stretch and plasma membrane tension on Na+-K+-ATPase activity in alveolar epithelial cells
Authors: Fisher Jacob L. , Margulies Susan S.
Published: August 2006

While a number of whole cell mechanical models have been proposed, few, if any, have focused on the relationship among plasma membrane tension, plasma membrane unfolding, and plasma membrane expansion and relaxation via lipid insertion. The goal of this communication is to develop such a model to better understand how plasma membrane tension, which we propose stimulates Na+-K+-ATPase activity but possibly also causes cell injury, may be generated in alveolar epithelial cells during mechanical ventilation. Assuming basic relationships between plasma membrane unfolding and tension and lipid insertion as the result of tension, we have captured plasma membrane mechanical responses observed in alveolar epithelial cells: fast deformation during fast cyclic stretch, slower, time-dependent deformation via lipid insertion during tonic stretch, and cell recovery after release from stretch. The model estimates plasma membrane tension and predicts Na+-K+-ATPase activation for a specified cell deformation time course. Model parameters were fit to plasma membrane tension, whole cell capacitance, and plasma membrane area data collected from the literature for osmotically swollen and shrunken cells. Predictions of membrane tension and stretch-stimulated Na+-K+-ATPase activity were validated with measurements from previous studies. As a proof of concept, we demonstrate experimentally that tonic stretch and consequent plasma membrane recruitment can be exploited to condition cells against subsequent cyclic stretch and hence mitigate stretch-induced responses, including stretch-induced cell death and stretch-induced modulation of Na+-K+-ATPase activity. Finally, the model was exercised to evaluate plasma membrane tension and potential Na+-K+-ATPase stimulation for an assortment of traditional and novel ventilation techniques.
Calcium flux in turtle ventricular myocytes
Authors: Galli Gina L. J. , Taylor Edwin W. , Shiels Holly A.
Published: August 2006

The relative contribution of the sarcoplasmic reticulum (SR), the L-type Ca2+channel and the Na+/Ca2+exchanger (NCX) were assessed in turtle ventricular myocytes using epifluorescent microscopy and electrophysiology. Confocal microscopy images of turtle myocytes revealed spindle-shaped cells, which lacked T-tubules and had a large surface area-to-volume ratio. Myocytes loaded with the fluorescent Ca2+-sensitive dye Fura-2 elicited Ca2+transients, which were insensitive to ryanodine and thapsigargin, indicating the SR plays a small role in the regulation of contraction and relaxation in the turtle ventricle. Sarcolemmal Ca2+currents were measured using the perforated-patch voltage-clamp technique. Depolarizing voltage steps to 0 mV elicited an inward current that could be blocked by nifedipine, indicating the presence of Ca2+currents originating from L-type Ca2+channels (ICa). The density of ICawas 3.2 ± 0.5 pA/pF, which led to an overall total Ca2+influx of 64.1 ± 9.3 μM/l. NCX activity was measured as the Ni+-sensitive current at two concentrations of intracellular Na+(7 and 14 mM). Total Ca2+influx through the NCX during depolarizing voltage steps to 0 mV was 58.5 ± 7.7 μmol/l and 26.7 ± 3.2 μmol/l at 14 and 7 mM intracellular Na+, respectively. In the absence of the SR and L-type Ca2+channels, the NCX is able to support myocyte contraction independently. Our results indicate turtle ventricular myocytes are primed for sarcolemmal Ca2+transport, and most of the Ca2+used for contraction originates from the L-type Ca2+channel.
A simple technique to characterize proximal and peripheral nitric oxide exchange using constant flow exhalations and an axial diffusion model
Authors: Condorelli Peter , Shin Hye-Won , Aledia Anna S. , Silkoff Philip E. , George Steven C.
Published: August 2006

The most common technique employed to describe pulmonary gas exchange of nitric oxide (NO) combines multiple constant flow exhalations with a two-compartment model (2CM) that neglects 1) the trumpet shape (increasing surface area per unit volume) of the airway tree and 2) gas phase axial diffusion of NO. However, recent evidence suggests that these features of the lungs are important determinants of NO exchange. The goal of this study is to present an algorithm that characterizes NO exchange using multiple constant flow exhalations and a model that considers the trumpet shape of the airway tree and axial diffusion (model TMAD). Solution of the diffusion equation for the TMAD for exhalation flows >100 ml/s can be reduced to the same linear relationship between the NO elimination rate and the flow; however, the interpretation of the slope and the intercept depend on the model. We tested the TMAD in healthy subjects ( n = 8) using commonly used and easily performed exhalation flows (100, 150, 200, and 250 ml/s). Compared with the 2CM, estimates (mean ± SD) from the TMAD for the maximum airway flux are statistically higher ( J′awNO= 770 ± 470 compared with 440 ± 270 pl/s), whereas estimates for the steady-state alveolar concentration are statistically lower (CANO= 0.66 ± 0.98 compared with 1.2 ± 0.80 parts/billion). Furthermore, CANOfrom the TMAD is not different from zero. We conclude that proximal (airways) NO production is larger than previously predicted with the 2CM and that peripheral (respiratory bronchioles and alveoli) NO is near zero in healthy subjects.
Changes in muscle coordination with training
Authors: Carson Richard G.
Published: August 2006

