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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↗
PubMed2006

Differing mechanisms of cAMP- versus seawater-induced oocyte maturation in marine nemertean worms II. The roles of tyrosine kinases and phosphatases.

Instead of blocking oocyte maturation as it does in most animals, cAMP causes oocytes of marine nemertean worms to initiate maturation (=germinal vesicle breakdown, "GVBD"). To characterize cAMP-induced GVBD in nemerteans, inhibitors of tyrosine kinase signaling were tested on Cerebratulus sp. oocytes that had been incubated in cAMP-elevating drugs versus seawater (SW) alone. Such tests yielded similar results for Src-like tyrosine kinase blockers, as the inhibitors prevented mitogen-activated protein kinase (MAPK) activation without stopping either GVBD or maturation-promoting factor (MPF) activation in both SW and cAMP-elevating treatments. Alternatively, genistein, a general tyrosine kinase antagonist, and piceatannol, an inhibitor of the tyrosine kinase Syk, reduced GVBD and MAPK/MPF activities in SW-, but not cAMP-induced maturation. Similarly, inhibitors of the human epidermal growth factor receptor-2 (HER-2) tyrosine kinase prevented GVBD and MAPK/MPF activations in oocytes treated with SW, but not with cAMP-elevating drugs. Antagonists of either protein tyrosine phosphatases (PTPs) or the dual-specificity phosphatase Cdc25 also reduced GVBD and MAPK/MPF activities in SW-treated oocytes without generally affecting cAMP-induced maturation. Collectively, these data suggest cAMP triggers GVBD via pathways that do not require MAPK activation or several components of tyrosine kinase signaling. In addition, such differences in tyrosine kinase cascades, coupled with the dissimilar patterns of Ser/Thr kinase signaling described in the accompanying study, indicate that nemertean oocytes are capable of utilizing multiple mechanisms to activate MPF during GVBD.

Animals↗
PubMed2001

Hypercalciuria in ex-preterm children, aged 7-8 years.

In a previous study, 8 of 28 ex-preterm infants, aged 4-5 years, had increased urinary calcium excretion. The aim of this study was to confirm this finding and to determine if raised urinary calcium excretion is associated with reduced bone mineralisation. Forty-six ex-preterm children, aged 7-9 years, and 40 age- and sex-matched controls were recruited. The calcium excretion measured from 3 separate 24-h urine collections was recorded and a dietary assessment made from a diary record. Data were retrieved from the neonatal case notes and included aminoglycoside usage. Dual energy X-ray absorptiometry was used to measure bone mineral content and bone mineral density (BMD) in all children. The mean maximum 24-h urinary calcium was significantly higher in the preterm group than the term group (P=0.01). Increased calcium excretion was associated with raised neonatal aminoglycoside levels (P=0.0013). Height standard deviation score and hip BMD were significantly lower in the 21 preterm children with a 24-h urinary calcium above 4 mg/kg per day than term controls (P=0.04 and P=0.004, respectively). Urinary calcium excretion had a negative relationship with hip BMD in the preterm group (P=0.004). This difference in BMD was not observed in the 25 preterm children with normocalciuria. In the 10 preterm girls with hypercalciuria, hip BMD was lower than in control females (P=0.01). This difference in hip BMD between the 11 preterm boys with hypercalciuria and term boys was not significant (P=0.05). In conclusion, preterm children are shorter and have a lower hip BMD than those with normocalciuria. Further prospective studies are required to assess this risk and its influence on subsequent impaired bone mineralisation.

Anthropometry↗
PubMed1987

Reporting colorectal cancer.

