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PubMed2004

Pre- and post-treatment patterns of human chorionic gonadotropin for early detection of persistence after a single dose of methotrexate for ectopic pregnancy.

OBJECTIVE: Given the great variability of human chorionic gonadotropin (HCG) levels after a single dose of methotrexate (MTX) for ectopic pregnancy, it remains complicated to identify cases undergoing persistence until a week from treatment. We evaluated whether pre-treatment patterns of HCG levels could be useful for an earlier detection of persistent trophoblast. STUDY DESIGN: A retrospective study on 62 patients treated by a systemic single dose of methotrexate (50 mg/m(2)) for an ectopic pregnancy. Samples for HCG detection were obtained on days -2 and 0 before the therapy, on days +3, +7 and then weekly until values were undetectable. Patients were divided into three groups: Group U (up, meaning "increasing") and Group D (down, meaning "decreasing") when HCG levels on day 0 were respectively higher or lower than day -2 level of more than 20% and Group P (plateau) when the difference between day -2 HCG level and the level on day 0 was less than 20%. RESULTS: All the patients of Group D underwent a complete resolution, with a percentage of 33.3% of cases who underwent an initial rise of HCG levels on day +3. The percentage of cases undergoing an initial rise of HCG levels in Group U patients was significantly higher than in Group P patients (60.0% versus 28.6%), but the resolution rate resulted similar in the two groups. For patients of Group P, an increase of HCG levels on day +3 was significantly correlated to the failure of the therapy. Indeed, comparing the cases with an immediate increase of HCG levels to the cases with immediate decrease of HCG levels on day +3, the persistence rate was 80% for the former and 12% for the latter (P < 0.0001). CONCLUSION: An initial rise of HCG levels after the therapy does not seem to have a clinical relevance in Group D and Group U patients, it well correlates to trophoblastic persistence in Group P patients.

Abortifacient Agents, Nonsteroidal↗
PubMed2006

Effects of amiodarone on electrical and structural remodeling induced in a canine rapid pacing-induced persistent atrial fibrillation model.

Structural in addition to electrical remodeling may be induced by persistent atrial fibrillation per se and make atrial fibrillation refractory to antiarrhythmic drug therapy. Matrix metalloproteinases (MMPs) contribute to structural remodeling in the interstitial space. Amiodarone is effective in treating persistent atrial fibrillation compared with other antiarrhythmic drugs. In mongrel dogs, right atrial pacing at 540 beats/min (bpm) was performed along with ventricular pacing at 100 bpm for 6 weeks after atrioventricular node ablation. Right atrial pacing at 400 bpm was continued for 4 weeks with (n=5) or without (n=5) oral amiodarone (30 mg/kg/day). In sham dogs, only ventricular pacing was done with (n=4) or without (n=6) amiodarone. In atrial pacing without amiodarone group, electrical remodeling characterized by monophasic action potential duration shortening, loss of action potential duration-rate adaptation and depressed conduction velocity and structural remodeling characterized by slightly but significantly increased interstitial fibrosis and enhanced MMP-2 activity compared with sham group were observed, and sustained atrial fibrillation was easily induced. In atrial pacing with amiodarone group, both electrical and structural remodeling were reversed and sustained atrial fibrillation was not induced. In sham group with amiodarone, action potential duration prolongation and depressed conduction velocity compared with sham without amiodarone were observed, but either increased fibrosis or enhanced MMP-2 activity was not observed. Not only electrical but structural remodeling were induced in a canine persistent atrial fibrillation model. Amiodarone reversed both of them, which may be related to its high efficacy in preventing recurrence of persistent atrial fibrillation.

Action Potentials↗
PubMed2005

Residues and source identification of persistent organic pollutants in farmland soils irrigated by effluents from biological treatment plants.