Three core concepts, activity-dependent coupling, the composition of muscle synergies, and Hebbian adaptation, are discussed with a view to illustrating the nature of the constraints imposed by the organization of the central nervous system on the changes in muscle coordination induced by training. It is argued that training invoked variations in the efficiency with which motor actions can be generated influence the stability of coordination by altering the potential for activity-dependent coupling between the cortical representations of the focal muscles recruited in a movement task and brain circuits that do not contribute directly to the required behavior. The behaviors that can be generated during training are also constrained by the composition of existing intrinsic muscle synergies. In circumstances in which attempts to produce forceful or high velocity movements would otherwise result in the generation of inappropriate actions, training designed to promote the development of control strategies specific to the desired movement outcome may be necessary to compensate for protogenic muscle recruitment patterns. Hebbian adaptation refers to processes whereby, for neurons that release action potentials at the same time, there is an increased probability that synaptic connections will be formed. Neural connectivity induced by the repetition of specific muscle recruitment patterns during training may, however, inhibit the subsequent acquisition of new skills. Consideration is given to the possibility that, in the presence of the appropriate sensory guidance, it is possible to gate Hebbian plasticity and to promote greater subsequent flexibility in the recruitment of the trained muscles in other task contexts.
Adolescent Varicocele: Association with Somatometric Parameters
Authors: Prabakaran Sushil , Kumanov Philip , Tomova Analia , Hubaveshki Stanislav , Agarwal Ashok
Published: August 2006

Introduction: The developmental changes that occur as a result of puberty have been hypothesized to be important causes of varicocele. Various somatometric parameters were known to affect the occurrence of varicocele during the growth period. We conducted this study in order to examine these relationships and to determine the incidence of varicocele in adolescent males. Patients and Methods: We evaluated 1,200 healthy males aged 0–19 years for varicocele and correlated it with the following somatometric parameters: age, height, body mass index (BMI), pubic hair distribution, penile length and testicular volume. Results: Adolescent varicocele was found in 5.6% of the participants. The 13- to 19-year age-group had the highest incidence of varicocele (10.5%). Logistic regression analysis showed that the incidence was positively correlated with age, height and penile length (odds ratio 1.61, 1.04 and 1.37, respectively) and negatively correlated with left testicular volume, BMI and pubic hair distribution (odds ratio 0.87, 0.87 and 0.47, respectively).Conclusion: Varicocele was more prevalent in tall boys with a lower BMI, who had quickly progressed through puberty. Our observations suggest that varicocele is associated with various somatometric parameters.
Is Laparoscopic Approach Safe for Ectopic Pelvic Kidneys?
Authors: Gupta N. , Mandhani A. , Sharma D. , Kapoor R. , Dubey D. , Kumar A.
Published: August 2006

Objective: To assess the feasibility and safety of a laparoscopic approach to pelvic kidneys for ablative and reconstructive surgery. Methods: BetweenJanuary 2002 and February 2005, 6 patients with a left pelvic kidney; 2 with ureteropelvic junction obstruction, 2 with nonfunctioning kidney and 2 with pelvic stones were selected. These patients underwent dismembered pyeloplasty, simple nephrectomy and pyelolithotomy by laparoscopic approach. For pyeloplasty, omitting the prior retrograde stent facilitated dissection around the pelvis, which was identified first and then the ureter was traced downwards. Dismembered pyeloplasty was done by continuous sutures using 4–0 vicryl over a double-J stent placed antegradely. During nephrectomy, the ureter was identified over the iliac vessels and divided first. Subsequent dissection was carried out after lifting the kidney to identify ectopic renal vessels. Pyelolithotomy was performed for a large single pelvic stone after placing the ureteric catheter and confirming the stone’s position by fluoroscopy. Results: One patient with pyelolithotomy was converted to open surgery while the others were completed laparoscopically.Mean hospital stay was 4.16 (range 3–5) days, blood loss 115 (range 30–300) ml and mean operative time was 170 (range 140–220) min. There were no post-operative complications. After pyeloplasty there was significant improvement in renal function and drainage pattern on diuretic scan at 11 and 12 months. Conclusion: The laparoscopic approach provides all the benefits of a minimally invasive procedure to the patients. Due to the different locations of renal vessels, it is safe to approach the ureter first when performing nephrectomy. When performing pyeloplasty, omitting the prior stent placement helps in the identification and dissection of the renal pelvis.
The Limited Significance of a Longer Duration of Neoadjuvant Hormonal Therapy prior to Radical Prostatectomy for High-Risk Prostate Cancer in Japanese Men
Authors: Miyake Hideaki , Sakai Iori , Inoue Taka-aki , Hara Isao , Fujisawa Masato
Published: August 2006

