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In this chapter, major trends in the development of metacognitive competences and its relationship to various aspects of cognitive/academic performance are described, with a focus on metamemory and reading comprehension. In a first step, classic and more recent theoretical models of metacognitive competences are presented that elaborate on the development of the declarative and procedural components of metacognition. The declarative component focuses on explicit and verbalizable knowledge, whereas the procedural component deals with monitoring and self-regulation processes. Common measures of both components are presented next, followed by a description of major developmental trends, as indicated by cross-sectional and longitudinal studies on developmental differences and changes in declarative knowledge, memory and comprehension monitoring, and self-regulation. Furthermore, research findings illustrating the relationship between metacognitive competences and cognitive performance in childhood and adolescence are presented for the domains of memory and reading comprehension, respectively. The final section focuses on educational implications of research on metacognition, underlining the importance of teacher behavior in the classroom and special instruction programs for students' acquisition of metacognitive competences.

Background Acute kidney injury (AKI) occurs frequently in critically ill patients and is associated with adverse outcomes. Cellular mechanisms underlying AKI and kidney cell responses to injury remain incompletely understood. Methods We performed single-nuclei transcriptomics, bulk transcriptomics, molecular imaging studies, and conventional histology on kidney tissues from 8 individuals with severe AKI (stage 2 or 3 according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria). Specimens were obtained within 1–2 h after individuals had succumbed to critical illness associated with respiratory infections, with 4 of 8 individuals diagnosed with COVID-19. Control kidney tissues were obtained post-mortem or after nephrectomy from individuals without AKI. Results High-depth single cell-resolved gene expression data of human kidneys affected by AKI revealed enrichment of novel injury-associated cell states within the major cell types of the tubular epithelium, in particular in proximal tubules, thick ascending limbs, and distal convoluted tubules. Four distinct, hierarchically interconnected injured cell states were distinguishable and characterized by transcriptome patterns associated with oxidative stress, hypoxia, interferon response, and epithelial-to-mesenchymal transition, respectively. Transcriptome differences between individuals with AKI were driven primarily by the cell type-specific abundance of these four injury subtypes rather than by private molecular responses. AKI-associated changes in gene expression between individuals with and without COVID-19 were similar. Conclusions The study provides an extensive resource of the cell type-specific transcriptomic responses associated with critical illness-associated AKI in humans, highlighting recurrent disease-associated signatures and inter-individual heterogeneity. Personalized molecular disease assessment in human AKI may foster the development of tailored therapies.

Gifted underachievers perform worse in school than would be expected based on their high intelligence. Possible causes for underachievement are low motivational dispositions (need for cognition) and metacognitive competences. This study tested the interplay of these variables longitudinally with gifted and non-gifted students from Germany (N = 341, 137 females) in Grades 6 (M = 12.02 years at t1) and 8 (M = 14.07 years). Declarative and procedural metacognitive competences were assessed in the domain of reading comprehension. Path analyses showed incremental effects of procedural metacognition over and above intelligence on the development of school achievement in gifted students (β = .139). Moreover, declarative metacognition and need for cognition interactively predicted procedural metacognition (β = .169), which mediated their effect on school achievement.

The present longitudinal study focused on domain-general predictors of arithmetics in elementary school. The role of executive functions (EFs) and fine motor skills for the prediction of arithmetic skills in 1st/2nd grade was examined. Data from N = 173 kindergarten children were included. Age, socioeconomic status, fluid intelligence, and processing speed were controlled. Regression analyses revealed that fine motor skills predicted arithmetic skills. When EFs were added, fine motor skills did not contribute to the prediction of arithmetic skills. Visuospatial working memory and interference control were significant predictors. Findings indicate an important role of EF as predictors of arithmetic skills.

The guidelines, which were first published in 2012, were fundamentally revised by a panel of experts from 9 medical and psychological societies and published on the website of the Association of the Scientific Medical Societies in Germany in December 2019 (AWMF registration number 051-029). The guidelines contribute to interdisciplinary quality assurance when assessing applicants for insurance or other compensation benefits who claim psychological or psychosomatic illnesses with resulting functional disorders. The guidelines are divided into 3 separate parts: part I describes specific aspects of the expert examination, part II describes the criteria for assessing occupational performance capacity in terms of different legal fields and part III deals with questions of causality in cases of claimed posttraumatic mental disorders.Die erstmals 2012 publizierte Leitlinie wurde durch ein Expertengremium von insgesamt 9 medizinischen und psychologischen Fachgesellschaften grundlegend überarbeitet und im Dezember 2019 auf der Website der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. publiziert (AWMF-Registernummer 051-029). Sie dient der interdisziplinären Qualitätssicherung bei der Begutachtung von Antragstellern auf Versicherungs- oder sonstige Entschädigungsleistungen, die psychische oder psychosomatische Erkrankungen mit hierdurch bedingten Funktionsstörungen geltend machen. Sie gliedert sich in 3 getrennte Teile: Teil I nennt spezifische Aspekte der gutachtlichen Untersuchung, Teil II beschreibt die Kriterien zur Begutachtung der beruflichen Leistungsfähigkeit vor dem Hintergrund unterschiedlicher Rechtsgebiete, Teil III beschäftigt sich mit Kausalitätsfragen bei geltend gemachten Traumafolgestörungen.

Chevron osteotomy with consecutive fixation is a commonly performed operative treatment option for hallux valgus deformities. The present retrospective study aims to compare the clinical and radiological outcome of novel bioabsorbable magnesium screw fixation with metal screw and Kirschner wire fixation. Eighteen matched triplets were assembled according to the following criteria: female gender, age difference less than 5 years, date of operation within 4 months, difference in preoperative intermetatarsal angle less than 5°, and equal experience of the first and second surgeon. These patients, between 18 and 85 years of age and with a minimum follow-up period of 12 months, were invited to a follow-up examination, of which only 16 matched triplets of patients entirely kept the appointment. Thus, 48 feet of 44 patients were clinically evaluated using the American Orthopaedic Foot & Ankle Society scale, Foot Function Index, University of California and Los Angeles Activity Score, as well as a visual analogue scale for pain, satisfaction, cosmetic results, and functional impairment. Radiographical assessment included measuring intermetatarsal angle and first metatarsophalangeal angles. All occurring complications and revision surgeries were noted. Significant differences were observed for postoperative intermetatarsal angle between magnesium screw and pin fixation (p = 0.009). Moreover, patients receiving magnesium screw were significantly more prone to undergo the same procedure again (p = 0.03). In conclusion, if the advantages of bioabsorbable magnesium screws outweigh the drawbacks of increased costs and a higher surgical demand, this implant might serve as possible chevron osteotomy fixation method. Compression screws and Kirschner wires also show comparable satisfactory outcomes. LEVEL OF EVIDENCE: III retrospective comparative study.

