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PubMed2001

Osteoporosis: A possible aetiological factor in the development of Scheuermann's disease.

The aim of this study was to test the hypothesis that spinal osteoporosis is an aetiological factor in the development of Scheuermann's disease in adolescents. Clinical and radiological data was collected on 12 individuals with Scheuermann's disease (SD). Lumbar spine bone mineral density (L2-4) was measured using dual energy X-ray absorptiometry. Age and sex-matched adolescents were used as controls. The number of standard deviations from the mean of age and sex-matched controls were calculated. In regards to results, SD patients demonstrated high bone densities of between 1 and 1.5 standard deviations above the mean of age-matched controls. These results suggest that osteoporosis is not an aetiological factor in Scheuermann's disease and that bone density measurements may indeed be higher than aged-matched controls in the general population.

Journal Article↗
PubMed1991

Dual relationships in psychotherapy.

A dual relationship in psychotherapy occurs when the therapist engages in another, significantly different relationship with the patient. The two relationships may be concurrent or sequential. For both sexual and nonsexual dual relationships, men are typically the perpetrators and women are typically the victims. This article presents examples of dual relationships, notes the attention that licensing boards and other agencies devote to this topic, reviews the meager research concerning nonsexual dual relationships, and discusses common strategies that promote both sexual and nonsexual dual relationships.

Attitude↗
PubMed2004

Evaluation of proposals of Belgian Social Security Institute for reimbursement of bone densitometry tests. Toward a cost-effective strategy for osteoporosis screening?

BACKGROUND AND AIMS: The Belgian Social Security Institute (hereafter INAMI) proposes a list of conditions to be considered as a prerequisite for reimbursement of Bone Mineral Density (BMD) measurements. The aim of this paper was to evaluate the diagnostic accuracy of the proposed criteria for identifying osteoporosis, and to gauge how useful they are for more rational application of densitometry tests. METHODS: 3748 Caucasian women aged at least 50 years old were recruited consecutively from an outpatient university center, from the database of which all relevant data corresponding to the INAMI list of clinical factors, as well as patients' age, weight and height, were collected. BMD measurements using dual X-ray absorptiometry were reported at the spine and hip regions. Diagnostic accuracy was evaluated through measures of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Additionally, from ROC analysis, benchmark values for age and body mass index were identified and then, used alone and in combination with the INAMI test, were applied to define various screening strategies. For each of them, associated costs per osteoporotic patient detected were estimated. Cost estimates refer only to the costs associated with the densitometric procedure from the perspective of the reimbursement health authorities. RESULTS: Applying INAMI criteria for detecting osteoporosis at any of the considered sites yielded sensitivity of 68.9%, specificity of 50.7%, PPV of 42.9% and NPV of 57.3%. Comparison of incremental costs per patient of the different strategies revealed that, with 67.1 Euros, the option of opening BMD coverage to women on the basis of the INAMI conditions would be more cost-effective than mass screening (90.1 Euros) or applying the age criterion alone (70.2 Euros). However, the BMI condition seems to act as a better indicator of risk than the INAMI criteria in those meeting the age condition (35.4 Euros). CONCLUSIONS: The accuracy of the INAMI proposal turns out to be quite unsatisfactory, and did not adequately cover the population at risk of osteoporosis. From a resource allocation perspective, the best strategy by far would be to recommend using concomitantly INAMI, age and BMI-selective criteria. Some adaptations could enhance the usefulness of the INAMI proposals as a selective approach for BMD referral and reimbursement.

Absorptiometry, Photon↗
PubMed2005

Distal variations of the neurovascular pedicle of the serratus anterior muscle as a flap.