Introduction: The objective of this study was to evaluate the therapeutic significance of a longer duration of neoadjuvant hormonal therapy (NHT) followed by radical prostatectomy (RP) in Japanese men with high-risk prostate cancer. Materials and Methods: This study included a total of 42 patients with high-risk prostate cancer who were treated with NHT for ≧8 months prior to RP. In this series high-risk prostate cancer was defined as clinical stage T2c or T3, pretreatment serum prostate-specific antigen (PSA) >20 ng/ml and/or a biopsy Gleason score of 8–10. Biochemical recurrence was defined as a serum PSA level of ≧0.2 ng/ml. The data of these patients were retrospectively reviewed to clarify the relationships between treatment outcomes and various clinicopathological parameters. Results: The clinical stage was T2c in 13 patients and T3 in 29, the median value of pretreatment serum PSA was 43.3 ng/ml (range 9.7–322.2), and the biopsy Gleason score was 6 in 3 patients, 7 in 16 and ≧8 in 23. Following NHT (median 12 months, range 8–27), the median value of serum PSA decreased to 0.05 ng/ml (<0.01–18.3 ng/ml), and 15 patients (35.7%) were pathologically downstaged. During the median follow-up of 38 months (range 8–58), 11 patients (26.2%) developed biochemical recurrence, and the multivariate analysis identified pretreatment serum PSA, biopsy Gleason score and percentage of positive biopsy core as independent predictors of biochemical recurrence. The 3-year biochemical recurrence-free survival rate of the 42 patients was 68.3%, which was not significantly different from that of 34 patients who underwent RP for high-risk prostate cancer without NHT during the same period. Conclusion: A longer duration of NHT followed by RP for patients with high-risk prostate cancer resulted in a comparatively favorable outcome. However, despite the nonrandomized retrospective analysis, the present findings suggest no significant impact of long-term NHT on biochemical recurrence. Longer follow-up is needed to determine whether this therapeutic strategy is beneficial for high-risk prostate cancer patients.
Systemic Inflammatory Response, Prostate-Specific Antigen and Survival in Patients with Metastatic Prostate Cancer
Authors: McArdle Peter A. , Mir Khurram , Almushatat A.S.K. , Wallace A. Michael , Underwood Mark A. , McMillan Donald C.
Published: August 2006

Background: It is increasingly recognised that, in cancer patients, disease progression is dependent on a complex interaction of the tumour and the host inflammatory response and that the systemic inflammatory response, as evidenced by an elevated C-reactive protein (CRP) concentration, may be a useful prognostic factor. Materials and Methods: The prognostic value of CRP compared with prostate-specific antigen (PSA) was examined in 62 patients with metastatic prostate cancer receiving androgen-deprivation therapy. Results: In all, 41 (66%) of patients died, 38 (61%) of their disease. On univariate survival analysis, PSA (p < 0.05) and CRP (p < 0.05) were significant predictors of cancer-specific survival. On multivariate analysis, both PSA (HR 1.96, 95% CI 1.00–3.83, p = 0.049) and CR (HR 1.97, 95% CI 0.99–3.92, p = 0.052) were independent predictors of cancer-specific survival. PSA concentrations were significantly correlated with those of CRP (rs = 0.46, p < 0.001). Conclusion: The results of the present study suggest that, in patients with metastatic prostate cancer, the presence of an elevated CRP concentration predicts poor outcome, independent of PSA.
Characterization of Biochemical Recurrence after Radical Prostatectomy
Authors: Molitierno Joseph , Evans Aubrey , Mohler James L. , Wallen Eric , Moore Dominic , Pruthi Raj S.
Published: August 2006

Background: This study sought to characterize the variables that predict postoperative prostate-specific antigen doubling time (PSADT) and biochemical recurrence time (RT) in patients who have failed radical prostatectomy (RP). Methods: A total of 477 patients underwent RP at our institution for clinically localized prostate cancer. Of these patients, 64 (13.4%) demonstrated evidence of postoperative biochemical failure. PSADT and biochemical RT were calculated for all patients. PSADT and RT were correlated with clinical variables including preoperative PSA level, patient age, race, prostate weight and with pathologic characteristics of the operative specimen using uni- and multivariate analyses. In addition, PSADT and RT were also correlated with each other and with the time to postoperative adjuvant therapy. Results: Median postoperative PSADT for patients who recurred after radical prostatectomy was 9.7 months. Postoperative PSADT was predicted by lymph node involvement (p < 0.001) and Gleason grade (p = 0.06). Rapid PSADT also correlated with institution of postoperative adjuvant therapy (p = 0.003). Median biochemical RT for all patients was 6.7 months. Gleason grade and pathologic stage were found to be predictors of RT (p < 0.002). Postoperative PSADT did not correlate with RT (r = 0.08; p = 0.53). PSADT and RT were not different between Caucasian- versus African-Americans. Conclusions: These results serve to better characterize our cohort of patients who have evidence of biochemical recurrence after radical prostatectomy. Aggressiveness of recurrent disease (i.e. PSADT) seems to be predicted by lymph node involvement and higher pathologic grade. Furthermore, the lack of correlation of RT and PSADT suggests that early recurrences are not necessarily aggressive tumors: conversely, aggressive recurrences may occur at any point in the postoperative period. This information may aid in the postoperative treatment of recurrent disease and help to better define those patients who are at higher risk for developing clinical recurrence and who would benefit from greater vigilance during the postoperative period.
Failure to Maintain a Suppressed Level of Serum Testosterone during Long-Acting Depot Luteinizing Hormone-Releasing Hormone Agonist Therapy in Patients with Advanced Prostate Cancer
Authors: Morote Juan , Esquena Salvador , Abascal José M. , Trilla Enrique , Cecchini Luis , Raventós Carles X. , Catalán Roberto , Reventós Jaume
Published: August 2006