Reporting colorectal cancer comprises two phases: the careful collection of pathological data; and the division of patients into groups with differing prognoses. Dukes' classification of rectal cancer was the outcome of this dual approach. It evolved over many years, and full details of its final form were not published until 1958, towards the end of his career. Others modified the classification during its evolution, and numerous rival pathological and clinicopathological systems now exist. The resulting confusion that surrounds the Dukes classification may make it impossible to compare pathological findings and the results of treatment between different centres. The importance of meticulous dissection and examination of surgical specimens is emphasised and a simple set of recommendations made. It is shown how modern statistical methods may identify pathological variables that have independent clinical importance. On the basis of this information a new system of prognostic categorisation for patients receiving apparently curative surgery for rectal cancer has been developed, which is superior to the Dukes classification in that it can place many more patients into groups with clear prognostic implications.

Colonic Neoplasms↗
PubMed2006

Single-chamber versus dual-chamber implantable cardioverter defibrillators: do we need physiologic pacing in the course?

BACKGROUND: Many patients with ICD receive different antiarrhythmic drugs (e.g. sotalol, amiodarone, beta-blockers) because of ventricular or atrial tachycardias. These drugs can cause AV-block or chronotropic incompetence resulting in a higher percentage of ventricular pacing. METHODS: We analyzed in a retrospective study the impact of DDD(R) versus VVI(R) mode on subjective (NYHA classification) and objective parameters [brain natriuretic peptide (BNP), 6 minute walk test, echocardiography] in 12 of 120 patients (age 60.2 +/- 11.2 years; 10 males, 2 females) who needed an upgrading of a single to a dual chamber ICD. The ICD had to be upgraded because of chronotropic incompetence in all patients with signs of progressing heart failure. Data were collected in VVI(R)-pacing and after 6 and 12 months in DDD(R)-pacing with a long AV-interval and AV hysteresis to reduce ventricular pacing. RESULTS: The 6 minute walk test (392.4 +/- 91.4 vs. 324.6 +/- 93.3 m, P < 0.001), NYHA-classification (1.4 +/- 0.3 vs. 2.6 +/- 0.8, P < 0.0001), BNP (234.1 +/- 73.5 vs. 410.4 +/- 297.0 pg/ml, P < 0.001), left ventricular ejection fraction (49.8 +/- 9.6 vs. 36.5 +/- 10.9 %, P < 0.0001) and A-wave (73.6 +/- 13.7 vs. 41.0 +/- 14.0 cm/sec, P < 0.0001) improved with DDD(R)-pacing after 12 months. The ventricular pacing decreased (84.2 +/- 18.1 vs. 1.1 +/- 1.7 %, P < 0.0001) after 12 months by DDD(R)-pacing with long AV-interval (220.0 +/- 10.4 ms) and AV hysteresis. CONCLUSION: Our data show a superiority of DDD(R) mode versus VVI(R) mode regarding subjective and objective parameters as NYHA-classification, BNP, 6 minute walk test, left ventricular ejection fraction and left ventricular endsystolic volume after 12 months. The improvements seem to depend on the reduction of ventricular pacing with advanced atrial contraction. But only a small number of patients needed the upgradation.

Journal Article↗
PubMed2000

Antipsychotic medication for those with both schizophrenia and learning disability.

BACKGROUND: Antipsychotic medication is the standard treatment for people with learning disability and schizophrenia. OBJECTIVES: To determine the efficacy of any antipsychotic medication for treating people with a dual diagnosis of learning disability and schizophrenia. SEARCH STRATEGY: Electronic searching of Biological Abstracts, the Cochrane Schizophrenia Group's Register of trials, the Cochrane Library, EMBASE, PsycLIT and MEDLINE. Unpublished data were sought from pharmaceutical companies. Both authors independently selected the relevant studies from the reports identified in this way. SELECTION CRITERIA: 1. All randomised controlled trials of antipsychotic medication, regardless of dosage, versus a placebo control, of longer than one month's duration. 2. Anyone over 18 years of age with both learning disability and schizophrenia. Learning disability was defined as a measured IQ of 70 or less. Any mode of diagnosis of schizophrenia was acceptable. DATA COLLECTION AND ANALYSIS: The two reviewers independently attempted to select and then extract data but it was not possible to do this with the single study that met the inclusion criteria. MAIN RESULTS: Only one relevant randomised trial was found by the searches. This study included four people with a dual diagnosis of schizophrenia and learning disability, but results were available for only two. The groups to which the other two people were allocated were unclear. In order to display the data, too many assumptions would have to have been made about these other two people and any results would be uninformative and potentially misleading. REVIEWER'S CONCLUSIONS: Using the methods described the reviewers found no randomised controlled trial evidence to guide the use of antipsychotic medication for those with both learning disability and schizophrenia. Until the urgent need for randomised controlled trials is met clinical practice will continue to be guided by extrapolation of evidence from randomised controlled trials involving people with schizophrenia but without learning disability and non-randomised trials of those with learning disability and schizophrenia.