Sewage and industrial effluents from biological treatment plant have been widely used for agricultural irrigation in north part of China. However, effluents after biological treatment still contain heavy metals and persistent organic contaminants. The persistent organic contaminants accumulated in soil may transfer through the food chains and cause adverse health effects on human or biological effects on soil fauna and flora after long-term application. In present study, field surveys were carried out in the farmlands irrigated by effluents from biological treatment plants that receive sewage wastewater and industrial discharges. Residues of polycyclic aromatic hydrocarbons (PAHs) and organochlorine pesticides (OCPs) in the soils irrigated using both ground water and effluents were compared. The origins of PAHs in the soils were discussed. The results showed that wastewater irrigation could cause accumulation of PAHs in soils close to the pollution discharge. Significantly higher concentrations of PAHs were observed in the sampling sites close to the entrance of main channel in contrast to those along branches and the reference sites. There was no significant relationship between the accumulation of persistent organic pollutants and organic matter content in soil (TOC). Soil contamination of these persistent organic pollutants as affected by effluent irrigation was characterized by the dominant accumulation of high-molecular-weight PAHs (HMW-PAHs). In the case study, concentration of benzo[a]pyrane (BaP, 45.6 ng/g), indeno[1,2,3-cd]pyrene (IcP, 86.3 ng/g), benzo[g,h,i]perlene (BgP, 66.9 ng/g) could exceed the limits of the soil quality standard for biodegraded soils. In identification of the sources, the IcP/BgP values of PAHs in soils were more close to that in air particulates from coal/coke source (1.09+/-0.03 ng/g) [Dickhut RM, Canuel EA, Gustafson KE, Liu K, Arzayus KM, Walkers E, et al. Automotive sources of carcinogenic polycyclic aromatic hydrocarbons associated with particulate matter in the chesapeake bay region. Environ Sci Technol 2000;34:4635-40]. Therefore, both of the PAHs residues in effluents and emission from a nearby coal/coke plant were responsible. Also in this case study, low levels of the OCPs were observed and were not of significant concern in this wastewater irrigation area. Among the different OCPs analyzed, DDTs (mean 8.41 ng/g) and HCHs (mean 2.91 ng/g) were the major components. From the ratios of DDT/DDTs and beta-HCH/HCHs, it indicated that OCPs residues should be from historical usage.

Agriculture↗
PubMed2004

Reproducibility of internal atrial defibrillation threshold in paroxysmal and persistent atrial fibrillation.

BACKGROUND: Several pharmacological or technical factors may affect atrial defibrillation threshold (ADFT) for internal cardioversion (ICV) in the treatment of atrial fibrillation (AF). METHODS: We evaluated the reproducibility of ADFT in lone paroxysmal (electrically induced AF, 10 pts, 51+/-4 years) or persistent AF (15 pts, 64+/-7 years). The AF pattern (F-F interval) was characterised before each ICV attempt. A first step-up synchronised ICV test (ICV1, biphasic shock waveform 6 ms/6 ms) with increasing energy levels from 0.2 to 20 J was performed by a dual-lead defibrillation system (right atrium-coronary sinus configuration) connected to an external cardioverter defibrillator. After 30 min of stable sinus rhythm, a new sustained AF was induced (>20 min duration) and ICV protocol was repeated (ICV2). The AF cycle length was recorded for 30 s from the lateral wall of right atrium in basal condition and before each cardioversion attempt. RESULTS: The mean values of AF cycle length before a successful shock were similar in both AF populations (paroxysmal AF: pre-ICV1 175+/-21 ms vs pre-ICV2 181+/-20 ms (p=NS); persistent AF pre-ICV1 194+/-25 ms vs pre-ICV2 202+/-15 ms (p=NS)). No significant differences were observed between the two successful ICV tests concerning intensity, energy and impedance levels. The value of ADFT energy was reproducible in paroxysmal AF population (SD differences 1.2, coefficient of variability 9.6%). In persistent AF group only the impedance was reproducible (SD differences 2.6 Omega, coefficient of variability 4.5%), but not the energy requirements (SD differences 9.6, coefficient of variability 44.3%). CONCLUSIONS: ADFT is reproducible in paroxysmal AF patients, while a high coefficient of variability is present in persistent AF, possibly related to different patterns of re-entrant circuits in the reinduced AF. This observation is important in order to evaluate factors influencing ICV-ADFT correctly in AF patients.

Aged↗
PubMed2004

Long-term persistent lymphopenia in hematopoietic stem cell donors after donation for donor lymphocyte infusion.

