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An in vitro comparison of the effect of number and pattern of positional screws on load resistance.

OBJECTIVE: The purpose of this in vitro investigation was to determine whether the number or pattern of placement of positional screws affected their ability to resist vertical loads resembling mastication. MATERIALS AND METHODS: Standardized bone substitutes were secured with varying numbers of 17.0-mm-long, 2.0-mm outer diameter, self-tapping titanium screws (W. Lorenz Surgical, Jacksonville, FL) in various patterns using a positional screw technique. These patterns included one, two, three, four, and five screws in a linear pattern; two screws in a vertical pattern; three screws in an L-pattern, inverted-L pattern, backward-L pattern, inverted-backward-L pattern, and right and left diagonal pattern; four screws in a box pattern; and five screws in a domino pattern. Five models of each group were fabricated along with a control group. The models were secured in a jig and subjected to vertical loads by an Instron 8511.20 Mechanical Testing Unit (Canton, MA) until failure. Common engineering standards, including yield load, yield displacement, stiffness, maximum load, and displacement at maximum load, were measured, and means and standard deviations were derived and compared for statistical significance with an analysis of variance (ANOVA) and Scheffe multiple comparison test. RESULTS: Screw number and pattern of placement affected the mechanical characteristics in resistance to vertical load. Screw numbers less than three and all linear patterns were the least effective. The three-screw L patterns, as a category, provided greater resistance to vertical loads than either the three-screw linear or three-screw diagonal patterns. The addition of more than three screws in geometric patterns offered no greater benefit than the three-screw L patterns. CONCLUSIONS: In this in vitro study, the three-screw L patterns were the most effective and efficient when using the positional screw technique.

Analysis of Variance↗

Patterns of factor-VIII related antigen on crossed immunoelectrophoresis and large pore polyacrylamide gel-crossed immunoelectrophoresis in von Willebrand's disease.

Plasma samples from patients with various types of von Willebrand's disease were subdivided into six patterns according to the electrophoretic mobility and shape of VIIIR: Ag on crossed immunoelectrophoresis (CIE): pattern 1 no precipitation are, pattern 2 normal mobility with low arc, arc, pattern 3 intermediate mobility with low arc, pattern 4 faster anodal mobility with low arc, pattern 5 normal mobility with normal are height, pattern 6 faster anodal mobility with normal are height. Of 62 patients, 14 had pattern 1, 6 pattern 2, 16 pattern 3, 12 pattern 4, 9 pattern 5, and 5 pattern 6. Large pore polyacrylamide-agarose gel-crossed immunoelectrophoresis (PAAG-CIE) of crude factor VIII fraction from cryoprecipitate revealed no arcs in patients with pattern 1, three arcs of reduced height in the patients with patterns 2 and 3, four arcs very similar to normal control in patients with pattern 5, and two arcs with fast anodal migration in the patients with patterns 4 and 6. Crude factor VIII fractions from normal cryosupernatant showed one low fast anodally migrating arc corresponding to the fourth arc of normal cryoprecipitate. No peak was seen in patients with pattern 1, and one low fast anodal arc similar to normal control was present in the patients with patterns 2, 3, 4, 5 and 6.

Antigens↗

Precise spatiotemporal repeating patterns in monkey primary and supplementary motor areas occur at chance levels.

Precise spatiotemporal patterns in neural discharge are a possible mechanism for information encoding in the brain. Previous studies have found that such patterns repeat and appear to relate to key behavioral events. Whether these patterns occur above chance levels remains controversial. To address this question, we have made simultaneous recordings from between two and nine neurons in the primary motor cortex and supplementary motor area of three monkeys while they performed a precision grip task. Out of a total of 67 neurons, 46 were antidromically identified as pyramidal tract neurons. Sections of recordings 60 s long were searched for patterns involving three or more spikes that repeated at least twice. The allowed jitter for pattern repetition was 3 ms, and the pattern length was limited to 192 ms. In all 11 recordings analyzed, large numbers of repeating patterns were found. To assess the expected chance level of patterns, "surrogate" datasets were generated. These had the same moment-by-moment modulation in firing rate as the experimental spike trains, and matched their interspike interval distribution, but did not preserve the precise timing of individual spikes. The number of repeating patterns in 10 randomly generated surrogates was used to form 99% confidence limits on the repeating pattern count expected by chance. There was close agreement between these confidence limits and the number of patterns seen in the experimental data. Analysis of high complexity patterns was carried out in four long recordings (mean duration 23.2 min, mean number of neurons simultaneously recorded 7.5). This analysis logged only patterns composed of a larger number (7-11) of spikes. The number of patterns seen in the surrogate datasets showed a small but significant excess over those seen in the original experimental data; this is discussed in the context of surrogate generation. The occurrence of repeating patterns in the experimental data were strongly associated with particular phases of the precision grip task; however, a similar task dependence was seen for the surrogate data. When a repeating pattern was used as a template to find inexact matches, in which up to half of the component spikes could be missing, similar numbers of matches were found in experimental and surrogate data, and the time of occurrence of such matches showed the same task dependence. We conclude that the existence of precise repeating patterns in our data are not due to cortical mechanisms that favor this form of coding, since as many, if not more, patterns are produced by spike trains constructed only to modulate their firing rate in the same way as the experimental data, and to match the interspike interval histograms. The task dependence of pattern occurrence is explicable as an artifact of the modulation of neural firing rate. The consequences for theories of temporal coding in the cortex are discussed.