Objectives: It was the aim of this study to analyze the failure rates in achieving or maintaining castrate levels of serum testosterone in patients with advanced prostate cancer treated with the 3-month luteinizing hormone-releasing hormone agonist (LH-RH) therapy. Methods:Total serum testosterone was determined in 234 patients with prostate cancer in a cross-sectional study. A subset of 90 patients submitted to radical prostatectomy was used as the control group (group 1), and 144 patients with advanced prostate cancer under androgen suppression therapy were included in the study group (groups 2 and 3). The study group was divided into 93 patients (group 2) treated with 50 mg daily bicalutamide and LH-RH agonist (maximal androgen blockade, MAB) and 51 patients treated with the LH-RH agonist alone (group 3). Median follow-up after androgen suppression was 42 months. The castrate testosterone level was defined below 50 ng/dl. Results: The mean serum testosterone level was 29.1 ng/dl in patients undergoing MAB (group 2) and 29.5 ng/dl in patients treated with the LH-RH agonist (group 3; p > 0.05). In group 1, the mean serum testosterone was 445.2 ng/dl (p < 0.0001). The rate of patients with a serum testosterone level higher than 50 ng/dl was 10.9% in patients undergoing androgen suppression, 10% in patients with MAB treatment and 12.5% in those with LH-RH agonist therapy (p > 0.05). In group 1, 98.9% of the patients had a serum testosterone level higher than 50 ng/dl. Conclusions: A small but clinically significant rate of patients under 3-month LH-RH agonist therapy fail to achieve or maintain castrate testosterone serum levels. This finding supports the need of monitoring testicular response during LH-RH agonist therapy.
Comparison of Transurethral Resection and Plasmakinetic Transurethral Resection Applications with Regard to Fluid Absorption Amounts in Benign Prostate Hyperplasia
Authors: Akçayöz Murat , Kaygisiz Onur , Akdemir Özgür , Aki Fazil T. , Adsan Öztüğ , Çetinkaya Mesut
Published: August 2006

Introduction: We compare the absorption of irrigant fluid during gyrus plasmakinetic transurethral prostatectomy (PK-TURP) and transurethral resection of the prostate (TURP). Patients and Methods: 42 patients with clinical benign prostatic hyperplasia were randomly assigned to undergo PK-TURP or TURP. In the PK-TURP group 0.9% NaCl was used as an irrigation fluid and 1.5% glycine in the TURP group. By adding ethanol to the irrigation fluids 1% ethanol-containing solutions were formed. All operations were carried out under spinal anesthesia and alcohol concentration of the ventilated air measurements were made just at the beginning of the operation, every 10 min peroperatively and at the end of the operation by using an alcoholmeter. Results: There was no difference in age, prostate volume and the length of operation time in either group. In both groups, the estimated absorbed fluid volume increased with the duration of surgery (p < 0.05). The difference between mean fluid absorption during PK-TURP and during TURP was the statistically significant (p < 0.01). Conclusion: PK-TURP operation causes lesser absorption of the irrigation fluid than the TURP operation. The lesser absorption of irrigation fluid and using saline instead of glycine decreases the risk of TUR syndrome.
Shock Wave Lithotripsy in Solitary Functioning Kidneys: Is Prophylactic Stenting Necessary?
Authors: Kumar S. , Sakthivel A. , Chacko K.N. , Kekre N.S. , Ganesh G.
Published: August 2006

Objective: To assess the safety of shock wave lithotripsy (SWL) without prophylactic stents in solitary functioning kidneys. Patients and Methods: Sixteen solitary functioning kidneys with 23 renal stones with a size of <15 mm were treated with SWL as the primary modality. All patients were counseled about the possibility of obstruction, and treatment was offered to those who consented. The safety of SWL was assessed by the need for interventions and the posttreatment renal function. Results: In 14 patients lithotripsy was uneventful. The duration of treatment ranged from 5 to 35 days. One patient with a 15-mm pelvic calculus presented with anuria which resolved before intervention. In 1 patient fragmentation failed, and percutaneous nephrolithotomy was performed. Conclusions: In solitary functioning kidneys, SWL is safe without prophylactic stents in properly selected and closely monitored patients. Avoiding stents decreases costs, duration of treatment, and stent-related morbidity without unduly compromising safety.
Renal Medullary Carcinoma
Authors: Leitão Victor Augusto , da Silva Jr. Walter , Ferreira Ubirajara , Denardi Fernandes , Billis Athanase , Rodrigues Netto Jr. Nelson
Published: August 2006

