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PubMed1997

Surgery of the thoracic aorta using deep hypothermic total circulatory arrest. Are there neurological consequences other than frank cerebral defects?

OBJECTIVE: Deep hypothermic total circulatory arrest has reduced primary morbidity and mortality in thoracic aortic surgery. Although frank neurological deficits have been proven to be a rare complication of this technique, the rate of subtle but irreversible neuropsychological disorders remains unknown. METHODS: A total of 23 patients (15 male, 8 female) who had undergone surgery for dissection or aneurysm of the thoracic aorta using deep hypothermic total circulatory arrest (mean 25.5 min, range 10-75 min) were studied retrospectively. The mean follow-up was 17 months. The following psychometric tests were conducted: a computer-based test battery to assess tonic alertness and sustained attention, the trail making test (TMT part A and B), the Münchner Gedächtnistest and a verbal learning test. In addition, a cerebral dopamine D2 receptor scintigraphy (using the SPECT technique) was performed. For comparison, 10 healthy subjects were studied. RESULTS: With regard to tonic alertness, 69.6 and 30.4% were below the 50th and 10th centiles, respectively, according to age- and education-corrected standard values. The impairment in sustained attention correlated significantly with the duration of the circulatory arrest. On the tests assessing short-term memory, the patients scored 30% below their age- and education-corrected peers. In terms of long-term memory, 60.9 and 39.1% of the patients were below one and two standard deviations, respectively. Concerning speed of information processing whilst 78.3% of the patients were below the 50th and 21.7% below the 10th centile. Indicative of some persistent and functional brain alteration, the dopamine D2 receptor binding was significantly reduced when compared with healthy subjects. CONCLUSIONS: These data prove a substantial and chronic reduction of higher cognitive function in some of the patients who underwent cardiac surgery using deep hypothermic total circulatory arrest; this was accompanied by a depression of the cerebral dopamine D2 receptor binding.

Adult↗
PubMed2001

Efficacy of antileukotriene agents in asthma management.

OBJECTIVE: This article reviews information on the role of three antileukotrienes (anti-LTs), montelukast, zafirlukast, and zileuton, in the management of asthma. After reading this article, readers should have an understanding of the efficacy of anti-LTs in specific patient populations. DATA SOURCES: Relevant and appropriately controlled clinical studies on the efficacy of anti-LTs were used. Only literature in the English language was reviewed. STUDY SELECTION: Material was taken from peer-reviewed journals and published abstracts. RESULTS: The efficacy of anti-LTs has been established in numerous randomized, controlled, multicenter trials involving patients with mild-to-moderate disease. These agents reduce asthma symptoms, beta2-agonist use, and asthma exacerbations, in addition to improving pulmonary function. The anti-LTs are also effective when added to low-dose or high-dose corticosteroid regimens in symptomatic asthma patients. They have proven efficacy in patients with aspirin-sensitive asthma, and they appear able to reduce nasal congestion in asthma patients with concomitant upper airway symptoms. Some anti-LTs have been shown to be effective in pediatric asthma patients. CONCLUSIONS: In reviewing available clinical results as well as real-world experience in managing asthma patients, the Antileukotriene Working Group concludes that anti-LTs may be used in patients with mild persistent asthma as well as in combination with other asthma medications at all levels of disease severity for long-term maintenance of asthma control.

Adrenal Cortex Hormones↗
PubMed2004

Juvenile- versus adult-onset depression: multiple differences imply different pathways.

BACKGROUND: Several sources of heterogeneity in major depression have been identified. These include age of onset, presence of co-morbid disorders, and history of childhood sexual abuse. This study examined these factors in the context of the contrast between onset of depression in young women before and after age 16. METHOD: Sampling was carried out in two phases. In the first, questionnaires were sent to women aged 25-36 in five primary care practices. Second-phase subjects for interview (n = 197) were drawn from three strata defined on the basis of childhood adversities. Interviews conducted and rated independently assessed (1) recalled childhood experiences, psychopathology and parental psychiatric disorder, and (2) adult personality functioning and adult lifetime psychopathology. Frequencies of predictor and response variables, effect estimates and their confidence intervals were weighted back to the general population questionnaire sample. RESULTS: Compared with adult-onset depression, juvenile-onset adult depression was associated with co-morbid childhood psychopathology and peer problems, poor parental care, and childhood sexual abuse involving actual or attempted intercourse; in adult life there were higher levels of co-morbid psychiatric disorders, and personality dysfunction. The adult-onset depression group was characterized by a history of contact childhood sexual abuse without actual or attempted intercourse, and to a lesser extent, poor parental care. CONCLUSIONS: The juvenile- versus adult-onset distinction appears to be important to heterogeneity in adult depression, implicating different individual and environmental factors during childhood, and different mechanisms in adult life.

