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Item does not contain fulltext The aim of the study was to evaluate the effect of continuous and discontinuous growth hormone treatment in Noonan's syndrome (NS) on linear growth and bone maturation. Thirty-seven children with NS aged between 5.4 and 17.5 y were treated with growth hormone (GH) in a dose of 0.15 IU kg)(-1) per day; 23 of these children were randomly assigned to one of 2 groups in a 3 y partly controlled prospective multicentre study. Group A (n = 8) immediately started GH treatment and after 2 y discontinued GH treatment for 1 y; group B (n = 15) served as a control group during the first year and started GH treatment after 1 y. After the 3 y study period, 17 out of the 23 children continued GH treatment. An additional 14 children (group C) were treated according to the same protocol, but without discontinuation of GH treatment. The effect of GH treatment for up to 3 y was evaluated in terms of gain in height standard deviation score (H-SDS) for calendar age and for bone age. Gain in H-SDS over the first year was significantly higher in the GH treatment group (+0.5) than in the non-treated group (+0.0); mean bone maturation was significantly faster in the GH treatment group (1.2 vs 0.5 y/y). Discontinuation in group A in the third study year resulted in catch-down growth (mean deltaH-SDS -0.2). Over 3 y of GH treatment, mean AH-SDS for calendar age was not significantly different between discontinuous (A: +0.8) and continuous treatment (B: +0.8; C: +1.2). Mean gain in H-SDS for bone age in the 3 groups (+0.2, 0.0. +0.3) was minimal after 3 y of GH treatment. CONCLUSION: This study confirmed the gain in H-SDS CA in Noonan's syndrome during long-term GH treatment. However, the accelerating effect of GH on bone maturation seemed to compromise the final height prognosis.

Event-related potentials (ERPs) were recorded during a recognition memory test for previously studied visual objects. Some studied objects were paired with the same context (landscape scenes) as at study, some were superimposed on a different studied context, and some were paired with new contexts. Unstudied objects were paired with either a studied or a new context. Three ERP memory effects were observed: an early effect elicited by all stimuli containing at least one studied component; a second effect elicited only by stimuli in which both object and context had been studied; and a third effect elicited by stimuli containing a studied object. Thus, test stimuli engaged three distinct kinds of memory-related neural activity which differed in their specificity for task-relevant features.

Event-related potentials (ERPs) were used to investigate whether the neural correlates of successful episodic encoding differ according to the nature of the study task. At study, 16 subjects were cued to make either animacy or alphabetic decisions about visually presented words. A recognition memory test with confidence judgements followed after a delay of 30 min. For the animacy task, words that were subsequently confidently recognised were associated with a positive-going ERP modulation. By contrast, for the alphabetic task, confident recognition was associated with a negative-going ERP modulation. Both types of subsequent memory effects started shortly after word onset. These findings suggest that the neural correlates of memory encoding differ qualitatively, rather than quantitatively, according to the nature of the study task. Episodic encoding thus seems to be supported by multiple, task-specific, neural systems. The early onset of these memory effects suggests that episodic encoding can be facilitated by processes that start before the onset of the to-be-encoded item.

The role of GH insufficiency in the pathogenesis of short stature in Noonan syndrome is unclear. Cross-sectional study. Seventeen patients with Noonan syndrome (13 boys, 4 girls; aged 4.8-13.3 (mean 9.2) years) and short stature before start of GH treatment. Spontaneous 12-h overnight GH secretion by continuous sampling analysed using Pulsar, plasma IGF-I and IGFBP-3 levels, and 24-h urinary GH excretion were measured at start of GH treatment. A glucagon stimulation test was performed. Height and height velocity were monitored before and after 1 year of GH treatment. IGF-I and IGFBP-3 were remeasured after 1 year of GH treatment. Nine of the 17 children had a mean overnight GH concentration below the lower limit of the normal range. In six of the 17 patients, overnight GH profiles showed high trough GH concentrations. Glucagon stimulation tests were normal in 16 of the 17 patients. Mean IGF-I level was below normal (-0.4 SD). None of the parameters regarding GH secretion obtained from the overnight profile or provocative test was related to height or height velocity, nor to first year response to GH treatment. IGF-I and IGFBP-3 did not correlate with any of the GH secretion data. IGF-I and IGFBP-3 were related to height and height velocity at the start of GH treatment (r = 0.53 (P < 0.01) and r = 0.61 (P < 0.03) respectively). Rises in IGF-I and IGFBP-3 under GH treatment were related to the increment in height velocity (r = 0.70 (P < 0.01) and r = 0.71 (P < 0.02) respectively). Abnormalities in GH secretion are frequent in patients with Noonan syndrome and short stature. These abnormalities were not related to auxology at start of or response to GH treatment. Clinically GH insufficiency is not important in Noonan syndrome and monitoring spontaneous GH secretion is not necessary before the start of GH treatment.