OBJECTIVES: To analyze the consequences of lymphocyte donations on lymphopoiesis in donors having previously undergone hematopoietic stem cell collection for allogeneic stem cell transplantation. METHODS: Repeated analysis of leukocyte subsets in the peripheral blood of 76 hematopoietic stem cell donors undergoing lymphocyte donation(s) for DLI. RESULTS: Grade I/II lymphopenia was present in 22 donors (29%) just before first apheresis for lymphocyte collection, demonstrating that former stem cell donation induced prolonged lymphopenia in a subset of donors. The monocytic lineage was not affected. Older age and history of PBSC harvest constituted 2 independent factors of lymphopenia, but had no influence on monocytopenia. The first apheresis induced lymphopenia in 36 donors (47%) and monocytopenia in 23 donors (39%). Lymphopenia before first apheresis and prior history of PBSC harvest were independent factors of apheresis-induced lymphopenia while those factors had no influence on monocytopenia. A time-dependent decrease in lymphocyte counts was observed in donors undergoing repeated aphereses, resulting in persistent and prolonged lymphopenia in 50% of donors. No persistent monocytopenia over time and aphereses was observed. Kaplan-Meier estimate of the risk to develop persistent lymphopenia after multiple aphereses was 21% +/- 6% at 2 months, 38% +/- 8% at 4 months, and 64% +/- 10% at 12 months. After Cox regression analysis, previous PBSC harvest remained the unique factor associated with the risk for persistent lymphopenia. CONCLUSIONS: Monitoring the potential long-term effects of repeated aphereses in hematopoietic stem cell donors appears important. Selecting young bone marrow donors for subsequent DLI significantly reduces the risk for acute and prolonged lymphopenias.

Adolescent↗
PubMed2004

Persistence of a Staphylococcus aureus small-colony variant under antibiotic pressure in vivo.

Staphylococcus aureus small-colony variants (SCVs) have been implicated in chronic and persistent infections. Bovine mastitis induced by S. aureus is an example of an infection difficult to eradicate by conventional antimicrobial therapies. In this study, the ability to colonize mouse mammary glands and persist under antibiotic treatment was assessed for S. aureus Newbould and an isogenic hemB mutant, which exhibited the classical SCV phenotype. The hemB mutant showed a markedly reduced capacity to colonize tissues. However, although the hemB mutant was as susceptible as S. aureus Newbould to cephapirin in vitro, it was over a 100 times more persistent than the parental strain in the mammary glands when 1 or 2 mg kg(-1) doses were administrated. These results suggest that, although the hemB mutant has a reduced ability to colonize mammary glands, the SCV phenotype may account for the persistence of S. aureus under antibiotic pressure in vivo.

Animals↗
PubMed2005

Long persistence of rigor mortis at constant low temperature.

We studied the persistence of rigor mortis by using physical manipulation. We tested the mobility of the knee on 146 corpses kept under refrigeration at Torino's city mortuary at a constant temperature of +4 degrees C. We found a persistence of complete rigor lasting for 10 days in all the cadavers we kept under observation; and in one case, rigor lasted for 16 days. Between the 11th and the 17th days, a progressively increasing number of corpses showed a change from complete into partial rigor (characterized by partial bending of the articulation). After the 17th day, all the remaining corpses showed partial rigor and in the two cadavers that were kept under observation "à outrance" we found the absolute resolution of rigor mortis occurred on the 28th day. Our results prove that it is possible to find a persistence of rigor mortis that is much longer than the expected when environmental conditions resemble average outdoor winter temperatures in temperate zones. Therefore, this datum must be considered when a corpse is found in those environmental conditions so that when estimating the time of death, we are not misled by the long persistence of rigor mortis.

Cryopreservation↗
PubMed2004

Sequential study of antigen persistence and concomitant inflammatory reactions relative to side-effects and growth of Atlantic salmon (Salmo salar L.) following intraperitoneal injection with oil-adjuvanted vaccines.