Adolescent↗
PubMed2003

Changes in heavy drinking over the third decade of life as a function of collegiate fraternity and sorority involvement: a prospective, multilevel analysis.

Although affiliation with a fraternity or sorority is an important risk factor for heavy drinking, recent research indicates that this risk may be limited to the college years. Random coefficient growth modeling was used to track changes in patterns of heavy drinking over the course of 11 years as a function of gender and collegiate Greek involvement (N=318). Overall, greater cumulative exposure to the Greek system led to increased heavy drinking during the college years, particularly among men. Shortly after leaving college, heavy drinking levels dropped markedly and remained low through approximately age 30. Inclusion of peer alcohol use norms in the model reduced the influence of Greek involvement. Implications for models of heavy drinking and health risks are discussed.

Adolescent↗
PubMed1979

Effects of medial preoptic-anterior hypothalamic lesions on development of sociosexual behavior in dogs.

Bilateral medial preoptic-anterior hypothalamic lesions in adult male dogs eliminate or impair copulatory behavior and reduce urine-marking responses but do not affect aggressive behavior. The present study examined the emergence of the adult forms of these same male sociosexual behavioral patterns when the lesions are made prior to puberty. The subjects were allowed to interact with male peers during development. Animals with lesions had reduced frequence of juvenile mounting and an almost total absence of male copulatory activity in adulthood. Urine-marking and aggressive behavior in the juvenile and adult periods were not affected by the lesions. The findings reveal a sparing of function with regard to urine-marking but not sexual behavior.

Aggression↗
PubMedDate not supplied

Can instructional and emotional support in the first-grade classroom make a difference for children at risk of school failure?

This study examined ways in which children's risk of school failure may be moderated by support from teachers. Participants were 910 children in a national prospective study. Children were identified as at risk at ages 5-6 years on the basis of demographic characteristics and the display of multiple functional (behavioral, attention, academic, social) problems reported by their kindergarten teachers. By the end of first grade, at-risk students placed in first-grade classrooms offering strong instructional and emotional support had achievement scores and student-teacher relationships commensurate with their low-risk peers; at-risk students placed in less supportive classrooms had lower achievement and more conflict with teachers. These findings have implications for understanding the role that classroom experience may play in pathways to positive adaptation.

Affect↗
PubMed1989

Peer-related communicative competence of preschool children: developmental and adaptive characteristics.

The peer-related communicative interactions of nonhandicapped 3- and 4-year-old children as well as a group of 4-year-old mildly developmentally delayed children were investigated in a cross-sectional descriptive study. Adjustments of speakers to companions varying in terms of chronological age and developmental status were of interest, as were comparisons among the three groups. All three groups made adjustments in communicative functions (directives and information statements), interactive style (strong and joint directives), and communications involving affect (disagreements), but only to mildly delayed children. Adjustments to mildly delayed children were more closely related to interpersonal and social status factors than to children's developmental levels. The communicative interactions of mildly delayed children were highly similar to the developmentally matched nonhandicapped group on all measures except for a lower level of speech complexity. Significant differences between 3- and 4-year-old nonhandicapped children were obtained only for measures of speech complexity.

Affect↗
PubMed1991

Sources of sex education as a function of sex, coital activity, and type of information.