Action Potentials↗

Identification of scanned and static tactile patterns.

Most of the studies in which the interactions between target and nontarget spatial patterns have been examined have tested patterns that are generated statically. Static patterns are those in which all the elements of the pattern are presented at the same time and at a fixed location on the skin; however, most tactile information comes to the skin by means of patterns' being scanned across the surface of the skin. In the present study, the interactions between target and nontarget patterns were measured for patterns generated in both the static and the scanned modes. Nontarget patterns often interfere with the perception of target patterns. Using patterns generated in the static mode, previous studies have identified two factors that produce interference in pattern identification: response competition and masking. Masking, in turn, appears to be the result of temporal integration of the target and nontarget patterns, as well as the displacement of target features. In the present study, these factors were examined for patterns generated in both static and scanned modes. Regardless of the mode in which the patterns were generated, similar functions were obtained relating identification performance to the temporal separation between the target and the nontarget patterns. Although statically generated patterns are more easily identified than scanned patterns, particularly at brief durations, mechanisms such as response competition, temporal integration, and the displacement of target features appear to be factors that affect scanned patterns to nearly the same degree as static patterns.

Adult↗

Perception of symmetry in infancy: the salience of vertical symmetry and the perception of pattern wholes.

Four experiments were conducted to assess converging aspects of 4-month-old infants' perception of symmetry in visual patterns. Experiments 1 and 2 manipulated the structure and orientation of comparable patterns in order to evaluate the specialty of vertical symmetry. Infants showed no preference among vertically symmetrical, vertically repeated, and obliquely symmetrical patterns, but they processed vertically symmetrical patterns more efficiently than either vertically repeated patterns or obliquely symmetrical patterns. Experiment 3 manipulated the spatial separation of pattern components in order to determine the ability of young infants to integrate and coalesce information in visual patterns that is distributed in space. Infants processed vertically symmetrical patterns whose components were contiguous or nearly contiguous about the vertical axis (0 to 2.5 degrees separations) more efficiently than discontiguous patterns (5 and 10 degrees separations). Thus, extreme spatial separation about the vertical meridian caused infants to lose the advantage for vertical symmetry, and by inference their holistic perception of the visual pattern. Experiment 4 manipulated the organization of individual components of a vertical pattern in order to examine further infants' sensitivity to perceptual organization and synthesis of pattern form. Infants discriminated vertically symmetrical patterns from asymmetrical patterns with a vertical organization, thereby demonstrating sensitivity to the symmetrical organization of the pattern above their perception of components in the pattern. The results of these four experiments together corroborate and extend previous findings that vertical symmetry has a special status in early perceptual development and that infants can perceive pattern wholes.

Female↗

[Glaucoma perimetry--optimization of test point patterns with an information index].

An experimental clinical study on 274 glaucomatous eyes was performed to investigate extensively the relation between test point patterns and information in glaucoma. We used the Humphrey Field Analyzer 620 and a special high-density pattern of 165 points containing all classic patterns of threshold perimetry (31, 32, 61). By deleting points the classic patterns, as well as other patterns, were deduced and compared. Using objective criteria, we measured the frequency of scotoma detection, modification, and refinement that occurred with pattern condensation in different areas. The average gain of information by new points, expressed by an information index, showed an exponential decrease with increasing spatial resolution. Also, the information index decreased toward the periphery for the same step. Optimal patterns, which have an equilibrated information index in all areas, should be denser in the center and coarser at the periphery. Two of these, a 3 degrees-4.2 degrees-6 degrees pattern (called "30-S") and a 4.2 degrees-6 degrees-8.5 degrees pattern ("half 30-S") were compared to the classic patterns and appeared to be superior, best demonstrable in the detection rate: each of the classic patterns (31, 32) missed 15% of the early glaucomatous defects, the adequate central condensed pattern only half of this. In the combination the classic patterns still missed 2.5% of the early defects; the corresponding central condensed pattern missed none. Moreover, these central condensed patterns have fewer points, so that test time is shorter. Changing to these patterns during follow-up is no problem, because this new family of test patterns is deduced from the classic patterns and corresponds in the majority of test locations.

Glaucoma↗

Echocardiographic assessment of patent ductus arteriosus shunt flow pattern in premature infants.