Young patients with sickle cell trait or disease present a higher risk for renal medullary carcinoma, an aggressive renal tumor, with dismal prognosis, with a median survival of 4 months from the time of diagnosis. We report a 26-year-old patient with a 2-month history of bone pain at the right iliac crest, loss of weight, recurrent macroscopic hematuria and abdominal mass. Imaging studies demonstrated a 10-cm mass in the right kidney. Pathological evaluation revealed a medullary carcinoma and the patient died after 4 months, despite adjuvant treatment. Whenever a patient with sickle cell trait or disease presents with hematuria and/or flank pain, the possibility of a renal medullary carcinoma should always be kept in mind, with thorough investigation and expeditious treatment.
Residual Need for Early Orthodontic Treatment and Orthodontic Treatment Experience among 13- to 14-Year-Old School Children in Kuwait
Authors: Årtun Jon , Kerosuo Heidi , Behbehani Faraj , Al-Jame Badreia
Published: August 2006

Objective: Our purpose was to determine the residual need for early orthodontic treatment and the parameters associated with orthodontic treatment experience in 13- to 14-year-old school children in Kuwait. Subjects and Methods: A total of 788 boys and 795 girls, representing about 6.7% of the target population, were selected according to cluster sampling methods. Information on nationality, family income and orthodontic treatment experience was collected through subject and family interviews. The occlusal morphology was recorded in a well-lit classroom or from initial study models of subjects with orthodontic treatment experience. Results: Only 6.7% of the 225 subjects with early treatment need, defined as overjet ≧6.5 mm, and functional posterior and anterior crossbite on 1 or more teeth, had treatment experience. Residual need for early treatment was present in 13.4% of the subjects. Only 26.8% of the subjects with treatment experience met our criteria for early treatment need. The odds of treatment experience were higher in the subjects attending private schools (p < 0.05), in those from families with an income of KWD >2,000 (USD 6,600; p < 0.01) and in subjects meeting the criteria for early treatment need (p < 0.01). Conclusions: About 15% of each birth cohort of school children in Kuwait need early orthodontic treatment. Less than 10% of those with a need have treatment experience at 13–14 years of age, and about 75% of those with treatment experience at that age do not need early treatment. The predictors for treatment experience at 13–14 years of age are private-school attendance, a high family income and need for early treatment.
Practice and Opinion towards Disposal of Unused Medication in Kuwait
Authors: Abahussain Eman A. , Ball Douglas E. , Matowe Wandikayi C.
Published: August 2006

Objectives: The aim of this study was to measure the attitude and practice of Kuwaiti patients in Kuwait with regard to safe disposal of unwanted medicines. Subjects and Methods: Three-hundred patients or their family members waiting for prescriptions at public general hospitals in Kuwait completed a questionnaire soliciting their practice with regard to medication use and disposal, and their opinion of the best way to dispose of unwanted medicines. Results: Almost half of the respondents (45.4%) obtained medicines on prescription more than 3 times a year and almost all had unwanted medicines in the home. Reasons for possessing unused medication were mostly due to a change of medication by the doctor (48.9%), or self-discontinuation (25.8%). Their most common method of disposal was to throw unwanted medicines in the trash (76.5%) or flush them down the drain (11.2%). Half (54.0%) thought that a system of taking medicines to pharmacies for safe disposal would be favorable. Conclusion: The study indicates that the need for an appropriate method for disposal of unwanted medication exists in Kuwait. Hence, guidelines on safe disposal of unwanted medicines are required and an organized method of collecting unused medication needs to be introduced.
Evidence of Occult Hepatitis B Virus Infection among Omani Blood Donors: A Preliminary Study
Authors: Kaminski Geraldine , Alnaqdy Adel , Al-Belushi Intesar , Nograles Jameel , Al-Dhahry Said H.
Published: August 2006

Objectives: The aim of this study was to determine the prevalence of hepatitis B surface antigen (HBsAg), hepatitis B core antibodies (anti-HBc) and hepatitis B virus (HBV) DNA among a selected group of Omani blood donors. Materials and Methods: Two hundred HBsAg-negative donors were screened for anti-HBc. Those found to be positive were investigated for HBV DNA by polymerase chain reaction. HBsAg was retested on these sera following an immune complex dissociation technique. Results: HBsAg was present in 2.8% of the donors. Forty-one out of 200 (20.5%) HBsAg-negative donors were positive for anti-HBc. Eleven were positive for HBsAg after dissociation, whereas 8 gave readings just over the cutoff. HBV DNA was not detected in this group. Conclusion: Findings indicate that testing donors for HBsAg alone is not sufficient to eliminate HBV from the blood supply in Oman.
Tuberculosis of the Greater Trochanter
Authors: Mouhsine E. , Pelet S. , Wettstein M. , Blanc C.-H. , Garofalo R. , Theumann N. , Borens O.
Published: August 2006

Objective: To present four cases of tuberculosis of the greater trochanter. Case Presentation and Intervention: The four cases (3 females and 1 male), aged 45–70 years, presented with mechanical pain in the trochanteric area associated with progressive swelling in the 3 female patients in whom mobility was also restricted. X-ray revealed a mass in 2 females; CT scan and MRI exhibited an abscess in the 3 females. Histological and bacteriological examinations showed Mycobacterium bovis in the 3 females and M. tuberculosis in the male. In the females, tritherapy and surgery were performed, while in the male quadritherapy and surgery. All the patients recovered and were followed up for 4–9 years. Conclusion: These cases show that both chemotherapy and surgery must be synergic if tuberculosis is diagnosed and an abscess is confirmed by imaging.
Osteochondroma of the Scapula Associated with Winging and Large Bursa Formation
Authors: Mohsen Mahmoodi Seyed , Moosa Nooruddin K. , Kumar Pradeep
Published: August 2006