Achievement in different domains, such as academics, music, or visual arts, plays a central role in all modern societies. Different psychological models aim to describe and explain achievement and its development in different domains. However, there remains a need for a framework that guides empirical research within and across different domains. With the talent-development-in-achievement-domains (TAD) framework, we provide a general talent-development framework applicable to a wide range of achievement domains. The overarching aim of this framework is to support empirical research by focusing on measurable psychological constructs and their meaning at different levels of talent development. Furthermore, the TAD framework can be used for constructing domain-specific talent-development models. With examples for the application of the TAD framework to the domains of mathematics, music, and visual arts, the review provided supports the suitability of the TAD framework for domain-specific model construction and indicates numerous research gaps and open questions that should be addressed in future research.

The role of motor coordination and executive functions in kindergarten for reading/spelling in 1st/2nd grade was examined in the light of other domain-general predictors. N = 173 children were included in the final analyses. A structural equation model with motor coordination, fluid intelligence, age and self-concept as predictors of reading/spelling fitted well. When EF were included, motor coordination and fluid intelligence were not associated with reading/spelling performance. A final model with EF, age and self-concept fitted best. Findings indicate an important role of EF for the development of reading and spelling and for the link between motor coordination and reading/spelling.

Hypokalemia contributes to the progression of chronic kidney disease, although a definitive pathophysiological theory to explain this remains to be established. K+deficiency results in profound alterations in renal epithelial transport. These include an increase in salt reabsorption via the Na+-Cl−cotransporter (NCC) of the distal convoluted tubule (DCT), which minimizes electroneutral K+loss in downstream nephron segments. In experimental conditions of dietary K+depletion, punctate structures in the DCT containing crucial NCC-regulating kinases have been discovered in the murine DCT and termed “WNK bodies,” referring to their component, with no K (lysine) kinases (WNKs). We hypothesized that in humans, WNK bodies occur in hypokalemia as well. Renal needle biopsies of patients with chronic hypokalemic nephropathy and appropriate controls were examined by histological stains and immunofluorescence. Segment- and organelle-specific marker proteins were used to characterize the intrarenal and subcellular distribution of established WNK body constituents, namely, WNKs and Ste20-related proline-alanine-rich kinase (SPAK). In both patients with hypokalemia, WNKs and SPAK concentrated in non-membrane-bound cytoplasmic regions in the DCT, consistent with prior descriptions of WNK bodies. The putative WNK bodies were located in the perinuclear region close to, but not within, the endoplasmic reticulum. They were closely adjacent to microtubules but not clustered in aggresomes. Notably, we provide the first report of WNK bodies, which are functionally challenging structures associated with K+deficiency, in human patients.

Cognitive and motor coordination skills of children with and without motor coordination impairments were examined with a one-year follow-up investigation. Initially, children were between 4 and 6 years old. Age-appropriate tests of executive functions (updating, switching, inhibition, interference control), motor coordination (the Movement Assessment Battery for Children-2) and fitness (the Körperkoordinations-Test für Kinder) were administered in two consecutive years. Several background variables (age, socioeconomic status, medical support, clinical interventions, leisure activities) and potential moderators (nonverbal intelligence, reaction time, visual perception) were controlled. The matched sample consisted of 48 control children and 48 children with motor coordination impairments. The children's executive functions dramatically improved during the one-year period. With regard to motor coordination performance, half of the impaired children caught up to the control children's level ("remission group"), while the remaining half showed no improvement ("persisting group"). Compared to the persisting group, the children in the remission group showed markedly better interference control at both measurement points. The correlation between executive functions and motor coordination is significant in the persisting group, but not in the remission group. The results of the study are discussed in the light of the role of executive functions, especially inhibition processes, for the automatization of motor coordination tasks.

Background: Despite increasing popularity of the Foot Function Index (FFI), normative values are still unavailable for this self-administered score. This study was designed to generate age- and sex-related normative values for the FFI-total and for both subscales FFI-pain and FFI-disability. Methods: We used the cross-cultural adapted and validated German version of the FFI to generate a data pool using the results of 625 individuals, including staff and visitors to our hospital and excluding persons scheduled for foot surgery or in after-treatment. Results: Mean values for FFI-total were calculated: 15.3 points (95% confidence interval [CI], 13.3-16.9), 14.9 points for FFI-pain (CI, 13.3-16.5), and 15.6 for FFI-disability (CI, 13.8-17.4). Results showed higher values for FFI-total, FFI-pain, and FFI-disability for individuals older than 40 years. In general, normative values showed a tendency for higher values with age. A slightly inconsistent distribution over different age groups with a peak for individuals in their 40s and 50s was observed, especially for FFI-pain. Men had better scores than women. Individuals with previous surgery showed lower scores in their respective score. Conclusions: Our data calculated normative values for a German-speaking cohort for FFI-total as well as for both subscales FFI-pain and FFI-disability. Our data quantified the increase of FFI-total, FFI-pain, and FFI-disability normative values with age but also showed a slightly inconsistent distribution of normative values over all age groups. We demonstrated higher normative values for women and slightly higher normative values for individuals with previous foot or ankle surgery. Level of Evidence: II, prospective comparative study

Parent trainings constitute an effective method to target aspects of parenting in child and adolescent psychiatric and psychotherapeutic care. Past research has mainly been conducted in outpatient contexts, with parents of children with externalizing disorders and often included only small sample sizes. The aim of the current study was first to assess the effectiveness of a novel parent training which is characterized by a universal approach, an open group concept, and short duration, and second to identify variables that have an influence on the effectiveness. A sample of n = 151 parent-child dyads treated in an inpatient clinic was included in the study and randomly assigned to a treatment group and a waiting-list control group. As dependent measures served child behavior problems, dysfunctional parenting, parental mental health, and parental self-efficacy measured with parent-rated questionnaires prior to the training, post training and 3 months after discharge of the clinic. Additionally, a parent-child-interaction observation was conducted and rated by blind raters. Results indicated a general inpatient treatment effect on all dependent measures assessed with questionnaires. An additional effect of the parent training was only shown for parenting and parental mental health with the treatment group revealing better outcomes post training and at follow-up. No effects were found for the measures assessed by interaction observation. Out of a number of variables, only a low monthly income was associated with a higher reduction of dysfunctional parenting. Results indicate that parent training does not contribute additionally to standard inpatient care with respect to child behavior, but does have an influence on parental well-being, which might have a positive effect on the long run.