Previous studies of the sources of sex education are reviewed and critically analyzed. Most previous studies have examined the limited issue of which source of sex education is most important, examined the sources of only a few sexual topics, or used inadequate methodology. In the present study, more adequate data regarding the relative contributions of parents, schools, reading, and peers to information about each of 35 different sexual topics were obtained from a sample of 232 male and female, coitally experienced or inexperienced, midwestern college students. Individual reading and peers were the highest rated sources overall and on most of the subcategories of items. Schools were highly rated sources for topics related to the anatomy and physiology of sex and venereal disease. Coitally experienced (CE) individuals reported receiving more information overall than coitally inexperienced (CIE) individuals. However, contrary to previous speculations, CE and CIE individuals did not differ in the amount of information received from parents. Instead, CE individuals received more information through reading and from peers than did CIE individuals. Consistent with previous findings, amount of information received from parents correlated negatively with performance on a sexual knowledge test. Comparison of the present results with previous research suggested a developmental hypothesis, namely, that as individuals develop from early adolescence to young adulthood and become more sexually active, individual reading becomes a more important source of sexual information.

Adolescent↗
PubMed1994

American College of Surgeons Verification/Consultation Program: analysis of unsuccessful verification reviews.

UNLABELLED: This study was designed to document the reasons hospitals have been unsuccessfully peer reviewed as potential trauma centers. METHOD: 120 trauma center reviews were performed by a peer review program between September 1987 and December 1992 using the American College of Surgeons (ACS) criteria. Fifty-four hospitals had criteria deficiencies. These reviews were studied for criteria deficiencies for each hospital with documentation of frequency and relationship to re-review outcome. RESULTS: There are 108 ACS criteria. The 54 hospitals had various combinations of 28 different criteria deficiencies. Deficiencies ranged from 1 to 15 per hospital. Thirty-one hospitals underwent a second review. Twenty-five hospitals had corrected the deficiencies and were verified. No hospital with over 8 deficiencies was subsequently verified. The Quality Improvement program was the most common deficiency (74%) and was correctable (50%). Other frequent deficiencies were no trauma service (46%), no surgeons in ED (41%), inadequate neurosurgeon response (35%), no trauma coordinator (31%), no trauma registry (28%), lack of surgical commitment (26%), and lack of 24 hour OR availability (24%). The lack of surgeon or hospital commitment accounted for most of the 28 criteria deficiencies. Subsequent verification was notably poorer for hospitals seeking verification for the purpose of designation versus verification only (29% versus 75%). Only 1 hospital with a prior ACS consultation visit failed the first verification review. CONCLUSIONS: A limited but critical set of criteria enable a hospital to function as a trauma center. Trauma quality improvement is a poorly understood but a correctable issue. Surgical and hospital commitment are essential for verification. Prior consultation may be of benefit.

General Surgery↗
PubMedDate not supplied

Functional ability and physical and psychosocial well-being of hypermobile schoolchildren.

OBJECTIVE: To compare the functional ability and the physical and psychosocial well-being of children with joint hypermobility to those of age- and sex-matched non-hypermobile subjects. METHODS: 311 healthy Italian schoolchildren aged 6.3 to 19.3 years were examined for hypermobility of the joints. Functional ability was assessed through the Childhood Health Assessment Questionnaire (CHAQ) and the physical and psychosocial well-being through the Childhood Health Questionnaire (CHQ). The parent's assessment of the child's overall well-being and of the child's pain was measured on a visual analogue scale. RESULTS: The overall prevalence of articular hypermobility was 34% (106/311), with the median hypermobility score being 3 (interquartile range 1, 5). Although the hypermobility score of girls (median 3: interquartile range 2, 5) exceeded that of boys (median 2.5; interquartile range 0, 5), this difference was not statistically significant (p = 0.16). The level of hypermobile children's pain in the preceding weeks, as assessed by the parents, was comparable to that recorded in the non-hypermobile peers. There was a weak negative correlation between the hypermobility score and the age of the child (r = -0.14, p=0.01). All instrument scores were comparable between hypermobile and non-hypermobile subjects, with the sole exception of a borderline significant greater impairment of the Role/social limitations-physical subscale of the CHQ in the hypermobile group. The hypermobility score was not correlated with any instrument score. CONCLUSIONS: The presence of joint hypermobility does not affect the functional ability and the physical and psychosocial well being of otherwise healthy children. These results suggest that the physical functioning in everyday life and the general health status of hypermobile children are not impaired.