This study compared self-reported television (TV)-viewing time with an objective measure obtained by an electronic TV monitor. As part of a larger study, 40 overweight and obese adults (BMI: 31.7 +/- 5.4 kg/m(2); 53% obese; mean age 41.4 +/- 13.0) self-reported TV-viewing time at study entry as the response to the question, "How many hours do you watch TV per day, on average?" Objective TV-viewing time was measured in min/day over 3 weeks/subject using electronic monitors. Self-reported viewing time was 4.3 +/- 1.3 h/day (mean +/- s.d.) (range: 3.0-8.0 h/day) vs. 4.9 +/- 2.6 h/day (0.8-13.3 h/day) recorded by the electronic TV monitor. Subjects underestimated their viewing time by 0.6 +/- 2.3 h/day (95% confidence interval = -1.34, 0.13), or 4.3 h/week. Slightly over half of the subjects (58%) underestimated their viewing time; 47.5% were within 1 h/day, and 72.5% were within 2 h/day of self-reported viewing time. Large errors were rare in this group, suggesting that a simple self-report measure of TV time may be useful for characterizing viewing behavior, although objective measurement adds precision that may be useful in certain settings.

Distinctive words elicit the P300 component of the event-related brain potential, and are also likely to be recalled. Previous studies have shown that the larger the P300 elicited by distinctive words, the more likely it is that those words will be recalled. The present study addressed whether this relationship is affected by the manner in which distinctiveness is induced. Distinctiveness was manipulated either by varying the size of the characters in which a word was displayed, or by surrounding the word with a frame at close or far distance. All distinctiveness attributes resulted in improved recall performance. The words whose size was distinctive elicited a large P300, and P300 amplitude was larger for subsequently recalled words. The frame attributes elicited a small P300, and the amplitude of these P300s was not correlated with subsequent recall performance. Instead, a frontal slow wave was correlated with subsequent recall performance in the far frame group. It is concluded that the relationship between P300 amplitude and subsequent recall depends on the type of distinctiveness attribute, and should therefore not be ascribed to a generalized effect of distinctiveness on memory encoding processes.

Uniparental disomy (UPD) is defined as the inheritance of both homologous chromosomes from only one parent. So far, maternal UPD 7 has been described in 28 cases. Here, we report 4 new cases, present clinical information of 5 cases previously reported by us, and review the clinical and molecular findings of all 32 cases. We found a phenotype characterized by pre- and postnatal growth retardation, occipitofrontal head circumference in the lower normal range, a triangular face, and retarded bone maturation. Findings of the facial gestalt included a high and broad forehead and a pointed chin. A broad mouth with down-turned corners, prominent ears, cafe-au-lait spots, hemihypotrophy, or clinodactyly were rarely present. Psychomotor development was delayed in 6 cases. The clinical findings strikingly resemble the phenotype of the heterogeneous Silver-Russell syndrome (SRS). Other anomalies were less frequently found than in SRS. Molecular investigations revealed 11 cases with isodisomy and 17 cases with heterodisomy. In 4 cases this information was not available. From the allelic distribution of the microsatellites investigated, 9 cases might be the consequence of an error at maternal meiosis I, and 6 cases might be due to non-disjunction at maternal meiosis II. Three of the 17 heterodisomic cases had trisomy 7 in chorionic villi, in the remaining cases no prenatal diagnosis through chorionic villus sampling was reported. Conclusion Maternal UPD 7 should be investigated in children with pre- and postnatal growth retardation and a facial gestalt characterized by a high and broad forehead and a pointed chin, as well as in confined placental mosaicism for trisomy 7.