Effects of full-time ability grouping on students' academic self-concept (ASC) and mathematics achievement were investigated in the first 3 years of secondary school (four waves of measurement; students' average age at first wave: 10.5 years). Students were primarily from middle and upper class families living in southern Germany. The study sample comprised 148 (60% male) students from 14 gifted classes and 148 (57% male) students from 25 regular classes (matched by propensity score matching). Data analyses involved multilevel and latent growth curve analyses. Findings revealed no evidence for contrast effects of class-average achievement or assimilation effects of class type on students' ASC. ASC remained stable over time. Students in gifted classes showed higher achievement gains than students in regular classes. [ABSTRACT FROM AUTHOR]

Research on the development of memory has a long history and constitutes one of the most active research areas in the field of cognitive development. In this article, we first describe major historical developments in the literature on children's memory, focusing on systematic research that began in the late 1960s. We then examine new developments in the field, describing four important lines of inquiry: (a) the development of implicit memory, (b) short- and long-term memory development in infancy, (c) longitudinal research on memory strategies and metamemory, and (d) developmental cognitive neuroscience of memory. Finally, promising lines of future research on memory development are briefly discussed.

IF 6.029; International audience; BackgroundThe prognostic value of lymphocyte infiltration (LI) of colorectal carcinoma (CC) has been demonstrated by several groups. However, no validated test is currently available for clinical practice. We previously described an automated and reproducible method for testing LI and aimed to validate it for clinical use.Patients and methodsAccording to National Institutes of Health criteria, we designed a prospective validation of this biomarker in patients included in the PETACC8 phase III study. Primary objective was to compare percentage of patients alive and without recurrence at 2 years in patients with high versus low LI (#NCT02364024). Associations of LI with patient recurrence and survival were analysed, and multivariable models were adjusted for treatment and relevant factors. Automated testing of LI was performed on virtual slides without access to clinical data.ResultsAmong the 1220 CC patients enrolled, LI was high, low and not evaluable in 241 (19.8%), 790 (64.8%) and 189 (15.5%), respectively. Primary objective was met with a 2-year recurrence rate of 14.4% versus 21.1% in patients with high and low LI, respectively (p = 0.02). Patients with high LI also had better disease free survival (DFS) and overall survival (OS). Tumour stage, grade, RAS status and BRAF status were with LI the only prognostic markers in multivariable analysis for OS. Subgroup analyses revealed that high LI had better DFS and OS in mismatch repair (MMR) proficient patients, and in patients without RAS mutation, but not in MMR deficient and RAS mutated patients.ConclusionAlthough this is the first validation with high level of evidence (IIB) of the prognostic value of a LI test in colon cancers, it still needs to be confirmed in independent series of colon cancer patients.

Objectives Exposure to hexavalent chromium (Cr(VI)) has been primarily studied in chromate production. Here, we measured personal exposure to respirable Cr(VI) together with airborne and urinary Cr and Ni in welders to explore levels and associations between various measures of exposure. Methods Shift concentrations of Cr(VI), Cr, and Ni were measured in respirable welding fumes in 50 men who used either gas metal arc welding (GMAW) (n = 24) or tungsten inert gas welding (TIG) (n = 19) as their major technique. Cr and Ni were determined in pre- and post-shift urine samples. Concentrations below the limit of quantification (LOQ) were multiply imputed. Spearman correlation coefficients (rs) were calculated with 95% confidence intervals (CIs) to explore associations between the exposure variables, and regression models were applied to estimate the effect of the parent metal on the urinary concentration. Results Regarding the respirable Cr(VI), 62% of the measurements were below the LOQ, the 75th percentile was 0.50 µg m-3, and 8 out of 50 (16%) welders exceeded 1 µg m-3. The highest shift concentration that occurred as a result of shielded metal arc welding (SMAW) was 180 µg m-3. The Cr(VI) content in total Cr ranged from 4 to 82% (median 20%), although the concentration correlated with total Cr (rs 0.55, 95% CI 0.46; 0.64). The correlation between Cr(VI) and Ni was weaker (rs 0.42, 95% CI 0.34; 0.51) than that between total Cr and Ni in welding fumes (rs 0.83, 95% CI 0.74; 0.92). Both Cr(VI) and total Cr influenced the urinary Cr concentrations in post-shift samples (P = 0.0008 and P ≤ 0.0001, respectively). The airborne shift exposure was a weaker determinant than the Cr content in pre-shift urine samples, which strongly correlated with post-shift urinary Cr (rs 0.78, 95% CI 0.69; 0.87). Conclusions The Cr(VI) content in total Cr varied considerably in welding fumes. The majority of welders using GMAW or TIG presented with shift concentrations of respirable Cr(VI) below 1 µg m-3. However, very high Cr(VI) concentrations may occur, for example in SMAW. The urinary concentration of total Cr, cannot be used to precisely determine the shift concentration of respirable Cr(VI) in welders.

Background Cognitive Rehabilitation for Alzheimer's disease (AD) is an integrative multimodal intervention. It aims to maintain autonomy and quality of life by enhancing the patients' abilities to compensate for decreased cognitive functioning. Objective We evaluated the feasibility of a group-based Cognitive Rehabilitation approach in mild AD dementia and assessed its effect on activities of daily living (ADL). Methods We included 16 patients with AD dementia in a controlled partial-randomized design. We adapted the manual-guided Cognitive Rehabilitation program (CORDIAL) to a group setting. Over the course of three months, one group received the Cognitive Rehabilitation intervention (n = 8), while the other group received a standardized Cognitive Training as an active control condition (n = 8). ADL-competence was measured as primary outcome. The secondary outcome parameters included cognitive abilities related to daily living, functional cognitive state, and non-cognitive domains, e.g., quality of life. For each scale, we assessed the interaction effect 'intervention by time', i.e., from pre-to post-intervention. Results We found no significant interaction effect of intervention by time on the primary outcome ADL-competence. The interaction effect was significant for quality of life (Cohen's d: -1.43), showing an increase in the intervention group compared with the control group. Conclusions Our study demonstrates the feasibility of a group-based Cognitive Rehabilitation program for patients with mild AD dementia. The Cognitive Rehabilitation showed no significant effect on ADL, possibly reflecting a lack of transfer between the therapy setting and real life. However, the group setting enhanced communication skills and coping mechanisms. Effects on ADL may not have reached statistical significance due to a limited sample size. Furthermore, future studies might use an extended duration of the intervention and integrate caregivers to a greater extent to increase transfer to activities of daily living.