AIMS: To identify the patent ductus arteriosus (PDA) shunt flow pattern using Doppler echocardiography; and to assess whether it could be used to predict the development of clinically significant PDA. METHODS: Premature infants weighing under 1500 g, who required mechanical ventilation, and in whom daily echocardiography could be performed from day 1 until the ductus closed, and on day 7 to confirm closure, were studied. The PDA shunt flow was identified from four Doppler patterns, and the closed pattern of a closed duct was also presented. Clinically significant PDA was diagnosed when there was colour Doppler echocardiographic evidence of left to right ductal shunt associated with at least two of the following clinical signs: heart murmur (systolic or continuous); persistent tachycardia (heart rate > 160/min); hyperactive precordial pulsation; bounding pulses; and radiographic evidence of cardiomegaly or pulmonary congestion. RESULTS: Of 68 infants enrolled into this study, clinically significant PDA developed in 31. The most recordable sequence of transition change of shunt flow pattern for clinically significant PDA was: pulmonary hypertension pattern, to growing pattern, to pulsatile pattern, to closing pattern, to closed pattern. And that for non-clinically significant PDA was: pulmonary hypertension pattern, to closing pattern, to closed pattern. The growing and the pulsatile patterns were mostly documented in infants with clinically significant PDA. The first documented growing pattern to predict clinically significant PDA gave a sensitivity of 64.5% and a specificity of 81.1%; the first documented pulsatile pattern gave a sensitivity of 93.5% and a specificity of 100%. CONCLUSION: Doppler echocardiographic assessment of PDA shunt flow pattern during the first 4 days of life is useful for predicting the development of clinically significant PDA in premature infants. At that stage, the closing or closed Doppler pattern indicates that infants are not at risk of developing clinically significant PDA; the growing or pulsatile Doppler pattern indicates a continuing risk of developing clinically significant PDA.

Anti-Inflammatory Agents, Non-Steroidal↗

Pattern-evoked responses and luminance-evoked responses in the human electroretinogram.

Electrical potentials were recorded from the cornea of the human eye in response to the onset and offset of square-wave stripe patterns varying in spatial frequency, luminance and contrast. Under high retinal illumination (50119 photopic td) the response to pattern onset was a positive wave (pattern-onset wave) followed by a negative after-potential. As long as the pattern was presented, a steady potential of positive polarity (plateau potential) was observed. The response to pattern offset was a biphasic negative-positive wave followed by a negative after-potential. A comparison between wave forms obtained with pattern onset-offset stimuli and luminance increase-decrease stimuli suggests: (a) the pattern-onset wave is the result of an interaction between a luminance-increase and a luminance-decrease response; (b) the plateau potential is mainly an additive superposition of two receptor processes originating from retinal areas that receive increases and decreases in local luminance; (c) the negative-positive potential is an a-wave and a b-wave originating from retinal areas that receive increases in local luminance. The amplitude of the pattern-onset wave was greatest at a spatial frequency around 3-4 c/deg. This behaviour was closely correlated with contrast sensitivity determined psychophysically by previous investigators. Therefore, the pattern-onset wave seems to be a pattern-evoked response. The amplitude of the b-wave following pattern offset showed a monotonic decrease with increasing spatial frequency. It is mainly a luminance-evoked response. Under low retinal illumination (457 photopic td) the pattern-onset wave and the b-wave at pattern offset were smaller. However, the pattern-onset wave had its maximum amplitude at a lower spatial frequency. When increases or decreases in space-average luminance were combined with pattern onset or offset, transitions between pattern- and luminance-evoked responses could be observed. The results suggest that a decrease in local luminance is the essential stimulus for evoking a pattern-related response while increases in local light intensity generate luminance-evoked responses.

Cornea↗

Binary patterning of polar and nonpolar amino acids in the sequences and structures of native proteins.

Protein sequences can be represented as binary patterns of polar ([symbol: see text]) and nonpolar ([symbol: see text]) amino acids. These binary sequence patterns are categorized into two classes: Class A patterns match the structural repeat of an idealized amphiphilic alpha-helix (3.6 residues per turn), and class B patterns match the structural repeat of an idealized amphiphilic beta-strand (2 residues per turn). The difference between these two classes of sequence patterns has led to a strategy for de novo protein design based on binary patterning of polar and nonpolar amino acids. Here we ask whether similar binary patterning is incorporated in the sequences and structures of natural proteins. Analysis of the Protein Data Bank demonstrates the following. (1) Class A sequence patterns occur considerably more frequently in the sequences of natural proteins that would be expected at random, but class B patterns occur less often than expected. (2) Each pattern is found predominantly in the secondary structure expected from the binary strategy for protein design. Thus, class A patterns are found more frequently in alpha-helices than in beta-strands, and class B patterns are found more frequently in beta-strands than in alpha-helices. (3) Among the alpha-helices of natural proteins, the most commonly used binary patterns are indeed the class A patterns. (4) Among all beta-strands in the database, the most commonly used binary patterns are not the expected class B patterns. (5) However, for solvent-exposed beta-strands, the correlation is striking: All beta-strands in the database that contain the class B patterns are exposed to solvent.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗

Different patterns of technetium-99m sestamibi uptake in multiple myeloma.