The persistence of antigens at the injection site (area around pyloric caeca and spleen), concomitant inflammatory reaction and granuloma development were monitored at 3, 6 and 12 months following intraperitoneal injection with multivalent, oil-adjuvanted vaccines in Atlantic salmon. Parallel assessment of side-effect profiles and growth rate were also performed. Antigen persistence was examined by use of a monoclonal antibody that recognises Aeromonas salmonicida lipopolysaccharide in an immunohistochemical method for in situ identification of bacteria or bacterial fragments. The inflammatory reaction was monitored using standard histological techniques. The amount of persistent antigens and size of inflammation/adhesions were estimated semi-quantitatively. A steady decrease in the quantity of antigens at the injection site was observed from 3 to 12 months. Antigens were consistently found in inflamed tissues located in the pancreatic region. The size of inflammation increased during the first 6 months but declined thereafter. These findings suggest that persistent antigens at the injection site may act as inflammatory stimulants that induce and perpetuate the inflammatory reaction, eventually leading to adverse side-effects.

Adjuvants, Immunologic↗
PubMed2006

Persistence of betanodavirus in Barramundi brain (BB) cell line involves the induction of Interferon response.

The BB cell line derived from the brain tissue of a barramundi (Lates calcarifer) that survived nervous necrosis virus (NNV) infection is persistently infected with NNV. To elucidate whether interferon (IFN) plays a role in the mechanism of NNV-persistent infection in BB cell line, a virus-negative control cell line was obtained by treating BB cells with NNV-specific rabbit antiserum for 5 subcultures. After the treatment, NNV titer or RNA or capsid protein was no longer detected in the cured BB (cBB) cells. Expression of Mx gene, encoding a type I IFN-inducible antiviral protein, was found in BB cells and cBB cells following NNV infection, but not in NNV-free cBB cells. Moreover, expression of Mx gene and antiviral activity against NNV were induced in cBB cells by the treatment with MAb-neutralized BB cell supernatant. Furthermore, NNV persistent infection was induced again in cBB cell culture if multiplicity of infection (MOI) was low (< or = 1). These experimental results indicated that IFN-like cytokines existed in the culture supernatant of BB cells, and IFN-induced response played an important role in protecting the majority of cells from virus lytic infection and regulating NNV persistence in the BB cell line.

Actins↗
PubMed2005

Persistent smokers after myocardial infarction: a group that requires special attention.

BACKGROUND: Despite the detrimental effects of smoking on the cardiovascular system, a significant number of patients with coronary heart disease continue to smoke. We aimed to record compliance to medication and attitude towards recommended lifestyle changes in patients who suffered from myocardial infarction (MI) and continued to smoke after the coronary event. METHODS: A total of 1011 consecutive patients (<75 years) with a history of MI (>6 months) were recruited during the period 2000-2003 from the outpatient cardiology clinic of a district general hospital. All patients were interviewed and blood was taken for lipid measurements. Glycosylated haemoglobin (HbA(1 c)) was also measured in all diabetics. RESULTS: Three hundred and twenty-nine (32.5%) patients reported smoking at interview, while 338 (33.5%) were ex-smokers of whom 278 (45.8% of all smokers) had quit smoking after MI and 344 (34%) had never smoked. Persistent smokers had significantly lower high-density lipoprotein cholesterol levels than nonsmokers (1.03+/-0.28 vs. 1.09+/-0.29 mmol/l, p=0.001). Persistent smokers with diabetes had poorer glycaemic control than nonsmoker diabetic patients as indicated by HbA(1c) levels (8+/-1.7% vs. 7.2+/-1.3%, p=0.001). Fewer persistent smokers were taking hypolipidaemic drugs than nonsmokers (31% vs. 40.3%, p=0.005). Finally, persistent smokers were less frequently performing regular exercise than nonsmokers (42% vs. 51%, p=0.008). CONCLUSIONS: Patients who remain smokers after MI have a more negative attitude towards health aspects, are less compliant with their medications, and therefore constitute a high-risk subgroup, which requires special attention and should be professionally encouraged and supported to stop smoking.

Adult↗
PubMed2004

Persistent HPV infection in postmenopausal age women.