Research in metacognition (Koriat, Ma'ayan, & Nussinson, 2006) suggests bidirectional links between monitoring and control during learning: When self-regulation is goal-driven, monitoring affects control so that increased study time (ST) enhances judgments of learning (JOLs). However, when self-regulation is data-driven, JOLs are based on the feedback from control, and therefore JOLs decrease with ST under the heuristic that ease of encoding is diagnostic of successful recall. Evidence for both types of relationships occurring within the same situation was found for adults. We examined the development of the ability to respond differentially to data-driven and goal-driven variation in ST within the same task. Children in Grades 5 and 6 exhibited a positive ST-JOL relationship for goal-driven regulation and a negative relationship for data-driven regulation but never in the same task. In contrast, the JOLs and recall of 9th graders and college students yielded differential cosensitivity to data-driven and goal-driven variation. The 5th and 6th graders also evidenced an adult-like pattern of JOLs and recall under a partitioning procedure that helped them in factoring the variation in ST due to data-driven and goal-driven variation in ST. The results are discussed in terms of the metacognitive sophistication needed for considering both types of variation simultaneously in making metacognitive judgments.

The distal soft tissue procedure has evolved into an indispensable additional surgical procedure to increase the corrective effect in hallux valgus surgery. Considering the biomechanical development of hallux valgus deformity, degenerative changes of the soft tissues around the first metatarsophalangeal joint contribute much more to the deformity than changes in the bony structures which can rather be seen as degenerative changes secondary to the deformity. Thus the principles in hallux valgus correction should aim to reverse all pathogenetic steps leading to deformity: release of the contracted lateral soft tissue structures, tightening of the torn-out medial structures and reduction and rebalancing the first metatarsal head onto the sesamoid complex. The scientific discussion over the last decades has clarified the impact of different surgical steps and methods on the efficacy of the lateral release, the risk of creating overcorrection or instability of the joint and the risk of avascular necrosis of the first metatarsal head. According to anatomical and clinical data, a lateral soft tissue release can be combined with a distal metatarsal osteotomy, provided that the osteotomy is performed in a defined safe zone without increasing the risk for avascular necrosis of the first metatarsal head. Transecting the lateral metatarsosesamoid suspensory ligament is the key to a successful lateral release in hallux valgus surgery. Release of the deep transverse metatarsal ligament and the adductor hallucis muscle does not contribute to hallux valgus correction. The lateral short sesamophalangeal ligament and the plantar attachment of the articular capsule should be preserved to avoid possible joint instability. Thus today, the distal soft tissue procedure cannot be seen only as a supplementary surgical procedure in cases where the bony procedure needs additional correction, but rather is an indispensable procedure to restore the physiological situation and function of the first metatarsophalangeal joint.

To explain the phenomenological overlap between dissociation and schizophrenia, a dissociative subtype of schizophrenia has been proposed as a possibility. Dissociation is often believed to be organized on a continuum, although 2 qualitatively different phenomena can be distinguished in theory, research, and clinical practice: (a) states of separation from self or environment (detachment dissociation) and (b) inaccessibility of normally accessible mental contents (compartmentalization dissociation). This study used the Positive and Negative Syndrome Scale (PANSS) and the Association for Methodology and Documentation in Psychiatry module for the interview assessment of dissociation to investigate the relationships between PANSS subscales, detachment dissociation, and compartmentalization dissociation in a sample of 72 patients with schizophrenia. A confirmatory factor analysis sustained the bipartite model, yielding factors that grouped dissociative items around amnesia and depersonalization/derealization. The latter factor also contained identity disturbances and was therefore not entirely consistent with the theoretical formulations of detachment dissociation. It is important to note that the structure of those factors may be influenced by the symptoms of schizophrenia to which they were specifically linked: The factor containing depersonalization/derealization was connected to the positive symptoms subscale of the PANSS, whereas the factor containing amnesia was associated with the negative subscale. Hence, a dichotomy of dissociation is confirmed inasmuch as its subtypes are as distinguishable as PANSS subscales. This has implications on theoretical and clinical levels.

The purpose of the current study was to examine the effectiveness of a workshop for teachers focussing on ADHD. A total of 44 educators answered a short version of the Knowledge of Attention Deficit Disorders Scale (KADDS) and self-report questions before, shortly after, and three month subsequent (follow-up) to a 2.5 hour long workshop. Results showed a significant increase in the educators’ knowledge at post-test, which remained stable in the follow-up. Whereas uncertainties (“don’t-know”-answers) decreased, heterogeneous results were found concerning the number of misconceptions. Educators upgraded their knowledge perception as well as their certainty in dealing with an affected child at post-test. The results show that even a relatively short workshop had a positive and persistent impact on educators’ ADHD expertise, which illustrates the potential of such workshops.

Background: We assessed the long-term results following Keller resection arthroplasty for the treatment of hallux rigidus. We then compared them with alternative surgical methods like cheilectomy, arthrodesis and joint replacement. Methods: Eighty-seven cases of Keller resection arthroplasty for hallux rigidus were reviewed with mean followup of 23 years. Their mean age at time of surgery was 50 years. Analysis included personal clinical evaluation with the AOFAS Hallux Score, quality-of-life assessment using the SF-36, radiographic assessment, pedobarographic evaluation and analysis of the patients' charts to detect any postoperative complications. Results: At the time of followup only five (5%) feet had undergone revision surgery. For all other cases we calculated a mean AOFAS score of 83 points. Sixty-nine of 73 unrevised patients (94%) would opt for this operation again under the same circumstances. SF-36 parameters showed age related normal values. Pedobarographic assessment revealed only moderate weightbearing alterations. Our long-term results compare favorably with published results following arthrodesis, cheilectomy or joint replacement for the treatment of painful hallux rigidus. Clinical results and subjective assessments were very good and complication rates were low compared to competing methods. Conclusion: Keller resection arthroplasty remains a valuable surgical option for the treatment of advanced stages of hallux rigidus with high patient satisfaction, moderate weightbearing alterations and comparable low complication rate in our experience.Level of Evidence: IV, Retrospective Case Series

Recent work on metacognition indicates that monitoring is sometimes based itself on the feedback from control operations. Evidence for this pattern has not only been shown in adults but also in elementary schoolchildren. To explore whether this finding can be generalized to a wide range of age groups, 160 participants from first to eighth grade participated in a study based on a self-paced study time (ST) allocation paradigm. In contrast to previous studies, picture pairs instead of word pairs were used as stimuli to compensate for reduced reading skills in younger participants. Actual ST and judgments of learning (JOLs) made at the end of each study trial were used as core variables. The results are in line with previous findings, in that children's JOLs decreased with increasing ST, suggesting that JOLs were based on the memorizing effort heuristic that easily learned items are more likely to be remembered. Weaker inverse relationship between JOLs and ST was found for the younger children. Overall, these results underline the importance of mnemonic cues in shaping metacognitive feelings not only in adults but also in older children and expose a developmental trend in their use along childhood.