Adolescent↗
PubMed2004

COX-2 selective inhibitors: a literature review of analgesic efficacy and safety in oral-maxillofacial surgery.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed analgesic agents in surgical outpatients. Major limitations of NSAIDs are their gastrointestinal (GI) adverse events (perforation, ulceration, and bleeding), impairment of hemostatic function, and renal failure (with long-term therapy). A new class of NSAIDs, the COX-2 selective inhibitors (CSIs or Coxibs), have been developed with the aim of reducing the GI adverse events of traditional NSAIDs while maintaining their effective anti-inflammatory and analgesic properties. OBJECTIVE: This is a narrative review of the literature aimed to discuss analgesic efficacy, clinical safety and cost-benefit ratio of CSIs in the treatment of post-oral surgery pain. METHODS: Relevant drug and clinical studies of analgesic efficacy and safety of CSIs in the management of postoperative dental pain were identified through searches of MEDLINE/PubMed, in peer-reviewed journals of medicine and dentistry. The Food and Drug Administration Web site was searched for data of tolerability. Hand-searching included several dental journals and bibliographies of relevant studies. The last electronic search was conducted in April 2003. RESULTS: Data from well-designed, randomized, controlled trials of CSIs on the management of post-oral surgery pain indicate that these drugs are as well-effective analgesic agents as traditional NSAIDs and offer clinical advantages in terms of GI safety and unimpaired platelet function. CSIs do not offer advantages of renal safety over traditional NSAIDs. CONCLUSION: Although CSIs display analgesic efficacy similar to that of traditional NSAIDs in the treatment of acute, post-oral surgery pain, there is reasonable evidence that these new drugs are preferable in patients who are at an increased risk of developing serious upper-GI complications, in patients who take aspirin for cardiovascular comorbid conditions, and in those allergic to aspirin. Furthermore, CSIs may be given more safely than NSAIDs in perioperative settings, because of their lack of impairment of the blood-clotting. However, the high costs of CSIs available at present limit their routine use in the short period of postoperative dental pain-in most cases 2 to 4 days after surgery-because there is not an increased risk of developing serious GI complications with the use of cost-saving NSAIDs. The GI safety advantages of CSIs may improve the tolerability of long-duration analgesic therapies, such as cases of painful temporomandibular joint disorders and chronic orofacial pain. Further studies are needed to determine the cost-benefit ratio of using CSIs for the management of acute pain.

Analgesics↗
PubMed1995

Quality of life after orthotopic liver transplantation in children. An overview of physical, psychological and social outcome.

Orthotopic liver transplantation is now routinely performed as a cure of numerous untreatable paediatric liver diseases. Evaluation of post-transplant quality of life is subjective and very difficult. It has to take into account the pre-transplant quality of life and the emotional stress to the family. Transplantation saves life in 65%-90% of the patients. Several diseases may, however, recur after transplantation, such as hepatitis B, C or NANB, or tumours. Some metabolic diseases may also progress in other organs. Extra-hepatic manifestations or sequelae may persist after transplantation. Complications of transplantation include renal function impairment, hypertension, viral and opportunistic diseases. Of particular concern is the post-transplant lymphoproliferative syndrome. Liver transplantation is able to restore growth. Children are less frequently admitted to hospital after transplantation, take fewer medications, return to school, are less dependent and interact more normally with their peers. Quality of life may not reach perfection, and depends also on the way our society accepts these imperfections.

Child↗
PubMed2006

Modulation of spatial bias in the dual task paradigm: evidence from patients with unilateral parietal lesions and controls.

Lateral attentional bias is common after unilateral brain damage. It has sometimes been proposed that lateral bias is increased by concurrent cognitive demands, perhaps because of lost top-down compensation. However, an important limitation of previous studies is the sole use of right hemisphere patients. Here we employed a dual task paradigm to measure spatial bias on a visual task while manipulating demands of a concurrent auditory task. Bias was examined in patients with left or right parietal lesions and controls. In Experiment 1 the addition of either a non-spatial or spatial auditory task led to a rightward shift in visual bias. This same rightward shift occurred in controls, left parietals and right parietals. Experiment 2 examined whether the participant's response hand affected their bias. In addition, it attempted to distinguish between the hypothesis that modulatory effects are strongly dependent on lateralization of the concurrent task, and the hypothesis that dual tasks cause a general rightward shift. Response hand was found to have no effect on spatial bias. In addition, bias did not differ between left hemisphere (verbal) and right hemisphere (pitch) concurrent tasks, though the trend was for a smaller rightward shift with the verbal task. Our results show that dual tasks do not exacerbate patients' underlying deficits; instead they cause a global shift in attention to the right. This shift may resemble general rightward shifts that have previously been linked to reduced arousal.