Antipsychotic Agents↗
PubMed2004

Osteopenia in children who have undergone posterior fossa or craniospinal irradiation for brain tumors.

OBJECTIVES: To determine lumbar spine and total body bone mineral density (BMD) in pediatric patients who have undergone cranial or craniospinal irradiation for posterior fossa tumors, specifically medulloblastoma and ependymoma and to analyze the association between degree of osteopenia and factors that may affect BMD. METHODS: Retrospective and prospective data collection included medical record review and examination, including pubertal, dietary, and activity assessment. Lumbar spine and total body BMD were measured by means of dual energy x-ray absorptiometry. Patients were routinely observed by the endocrinology department, and hormone deficiencies were corrected promptly. A subset of patients received calcium and vitamin D supplementation and underwent repeat BMD measurement 1 year later. RESULTS: Of 24 patients aged 4 to 20 years, 11 of whom were male, recruited from 1996 through 1999, 19 had medulloblastoma. All 19 underwent craniospinal radiotherapy plus a boost to the posterior fossa (mean +/- SD of 5410 +/- 130 rad [54.1 +/- 1.3 Gy] to the posterior fossa, mean +/- SD of 3470 +/- 460 rad [34.7 +/- 4.6 Gy] to the whole brain and spinal axis), and 8 of 19 underwent chemotherapy. The remaining 5 patients had ependymoma and underwent irradiation to the posterior fossa only (mean +/- SD of 5680 +/- 720 rad [56.8 +/- 7.2 Gy]). Therefore, there were 3 treatment groups: craniospinal irradiation and chemotherapy, only craniospinal irradiation, and only posterior fossa irradiation. Bone mineral studies were performed a mean +/- SD of 5.42 +/- 3.23 years after therapy. Our patients had lower total body BMD (mean z score, -0.47; 95% confidence interval, -0.85 to -0.09) and lumbar spine BMD (mean z score, -1.27; 95% confidence interval, -1.81 to -0.73) as compared with those of the the general population. There was no significant difference in mean lumbar spine BMD between patients in the 3 groups. Our patients consumed a diet deficient in vitamin D and calcium (mean +/- SD 53.6% +/- 24.1% and 70.0% +/- 37.4% of the amount recommended, respectively). Of 7 patients who underwent measurements 1 year later, 5 had in increase in BMD that was parallel to normal curves, with no compensatory increase. Four patients were hypothyroid, 6 were growth hormone deficient, and 6 were both. All hormones were replaced, with the exception of growth hormone in 1 patient. By using regression analysis, the factors that affected lumbar spine BMD, protectively in both cases, were calcium intake (beta = 0.015, 95% confidence interval, 0.001-0.029) and female sex (beta = 1.422, 95% confidence interval, 0.456-2.388). CONCLUSIONS: Children who have undergone irradiation for posterior fossa tumors have diminished total body and lumbar spine BMD, as compared with those of the general population. This reduction was similar within all 3 treatment groups, which suggests that chemotherapy did not play a major role and that localized irradiation may have systemic effects. This population often has balance and gait problems, so the risk of falling, coupled with osteopenia, may place them at considerably increased risk of fractures.

Adolescent↗
PubMed2004

Bone mineral density in old age: the influence of age at menarche and menopause.