Technetium-99m 2-methoxyisobutylisonitrile (99mTc-MIBI) has been proposed as a potential tracer in patients with multiple myeloma (MM). The aims of this study were to evaluate the incidence of various patterns of diffuse 99mTc-MIBI uptake in patients with MM, to assess their relationship with clinical status and stage of disease, and to try to clarify the meaning of the diffuse bone marrow uptake of 99mTc-MIBI. Thirty-nine consecutive patients with MM were studied. Twenty-nine of these patients had active disease (13 in stage I, ten in stage II, and six in stage III) and ten were in remission after chemotherapy. Anterior and posterior whole-body scans were obtained 10 min after i.v. injection of 555 MBq of 99mTc-MIBI. The scans were classified as showing: pattern N, when only physiological uptake was present; pattern D, when diffuse bone marrow uptake was observed; pattern F, when areas of focal uptake of the radiotracer were evident; or pattern D+F, when both D and F patterns were observed. Diffuse bone marrow uptake was scored according to extension and intensity. Seven of the 39 patients (18%) showed pattern N, 18 (46%) pattern D, 2 (5%) pattern F, and 12 (31%) pattern D+F. Of the 32 patients with a positive 99mTc-MIBI scan (i.e. showing pattern D, F or D+F), 29 (91%) had active disease. Only three patients in remission showed pattern D, but with a very low bone marrow uptake score. Both extension and intensity of diffuse bone marrow uptake correlated with the amount of the monoclonal component and the percentage of bone marrow plasma cells. The distribution of the 99mTc-MIBI uptake patterns differed among patients in different stages of disease. Using as criteria for advanced stage the presence of either focal uptake (pattern F or D+F) or pattern D with a high score, high (90%) diagnostic accuracy was obtained. In conclusion, the patterns of 99mTc-MIBI uptake in patients with MM are related to both the clinical status and the stage of disease. The presence of focal uptake or of intense diffuse bone marrow uptake suggests that the patient has active and advanced stage disease, while a negative scan in a patient with MM clearly indicates remission.

Antibodies, Monoclonal↗

Zebrafish puma mutant decouples pigment pattern and somatic metamorphosis.

The genetic and developmental bases for trait expression and variation in adults are largely unknown. One system in which genes and cell behaviors underlying adult traits can be elucidated is the larval-to-adult transformation of zebrafish, Danio rerio. Metamorphosis in this and many other teleost fishes resembles amphibian metamorphosis, as a variety of larval traits (e.g., fins, skin, digestive tract, sensory systems) are remodeled in a coordinated manner to generate the adult form. Among these traits is the pigment pattern, which comprises several neural crest-derived pigment cell classes, including black melanophores, yellow xanthophores, and iridescent iridophores. D. rerio embryos and early larvae exhibit a relatively simple pattern of melanophore stripes, but this pattern is transformed during metamorphosis into the more complex pattern of the adult, consisting of alternating dark (melanophore, iridophore) and light (xanthophore, iridophore) horizontal stripes. While it is clear that some pigment cells differentiate de novo during pigment pattern metamorphosis, the extent to which larval and adult pigment patterns are developmentally independent has not been known. In this study, we show that a subset of embryonic/early larval melanophores persists into adult stages in wild-type fish; thus, larval and adult pigment patterns are not completely independent in this species. We also analyze puma mutant zebrafish, derived from a forward genetic screen to isolate mutations affecting postembryonic development. In puma mutants, a wild-type embryonic/early larval pigment pattern forms, but supernumerary early larval melanophores persist in ectopic locations through juvenile and adult stages. We then show that, although puma mutants undergo a somatic metamorphosis at the same time as wild-type fish, metamorphic melanophores that normally appear during these stages are absent. The puma mutation thus decouples metamorphosis of the pigment pattern from the metamorphosis of many other traits. Nevertheless, puma mutants ultimately recover large numbers of melanophores and exhibit extensive pattern regulation during juvenile development, when the wild-type pigment pattern already would be completed. Finally, we demonstrate that the puma mutant is both temperature-sensitive and growth-sensitive: extremely severe pigment pattern defects result at a high temperature, a high growth rate, or both; whereas a wild-type pigment pattern can be rescued at a low temperature and a low growth rate. Taken together, these results provide new insights into zebrafish pigment pattern metamorphosis and the capacity for pattern regulation when normal patterning mechanisms go awry.

Animals↗

Sinusoidal heart rate pattern: Reappraisal of its definition and clinical significance.