Acoustic Stimulation↗
PubMed2006

Similar gene expression profiles do not imply similar tissue functions.

Although similarities in gene expression among tissues are commonly inferred to reflect functional constraints, this has never been formally tested. Furthermore, it is unclear which evolutionary processes are responsible for the observed similarities. When examining genome-wide expression data in mouse, we found that patterns of expression similarity between tissues extend to genes that are unlikely to function in the tissues. Thus, ectopic expression can seem coordinated across tissues. This indicates that knowledge of gene expression patterns per se is insufficient to infer gene function. Ectopic expression is possibly explained as expression leakage, caused by spreading of chromatin modifications or the transcription apparatus into neighboring genes.

Animals↗
PubMed2003

Increase of functional diversity by alternative splicing.

A large-scale analysis of protein isoforms arising from alternative splicing shows that alternative splicing tends to insert or delete complete protein domains more frequently than expected by chance, whereas disruption of domains and other structural modules is less frequent. If domain regions are disrupted, the functional effect, as predicted from 3D structure, is frequently equivalent to removal of the entire domain. Also, short alternative splicing events within domains, which might preserve folded structure, target functional residues more frequently than expected. Thus, it seems that positive selection has had a major role in the evolution of alternative splicing.

Alternative Splicing↗
PubMed1998

Cerebellar contribution to linguistic processing efficiency revealed by focal damage.

The cerebellum's role in cognitive skills was examined in a child (L.C.) with focal injury to the left cerebellum. Initial symptoms included aphasia and dysarthria. At 3 and 9 months post-injury, clinical neuropsychological tests revealed persistent psychomotor slowing as well as deficits in executive functions. Further cognitive testing at 13 and 16 months post-injury demonstrated that L.C. processed information from both the linguistic and nonlinguistic domains more slowly than age-, grade- and sex-matched controls. Notably, her linguistic processing was more than twice as slow as that of her peers, whereas her nonlinguistic processing was only approximately 20% slower. Within each domain the degree of cognitive slowing was approximately the same across diverse tasks. These results are consistent with the hypothesis of a cerebellar contribution to cognitive processing, particularly the processing of linguistic information.

Cerebellar Diseases↗
PubMed1988

Five domains of interpersonal competence in peer relationships.

In three studies we investigated the utility of distinguishing among different domains of interpersonal competence in college students' peer relationships. In Study 1 we developed a questionnaire to assess five dimensions of competence: initiating relationships, self-disclosure, asserting displeasure with others' actions, providing emotional support, and managing interpersonal conflicts. Initial validation evidence was gathered. We found that self-perceptions of competence varied as a function of sex of subject, sex of interaction partner, and competence domain. In Study 2 we found moderate levels of agreement between ratings of competence by subjects and their roommates. Interpersonal competence scores were also related in predictable ways to subject and roommate reports of masculinity and femininity, social self-esteem, loneliness, and social desirability. In Study 3 we obtained ratings of subjects' competence from their close friends and new acquaintances. Relationship satisfaction among new acquaintances was predicted best by initiation competence, whereas satisfaction in friendships was most strongly related to emotional support competence. The findings provide strong evidence of the usefulness of distinguishing among domains of interpersonal competence.

Assertiveness↗
PubMed2003

Association of bullying with adolescent health-related quality of life.

OBJECTIVE: To examine the relationship between being bullied and health-related quality of life (HR-QOL) in adolescence. METHODOLOGY: Subjects were a cohort of 805 adolescents with a mean age of 13.6 years (standard deviation 0.2 years). An adolescent questionnaire elicited the frequency of being bullied. HR-QOL was measured using the Child Health Questionnaire - Parent Report Form (CHQ-PF50) and Dartmouth COOP Functional Health Assessment Charts for Adolescents. RESULTS: Thirty-six per cent of boys and 38 per cent of girls reported being bullied at least weekly. Adolescent psychosocial HR-QOL was inversely related to frequency of being bullied, while physical HR-QOL was not related. CONCLUSION: Peer bullying is an important determinant of adolescent HR-QOL with a negative impact on psychosocial well-being.

Adolescent↗