Syndromes with focal overgrowth are sporadic diseases and comprise Proteus syndrome and congenital lipomatous overgrowth, vascular malformations, and epidermal naevi (CLOVE) syndrome, and isolated hemihyperplasia. We describe 3 children classified according to standard criteria with dysregulated growth of various tissues that was excised, together with excess toes, and tumours. Correct classification facilitates diagnosis and operations. Interdisciplinary treatment and follow-up are recommended to prevent disfiguration.

Antineutrophil cytoplasmic autoantibodies (ANCA) are associated with necrotizing crescentic glomerulonephritis (NCGN) and systemic vasculitis. We examined the role of phosphoinositol 3 kinase-gamma isoform (PI3Kgamma) in ANCA-activated neutrophil functions. Further, we tested whether its inhibition protects a mouse model of ANCA NCGN from developing NCGN. We transplanted bone marrow from wild-type mice or PI3Kgamma-deficient mice into myeloperoxidase-deficient mice immunized with myeloperoxidase. Bone marrow from PI3Kgamma(-/-) mice protected against development of the disease. Similarly, bone marrow transplanted from wild-type mice followed by treatment with the specific PI3Kgamma inhibitor AS605240 also protected these mice against NCGN in this model. AS605240 significantly abrogated myeloperoxidase- or proteinase 3-ANCA-stimulated superoxide production in vitro. Furthermore, ANCA-induced degranulation and GM-CSF-stimulated migration in a transwell assay of isolated human neutrophils were also abrogated by the drug. We found that PI3Kgamma plays a pivotal role in ANCA-induced NCGN and suggest that its specific inhibition may provide a novel treatment target.

This longitudinal study explored the importance of kindergarten measures of phonological awareness, working memory, and quantity-number competencies (QNC) for predicting mathematical school achievement in third graders (mean age 8 years 8 months). It was found that the impact of phonological awareness and visual-spatial working memory, assessed at 5 years of age, was mediated by early QNC, which predicted math achievement in third grade. Importantly, and confirming our isolated number words hypothesis, phonological awareness had no impact on higher numerical competencies (i.e., when number words needed to be linked with quantities [QNC Level II and above]) but predicted basic numerical competencies (i.e., when number words were isolated from quantities [QNC Level I]), explaining the moderate relationship between early literacy development and the development of mathematical competencies.

Background: The preoperative diagnostic imaging of peripheral nerve lesions and the postoperative monitoring of microsurgically coapted nerves remain unsolved problems. The aim of this study was to investigate peripheral nerve regeneration after complete neurotmesis with magnetic resonance imaging techniques. Methods: Study groups included 70 rats. Their right sciatic nerve was either cut and left untreated or epineurially coapted. After postoperative days 3, 6, 10, and 14 and then weekly until postoperative day 84, these rats underwent scanning at 4.7 T. T 2 signal intensities of the nerves were analyzed. In parallel, on postoperative days 3, 6, 10, 14, 21, 28, 42, 63, or 84, rats were killed for histologic processing. These findings were related to the corresponding images. Results: After an initial T 2 signal increase of the nerves in both groups, the coapted group demonstrated a major T 2 signal decrease in the distal part of the nerve after postoperative day 21, whereas in the unrepaired group a signal decrease was not observed until postoperative day 42. Differences between the two groups were significant at postoperative days 3, 6, and 28 and thereafter. The signal decrease in the coapted nerves could be correlated to the ingrowth of regenerating axons observed by histology. Moreover, the continuity of coapted nerves or an explicit gap in the unrepaired group was detectable at every time point. Conclusions: This study presents novel magnetic resonance imaging data regarding regeneration after neurotmesis. High-field-strength magnetic resonance imaging has the potential to diagnose a discontinuity within a nerve of interest and monitor its regeneration after coaptation.

The requirement for nodal analysis currently confounds the oncological propriety of focused purely endoscopic resection for early-stage colon cancer and complicates the evolution of innovative alternatives such as natural orifice transluminal endoscopic surgery (NOTES) and its hybrids. Adjunctive sentinel node biopsy (SNB) deserves consideration as a means of addressing this shortfall.Data from two prospectively maintained databases established for multicentric studies of SNB in colon cancer that employed similar methodologies were pooled to establish technique potency selectively in T1/T2 disease (both overall and under optimized conditions) and to project potential clinical impact.Of 891 patients with T1-4, M0 intraperitoneal colon cancer, 225 had T1/T2 disease. Sentinel nodes were either not found or were falsely negative in 18 patients with T1/T2 cancers (8%) as compared with 17% (112/646) in those with T3/T4 disease (P = 0.001). Negative predictive value (NPV) in the former exceeded 95%, while sensitivity [including immunohistochemistry (IHC)] was 81%. In the 193 patients with T1/T2 disease recruited from those centers contributing22 patients, sensitivity was 89% and NPV 97%. Thus, in this cohort, SNB could have correctly prompted localized resection (obviating en bloc mesenteric dissection) in 75% (144) of patients, including 59 with T1 lesions potentially amenable to intraluminal resection alone as their definitive treatment. Forty-four patients (23.4%) would still have conventional resection, leaving three patients (1.6% overall) understaged (11% false-negative rate).These findings support the further investigation of SNB as oncological augment for localized resective techniques. Specific prospective study should pursue this goal.

Platelet function and the clinical course of the disease were prospectively investigated in 29 patients with myeloproliferative disorders. Serial determinations (median: 5 investigations per patient within 17 months) of platelet aggregation, plasma and intraplatelet concentrations of beta-thromboglobulin (beta TG) and platelet factor 4 (PF4), and of fibrinopeptide A (FPA) plasma levels were carried out. In the chronic phase of polycythaemia vera, patients with thrombohaemorrhagic complications during the study period had higher platelet count, more severe platelet aggregation defects, and increased plasma levels of beta TG and FPA compared to patients without complications. However, thrombohaemorrhagic complications were not predicted by changes in these parameters in the individual patient during the chronic disease phase. When patients with chronic myelogenous leukaemia entered blast crisis, bleeding complications were related to thrombocytopenia, impaired platelet function and low intraplatelet concentrations of beta TG and PF4. Cytoreduction by chemotherapy in the chronic phase of CML did not alter beta TG and PF4 plasma levels, whereas treatment of polycythaemia rubra vera by venesection favourably influenced platelet alpha-granule secretion and increased intraplatelet concentrations of beta TG and PF4.