Being aware that age at menarche, age at menopause, and length of fertile period influence bone mineral density (BMD) in the early postmenopausal period, we have failed to find any earlier studies where such an influence on the axial skeleton has been studied in old age when the incidence of hip fracture starts to increase. A large cohort of women, all 75 years old (n = 1044) participated in the Malmö Osteoporosis Prospective Risk Assessment (OPRA) Study. The BMD of the lumbar spine and femoral neck was assessed by a dual-energy X-ray absorptiometry (DXA) technique. Age at menarche and at menopause was recalled with a questionnaire. Also, data on estrogen medication was collected. We found that, after excluding ever-users of potent estrogens (n = 49), there was a small but significant correlation of early menarcheal age with high BMD of the lumbar spine (r = -0.08; P = 0.017) and femoral neck (r = -0.10; P = 0.002) at age 75. Excluding the extremes (5% of the women) with very early or very late menarche, age at menarche no longer influenced the BMD in old age (r = -0.06; P = 0.113). Age at menopause had no influence on the BMD of the lumbar spine (r = 0.04; P = 0.246) or femoral neck (r = 0.00; P = 0.985), at age 75. The length of the fertile period did not influence BMD in old age. The influence of menarcheal or menopausal age on BMD at age 75 was not substantially altered after including body mass index (BMI) in a multiple regression model. Age at menarche or menopause seems to be of limited or no importance as a risk factor for osteoporosis when subjects are age 75 or older.

Aged↗
PubMed1999

Clinical validity and stability of active and passive cervical range of motion with regard to total and unilateral uniplanar motion.

STUDY DESIGN: A study of inter- and intra-examiner reliability and clinical validity using two instruments for assessment of spinal range of motion in healthy individuals. OBJECTIVE: To assess the clinical validity, stability, and normative values for active and passive cervical range of motion as measured by the CA-6000 (Orthopedic Systems Inc., Union City, CA), an electrogoniometer. SUMMARY OF BACKGROUND DATA: The authors' early trials with the electrogoniometer yielded values that differed substantially from those in other reports. The authors sought to resolve those discrepancies and understand their sources. METHODS: Axial rotations along the transverse, coronal, and frontal planes were measured as half-cycles (i.e., left-right or flexion-extension) that were repeated seven times per trial. Test-retest data were collected on the same healthy individuals for active and passive motion using men and women aged 20-39 years. For validity, simultaneous digital dual inclinometry and electrogoniometry were performed twice over a 1-week interval. In addition, a bench test was performed for validation of axial rotation. RESULTS: Clinical reliability of the CA-6000 was high for inter- and intra-examiner studies of total active motion, and validity was high when compared with that obtained with dual inclinometry. Total range of motion had less between-trial variability than half-cycles, axial rotation and lateral bending measurements had greater reliability than did flexion-extension measurements, and active motion was more reliable than passive motion. CONCLUSION: The CA-6000 provides valid and reliable measures of cervical range of motion. Discrepancies reported elsewhere appear to have arisen from several sources, as discussed in this article.

Adult↗
PubMed1998

Effect of erythromycin lactobionate on myoelectric activity of ileum, cecum, and right ventral colon, and cecal emptying of radiolabeled markers in clinically normal ponies.