OBJECTIVES: To address the clinical significance of sinusoidal heart rate (SHR) pattern and review its occurrence, define its characteristics, and explain its physiopathology. BACKGROUND: In 1972, Manseau et al. and Kubli et al. described an undulating wave form alternating with a flat or smooth baseline fetal heart rate (FHR) in severely affected, Rh-sensitized and dying fetuses. This FHR pattern was called 'sinusoidal' because of its sine waveform. Subsequently, Modanlou et al. described SHR pattern associated with fetal to maternal hemorrhage causing severe fetal anemia and hydrops fetalis. Both Manseau et al. and Kubli et al. stated that this particular FHR pattern, whatever its pathogenesis, was an extremely significant finding that implied severe fetal jeopardy and impending fetal death. UNDULATING FHR PATTERN: Undulating FHR pattern may be due to the following: (1) true SHR pattern; (2) drugs; (3) pre-mortem FHR pattern; (4) pseudo-SHR pattern; and (5) equivocal FHR patterns. FETAL CONDITIONS ASSOCIATED WITH SHR PATTERN: SHR pattern has been reported with the following fetal conditions: (1) severe fetal anemia of several etiologies; (2) effects of drugs, particularly narcotics; (3) fetal asphyxia/hypoxia; (4) fetal infection; (5) fetal cardiac anomalies; (6) fetal sleep cycles; and (7) sucking and rhythmic movements of fetal mouth. DEFINITION OF TRUE SHR PATTERN: Modanlou and Freeman proposed the following definition for the interpretation of true SHR pattern: (a) stable baseline FHR of 120-160 bpm; (b) amplitude of 5-15 bpm, rarely greater; (c) frequency of 2-5 cycles per minute; (d) fixed or flat short-term variability; (e) oscillation of the sinusoidal wave from above and below a baseline; and (f) no areas of normal FHR variability or reactivity. PHYSIOPATHOLOGY: Since its early recognition, the physiopathology of SHR became a matter of debate. Murata et al. noted a rise of arginine vasopressin levels in the blood of posthemorrhagic/anemic fetal lamb. Further works by the same authors revealed that with chemical or surgical vagotomy, arginine vasopressin infusion produced SHR pattern, thus providing the role of autonomic nervous system dysfunction combined with the increase in arginine vasopressin as the etiology. CONCLUSION: SHR is a rare occurrence. A true SHR is an ominous sign of fetal jeopardy needing immediate intervention. The correct diagnosis of true SHR pattern should also include fetal biophysical profile and the absence of drugs such as narcotics.

Arrhythmias, Cardiac↗

Plasticity in the multifunctional buccal central pattern generator of Helisoma illuminated by the identification of phase 3 interneurons.

1. The mechanism for generating diverse patterns of buccal motor neuron activity was explored in the multifunctional central pattern generator (CPG) of Helisoma. The standard pattern of motor neuron activity, which results in typical feeding behavior, consists of three distinct phases of buccal motor neuron activity. We have previously identified CPG interneurons that control the motor neuron activity during phases 1 and 2 of the standard pattern. Here we identify a pair of interneurons responsible for buccal motor neuron activity during phase 3, and examine the variability in the interactions between this third subunit and other subunits of the CPG. 2. During the production of the standard pattern, phase 3 excitation in many buccal motor neurons follows a prominent phase 2 inhibitory postsynaptic potential. Therefore phase 3 excitation was previously attributed to postinhibitory rebound (PIR) in these motor neurons. Two classes of observations indicated that PIR was insufficient to account for phase 3 activity, necessitating phase 3 interneurons. 1) A subset of identified buccal neurons is inhibited during phase 3 by discrete synaptic input. 2) Other identified buccal neurons display discrete excitation during both phases 2 and 3. 3. A bilaterally symmetrical pair of CPG interneurons, named N3a, was identified and characterized as the source of phase 3 postsynaptic potentials in motor neurons. During phase 3 of the standard motor pattern, interneuron N3a generated bursts of action potentials. Stimulation of N3a, in quiescent preparations, evoked a depolarization in motor neurons that are excited during phase 3 and a hyperpolarization in motor neurons that are inhibited during phase 3. Hyperpolarization of N3a during patterned motor activity eliminated both phase 3 excitation and inhibition. Physiological and morphological characterization of interneuron N3a is provided to invite comparisons with possible homologues in other gastropod feeding CPGs. 4. These data support a model proposed for the organization of the tripartite buccal CPG. According to the model, each of the three phases of buccal motor neuron activity is controlled by discrete subsets of pattern-generating interneurons called subunit 1 (S1), subunit 2 (S2), and subunit 3 (S3). The standard pattern of buccal motor neuron activity underlying feeding is mediated by an S1-S2-S3 sequence of CPG subunit activity. However, a number of "nonstandard" patterns of buccal motor activity were observed. In particular, S2 and S3 activity can occur independently or be linked sequentially in rhythmic patterns other than the standard feeding pattern. Simultaneous recordings of S3 interneuron N3a with effector neurons indicated that N3a can account for phase-3-like postsynaptic potentials (PSPs) in nonstandard patterns. The variety of patterns of buccal motor neuron activity indicates that each CPG subunit can be active in the absence of, or in concert with, activity in any other subunit. 5. To explore how CPG activity may be regulated to generate a particular motor pattern from the CPG's full repertoire, we applied the neuromodulator serotonin. Serotonin initiated and sustained the production of an S2-S3 pattern of activity, in part by enhancing PIR in S3 interneuron N3a after the termination of phase 2 inhibition.