Research on different subtypes of attention deficit hyperactivity disorder (ADHD) yielded inconsistent results regarding the nature of cognitive deficits. Whereas some studies report significant differences between subtypes, others fail to report these differences. In fact, the majority of studies in the field of ADHD does not differentiate between subtypes at all. The present study adopted the cognitive task of negating valence to compare the DSM-defined ADHD combined subtype (ADHD-C; n = 25), the inattentive subtype (ADHD-I; n = 25) and the control group (n = 30). As a main result, children with ADHD-C showed significant impairments compared to children with ADHD-I and the control group on conscious responses-driven by executive function, as well as on unconscious associative tasks. Medical treatment with stimulants positively influenced cognitive performance, although to a different extent for subgroups. The results are discussed in the context of current theories of ADHD and imply indications for further research in this field.

The purpose of this study was to evaluate the feasibility, quality, and possible future implications of magnetic resonance imaging (MRI) of the human hand and wrist at 7 T. Images of the left hand of a healthy volunteer were acquired with a 7- and a 1.5-T whole body system and comparatively analyzed. Axial and coronal two-dimensional gradient echo (GRE) images with inflow saturation, coronal 3D GRE images, and time-of-flight angiographies were obtained without averaging. Image details were related to the complex hand anatomy. With the 7-T protocols established in this study, high-quality and high-resolution images of the hand and wrist were obtained. In the 2D GRE images at 7 T, small anatomical structures of the hand were depicted in vivo with superior detail and resolution, compared to 1.5 T and published studies at lower field strength. Signal-to-noise ratios (SNRs) were approximately five times higher at 7 T compared to 1.5 T. Additionally, thin 3D GRE images with good quality of the whole hand were obtained in a short acquisition time. Moreover, time-of-flight angiographies of the small hand arteries have been acquired without the application of contrast agents. Seven-tesla imaging of the hand can be used in vivo with ultra-high resolution and sufficient SNR. It allows for exact delineation of most anatomical structures including nerves, muscles, tendons, ligaments, cartilage, and blood vessels.

Children who were 4 to 8 years of age were asked to perform a sort-recall task where only half of the items had to be studied and remembered. Following a baseline trial, children were assigned to 1 of 3 groups and were prompted to use either a sorting or a clustering strategy (experimental groups) or were not prompted at all (control group). Children were seen 2 weeks later and given a new set of items for the transfer-of-training sort-recall phases. Levels of recall and strategy use (sorting, clustering, multiple strategy use) were higher for older children, typical items, sorting prompts, and trials with repeated presentations of test materials. Older children used more strategies than younger children, although even 4-year-olds used more than one strategy when performing the memory tasks. Results of multivariate cluster analyses revealed systematic individual differences, separating low performers from production-deficient children and high performers. Overall, findings show that clustering appears to be an early developing, but less effective strategy, with multiple-strategy use and especially sorting being used more frequently and effectively by older children.

The multiaxial system of operational psychodynamic diagnosis (OPD) is based on five axes covering illness experience and prerequisites for treatment, interpersonal relations, conflict, structure and symptomatology following ICD-10, Chapter V (F). The new version, OPD-2, has developed from a purely diagnostic system into one including a set of tools and procedures for treatment planning and for measuring change, as well as for determining the appropriate main focuses of treatment and developing appropriate treatment strategies. Focusing on axis I of the system, the concept and content of OPD are introduced and data concerning aspects of reliability and validity are discussed.

Case presentation Since October, 2006, a 46-year-old white male had increasingly severe and permanent facial pain that started in the left maxilla and radiated over the left side of his face and head. By January, 2007, the intensity of pain had increased to the extent where it caused insomnia. The symptoms were not accompanied by fever, night sweats, weight loss, or any other evidence of an underlying systemic condition. Two healthy teeth were extracted without any benefi t. The pain was not orthostatic because it was aggravated when the patient was lying down, and it did not respond to non-steroidal anti-infl ammatory drugs or opioids. The patient’s medical history was unremarkable with no history of autoimmune disease, neoplasia, arthralgia, cardiopulmonary disorders, nor dermatological diseases. There was no history of epistaxis, sinusitis, or any other disorders of the ears, nose, or throat. He was a heavy smoker (about 30 pack-years) but denied alcohol consumption or any other substance abuse and was not on any regular medication. Clinical and neurological examinations, including consultation with an ear, nose, and throat specialist, did not fi nd any distinctive features. Notably, he had no clinical signs of meningeal involvement or sinusitis. Apart from mild left papilloedema, an ophthalmological examination was also unremarkable.

Cytokines, such as granulocyte macrophage-colony stimulating factor (GM-CSF) and interleukin (IL)-8 attract neutrophils into inflammatory sites. During emigration from the blood neutrophils interact with extracellular matrix proteins such as fibronectin. Fibronectin provides beta2-integrin co-stimulation, allowing GM-CSF and IL-8 to activate nuclear factor (NF)-kappaB, an effect that does not occur in suspension. We tested the hypothesis that exposure of mice to fever-like temperatures abrogates neutrophil recruitment and NF-kappaB activation in a mouse model of skin inflammation. Mice that were exposed to 40 degrees C for 1 hour showed strongly reduced GM-CSF- and IL-8-induced neutrophilic skin inflammation. In vitro heat exposure did not interfere with neutrophil adhesion or spreading on fibronectin but strongly inhibited migration toward both cytokines. Using specific inhibitors, we found that PI3-K/Akt was pivotal for neutrophil migration and that heat down-regulated this pathway. Furthermore, neutrophils on fibronectin showed abrogated NF-kappaB activation in response to GM-CSF and IL-8 after heat. In vivo heat exposure of mice followed by ex vivo stimulation of isolated bone marrow neutrophils confirmed these results. Finally, less NF-kappaB activation was seen in the inflammatory lesions of mice exposed to fever-like temperatures as demonstrated by in situ hybridization for IkappaBalpha mRNA. These new findings suggest that heat may have anti-inflammatory effects in neutrophil-dependent inflammation.

Two studies were conducted in which two different indicators of metacognitive monitoring were investigated in a complex everyday memory task. In the first phase of each experiment, 8- and 10-year-olds as well as adults were shown a short event (video) and gave judgments of learning, that is, rated their certainty that they would later be able to recall specific details correctly. In the second phase of the experiments, participants underwent a memory interview about the event and in Study 2 also gave confidence judgments, that is, rated their certainty that the provided answers to the memory questions were correct. Results revealed significant influences of memory characteristics on monitoring in that delaying judgments and monitoring judgments concerning irretrievable information affected judgments of learning. From 8 years of age onward, there were relatively appropriate metamemorial monitoring abilities in both indicators. Moderate intraindividual consistency was found across the two measures of metacognitive monitoring, with a tendency toward higher consistency in older age groups. The results are discussed in terms of the adequacy of the underlying theoretical construct.