The serratus anterior muscle has recently been suggested as a versatile and reliable flap for reconstruction of complex craniofacial and neck lesions, extremity and sacroiliac region injuries, as well as intrathoracic and extrathoracic reconstruction procedures. The muscle has been used as a microvascular flap or a pedicled transfer and has been transferred in combination with other muscles, bones, and skin. We performed 15 dissections of adult axilla regions that were examined under x3.5 loupe magnification to collect anatomic data regarding the neurovascular pedicle of the serratus anterior muscle. The serratus muscle and fascia were found to have a dual blood supply, with the upper part supplied by the lateral thoracic artery and the lower part by terminal branches of the thoracodorsal artery. The lateral thoracic artery was noted to supply the upper four slips but it extended into the lower serratus anterior muscle in two cases. Seven branching patterns were found in the lower serratus anterior muscle. In type I, the only branch of serrati proceeded over the long thoracic nerve. Type II had the only branch of serrati proceeding under the long thoracic nerve. In type III, double branches of serrati proceeded over the long thoracic nerve; while in type IV branches of serrati ran with a double branch under the long thoracic nerve. In type V, three serrati branches proceeded over the long thoracic nerve. Type VI serrati branches were branches of thoracodorsalis, which was hypoplastic, and the supply was maintained from the lateral thoracic artery. In type VII, one serrati branch ran over the long thoracic nerve. There was no connection between the branches of serrati and the branches of the lateral thoracic artery. The length of the long thoracic nerve, the number of motor axons and the vascular network in anatomic proximity to this nerve make it an expendable but powerful source of reconstructions of head, neck, chest wall and extremity defects. Results of this study provide an anatomic framework to improve current reconstructive or aesthetic procedures on the serratus anterior neurovascular structures.

Adult↗
PubMed2002

Neuropsychological and psychosocial correlates of adult arithmetic deficiency.

The purpose of this study was to examine adult correlates of rule-derived arithmetic deficiency. The authors collected neuropsychological, handedness, gender, and psychosocial data of adults with stringently defined arithmetic deficiency (AD; N = 45), reading deficiency (N = 45), and dual deficiency (N = 45). The authors did not match groups on IQ score and did not restrict analyses to right-handed men. The results indicated that AD in adults is associated with nonverbal reasoning and constructional problems. Otherwise, there was no association between AD and dysphoric complaints as defined by Minnesota Multiphasic Personality Inventory elevations. The authors also found overall intelligence was lower in adults with AD, and gender distribution differed markedly from the reading and dual deficient groups. Potential gender bias in remediation referral patterns was identified.

Adult↗
PubMed1996

Biomechanical analysis of thoracolumbar interbody constructs. How important is the endplate?

STUDY DESIGN: A biomechanical study of human cadaveric thoracic vertebral bodies was conducted using several anterior fusion options subjected to axial loads. This study emphasized the contribution of the endplate to resistance of graft subsidence. OBJECTIVES: To determine the importance of the vertebral endplate in resisting subsidence of various constructs into the vertebral body; the relative efficacy of potential alternative graft constructs such as iliac crest, ribs, humerus, and titanium mesh cage; and the importance of bone mineral content, vertebral level, and cross-sectional graft area on construct subsidence. SUMMARY OF BACKGROUND DATA: As the fixation length of anterior and posterior spinal constructs is reduced, load sharing of the anterior column has become more important to reduce failure of the shorter devices. Several alternative graft constructs and surgical techniques have been used for reconstruction of the anterior column. There exist little comparative data as to whether any of these constructs are superior and whether the vertebral endplate contributes significantly to the integrity of the construct. METHODS: Sixty-three isolated human cadaveric vertebral bodies from T3 to T12 were used to test seven different constructs in direct axial load onto prepared endplates with an electrohydraulic testing device. These constructs were: 1) titanium mesh cage (17 x 22 mm) on intact endplate, 2) C-shaped humerus on intact endplate, 3) tricorticated iliac graft in "tee configuration" on intact endplate, 4) tricorticated iliac graft in cancellous trough, 5) triple rib strut graft, 6) single rib on endplate, and 7) single rib on cancellous body. Dual X-ray absorptiometry assessment of bone mineral content was performed. A uniaxial load was applied with force and displacement data collected to determine maximal load to "failure" of the vertebral body. RESULTS: Preservation of vertebral endplate did not significantly increase the resistance to graft subsidence. The titanium cage construct provided the greatest resistance to axial load. CONCLUSIONS: Preservation of the vertebral endplate may not offer a significant biomechanical advantage in reconstructing the anterior column. Several alternative constructs are mechanically equivalent.