Animals↗

Analysis of MRI patterns aids prediction of progression in X-linked adrenoleukodystrophy.

BACKGROUND: X-linked adrenoleukodystrophy (X-ALD) has variants with widely different outcomes, hampering clinical counseling and evaluation of therapies. OBJECTIVE: To evaluate the degree to which MRI patterns can predict lesion progression. METHODS: Two hundred six boys and men with cerebral X-ALD (median age 12.2 years, mean age 18.5 years, age range 1.7 to 73.8 years) were studied. In 140 individuals, follow-up MRI were available. Data after bone marrow transplantation (BMT) were excluded. The patterns of MRI abnormalities were subdivided into five groups based on the anatomic location of the initial T2 signal hyperintensity (pattern 1: parieto-occipital white matter, pattern 2: frontal white matter, pattern 3: corticospinal tract, pattern 4: cerebellar white matter, pattern 5: concomitant parieto-occipital and frontal white matter). The X-ALD MRI Severity Scale, a 34-point scale previously described, was used in the analysis. RESULTS: Pattern 1 patients had rapid progression if contrast enhancement was present and if the MRI abnormality manifested at an early age. The latter was also true for pattern 2 patients. Based on these variables, predictive formulas were constructed for these two patterns using multiple regressions. MRI progression was much slower in pattern 3 and 4 patients, whereas in the few pattern 5 patients, it was more rapid than in any other of the patterns. Patterns 1 and 5 occurred mainly in childhood, patterns 2 and 4 in adolescence, and pattern 3 in adults. CONCLUSIONS: MRI progression in X-ALD depends on patient age, initial MRI Severity Scale score, and anatomic location of the lesion. When used in combination, these data aid the prediction of disease course and the selection of patients for BMT.

Adolescent↗

Distribution patterns of primary and permanent dentition in children with unilateral complete cleft lip and palate.

OBJECTIVE: To investigate the distribution patterns of primary and permanent teeth in the cleft area and the numerical variation in teeth in unilateral complete cleft lip and palate (UCLP) patients. DESIGN: A survey of the dentition in UCLP patients. SETTING: Craniofacial Center, Chang Gung Memorial Hospital, Taipei, Taiwan. PATIENTS: 137 UCLP patients who met the following criteria: (1) have had at least one panoramic film taken, (2) the first panoramic film illustrates either primary or early mixed dentition. Evaluation of both permanent and primary dentition was available in 91 cases. MAIN OUTCOME MEASURES: Two evaluators performed independent evaluations of number and distribution of teeth in UCLP patients. The hypothesis that there are two odontogenic origins for maxillary lateral incisors was proposed to explain the occurrence of distribution patterns of dentition in the cleft area and to explain differences between primary and permanent dentition in UCLP patients. RESULTS: Four distribution patterns in the cleft area were identified in both the primary and the permanent dentition. In the primary dentition, placement of the lateral incisor distal to the alveolar cleft was the predominant pattern (pattern y, 82.4%), followed by absence of the cleft side maxillary lateral incisor (pattern ab, 9.9%), presence of one tooth on each side of the alveolar cleft (pattern xy, 5.5%), and placement of the lateral incisor mesial to the alveolar cleft (pattern x, 2.2%). In the permanent dentition, the most common pattern was the absence of the maxillary lateral incisor on the cleft side (pattern AB, 51.8%), followed by lateral incisor placement distal to the alveolar cleft (pattern Y, 46%), lateral incisor placement mesial to the alveolar cleft (pattern X, 1.5%) and the presence of one tooth on each side of the alveolar cleft (pattern XY, 0.7%). The discrepancy between the distribution patterns of primary dentition and permanent dentition successors is 57.1%. Variations in tooth number in both primary and permanent dentition of UCLP patients occurred most often in the cleft area. Abnormalities in the number of teeth (hypodontia or hyperdontia) outside the cleft area were more common in the permanent dentition than in the primary dentition (24.1% versus 4.4%). CONCLUSIONS: Four distribution patterns in the cleft area were identified in both sets of dentition. Our findings of distribution patterns in UCLP patients support the hypothesis that there may be two odontogenic origins for maxillary lateral incisors. Clinicians involved in managing the dentition of UCLP patients should consider the high frequency of numerical variation both in and outside the cleft area before starting dental treatment.

Anodontia↗

Serial CT in fibrosing alveolitis: prognostic significance of the initial pattern.