OBJECTIVE: Persistence of human papillomavirus (HPV) is associated with an increased risk of developing cervical SIL and cancer in young women. Because this association in older, postmenopausal age women has received little attention, we evaluated persistence of HPV among women in this age group. METHODS: Women (n=105) ages 45-64 were examined annually for 7 years to evaluate HPV in cervical cytologic specimens. PCR, dot blot hybridization and DNA sequencing were used to detect HPV types. RESULTS: The cumulative prevalence of HPV was 34%, and 24% had HPV high-risk oncogenic types which are associated with genital cancers. The most common oncogenic types were HPV-16 (72%) and HPV-31 (16%). The persistence rate of HPV infection was 16%. No specific risk factors were associated with repeat viral positivity. CONCLUSION: Postmenopausal women are infected with persistent oncogenic HPV at a substantial rate, supporting the need for continued screening in postmenopausal women to detect preneoplastic genital lesions.

Age Factors↗
PubMed2005

Closure of persistent tracheocutaneous fistula following "starplasty" tracheostomy in children.

OBJECTIVE: The "starplasty" technique of pediatric tracheostomy was introduced in 1990 as an alternative pediatric tracheostomy technique associated with several advantages. The only apparent drawback of this technique is the higher incidence of persistent tracheocutaneous fistula following decannulation. Several methods have been proposed for closure of persistent tracheocutaneous fistula in children, including fistulectomy with primary closure and fistulectomy with healing by secondary intent. Some authors advocate placement of a drain at the time of primary closure. We present our experience with closure of persistent tracheocutaneous fistula following starplasty in children over the past 15 years. METHODS: Ninety-six starplasty procedures were performed on 96 children from 1990 to present, all by the senior author or under the guidance of the senior author. Twenty-eight of these children have been decannulated. Three fistulas closed spontaneously following decannulation. Of the remaining 25 children, 13 have undergone surgical closure of the tracheocutaneous fistula by the senior author. All tracheocutaneous fistula closures were performed as a fistulectomy with primary closure in three layers. Drains were not used in any of the patients. RESULTS: There were three minor complications in the postoperative period (wound infection and airway granuloma) and no major complications. None of the patients have experienced any degree of airway stenosis and there was no need for a repeat tracheotomy in any of the tracheocutaneous fistula closure patients. The cosmetic results were deemed to be good. CONCLUSIONS: "Starplasty" is a safe, reliable pediatric tracheostomy technique that has been shown to decrease the incidence of perioperative morbidity and mortality. The only drawback appears to be a high incidence of postoperative tracheocutaneous fistula. Our method of persistent tracheocutaneous fistula closure following starplasty is safe and effective, with no major complications and no incidence of postoperative airway narrowing.

Child↗
PubMed2006

Left atrial ablation versus biatrial ablation for persistent and permanent atrial fibrillation: a prospective and randomized study.

OBJECTIVES: The aim of this study was to compare--in patients with persistent and permanent atrial fibrillation (AF)--the efficacy and safety of left atrial ablation with that of a biatrial approach. BACKGROUND: Left atrium-based catheter ablation of AF, although very effective in the paroxysmal form of the arrhythmia, has an insufficient efficacy in patients with persistent and permanent AF. METHODS: Eighty highly symptomatic patients (age, 58.6 +/- 8.9 years) with persistent (n = 43) and permanent AF (n = 37), refractory to antiarrhythmic drugs, were randomized to two different ablation approaches guided by electroanatomical mapping. A procedure including circumferential pulmonary vein, mitral isthmus, and cavotricuspid isthmus ablation was performed in 41 cases (left atrial ablation group). In the remaining 39 patients (biatrial ablation group), the aforementioned approach was integrated by the following lesions in the right atrium: intercaval posterior line, intercaval septal line, and electrical disconnection of the superior vena cava. RESULTS: During follow-up (mean duration 14 +/- 5 months), AF recurred in 39% of patients in the left atrial ablation group and in 15% of patients in the biatrial ablation group (p = 0.022). Multivariable Cox regression analysis showed that ablation technique was an independent predictor of AF recurrence during follow-up. CONCLUSIONS: In patients with persistent and permanent AF, circumferential pulmonary vein ablation, combined with linear lesions in the right atrium, is feasible, safe, and has a significantly higher success rate than left atrial and cavotricuspid ablation alone.

Atrial Fibrillation↗
PubMed2004

Levocetirizine improves quality of life and reduces costs in long-term management of persistent allergic rhinitis.