Adult↗
PubMed2004

The differential effects of Sternberg short- and long-term memory scanning on the late Nd and P300 in a dual-task paradigm.

We previously reported that the late negative difference (Nd) waveform elicited during dichotic listening was reduced in amplitude by a concurrent simulated flying task having a wide variety of cognitive demands (Psychophysiology, 39, 2002, 236). The main purpose of the present study was to determine how tasks involving the specific demands of short-term memory (STM) or long-term memory (LTM) would influence the early and late Nd waveforms. To this end, 16 participants performed dichotic listening alone and in conjunction with the varied-set (STM) and fixed-set (LTM) versions of Sternberg's memory scanning paradigm. Event-related brain potential (ERP) data was collected concurrently from both the auditory and visual tasks. The results showed that the STM task, but not the LTM task, reduced the amplitude of the auditory late Nd. The auditory early Nd component was unaffected by either task. Furthermore, both the auditory and visual P300s were decreased in amplitude by all the dual-task conditions. These data suggest that the auditory late Nd is linked to more specific working memory processes than is P300.

Acoustic Stimulation↗
PubMed2000

Osteoporosis and implant failure: an exploratory case-control study.

BACKGROUND: Osteoporosis has been suggested as a risk factor for implant failure, but data supporting such a link are limited. METHODS: A case-control study was designed to evaluate the association between osteoporosis and dental implant failure. Cases (n = 49) and controls (n = 49) were selected from a private practice. The following measures were collected for each patient: 1) peripheral dual-energy x-ray absorptiometry (pDEXA) bone measurements at the distal and proximal radius and ulna; 2) classification of bone quality and quantity at the time of implant placement; and 3) questionnaire data regarding potentially confounding variables. Generalized estimating equations were used to relate the likelihood of having at least one implant failure in an individual to osteoporosis measures. RESULTS: The results suggested that there was no association between pDEXA scores at the radius and ulna and the risk for implant failure. For every 1-unit increase in bone density as measured by pDEXA t-score at proximal and distal radius and ulna, the risk for a patient to lose at least one implant changed by +14% and -6%, respectively (odds ratio, 1.14; 95% confidence interval, 0.80-1.62 and odds ratio, 0.94; 95% confidence interval, 0.71-1.23). The simple visual assessment of local bone quality had a moderately sized relationship to implant failure. Implants placed in sites with thin cortical bone increased the chance for a patient to lose at least one implant by 130% when compared to implants placed in a thick cortical layer or compact bone (odds ratio, 2.3; 95% confidence interval, 1.0-5.4). CONCLUSIONS: This exploratory study suggests that a simple visual assessment of bone quality at the site of implant placement may be more informative regarding implant failure than pDEXA bone density measures obtained at peripheral bones. In order to determine whether peripheral osteoporosis measurements have a small or moderate association with implant loss, studies with larger sample sizes will be required.

Absorptiometry, Photon↗
PubMed2002

Accuracy of blood pressure measurement and anthropometry among volunteer observers in a large community survey.

The Busselton Survey is a population survey that is held about every three years. In 1994-1995 a re-survey was held of all past participants and 8,502 attended. Financial constraints precluded employing staff for data collection for blood pressure and anthropometry, these therefore were collected by unpaid lay volunteers. Quality control by a health professional was critical to the assessment and maintenance of accuracy in these measurements. For blood pressure three readings were taken simultaneously by a quality control person and the volunteer using a dual stethoscope. Duplicate anthropometric measurements were taken by a criterion anthropometrist and the volunteer. Inter and intra-observer technical errors of measurement (TEM) were calculated. Sixty-two volunteers were trained to take BP measurements; of these, 38 collected data, and 63 were trained in anthropometry; of these, 30 were suitable as measurers. Training was conducted on a group and individual basis by the quality assurance person for the study both in the Perth metropolitan area and rural Busselton. The TEM for SBP was 1.6 mm Hg (SD 1.0 mm Hg) and 1.5 mm Hg (SD 0.8) for DBP. For skin-folds intra-observer TEM ranged from 0.6 mm to 1.0 mm. Between-observer TEM ranged from 2.1 mm to 5.4 mm. For limb and waist circumferences, intra-observer TEM ranged from 0.3 cm to 1.6 cm. Between-observer TEM for circumferences ranged from 0.5 cm to 1.9 cm. Unpaid volunteer measurers can, if carefully trained and supervised, provide acceptable blood pressure data and anthropometry in large population surveys.