Een 16-jarige patiente presenteerde zich met een onregelmatig vergrote schildklier bij euthyreoidie en negatieve anti-TPO-antistoffen. Omdat cytologisch onderzoek verdacht was voor een folliculair schildkliercarcinoom, werd hemistrumectomie links verricht. Hierbij bleek sprake van multinodulair struma.

Short stature and ovarian failure are the main features in Turner syndrome (TS). To optimize GH and estrogen treatment, we studied 68 previously untreated girls with TS, age 2–11 yr, who were randomly assigned to one of three GH dosage groups: group A, 4 IU/m2·day (≈0.045 mg/kg·day); group B, first yr 4, thereafter 6 IU/m2·day (≈0.0675 mg/kg/day); group C, first yr 4, second yr 6, thereafter 8 IU/m2·day (≈0.090 mg/kg·day). In the first 4 yr of GH treatment, no estrogens for pubertal induction were given to the girls. Thereafter, girls started with 17β-estradiol (5 μg/kg bw·day, orally) when they had reached the age of 12 yr. Subjects were followed up until attainment of adult height or until cessation of treatment because of satisfaction with the height achieved. Seven-year data of all girls were evaluated to compare the growth-promoting effects of three GH dosages during childhood. After 7 yr, 85% of the girls had reached a height within the normal range for healthy Dutch girls. The 7-yr increment in hei...

Catfish spine envenomations are common injuries, reported in both freshwater and saltwater. Such injuries are complex puncture wounds, often complicated by severe infection. Signs and symptoms range from simple local pain and bleeding to systemic manifestations with hemodynamic compromise. Care and treatment involve aggressive pain management, judicious wound cleansing, prophylactic antibiotics, and close follow-up. A case of catfish spine envenomation from a freshwater catfish is presented here.

BackgroundIn contrast to the high incidence of testicular adrenal rest tumours (TART) in adult male patients with congenital adrenal hyperplasia (CAH), ovarian adrenal rest tumours in female CAH patients are very rare and other locations of adrenal rest tumours have never been reported. Here, we report on an adult patient with CAH due to 3β-hydroxysteroid dehydrogenase (HSD) deficiency with bilateral TART and additionally a large perirenal adrenal rest tumour.Case reportThe patient was known with CAH due to 3β-HSD deficiency and treated with hydrocortisone and fludrocortisone since the neonatal period. In puberty, there was lack of compliance with consequently high POMC concentrations. At the age of 16 years, bilateral TART were detected by scrotal ultrasound. Intensifying glucocorticoid medication did not result in decrease in POMC concentrations and shrinkage of size of the tumours. At the age of 23 years, abdominal ultrasound was performed because of abdominal complaints, showing a round inhomogeneous structure with a diameter of 4 cm near the left renal hilus. A computer tomography scan showed a multinodular lesion in the retroperitoneal region beside the left kidney. Histological investigation after removal of the tumour showed sheets of large polygonal cells with abundant eosinophilic cytoplasm, separated by dense fibrous tissue strands. The histological and immunohistochemical profile resulted in a diagnosis of an adrenal rest tumour.ConclusionIn adult CAH patients, ectopic adrenal rest tumours can be present outside the testicular region. Further investigations are necessary to determine whether regularly screening for these tumours is useful.