Although operative excision is regarded as the treatment of choice in Morton's neuroma, it remains unclear whether transection of deep transverse metatarsal ligament (DTML) is a risk for metatarsal splaying and whether simultaneous surgery in adjacent intermetatarsal spaces is a risk for osteonecrosis of the adjacent metatarsals.Fifty-seven feet in 47 patients had excision of a Morton's neuroma, with a mean follow-up of 15.3 years. Feet were categorised depending upon whether the DTML was or was not divided. Pre-operative and post-operative intermetatarsal angles were measured on standardised weightbearing radiographs and inspected for evidence of osteonecrosis.Comparison of pre- and post-operative intermetatarsal angles in patients with surgery in the second web space showed no significant increase (transected p = 0.659, preserved p = 0.142). In regards to comparison of pre- and post-operative radiographic intermetatarsal angles in patients with surgery in the third web space, statistical analysis also did not show a significance increase (transected p = 0.240, preserved p = 0.078). Radiological assessment showed no signs of osteonecrosis of metatarsal heads, not even in cases of double-space surgery.In conclusion, DTML transection does not increase the intermetatarsal angle or the risk of splayfoot development. Moreover, transection is recommended due to an enhanced overview during surgery and better clinical outcome. Our data could also prove that double-space surgery is not a risk for avascular osteonecrosis.

Relationship Between Age of School Entry and Behaviour Problems Recent studies demonstrated that children who are relatively young within a school year show more behaviour problems, are at greater risk of being diagnosed with attention- eficit/hyperactivity disorder (ADHD) and treated with stimulants compared to their older classmates. In this paper we examine the association of age at school entry and behavioural problems for a German sample of elementary school children, who were enrolled in 2009 (N = 928). We used teacher ratings on the Strengths and Difficulties Questionnaire (SDQ) as well as the prevalence of ADHD diagnosis and medication. Our analyses showed that those children with a relatively younger age at school entry were judged more hyperactive than their older peers when sex was controlled for. After stratifying for sex, the effect of age at school entry on hyperactivity was now only significant for boys. No association with age at school entry could be found for the other SDQ-subscales as well as for ADHD diagnosis and medication. Although we could only partially demonstrate a significant relationship between age at school entry and behavioral problems in German elementary school-children, understanding these associations may help to consider children´s maturity differences when evaluating the child´s behavior.

Purpose: To evaluate a handheld vacuum-assisted device system for magnetic resonance image (MRI)-guided breast lesion biopsy. Material and Methods: In 32 patients, a total of 42 suspicious breast lesions (mean diameter 7.5 mm for mass lesions, 11.6 mm for non-masslike diffuse lesions) seen with MRI (no suspicious changes in breast ultrasound or mammography) were biopsied (27 lateral, 15 medial) using a 10G vacuum-assisted breast biopsy device under MR guidance. Histology of biopsy specimens was compared with final histology after surgery or follow-up in benign lesions. Results: In all biopsies, technical success was achieved. Histology revealed 11 lesions with ductal carcinoma in situ (DCIS) or invasive cancer, three with intermediate lesions (LCIS) and 28 with benign breast lesions (adenosis, infected hematoma). In one patient with discordant results of MRI and histology, surgical excision revealed medullary cancer. In the follow-up (mean 18 months) of the histological benign lesions, no breast cancer development was observed. Besides minor complications (hematoma, n = 6), with no further therapeutic interventions, no complications occurred. Conclusion: MRI-guided breast lesion biopsy using a handheld vacuum-assisted device is a safe and effective method for the work-up of suspicious lesions seen with breast MRI without changes in mammography or ultrasound. In the case of discordant histology of vacuum biopsy and breast MRI appearance, surgical excision is recommended.

Background Fiberoptic ductoscopy is increasingly used to evaluate pathologic nipple discharge. A major limitation of this technique is the inability to obtain tissue samples from suspicious intraductal lesions. We present a novel technique for ductoscopic biopsy of intraluminal tumors. Methods From 2002 to 2005 ductoscopy was performed in 38 women with nipple discharge using a rigid gradient index microendoscope (diameter 0.7 mm) and a special needle for intraductal vacuum assisted biopsy. Results of preoperative biopsy were correlated with the histology of the resection specimen Results Cannulation of the discharging duct was successful in 37 of 38 patients (97%). Intraductal lesions were diagnosed in 29 women (78%). The sensitivity of ductoscopy and galactography in the detection of intraductal lesion was comparable (96% vs. 89%). Ductoscopic biopsy of intraductal lesions was technically successful in all but one case. Generally, the quality of the biopsy samples was good. Diagnostic biopsy samples were obtained in 26 of 28 patients (93%). Two samples contained necrosis and were considered to be non-representative. Histological analysis of the biopsy specimens showed 22 papilloma, 2 in situ carcinoma and 2 invasive carcinoma. Histology of the resection specimens confirmed the diagnosis in all cases, but there was one case with additional carcinoma lobulare in situ. Conclusions Ductoscopic vacuum assisted biopsy is a new technique for tissue sampling of intraductal breast lesions. This method may improve preoperative evaluation of pathologic nipple discharge in selected patients, but it should not be considered as a method for screening of early breast cancer.

Although pathological dissociation (PD) has received increasing scientific attention in Anglo-American countries, European research on the frequency, clinical and demographic correlates of this discontinuous construct are lacking. An 8-item subscale of the Dissociative Experiences Scale, called the DES-Taxon, was administered to five samples comprising a non-clinical population, students, unselected psychiatric inpatients, eating-disordered inpatients and psychosomatic outpatients with a total of 1,759 adult participants. In the two non-clinical samples, the frequency of PD ranged between 0.3 and 1.8%. Its prevalence was highest in the psychiatric inpatients (5.4%) followed by the eating disorders (4.8%) and the psychosomatic outpatients (2.2%). PD was seen in all diagnostic groups and it was associated with more psychopathological distress and younger age. PD is frequently found in clinical populations in European countries, too. However, methodological problems relating to its empirical determination might obscure the clinical and scientific value of the construct.

We report two empirical studies that investigated previously reported benefits of a high accuracy motivation, and thus a high threshold, for children’s and adults’ event recall and for their ability to resist false suggestions. In the studies, 6-, 7-, and 8-year-olds, as well as adults, were shown a brief video about an event and were later asked unbiased and misleading questions about it. In Study 1, participants were either (a) given the typical accuracy instructions (including the option to answer with “I don’t know”), (b) reminded of the accuracy instructions during the interview, or (c) immediately given feedback and a token for every correct answer. The results showed that the reminders were ineffective in stimulating strategic control behavior in children, independent of age. In Study 2, the confounding effects of feedback and incentives were disentangled by contrasting (a) free report, (b) feedback only, (c) incentives only, and (d) feedback plus incentives. Analyses on recall performance and suggestibility revealed that both feedback and incentives are necessary to increase children’s accurate memory reports.