Anthropometry↗
PubMed1992

Age-related decrements in bone mineral density in women over 65.

Age-related changes in bone density contribute to the risk of fractures. To describe the relationship between age and bone mass in elderly women, we studied a large cohort of women over age 65 years who were recruited from population-based lists in four cities in the United States. Bone density in g/cm2 was measured by single-photon absorptiometry (SPA) and dual x-ray absorptiometry (DXA) at the distal and proximal radius, the calcaneus, the lumbar spine, and the proximal femur. Centralized data collection was used to control data quality and consistency. We found a strong inverse relationship between bone density and age for most sites. Decrements in bone density between women aged 65-69 years and women 85 years and older exceeded 16% in all regions except the spine, where the difference between the two age groups was 6%. Ward's triangle and the calcaneus exhibited the largest decrements, with 26 and 21%, respectively. The estimates of annual changes in bone mineral density by linear regression at sites other than the spine ranged from -0.82% at the femoral neck and trochanter to -1.30% at Ward's triangle. Correlations between the different regions ranged from r = 0.51 between the proximal radius and Ward's triangle to r = 0.66 between the distal radius and calcaneus. We conclude that the inverse relationship between age and bone mass measured by absorptiometry techniques in white women continues into the ninth decade of life. The relationship is strongest for bone density of Ward's triangle and the calcaneus and weakest for the spine.

Absorptiometry, Photon↗
PubMedDate not supplied

Computational systems analysis of developmental toxicity: design, development and implementation of a Birth Defects Systems Manager (BDSM).

Birth defects and developmental disabilities remain an important public health issue worldwide. With the availability of genomic sequences from a growing number of human and model organisms and the rapid expansion of the public repositories holding large-scale gene expression datasets, a computational systems analysis of developmental toxicology can incorporate this vast digital information toward the realization of predictive models for complex disease. Here we describe the initial design, development and implementation of a Birth Defects Systems Manager (BDSM). The project was motivated by the need for a computational-bioinformatics infrastructure to manage vast digital information from functional genomics and for a new knowledge environment specifically engineered for the analysis of developmental processes and toxicities. Proof-of-concept tested BDSM using meta-analysis of gene expression data collected from different laboratories, technology platforms, and study models. The composite dataset incorporated 232 microarray comparisons of RNA samples by single or dual microarray platforms, cDNA or oligonucleotide based probes, and human or mouse sequence information. Preliminary results identified system-level features in the embryonic transcriptome as it reacted to various developmental-teratological stimuli. BDSM is open access through the worldwide web (http://systemsanalysis.louisville.edu/) and can be integrated with other bioinformatics tools and resources to advance the pace of discovery in birth defects research.

Animals↗
PubMed2002

Mechanisms linking angiotensin II and atherogenesis.

PURPOSE OF REVIEW: The concept that angiotensin II plays a central role in early atherogenesis, progression to atherosclerotic plaque, and the most serious clinical sequelae of coronary artery disease is the subject of considerable current interest. Results from recent large clinical trials confirm that blunting of the renin-angiotensin system through either angiotensin converting enzyme inhibition or angiotensin II type 1 receptor blockade incurs significant beneficial outcomes in patients with coronary artery disease. The exact mechanisms for these effects are not yet clear, but are suggested by studies demonstrating that suppression of the renin-angiotensin system is associated with muted vascular oxidative stress. RECENT FINDINGS: As most of the biological effects of the renin-angiotensin system occur through stimulation of the angiotensin II type 1 receptor, the focus of this review is on changes in the vascular wall mediated by this receptor and primarily related to endothelial and vascular smooth muscle cells, monocyte/macrophages and platelets. The interactions between angiotensin II and nitric oxide exert particular demands on the vascular capacity to adapt to dyslipidemia, hypertension, estrogen deficiency and diabetes mellitus that appear to exacerbate atherogenesis. Associated with each of these conditions is angiotensin II-mediated stimulation of macrophages, platelet aggregation, plasminogen activator inhibitor 1, endothelial dysfunction, vascular smooth muscle cell proliferation and migration, apoptosis, leukocyte recruitment, fibrogenesis and thrombosis. SUMMARY: Inhibition of the actions of angiotensin II serves a dual purpose: indirectly through reduction of mechanical stress on the vascular wall, and directly by diminished stimulation for vascular restructuring and remodeling. Collectively, data from studies published over the last year confirm and extend the notion that angiotensin II is a true cytokine prevalent at all stages of atherogenesis.