Objective: To report a case of scapular osteochondroma associated with pain and winging that is rarely reported in the medical literature. Case Presentation and Identification: A 19-year-old male presented with pain and winging of the right scapula. CT scan revealed an osteochondroma of the medial border of the scapula with a large bursa between the chest wall and the tumour. Excision of the tumour relieved the symptoms. Pathological study showed osteochondroma of the scapula. In a follow-up 1 year later he was free of pain with no clinical or radiological sign of recurrence. Conclusion: A case of scapular osteochondroma associated with pain and winging treated by excision and follow-up showed no sign of clinical or radiological recurrence.
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy: An Imaging Mimic of Multiple Sclerosis
Authors: Pandey Tarun , Abubacker Shefeek
Published: August 2006

Objective and Importance: To describe the imaging findings of two cases of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) mimicking multiple sclerosis. Clinical Presentation and Intervention: Two cases presenting with neurological signs and symptoms were referred for magnetic resonance imaging (MRI) evaluation of the brain. Case 1 was a 36-year-old female patient presenting with recurrent headaches and recent onset numbness in the fingers of the right hand. Neurological examination showed a mild sensory deficit in the right hand. Case 2 was a 31-year-old female patient presenting with attacks of right-sided numbness of the face and body. The neurological examination revealed a sensory loss in the face and brisk deep tendon reflexes. Routine MRI sequences showed two types of lesions in both cases: ‘punctate’ hyperintense lesions on T2-weighted images (T2WI)/fluid-attenuated inversion recovery (FLAIR) images, hypointense on T1-weighted images (T1WI) and ‘diffuse’ white matter lesions, hyperintense on T2WI/FLAIR sequences and isointense to hypointense on T1WI. All lesions showed no contrast enhancement. Both cases were previously clinically and radiologically diagnosed as multiple sclerosis. There was a strong family history consistent with recurrent infarctions in other family members of both patients. Both cases were later diagnosed as CADASIL by skin biopsy/genetic linkage studies and follow-up. Conclusion:The cases showed that CADASIL causes stroke-like episodes in adults and can mimic multiple sclerosis on imaging. Clinical evaluation and MRI findings allow a differentiation of the two entities.
High Prevalence of Abnormal Glucose Metabolism and Poor Sensitivity of Fasting Plasma Glucose in the Chronic Phase of Stroke
Authors: Ivey Frederick M. , Ryan Alice S. , Hafer-Macko Charlene E. , Garrity Brian M. , Sorkin John D. , Goldberg Andrew P. , Macko Richard F.
Published: August 2006

Background: Cardiovascular disease is the leading cause of death in long-term stroke survivors, and whole-body glucose metabolism is strongly linked to cardiovascular disease risk. This study provides important preliminary information on the prevalence of abnormal glucose metabolism in chronic stroke patients (mean 3 years after stroke) and reports on the utility of screening for abnormalities using fasting plasma glucose (FPG) in this population. Methods: Two hundred and sixteen chronic hemiparetic stroke patients were screened for diabetes status by medical history and FPG. A subset (n = 80) was evaluated by oral glucose tolerance test to assess the utility of screening for abnormalities using FPG alone. Results: Seventy-five of the 216 (35%) had type 2 diabetes by medical history. Another 70 were either diabetic (n = 11) or had impaired fasting glucose (n = 59) based on a single blood draw at the time of screening. FPG among non-diabetic stroke patients had a sensitivity of 49% for predicting abnormalities in the 2-hour glucose level during oral glucose tolerance test. Cumulative results identify 77% as abnormal (impaired or diabetic) on the basis of medical history, fasting plasma glucose, and/or 2-hour glucose level. Conclusions: The prevalence of abnormal glucose metabolism is extremely high in chronic stroke and is underestimated on the basis of FPG.
Predictors of Cerebral Microbleeds in Acute Ischemic Stroke and TIA Patients
Authors: Ovbiagele Bruce , Saver Jeffrey L. , Sanossian Nerses , Salamon Noriko , Villablanca Pablo , Alger Jeffry R. , Razinia Tannaz , Kim Doojin , Liebeskind David S.
Published: August 2006