We used rats transgenic for the human angiotensinogen (hAogen) gene and the human renin (hRen) gene and crossed the strains to produce a model of preeclampsia in the dams. The female (n=9) hAogen × male hRen cross had severe (telemetry-measured) hypertension and albuminuria, which developed during the last trimester of pregnancy and subsided after delivery. The converse cross (n=9) and control (n=9) SD rats did not. We demonstrated that the female hAogen × male hRen cross had agonistic antibodies capable of activating the angiotensin (Ang) II AT1 receptor (AT1R-AA) and defined the epitope on the receptor’s second extracellular loop. The phenomenon also occurs in humans with preeclampsia. The rats displayed renal histology reminiscent of preeclampsia, including fibrin deposition confined to the glomeruli. The complement system was activated in glomeruli and IgG deposits were present that may represent AT1R-AA. Finally, we observed an atherosis-like lesion in the spiral arteries of the placental bed, which we called placental-bed arteriolosclerosis. Our model may be relevant to preeclampsia in humans.

In accordance with its general orientation, International Orthopaedics , the official journal of the Societe Internationale de Chirurgie Orthopedique et de Traumatologie (SICOT), publishes original papers from all over the world dealing with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. This special issue pays attention to current trends in foot and ankle surgery. Despite a variety of journals dedicated to foot and ankle surgery, specialised orthopaedic surgeons see it as an important mission to present their knowledge to a widespread readership. During the 1970s and 1980s, foot and ankle surgery was in the shadow of the enormous success of hip and knee arthroplasty and new treatment options enabled by arthroscopy. However, since the 1980s, foot and ankle surgery has shown similar development induced by technical progress and a better understanding of biomechanics. This evolution has led to sophisticated new methods in forefoot surgery, the rise of anklejoint arthroplasty, better options for treating degenerative joint and tendon problems, elaborate methods of osteosynthesis and an attempt to introduce computer-aided techniques. On the other hand, pharmacological developments, such as the new class of biological drugs largely superseded much of orthopaedic surgery in rheumatoid arthritis patients. The aim of this special issue, therefore, is to spread knowledge about the state of the art in foot and ankle surgery amongst all orthopaedic surgeons who may not be regularly confrontedwith latest discussions in this field.We are proud to present review articles written by top specialist in their field to provide the interested reader with a compendium of current knowledge on this subject. The expert reader will find complete reference lists to complement this information. A perfect example of finding a way from a dogmatic approach to profound knowledge is given in the review by Doty and Coughlin [1], summarising the work of Michael Coughlin and coworkers during the last decade, analysing Karl Knahr

Determination of individual maximum voluntary contraction (MVC) force is used as the gold standard for normalising surface EMG (SEMG) data. Assuming a linear amplitude-force relationship, individual strain levels are defined according to percentage rates of the measured MVC levels. The purpose of the study was to investigate if the assumed force-strain relationship can be applied without qualification. Therefore, healthy volunteers (nine men, ten women) were investigated during isometric exercises of shoulder muscles at MVC and 50% levels. Tasks were performed at four different angular positions in frontal, sagittal and horizontal planes. In each plane, both possible force directions were investigated. SEMG was taken simultaneously from 13 muscles of the shoulder and upper arms from both sides of the body. At a force level of 50% MVC, SEMG amplitude levels were compared to the expected 50% level. Differences in muscular co-ordination patterns were also determined. During retroversion and horizontal flexion, amplitude levels significantly remained at levels below 50%. This was seen for all the muscles investigated, independent of relative contribution to force production. During horizontal extension and abduction, the main force-producing muscles showed amplitude levels that significantly exceeded the expected 50% level. Co-ordination patterns differed significantly between MVC and submaximal conditions for anteversion, retroversion and horizontal extension. Specifically, four shoulder muscles showed higher proportions at the 50% level compared to MVC. Therefore, certain percentage rates of MVC force levels exhibit quite different strain rates, as identified by SEMG. Depending on force direction, differences in co-ordination patterns exist between MVC and submaximal test conditions. Both findings have implications for therapeutic and training applications.

Congestive heart failure (CHF) is the inability of the heart to deliver a sufficient oxygen supply to meet the metabolic demands of the tissues at normal filling pressures, both at rest and during exercise. CHF may arise from reduced inotropy, volume overload, pressure overload, or reduced diastolic dilatation.1 Long-standing hypertension causes CHF by increased pressure overload. With time’s passage, pressure overload induces expression of proto-oncogenes (such as c-fos, c-myc, c-jun , and others) that foster myocardial hypertrophy. Hypertrophy entails an increase in the size of individual muscle cells and the overall muscle mass. However, the heart developing hypertrophy under these conditions is limited because the heart operates at a lower inotropic state. Furthermore, structural and biochemical changes occur that have long-term deleterious effects, notably dilatation. Chronic pressure overload is thus accompanied by progressive growth abnormalities and apoptotic cell death.2 The condition has been termed the “cardiomyopathy of overload.”3 The heart’s adaptation to overload is wide, perhaps because hypertension itself is heterogeneous. For instance, hypertension is strongly associated with obesity that has its own blood pressure-independent effects on the heart. In young obese persons, subclinical left ventricular diastolic dysfunction is present in all grades of isolated obesity, whereas systolic function is actually increased.4 How such persons present clinically 40 years later is unclear, but because large segments of society now qualify as obese, the topic is of major concern. A 65-year-old woman was transferred to our intensive care unit because of heart and renal failure. Three months before admission, she had become progressively dyspneic. Attempts had been made to treat her with an angiotensin-converting enzyme inhibitor, β-blocker, and furosemide to no avail. She had increasing abdominal girth and edema. Her painful brawny lower extremity skin changes were interpreted as cellulitis, for which she was administered antibiotics on …

The current study investigated the influence of presentation modality (live, video, and slide show) on children's memory, suggestibility, recognition, and metamemorial monitoring processes. A total of 270 children in three age groups (5- and 6-year-olds, 7- and 8-year-olds, and 9- and 10-year-olds) watched a magic show and were questioned about it 1 week later. The live show yielded more correct answers to nonleading questions, higher resistance to misleading questions, and better recognition memory than did the video condition, which in turn resulted in better performance than did the slide show. Although presentation modality raised the general level of memory performance, the effects were equally strong in all age groups and did not affect memory phenomena such as the size of the misinformation effect and confidence judgments.