BACKGROUND: Allergic Rhinitis and its Impact on Asthma in collaboration with the World Health Organization initiative reclassified allergic rhinitis, like asthma, by duration and severity. The Xyzal in Persistent Rhinitis Trial is the first large, long-term clinical trial studying patients with persistent rhinitis as defined by Allergic Rhinitis and its Impact on Asthma. OBJECTIVES: Two primary objectives were defined: comparison of the Rhinoconjunctivitis Quality of Life Questionnaire overall score and Total 5 Symptoms Score (rhinorrhea, sneezing, nasal congestion, and nasal and ocular pruritus) over a period of 4 weeks between levocetirizine 5 mg and placebo. Secondary endpoints included similar evaluations at 1 week and 3, 4.5, and 6 months, summary scores for a general health status questionnaire (Medical Outcomes Survey Short Form 36), a pharmacoeconomic assessment, comorbidities, and a safety evaluation. METHODS: The Xyzal in Persistent Rhinitis Trial was a 6-month double-blind, placebo-controlled, multicenter, multinational trial in 551 patients. Adults with persistent rhinitis sensitized to both grass pollen and house dust mite were randomized to receive levocetirizine 5 mg/d or placebo. RESULTS: A total of 421 patients completed the full study. Levocetirizine significantly improved both the Rhinoconjunctivitis Quality of Life Questionnaire overall score and the Total 5 Symptoms Score from week 1 to 6 months (all P values <.001). Medical Outcomes Survey Short Form 36 summary scores were also improved in the levocetirizine group compared with the placebo group. Treatment cessation because of lack of effect, comorbidities, and overall costs of disease, and comorbidities per working patient per month (160.27 vs 108.18) were lower in the levocetirizine group. CONCLUSION: Levocetirizine was shown to improve quality of life and symptoms and to decrease the overall costs of the disease over the 6-month treatment period.

Adolescent↗
PubMed2005

Understanding mild persistent asthma in children: the next frontier.

Limitations in asthma prevalence studies and difficulties in diagnosing pediatric asthma lead to uncertainty over the full extent of mild persistent asthma in children and adolescents. Although recent surveys have reported that the majority of pediatric patients with asthma in the United States and Europe have symptoms consistent with mild disease, these surveys have limitations in design. Thus, the true prevalence of mild asthma remains unknown. It is unclear whether children with mild persistent asthma progress to more severe asthma, but the risk of severe asthma exacerbations seems to be unrelated to the symptom severity. Clinical studies restricted to pediatric patients with mild asthma are limited, but available data do suggest substantial morbidity of mild persistent asthma in this population and support inhaled corticosteroid intervention. There is a need for further investigation into the true prevalence of mild persistent asthma in children and adolescents, and optimal treatment.

Adolescent↗
PubMed2006

Persistence, adherence, and effectiveness of combination therapy among adult patients with asthma.

BACKGROUND: Limited evidence exists on adherence and effectiveness of combination therapy (inhaled corticosteroids and long-acting beta(2)-agonists in the same inhaler) in asthma. OBJECTIVE: To compare persistence, adherence, and effectiveness between patients with asthma 16 to 44 years old starting combination or concurrent therapies (inhaled corticosteroids and long-acting beta(2)-agonists in 2 different inhalers). METHODS: This retrospective 1-to-1 matched cohort included newly treated asthmatics with either a combination or concurrent therapy selected from the Régie de l'assurance maladie du Québec database between 1999 and 2002. Persistence was determined by Kaplan-Meier and Cox regression analyses. Adherence was estimated by the number of prescriptions filled during the first year and compared between the 2 drug regimens using a linear regression model. Treatment effectiveness to reduce the rate of moderate to severe asthma exacerbations was estimated with Poisson regression models. RESULTS: Persistence fell to 10% and 5% after 12 months for combination and concurrent users, respectively. Combination users were found to be 17% less likely to stop their treatment (adjusted hazard ratio, 0.83; 95% CI, 0.78, 0.88) and filled on average 0.9 more prescription per year than concurrent users (P = .0001). Combination users were also found to be 17% less likely to have a moderate to severe asthma exacerbation (adjusted rate ratio, 0.83; 95% CI, 0.75, 0.91). CONCLUSION: The observed differences in treatment persistence and adherence were found to be associated with a reduction in the rate of moderate to severe asthma exacerbations among combination users. CLINICAL IMPLICATIONS: Combination therapy might be preferred to concurrent therapy for patients with asthma with low adherence to controller therapies.