OBJECTIVE: To determine the effect of erythromycin lactobionate (ERY) on ileocecocolic myoelectric activity and passage of radiolabeled markers from the cecum. ANIMALS: 6 healthy adult ponies. PROCEDURE: After a 12-hour nonfeeding period, 370 MBq of technetium 99m-labeled sulfur colloid in egg albumen and 37 MBq of indium 111-labeled diethyltriaminepentaacetic acid in 60 ml of water were administered directly into the cecal apex. The following drug concentrations were tested: ERY, 0.01, 0.10, 1.0, and 10.0 mg/kg of body weight; ERY, 0.10 mg/kg bolus; and saline (0.9% NaCl) solution, 10 ml. All treatments, with the exception of the 0.10-mg/kg bolus and saline solution, were infusions administered i.v. during a 60-minute period in a randomized complete block design. Each treatment was administered 2 times/pony. Dual-phase scintigraphic images were obtained, and the best-fit function was determined for each study, using data from the right side. Myoelectric data were collected before and after each treatment and analyzed for spike burst rate, relative activity, and burst duration. RESULTS: The time to 50% emptying (t50) after ERY administration was dose dependent, and all treatments, with the exception of the 0.01-mg/kg infusion, resulted in a significantly shorter t50 than that observed after saline administration (230.2 +/- 17.12 minutes). The shortest t50 was observed after the 1.0 mg/kg dosage of ERY (76.9 +/- 22.0 minutes). Although not significantly different, the t50 and beta were shorter (108.6 +/- 25.9 minutes) and steeper after a bolus dose of 0.10 mg/kg of ERY than after infusion at the same dosage (131.1 +/- 18.7 minutes). CONCLUSIONS AND CLINICAL RELEVANCE: ERY may be a useful prokinetic for prevention or treatment of cecal motility dysfunction. The ability of ERY to evoke a similar response during the early postanesthetic or postoperative period remains to be determined.

Animals↗
PubMed1995

A new anatomic index based on current knowledge for calculating the cumulative percentage of pagetic bone per subject and other parameters.

New data provided by dual-energy X-ray absorptiometry, together with discordances between Howarth's and Coutris' tables for estimating the percentage of bone tissue affected with Paget's disease in a given individual, prompted us to reevaluate the percentage of bone tissue contained in each segment of the skeleton. We weighed each bone in the skeleton of a 30-year-old male, calculated weight ratios from a collection of 48 bones, performed dual-energy X-ray absorptiometry measurements in 22 patients using a Hologic QDR 2000 apparatus, and obtained information from a company that supplies medical schools with human skeletons. We used these data to develop a new anatomic index. The percentage of bone tissue in the skull was 17 in males and 21 in females versus only 11 in Howarth's table; differences were also found at other sites, including the spine (8.5% versus 11%), the femur (9.5% versus 8%), the sacrum (2% versus 3%), and the ribs (5% versus 9%). Our index is useful for calculating the percentage of pagetized bone (i.e., bone in which pagetic lesions develop during follow-up) but underestimates the total percentage of pagetic bone because of the increase in bone mass associated with Paget's disease.

Absorptiometry, Photon↗
PubMed1990

Feed intake, weaning weight and net returns comparisons for four breeding systems.

Feed intake, weaning weight and direct and maternal contributions to weaning weight were estimated for four breeding systems using data collected between 1979 and 1986 from 773 cow-calf pairs at the Elora Beef Research Centre. Breeding systems included purebred Hereford (HE), small rotational dual purpose (SR) (a four-way rotational crossing system utilizing Tarentaise, Angus, Gelbvieh and Pinzgauer breeds), large rotational beef (LR) (composed of Maine-Anjou, Simmental and Charolais) and Angus-sired large rotational beef (AL) utilizing Angus as the sire breed and LR as the maternal breed. Large rotational dams had the highest feed intakes for both dry (8.9 kg DM/d) and lactation (11.5 kg DM/d) periods. Conversely, HE calves consumed the greatest amounts of creep feed (309 kg DM), followed by AL, SR and LR. The large rotational system had the highest weaning weights (265 kg) and direct (12.3 kg greater than average of observations) and maternal (9.6 kg greater than average of observations) contributions to weaning weight, followed by AL, SR and HE for all three traits. An equation was derived for net returns that included parameters for feed intake and direct and maternal weaning weight. A linear programming model was designed to incorporate this equation as the objective function and determine the breeding system(s) that maximized net returns under various production conditions. In general, LR produced the greatest net returns, followed by SR and either AL or HE, depending on specific resource constraints (limited feed supply or herd size) included in the model.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2000

Eradication of helicobacter pylori for non-ulcer dyspepsia.