Background: Cerebral microbleeds (CMB) detected on gradient-echo T2*-weighted MRI have been associated with cognitive impairment and the potential for increased risk of intracranial hemorrhage. We evaluated risk factors for these microangiopathic lesions in a cohort of stroke and transient ischemic attack patients. Methods: Presence and number of CMB in consecutive acute stroke patients admitted to a university hospital stroke service over an 18-month period were rated. Multivariate models were generated to determine the contribution of 21 demographic and clinical variables to the frequency and number of CMB. Results: Of 164 patients (mean age 71 years, 52% female), 57 (35%) had CMB evident on gradient-echo T2*-weighted MRI. CMB were more commonly noted among patients with small vessel disease ischemic stroke mechanism (47%) than large vessel atherothromboembolic (12%) or cardioembolic (18%, p = 0.0001). In univariate analysis, patients with CMB were older, (p = 0.008), more likely to have been on >1 antihypertensive prior to admission (p = 0.024) than those without CMB. In multivariate logistic regression analyses, presumed small vessel stroke subtype, history of atrial fibrillation, being on >1 antihypertensive prior to admission, and smoking were independent factors increasing the risk of CMB. Logistic regression analysis by number of CMB showed almost similar findings. Conclusions: CMB are more frequently noted in hospitalized stroke and transient ischemic attack patients with small vessel ischemia, as well as those with important modifiable vascular risk factors like atrial fibrillation and smoking.
Does Clinical-CT ‘Mismatch’ Predict Early Response to Treatment with Recombinant Tissue Plasminogen Activator?
Authors: Choi John Y. , Pary Jennifer K. , Alexandrov Andrei V. , Molina Carlos A. , Garami Zsolt , Malkoff Marc D. , Rubiera Marta , Shaltoni Hashem M. , Moye Lemuel A. , Grotta James C.
Published: August 2006

Background:We hypothesized that patients with clinically severe strokes but less severe early ischemic changes on brain CT (i.e., clinical-CT mismatch) may respond better to intravenous recombinant tissue plasminogen activator (i.v. rt-PA) within 3 h of symptom onset. Methods: In this secondary analysis of the CLOTBUST data, patients with middle cerebral artery occlusions on transcranial Doppler (TCD) were treated with i.v. rt-PA. Alberta Stroke Program Early CT Scores were obtained with raters blinded to the NIH Stroke Scale and TCD results. Two mismatch criteria and three criteria of response to therapy were explored. Results: Of 126 patients, 67% had a mismatch type 1 and 74% had a mismatch type 2. The presence of clinical-CT mismatch by either definition did not correlate with any of the three criteria of response to rt-PA. Recanalization was a strong determinant of response, whether or not mismatch was present. Conclusions: Mismatch between severity of neurological deficit and CT findings is common but does not predict response to rt-PA therapy given within 3 h.
Patterns of Cerebral Perfusion in Patients with Asymptomatic Internal Carotid Artery Disease
Authors: Chaves Claudia , Hreib Kinan , Allam Gregory , Liberman Rebecca F. , Lee Grace , Caplan Louis R.
Published: August 2006

Background: The perfusion profile of patients with asymptomatic internal carotid artery (ICA) disease has not been well studied. The purpose of this study is to describethe perfusion patterns of patients with asymptomatic ICA disease using computed tomography perfusion (CTP) and its potential value in identifying patients at higher risk for transient ischemic attacks (TIAs) or strokes. Methods: We analyzed 32 patients with asymptomatic high grade ICA disease who had CTP and computed tomography angiography (CTA) of the head and neck. Twenty-four patients had severe ICA stenosis and eight had ICA occlusion. The degree of ipsilateral external carotid artery (ECA) and contralateral ICA stenosis, patency of the anterior communicating artery (ACOM), A1 segment and posterior communicating artery (PCOM) were evaluated in all patients. Results: Sixteen patients had normal CTP and the other 16 patients had cerebral hypoperfusion, characterized by abnormalities in one or more of the three perfusion maps. Ipsilateral hypoplastic A1 segment was more frequent in the group with cerebral hypoperfusion (p = 0.025). Ipsilateral TIAs occurred in two patients, both with cerebral hypoperfusion. Conclusion: Cerebral hypoperfusion is present in half of the patients with asymptomatic ICA disease, predominantly in patients with a hypoplastic ipsilateral A1 segment. These patients likely represent a higher-risk group for symptomatic brain ischemia.
Body Mass Index and Risk of Stroke Mortality among a Random Sample of Japanese Adults: 19-Year Follow-Up of NIPPON DATA80
Authors: Oki Izumi , Nakamura Yosikazu , Okamura Tomonori , Okayama Akira , Hayakawa Takehito , Kita Yoshikuni , Ueshima Hirotsugu
Published: August 2006

Background: The relationship between body mass index (BMI) and stroke mortality remains unclear. The aim of the present study was to elucidate the relationship between BMI and stroke death in a representative cohort of Japanese men and women. Methods: We analyzed a database of 9,526 men and women aged 30 years and older who were randomly selected throughout Japan in 1980. These individuals had no history of stroke and were followed for 19 years. Hazard ratios (HR) and their 95% confidence intervals (CI) of deaths due to total stroke, cerebral infarction, and intracerebral hemorrhage were examined using Cox’s proportional hazards regression models of BMI levels. Results: A U-shaped association between BMI and cerebral infarction mortality was observed. Participants with the highest BMI category (BMI ≧ 30.0) showed a significantly highest HR for cerebral infarction (HR 2.46, 95% CI 1.01–5.99). The excess risk at the lower extreme of the BMI was confined to men. These associations did not change after excluding deaths occurring in the first 2 years of follow-up. Conclusions: In the Japanese general population, a U-shaped association between BMI and cerebral infarction mortality was found and the excess risk at the lower extreme of the BMI was confined to men.
Molecular Mediators of αvβ3-Induced Endothelial Cell Survival
Authors: Rice Julie , Courter Donald L. , Giachelli Cecilia M. , Scatena Marta
Published: August 2006