Angiotensin II↗
PubMed2004

Impact of a disruption of a pathway delivering copper to mitochondria on Podospora anserina metabolism and life span.

A global depletion of cellular copper as the result of a deficiency in high-affinity copper uptake was previously shown to affect the phenotype and life span of the filamentous fungus Podospora anserina. We report here the construction of a strain in which the delivery of copper to complex IV of the mitochondrial respiratory chain is affected. This strain, PaCox17::ble, is a PaCox17-null mutant that does not synthesize the molecular chaperone targeting copper to cytochrome c oxidase subunit II. PaCox17::ble is characterized by a decreased growth rate, a reduction in aerial hyphae formation, reduced female fertility, and a dramatic increase in life span. The mutant respires via a cyanide-resistant alternative pathway, displays superoxide dismutase (SOD) activity profiles significantly differing from those of the wild-type strain and is characterized by a stabilization of the mitochondrial DNA. Collectively, the presented data define individual components of a molecular network effective in life span modulation and copper as an element with a dual effect. As a cofactor of complex IV of the respiratory chain, it is indirectly involved in the generation of reactive oxygen species (ROS) and thereby plays a life span-limiting role. In contrast, Cu/Zn SOD as a ROS-scavenging enzyme lowers molecular damage and thus positively affects life span. Such considerations explain the reported differences in life span of independent mutants and spread more light on the delicate tuning of the molecular network influencing biological ageing.

Amino Acid Sequence↗
PubMed2004

Household survey of dengue infection in central Brazil: spatial point pattern analysis and risk factors assessment.

Urban dengue fever is now considered a major public health threat in most American countries. A household survey was conducted in the city of Goiania in central Brazil in 2001 to assess prevalence of dengue infection and individual and area-based risk factors. Spatial point pattern analysis was performed using the dual Kernel method. A total of 1,610 households were surveyed; 1,585 individuals more than five years old had blood and data collected. Sera were tested for IgM/IgG antibodies by an enzyme-linked immunoassay. Area-based indicators derived from census data were linked to geocoded residential address. The seroprevalence of dengue was 29.5% and the estimate prevalence surface reached 50% in the outskirts areas. The risk of infection was significantly associated with older age (P < 0.01), low education (odds ratio [OR] = 3.45, 95% confidence interval [CI] = 1.82-6.55), and low income (OR = 1.32, 95% CI = 1.02-1.71) in multivariate analysis. This study highlighted the heterogeneity of dengue transmission within the city and can assist in spatial targeting control interventions.

Adolescent↗
PubMed2002

Endoscopic hemostasis of a bleeding marginal ulcer: hemoclipping or dual therapy with epinephrine injection and heater probe thermocoagulation.