BACKGROUND: Helicobacter pylori (H pylori) is the main cause of peptic ulcer disease. The role of H pylori in non-ulcer dyspepsia is less clear. OBJECTIVES: To determine the effect of H pylori eradication on dyspepsia symptoms and quality of life scores in patients with non-ulcer dyspepsia. SEARCH STRATEGY: Trials were identified through electronic searches of the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, CINAHL and SIGLE, using appropriate subject headings and keywords, searching bibliographies of retrieved articles, and through contacts with experts in the fields of dyspepsia and with pharmaceutical companies. SELECTION CRITERIA: All parallel group randomised controlled trials (RCTs) comparing drugs to eradicate H pylori with placebo or other drugs known not to eradicate H pylori for patients with non-ulcer dyspepsia. DATA COLLECTION AND ANALYSIS: Data were collected on individual and global dyspeptic symptom scores, quality of life measures and adverse effects. Dyspepsia outcomes were dichotomised into minimal/resolved versus same/worse symptoms. MAIN RESULTS: Seven randomised controlled trials were included in the systematic review. Five trials compared proton pump inhibitor dual or triple therapy with a proton pump inhibitor + placebo antibiotics, and evaluated dyspepsia at 6-12 months in 1,385 patients. H pylori eradication was significantly superior to placebo in treating non ulcer dyspepsia (relative risk reduction = 7%; 95% CI = 1% to 12%; p=0.02) and there was no significant heterogeneity between the studies. The number needed to treat to cure one case of dyspepsia = 19 (95% CI = 11 to 132). A further two trials compared Bismuth based H pylori eradication with an alternative pharmacological agent. These trials were smaller and had a shorter follow-up but suggested H pylori eradication was more effective than either H2 receptor antagonists or sucralfate in treating non-ulcer dyspepsia. REVIEWER'S CONCLUSIONS: H pylori eradication may be an effective therapy for H pylori positive non-ulcer dyspepsia. This result is not robust and further evidence on the efficacy of H pylori eradication in non ulcer dyspepsia would be helpful. The effect is modest and economic models would help establish whether this approach is cost-effective. This review will be updated as results from other ongoing trials (Malfertheiner 2000) are made available.

Anti-Bacterial Agents↗
PubMed2006

Preferred skeletal site for osteoporosis screening in high-risk populations.

OBJECTIVES: The current World Health Organization (WHO) definition of osteoporosis, which is based on densitometry of lumbar and femoral regions, is extensively used for decision-making in clinical practice. Discordance in diagnosis of osteoporosis using this definition is a known phenomenon. The aim of this study was to evaluate the impact of such discordance and to assess the diagnostic value of using one skeletal site for screening purposes as opposed to the two sites required in the WHO criteria. STUDY DESIGN: Data was collected from 4188 individuals (3848 female); mean age=53.4 years (standard deviation 11.8) referred to a community-based outpatient osteoporosis testing centre in Tehran, Iran. METHODS: Dual-energy X-ray absorptiometry (DXA) was performed on L1-L4 lumbar spine and total hip for all cases. The DXA results were categorized according to WHO criteria. Sensitivity for each site was calculated as number of cases with T-score < -2.5 at that site divided by the total number of cases with T-score < -2.5 at any site. RESULTS: Prevalence of osteoporosis diagnosis using lumbar DXA, femoral DXA, and WHO criteria (either of the sites) were 24.7%, 12.4%, and 27.8%, respectively. Sensitivity of lumbar DXA for diagnosis of osteoporosis (88.9%) was significantly higher than femoral DXA (44.6%, P<0.001); but this difference became non-significant for men > or = 60 and women > or = 70 (P=0.615 and P=0.077, respectively). Agreement of the procedures in different sites (kappa) was 0.40 (0.37 to 0.43). When proximal femur was considered as the reference, positive likelihood ratios of lumbar DXA to detect cases were 4.7 and 2.0 in younger and older groups, respectively. CONCLUSIONS: Concerning the high rate of discordance and low agreement between DXA results, the data obtained from each anatomical site cannot predict the condition of the other site. However, if use of a single assessment is intended for screening programs, public health authorities can develop different strategies for different age groups of their population. We propose lumbar DXA for the younger group (men < 60 and women < 70) and femoral densitometry for the older.