OBJECTIVE: In patients with fibrosing alveolitis, a reticular pattern on CT scans of the lungs correlates with histologic findings of fibrosis, whereas a ground-glass pattern has been reported to correlate with reversible inflammatory disease. The majority of patients with fibrosing alveolitis have a ground-glass component visible on CT scans, but response to therapy is infrequent. The aim of this study was to evaluate the prognostic significance of the relative extents of ground-glass and reticular patterns by analyzing serial changes in these CT appearances. SUBJECTS AND METHODS: Serial CT scans were analyzed in 56 patients (21 with idiopathic pulmonary fibrosis and 35 with fibrosing alveolitis associated with systemic sclerosis). The relative extents of ground-glass and reticular patterns were assessed on the initial CT scan. Overall extent of abnormal lung and distribution of disease on initial CT scans were also categorized. Changes in extent and appearance of disease were evaluated in paired anatomically comparable CT sections and assessed independently by two observers; the median interval between scans was 16 months. Serial changes on CT were examined in relation to the initial pattern, extent, and distribution of disease seen on CT scans and in relation to trends in results of concurrent pulmonary function tests. RESULTS: Changes in the extent of disease were due to regression of a ground-glass pattern in 18 patients, an increase in a reticular pattern in nine patients, and an increase in a ground-glass pattern in five patients. A reticular pattern did not regress in any patient. In treated patients, diminution in extent of disease, shown as regression of a ground-glass pattern, was seen most frequently when a ground-glass pattern was the most extensive abnormality at initial scanning (p < .002), independent of extent or distribution of disease seen on CT scans and the type of fibrosing alveolitis. When a ground-glass pattern was associated with an equally extensive reticular pattern, the extent of disease diminished with therapy in a minority of patients (5/13). Improvement in results of pulmonary function tests was associated with regression of a ground-glass pattern in the majority of patients (8/11). CONCLUSION: These findings indicate that the prognostic significance of a ground-glass pattern depends on the extent of an associated reticular pattern and is independent of the extent and distribution of disease.

Female↗

Lifetime earnings patterns, the distribution of future Social Security benefits, and the impact of pension reform.