Administration, Inhalation↗
PubMed2007

Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of school-aged children.

OBJECTIVE: To identify eating and activity factors associated with school-aged children's onset of overweight and persistent overweight. DESIGN: Data were gathered at four time points between kindergarten entry and spring of third grade. Children were directly weighed and measured and categorized as not overweight (<95th percentile of body mass index) or overweight (> or =95th percentile body mass index); parents were interviewed by telephone or in person. SUBJECTS/SETTING: Subjects were participants in the Early Childhood Longitudinal Study-Kindergarten Cohort, a nationally representative sample of children who entered kindergarten during 1998-1999. Children who weighed <2,000 g at birth, received therapeutic services before kindergarten, skipped or repeated a grade, or without complete height and weight data were excluded, resulting in 8,459 participants. Children with intermittent overweight were not examined (n=459); analyses addressed 8,000 children. MAIN OUTCOME MEASURES: Three mutually exclusive groups of children were identified: never overweight, overweight onset, and persistent overweight. STATISTICAL ANALYSES PERFORMED: Multilevel, multivariate logistic regression analyses estimated the effects of eating and activity factors on the odds of overweight onset and persistent overweight above child sex, race, and family socioeconomic status. RESULTS: Children who watched more television (odds ratio [OR] 1.02) and ate fewer family meals (OR 1.08) were more likely to be overweight for the first time at spring semester of third grade. Children who watched more television (OR 1.03), ate fewer family meals (OR 1.08), and lived in neighborhoods perceived by parents as less safe for outdoor play (OR 1.32) were more likely to be persistently overweight. Child aerobic exercise and opportunities for activity were not associated with a greater likelihood of weight problems. CONCLUSIONS: This study supports theories regarding the contributions of television watching, family meals, and neighborhood safety to childhood weight status. When working with families to prevent and treat childhood weight problems, food and nutrition professionals should attend to children's time spent with screen media, the frequency of family mealtimes, and parents' perceptions of neighborhood safety for children's outdoor play.

Body Mass Index↗
PubMed2005

Lipid tear deficiency in persistent dry eye after laser in situ keratomileusis and treatment results of new eye-warming device.

PURPOSE: To determine whether lipid tear deficiency is a significant pathogenic factor in persistent dry eyes after laser in situ keratomileusis (LASIK). SETTING: Ocular Surface Center, Miami, Florida, USA. METHODS: Thirty-four eyes of 17 patients (mean 46.35 years +/- 11 [SD]) complaining of persistent dryness more than 12 months after LASIK were prospectively studied by symptom scoring and kinetic analysis of tear interference image, tear breakup time, and fluorescein clearance test. Once patients had been clear of inflammation and treated for aqueous tear deficiency, lipid tear deficiency was further confirmed and treated with Eyefeel (Kao, Inc.), an eye-warming device, 4 times daily for 4 weeks. RESULTS: Sixteen patients were asymptomatic before LASIK but dryness persisted for 41 +/- 19.3 months. Delayed tear clearance was observed in 15 patients (88.2%) and floppy lids in 12 patients (70.5%). Aqueous tear deficiency was reconfirmed in 16 eyes (53.3%). After Eyefeel treatment, there was a subjective improvement of ocular surface diseases index from 60.6 +/- 10.6 to 25.8 +/- 18.5 (P = .0007). Tear breakup time was improved from 2.4 +/- 3.9 seconds to 7.9 +/- 3.6 seconds (P = .004). There was a tear interference pattern change from a vertical lipid tear deficiency to a horizontal normal in 7 eyes. There was a mean lipid spread time improvement from 1.3 +/- 0.4 sec to 0.8 +/- 0.4 sec (P = .001), and there was a mean lipid thickness improvement from 63.5 +/- 23 nm to 79.5 +/- 27 nm (P = .04). CONCLUSION: Persistent nature of dry eye after LASIK is attributed to in part to delayed tear clearance, undercorrected aqueous tear deficiency, and nonrecognized lipid tear deficiency.

Adult↗