Absorptiometry, Photon↗
PubMed2001

Integration of the medical degree in oral and maxillofacial surgery: A 10-year follow-up.

PURPOSE: Ten years ago, the American Association of Oral and Maxillofacial Surgeons membership was surveyed to evaluate the influence that integration of a medical degree might have on oral and maxillofacial training. The intent of the current survey was to reassess the influence a medical degree has had on the specialty over the past 10 years. PATIENTS AND METHODS: The effects of a medical degree on privileges, referral patterns, and its role in the office, hospital, and academic settings were studied. Biographical data was collected and responses were evaluated for the following groups: 1) the nation as a whole, 2) MD versus non-MD oral and maxillofacial surgeons (OMS), 3) geographic regions of practice, 4) population, 5) number of years in practice, and 6) involvement in academic programs. RESULTS: The results of this survey were similar to the previous one. Substantially different responses were seen between the dual-degree and single-degree OMS as well as differences between geographic locations, years in practice, and academic involvement. MD-DDS and academic OMS again possessed a broader spectrum of privileges than their colleagues. Recently trained OMS again possessed a greater number of privileges than more experienced surgeons. CONCLUSION: Overall there has been a trend toward increasing surgical privileges over the past 10 years for both single- and dual-degree OMS. The results presented emphasize the need to continually assess the influence that a medical degree has on the specialty.

Credentialing↗
PubMed2006

Serum magnesium and type-2 diabetes in African Americans and Hispanics: a New York cohort.

OBJECTIVES: The aim of this study was to examine the relationship of serum Mg with stage of diabetes measured by fasting serum glucose in a cohort of 485 African American and Hispanic adults. METHODS: The cross sectional Rosetta study was designed to assess body composition in a multi-racial cohort of healthy adults living in New York City. The data utilized for the current analyses were collected during the years 1990 to 2000. Serum Mg and glucose were measured after a 10-12 hour fast. Dual-energy x-ray absorptiometry was used to measure fat mass (FM) and fat free mass (FFM). RESULTS: The mean age of the cohort was 53 +/- 16 years. Hispanics had significantly lower (p < 0.05) mean serum Mg levels (0.82 +/- 0.07 mmol/L vs. 0.85 +/- 0.07 mmol/L) and FFM (48.8 +/- 10.9 kg vs. 50.9 +/- 10.3 kg) compared to African Americans. In both race/ethnic groups, individuals classified as having diabetes had significantly (p < 0.001) lower serum concentrations of Mg (0.80 +/- 0.07 mmol/L) compared to the normal group (0.84 +/- 0.07 mmol/L). CONCLUSIONS: These results show that in African American and Hispanic adults, those with diabetes have lower serum Mg levels compared to those classified as pre-diabetic or those with normal fasting glucose levels.

Adipose Tissue↗
PubMed1982

Microprocessor-based system for collection and storage of the equine vectorcardiogram.

To evaluate the clinical application of a semiorthogonal lead system for use in the horse, an inexpensive means of recording and storing the ECG was required which would allow the subsequent vectorcardiographic analysis to be computerized. In investigating the various options for the system the basic requirements for the digitization of analogue data were reviewed and previous studies examined. The system subsequently developed used an 8080 microprocessor and a multichannel 8-bit analogue to digital converter. This unit was signal-level compatible with the laboratory recorder used in the study and was capable of functioning as a remote terminal. Storage was achieved through the use of a dual-drive task storage system. Programs were written in machine language, both to control the data acquisition procedure and subsequent storage and to facilitate the transfer of data from the microprocessor to a central computing facility for analysis. Data were collected with 8-bit accuracy at a sampling rate of 2,702 samples/s/ channel for 3 channels of data with a system frequency response before digitization of 0.05 to 2,500 Hz. Preliminary analysis indicated that for accurate reproduction, the frequency response of the system before digitization should be a minimum of direct current, to 1,300 Hz, dictating a sampling rate of at least 2,000 samples/s.