In order to assess the effect of Social Security reform on current and future workers, it is essential to accurately characterize the initial situations of representative workers affected by reform. For the purpose of analyzing typical reforms, the most important characteristic of a worker is the level and pattern of his or her preretirement earnings. Under the current system, pensions are determined largely by the level of the workers' earnings averaged over their work life. However, several reform proposals would create individual retirement accounts for which the pension would depend on the investment accumulation within the account. Thus, the pension would also depend on the timing of the contributions into the account and hence on the exact shape of the worker's lifetime earnings profile. Most analysis of the distributional impact of reform has focused, however, on calculating benefit changes among a handful of hypothetical workers whose relative earnings are constant over their work life. The earnings levels are not necessarily chosen to represent the situations of workers who have typical or truly representative earnings patterns. Consequently, the results of such analysis can be misleading, especially if reform involves introducing a fundamentally new kind of pension formula. This article presents two broad approaches to creating representative earnings profiles for policy evaluation. First, we use standard econometric methods to predict future earnings for a representative sample of workers drawn from the Survey of Income and Program Participation (SIPP). Our statistical estimates are based on a simple representation of typical career earnings paths and a fixed-effect statistical specification. Because our estimation file contains information on each worker's annual earnings from 1951 through 1996 as reported in the Social Security Administration's earnings files, we have a record (though an incomplete one) of the actual earnings that will be used to determine future benefit payments. Our estimates of the earnings function permit us to make highly differentiated predictions of future earnings for each member of our sample. By combining the historical information on individual earnings with our prediction of future earnings up through the normal retirement age, our first approach produces tens of thousands of predicted career earnings paths that can be used in microsimulation policy analysis. Our second approach to creating lifetime earnings profiles is similar in some ways to the traditional method. For example, it is based on the creation of only a handful of "stylized" career earnings patterns. An important difference with the traditional method, however, is that we define the career earnings patterns so that they are truly representative of patterns observed in the workforce. We use simple mathematical formulas to characterize each stylized earnings pattern, and we then produce estimates of the average path of annual earnings for workers whose career earning path falls within each of the stylized patterns we have defined. Finally, we calculate the percentage of workers in successive birth-year cohorts who have earnings profiles that match each of the stylized earnings patterns. Although this method may seem simple, it allows the analyst to create stylized earnings patterns that are widely varied but still representative of earnings patterns observed among sizable groups of U.S. workers. The effects of policy reforms can then be calculated for workers with each of the stylized earnings patterns. Our analysis of U.S. lifetime earnings patterns and of the impact of selected policy reforms produces a number of findings about past trends in earnings, typical earnings patterns in the population, and the potential impact of reform. The analysis focuses on men and women born between 1931 and 1960. Along with earlier analysts, we find that men earn substantially higher lifetime wages than women and typically attain their peak career earnings at a somewhat earlier age. However, the difference in career earnings patterns between men and women has narrowed dramatically over time. Workers with greater educational attainment earn substantially higher wages than those with less education, and they attain their peak career earnings later in life. For example, among men with the least education, peak earnings are often attained around or even before age 40, whereas many men with substantial postsecondary schooling do not reach their peak career earnings until after 50. Our tabulations of the lifetime earnings profiles of the oldest cohorts (born around 1930) and projections of the earnings of the youngest profiles (born around 1960) imply that the inequality of lifetime earnings has increased noticeably over time. Women in the top one-fifth of female earners and men in the top one-fifth of male earners are predicted to receive a growing multiple of the economy-wide average wage during their career. Women born between 1931 and 1935 who were in the top fifth of female earners had lifetime average earnings that were approximately equal to the average economy-wide wage. In contrast, women born after 1951 who were in the top fifth of earners are predicted to earn almost 50 percent more, that is, roughly 150 percent of the economy-wide average wage. Women with a lower rank in the female earnings distribution will also see gains in their lifetime average earnings, but their gains are predicted to be proportionately much smaller than those of women with a high rank in the distribution. Men with high earnings are also predicted to enjoy substantial gains in their relative lifetime earnings, while men with a lower rank in the earnings distribution will probably see a significant erosion in their typical wages relative to the economy-wide average wage. That is mainly the result of a sharp decline in the relative earnings of low-wage men born after 1950. In creating stylized earnings profiles that are representative of those of significant minorities of U.S. workers, we emphasized three critical elements of the earnings path: the average level of earnings over a worker's career, the upward or downward trend in earnings from the worker's 30s through his or her early 60s, and the "sagging" or "hump-shaped" profile of earnings over the worker's career. That classification scheme yields 27 characteristic patterns of lifetime earnings. Surprisingly, the differnce between men and women within each of those categories is quite modest. The main difference between men and women is in the proportions of workers who fall in each category. Only 14 percent of men born between 1931 and 1940 fall in earnings categories with the lowest one-third of lifetime earnings, whereas 53 percent of women born in those years have low-average-earnings profiles. On the other hand, women born in those years are more likely to have a rising trend in lifetime earnings, while men are more likely to have a declining trend. We find that the distribution of lifetime earnings contains relatively more workers with below-average earnings and relatively fewer with very high earnings than assumed in the Social Security Administration's traditional policy analysis. For example, the "low earner" traditionally assumed by the Office of the Chief Actuary is assigned a level of average lifetime earnings that we find to be higher than the average earnings of persons in the bottom one-third of the lifetime earnings distribution. The stylized earnings profiles developed here can be used for policy evaluation, and the results can be compared with those from the more traditional analysis. That comparison produces several notable findings. Because earnings profiles that are actually representative of the population tend to have lower average earnings than assumed in the traditional analysis, workers typically accumulate somewhat less Social Security wealth than implied in the traditional analysis. On the other hand, because the basic benefit formula is tilted in favor of lower-income workers, the internal rate of return on Social Security contributions is somewhat higher than detected in the traditional analysis. Moreover, the primary insurance amount measured as a percentage of the worker's average indexed earnings tends to be higher than implied by the traditional analysis. Finally, the stylized earnings patterns can be used to compare benefit levels enjoyed by workers under the traditional Social Security formula and under an alternative plan based on individual investment accounts. That comparison shows, as expected, that the traditional formula favors low-wage workers and one-earner couples, while an investment account favors single, high-wage workers. Comparing two workers with the same lifetime average earnings, the traditional formula favors workers with rising earnings profiles (that is, with lifetime earnings heavily concentrated at the end of their career), while investment account pensions favor workers with declining earnings profiles (that is, with earnings concentrated early in their career).

Adult↗

[The relationship between gestational weeks and fetal breathing movements in each pattern of the fetal heart rate].

Fetal breathing movement (FBM) was analysed in each fetal heart rate (FHR) pattern and the gestational 2 weeks. FHR pattern was divided in automated FHR analysis into 3 groups; active, intermediate and resting patterns. The patients consisted of 102 pregnant women at 30-41 weeks, including 13 complicated pregnancies. 1) The active pattern percentage was 52.7% at 32-33 weeks and it decreased gradually. That of the resting pattern was 25.5% at 32-33 weeks and it increased gradually. 2) The percentages of positive FBM in the active pattern were significantly larger than those in the resting pattern in each 2 weeks. 3) The duration of continuous FBM ranged from 3 to 202 sec. FBM of long duration tended to exist in the resting pattern rather than in the active pattern. 4) The percent time ratio of FBM ranged from 1.0 to 92.7% and showed no definite relationship with the FHR patterns or gestational weeks. 5) The FBM rates in each FHR pattern showed no significant differences. Their sequential differences after 36 weeks were significant; that is, FBM in the resting pattern was more regular than that in the active pattern. 6) In high risk pregnancy, the resting pattern percentage was 52.3% and the ratio of positive FBM in the resting pattern was significantly smaller than that in active pattern.

Echocardiography↗