BACKGROUND AND AIMS: Endoscopic hemoclipping and dual therapy with epinephrine injection and heater probe thermocoagulation have been proven effective in the hemostasis of bleeding peptic ulcers. However, the hemostatic efficacy has not been investigated in bleeding marginal ulcers. The aim of this study is to investigate the hemostatic efficacy of endoscopic hemoclipping and dual therapy with epinephrine injection and heater probe thermocoagulation in bleeding marginal ulcers. METHODS: From November 1997 to July 2000, 50 patients with active marginal ulcer bleeding underwent either hemoclipping (20 patients) or dual therapy (30 patients) for hemostasis. The demographic data, clinicopathological characteristics, endoscopic findings, initial hemostatic rates, rebleeding rates, amount of blood transfusion, the need of surgery, and mortality rates were collected and analyzed. RESULTS: Marginal ulcers were located at the anastomotic site (64%), saddle portion (22%), efferent loop (10%), or at the afferent loop (4%). The bleeding stigmata were classified into spurting artery (32%), oozing vessel (38%), visible vessel (20%), and blood clot adhesion (10%). The overall therapeutic results in 50 patients were initial hemostasis (100%), rebleeding rate (22%), need for surgery (4%), and hospital mortality rate (4%). There was no significant difference in demographic data and clinicopathological characteristics between the two modes of treatments, whereas recurrent bleeding developed in 5% in the hemoclipping group and 33% in the dual therapy group. No complication related to the procedure occurred in either mode of therapy. The hospital mortality rates were 0 and 6.7%, respectively. CONCLUSION: Endoscopy is effective in achieving initial hemostasis from bleeding marginal ulcers. However, the rebleeding rate remains high and repeated endoscopy may be needed to arrest the hemorrhage.

Adrenergic Agonists↗
PubMed1998

Effect of dual and triple energy window scatter correction methods on image quality in liver scintigraphy.

AIM: To investigate the effect of two scatter correction methods on lesion detectability for both planar and tomographic hepatic imaging. METHODS: All planar and tomographic acquisitions involved simultaneous collection of photons in the main photopeak window (126-154 keV) and three additional windows (92-116, 116-126 and 154-164 keV). Uncorrected and corrected for scatter images were obtained from the same acquisition data. The dual energy window (DEW) and the triple energy window (TEW) scatter compensation methods were used to obtain two sets of corrected images. The DEW method was implemented with main photopeak window 126-154 keV, Compton scatter window 92-126 keV and scatter multiplier k = 0.5. A modified TEW method was also applied with main photopeak window 126-154 keV and scatter subwindows 116-126 keV and 154-164 keV. Phantoms were used to study the effect of scatter correction on contrast and signal-to-noise ratio. The observer's ability to identify lesions was studied on uncorrected and corrected for scatter patient images. RESULTS: In planar imaging, both scatter compensation methods yielded contrast enhancement. However signal to noise ratio (SNR) was degraded to 0.63 and 0.67 when DEW and TEW were applied respectively. In SPECT images, contrast was increased by a factor of 2.4 and 1.7, while SNR was degraded to 0.60 and 0.64 when DEW and TEW methods were used respectively. CONCLUSIONS: Scatter correction using DEW and TEW methods may improve observer's ability to distinguish lesions in planar (p < 0.05 for both methods) and SPECT (p < 0.05 for both methods) liver studies.

Adult↗
PubMed1989

Transplacental transfer and biotransformation studies of valproic acid and its glucuronide(s) in the perfused human placenta.

Transplacental transfer and biotransformation of valproic acid (VPA) and its acyl glucuronide conjugate (VPA-G) were investigated in the isolated perfused term human placenta. In peripheral lobules perfused under dual (maternal and fetal) recirculation for 6 hr, VPA was readily transferred, reaching equilibrium (stable maternal and fetal VPA concentrations with no transplacental gradient of unbound VPA) within 1.5 hr. Metabolism of VPA was not detected. VPA-G was transferred more slowly. After 6 hr of dual recirculation, equilibrium had not been reached and VPA-G had undergone extensive hydrolysis to VPA (34%) and rearrangement via acyl migration to structural isomers (collectively VPA-GR, 9%). Hydrolysis of VPA-G occurred, at least in part, in the perfusates contaminated with placental blood and/or with enzymes leached from placental tissue. Reliable transfer data for VPA-G were obtained using the dual single pass perfusion method. Steady state was achieved within 15 min and VPA, VPA-G and VPA-GR were transferred from maternal to fetal perfusates at 95, 13 and 17%, respectively, of antipyrine clearance. Transfer was positively correlated with lipophilicity as measured by the logarithm of the octanol/water partition coefficient: 0.204, -1.85, -1.66 for VPA, VPA-G and VPA-GR, respectively.

Biotransformation↗