Animals↗
PubMed2004

Liver transplantation in cirrhotic patients with small hepatocellular carcinoma: an analysis of pre-operative imaging, explant histology and prognostic histologic indicators.

BACKGROUND: In recent years, liver transplantation in patients with hepatocellular cancers and cirrhosis has been restricted to those with small cancers (<5 cm for solitary and <3 cm for multifocal HCC with <3 nodules). The selection of patients for liver transplantation is based on pre-operative imaging. The accuracy of imaging correlated with explant histology and the effect of tumour stage has not been evaluated in this selected population. METHODS: In this study, prospectively collected data for 30 patients who underwent orthotopic liver transplantation for cirrhosis complicated by small hepatocellular carcinoma (HCC) at a single centre have been reviewed with the aim of correlating radiological findings, explant histology and patient outcome. Patients who underwent orthotopic liver transplantation between 1995 and 1999 had plain and contrast-enhanced dual-phase spiral CT (DCT) scans of the liver. Patients suspected of having HCC on CT scan or due to elevated serum alpha-fetoprotein underwent iodized oil CT (IOCT). Following transplantation, the explanted liver was serially sectioned at 10-mm intervals and examined by a pathologist blinded to the results of imaging. Data collected prospectively on imaging and histology were compared with outcome data. The median period of follow-up was 1,139 days (range 690-1,955 days) after transplantation. All patients were followed up by clinical assessment, assessment of serum alpha-protein levels and imaging when indicated. RESULTS: All the patients transplanted fulfilled the selective criteria on the basis of imaging (solitary HCC <5 cm in diameter or multifocal HCC <3 cm in diameter with <3 nodules). Of the 30 patients transplanted, 46 HCCs were detected on explant histology with a median size of 24 mm (range 6-75 mm). Ten patients had multifocal disease (median number of lesions 2, range 2-4). No significant difference was observed between IOCT and DCT with regards to the sensitivity (67.4 vs. 68%) and specificity (78.97 vs. 88.6%) of detecting HCCs. IOCT had a positive predictive value of 78.9% as compared to 82.8% for DCT. IOCT had an overall sensitivity of 40% as compared to 30% for DCT in detecting multifocal disease (not significant). Histological assessment of the explanted livers showed that 8 patients had well-, 17 moderate and 5 poorly differentiated HCCs. Tumour size and the presence of multifocal disease did not influence survival in this study. Microvascular invasion was more common with larger tumours (from 38% with lesions less than 40 mm in diameter to 60% with lesions >40 mm in diameter; p < 0.01) and with moderately (29.4%) or poorly differentiated (60%) HCCs than well-differentiated HCC (12.5%) (p < 0.04 and 0.01 for well- vs. moderately and poorly differentiated HCC, respectively). Microvascular invasion on explant histology was associated with poor survival. Of the 17 transplant recipients without vascular invasion, 15 were alive at 1 and 2 years in comparison to 7 of 9 with microscopic vascular invasion (p < 0.01). Four patients died in the post-transplant period due to recurrent HCC. Overall survival [after excluding early post-transplant sepsis-induced deaths (n = 4)] at 1 year was 83.3%. CONCLUSIONS: Selective criteria for transplantation of HCC in cirrhosis are associated with a 1-year and 3-year survival rate of 73.3% (including early post-transplant sepsis-induced deaths). IOCT and DCT are similar in their ability to detect unifocal or multifocal HCC. Tumour size and number are not predictive of recurrence with these selective criteria, but microscopic vascular invasion is a bad prognostic factor.

Carcinoma, Hepatocellular↗