The αvβ3 integrin interaction with the extracellular matrix (ECM) plays an essential role in inhibiting apoptosis in endothelial cells. We have recently shown that αvβ3 ligation on rat aortic endothelial cells (RAECs) specifically activates the transcription factor nuclear factor ĸB (NF-ĸB) and promotes cell survival. Inhibiting NF-ĸB nuclear translocation abolished the protective effect of αvβ3 ligands. Here, we report that ligation of αvβ3 by its ligand, osteopontin (OPN), induces the phosphorylation and activation of inhibitory kappa B kinase beta (IKKβ) and promotes the specific degradation of inhibitory kappa Bα (IĸBα) in RAECs. Overexpression of a dominant negative (DN) IKKβ protein prevents IĸBα phosphorylation, NF-ĸB activation, and inhibits the protective effects of OPN. The NF-ĸB-inducing kinase (NIK) has been shown to be one of the upstream kinases involved in IKK activation. OPN-mediated NF-ĸB activity is increased upon NIK wild-type (WT) overexpression and blocked following NIK DN overexpression. In addition, NIK –/– mouse embryonic fibroblasts (MEFs) plated on OPN display reduced NF-ĸB activity and decreased IĸBα phosphorylation compared to NIK +/+ MEFs. Finally, functional inhibition of integrin β3-dependent NF-ĸB signaling decreases OPN-induced IĸBα, IKKβ and NIK phosphorylation. These studies for the first time show that the αvβ3-NF-ĸB-dependent endothelial survival pathway is dependent on IĸBα, IKKβ, and NIK.
Young Age Is Associated with Favorable Characteristics but Is Not an Independent Prognostic Factor in Patients with Epithelial Ovarian Cancer: A Single Institution Experience
Authors: Bozas George , Dimopoulos Meletios A. , Kastritis Efstathios , Efstathiou Eleni , Koutsoukou Vassiliki , Rodolakis Alexandros , Vlahos George , Voulgaris Zannis , Papageorgiou Theoharis , Gika Dimitra , Papadimitriou Christos , Bamias Aristotle
Published: August 2006

Background: Young age has been reported to be a favorable prognostic factor in ovarian cancer. The aim of the present study was to investigate the characteristics of ovarian cancer presenting in patients aged ≤40 and assess the prognostic significance of young age. Methods: Data from 591 consecutive ovarian cancer patients, including 37 subjects (6.3%) aged ≤40, who were treated postoperatively with platinum-based chemotherapy in our institution were retrospectively reviewed. Results: In our series, age ≤40 did not show an independent association with overall (p = 0.542) or progression-free survival (p = 0.334). Nonetheless, it was correlated with low tumor grade (p = 0.009) and small volume of residual disease after primary surgery (p = 0.020), while there was a nonsignificant trend for correlation with performance status 0 (p = 0.052). Stratified analysis showed that age ≤40 was associated with improved overall survival in the subgroups of serous histology and stage IIC–IV disease; however, multivariate analyses failed to identify age as an independent predictor of survival within either subgroup (p = 0.079 and p = 0.585, respectively). Conclusions: Age ≤40 was not an independent prognostic factor in our analysis. The survival advantage of young patients may be attributed to the association with low tumor grade, more complete surgical debulking and better performance status.
Frequency of Febrile Neutropenia in Breast Cancer Patients Receiving Epirubicin and Docetaxel/Paclitaxel with Colony-Stimulating Growth Factors: A Comparison of Filgrastim or Lenograstim with Pegfilgrastim
Authors: Schippinger Walter , Holub Robert , Dandachi Nadia , Bauernhofer Thomas , Samonigg Hellmut
Published: August 2006

Objective: Recombinant granulocyte colony-stimulating factors (G-CSF) have been shown to be effective in reducing the risk of infections associated with antitumour chemotherapy. This report describes a single-centre experience of the efficacy of pegfilgrastim compared with filgrastim or lenograstim in reducing the incidence of febrile neutropenia in patients receiving combination chemotherapy with taxane and epirubicin in a neoadjuvant and adjuvant setting. Methods: A total of 118 patients with breast cancer were treated with either epirubicin 75 mg/m2 and docetaxel 75 mg/m2 or epirubicin 90 mg/m2 and paclitaxel 200 mg/m2 every 3 weeks; 88 received G-CSF support with daily filgrastim or lenograstim and 30 with pegfilgrastim once per cycle. Results: Eight patients (9.1%) with prophylactic filgrastim or lenograstim support developed febrile neutropenia, as well as 1 patient (3.3%) in the pegfilgrastim group (p = 0.445). Febrile neutropenia occurred in 13 (2.7%) of 476 filgrastim or lenograstim supported chemotherapy cycles and in 2 (1.2%) of 172 cycles with pegfilgrastim support (p = 0.376). The frequency of chemotherapy delays and dose reductions was not significantly different between the two G-CSF treatment groups. Conclusion: These data show a trend towards superiority of pegfilgrastim over filgrastim or lenograstim in reducing the frequency of febrile neutropenia in patients treated with taxane and epirubicin chemotherapy regimens for breast cancer.