The number of subjects that have successfully completed treatment for a cancer diagnosed during childhood and are entering adulthood is increasing over time. Members of the International Berlin-Frankfurt-Munster (I-BFM) Early and Late Toxicity Educational Committee (ELTEC) invited 45 paediatric cancer experts (representing oncologists, psychologists, nurses, epidemiologists, parents, and survivors) from 13 European countries (with five additional experts from North America) to Erice, Sicily (from October 27 to 29, 2006) to discuss the circumstances in which the word 'cure' should be used when speaking about children with cancer, and when and why continuing follow-up and care may be required. The objective of the gathering was to generate from the personal and professional experience of the participants an overview statement of the group's philosophy of cure and care of survivors of childhood cancer. The ten points reflect what the group considers essential in the survivors' cure and care.

Laskowski and colleagues in this issue of the journal1 report on two cases of severe drug-induced hyperthermia treated with ice water submersion. Hyperthermia is a common presentation in medicine a...

•Twelve-person Special Forces team •Planned interdiction operation in arid, mountainous Middle Eastern terrain •Two trucks with surface-to-air missiles expected in several hours •Estimated hostile strength is 10 men with automatic weapons in two armored personnel carriers •Helicopter insertion/extraction •Six-mile patrol to target; planned extraction close to anticipated contact site •While patrol is in position, one team member is bitten on the leg by unidentified snake •Over the next 5 minutes, the pain becomes increasingly severe, and the injured man becomes dizzy and confused •Target convoy is expected in 1-2 hours

Ripening of dredged material in a deposit is a natural ‘drying’ process by which raw dredged material transforms into soil. The aim of ripening is to obtain soil which complies with environmental legislations and geotechnical specifications for application in earthworks (e.g. dikes, noise reduction banks, landfill covers). The paper deals with the background and contents of a monitoring programme on the ripening behaviour of clayey, peaty, and sandy dredged material, and changes in chemical composition, especially of organic compouds, and leaching characteristics during ripening. The main objectives of the monitoring programme are (1) to develop a management system for the ripening process, (2) to quantify the input and output volumes of dredged material, and (3) to develop guidelines for the design of (transit) deposits. The results of the monitoring programme will also be used for calibration and validation of a computer model on ripening. Prelimanary results on ripening of clayey material and biodegration of PAH and mineral oil are presented. On the basis of these results it is expected that large volumes of slightly to moderately contaminated dredged material are suitable for beneficial use after ripening.

Pendred syndrome is an autosomal recessive disorder characterized by early childhood deafness and goiter. A century after its recognition as a syndrome by Vaughan Pendred, the disease gene ( PDS ) was mapped to chromosome 7q22-q31.1 and, recently, found to encode a putative sulfate transporter. We performed mutation analysis of the PDS gene in patients from 14 Pendred families originating from seven countries and identified all mutations. The mutations include three single base deletions, one splice site mutation and 10 missense mutations. One missense mutation (L236P) was found in a homozygous state in two consanguineous families and in a heterozygous state in five additional non-consanguineous families. Another missense mutation (T416P) was found in a homozygous state in one family and in a heterozygous state in four families. Pendred patients in three non-consanguineous families were shown to be compound heterozygotes for L236P and T416P. In total, one or both of these mutations were found in nine of the 14 families analyzed. The identification of two frequent PDS mutations will facilitate the molecular diagnosis of Pendred syndrome.

Neural activity elicited by an event can predict whether the event is successfully encoded into memory. Here we assessed whether memory encoding relies not only on neural activity that follows an event, but also on activity that precedes it. In two experiments we found that human brain activity elicited by a cue presented just before a word could predict whether the word would be recollected in a later memory test.

We studied the growth-promoting effect of treatment with recombinant human growth hormone in 23 pre-pubertal children with Noonan syndrome, aged between 5.4 and 14.3 y, and all with a height < 1.4 SD for Tanner standards. The growth response and skeletal maturation after 1 y of recombinant human growth hormone treatment (0.15 U/kg/day given by daily injection) in the Noonan syndrome patients was compared with the auxological changes observed in a group of 17 girls with Turner syndrome with a comparable age and height deficit who were treated with recombinant human growth hormone in a similar way. During 1 y of treatment, the mean +/- SD height velocity increased by 4.0 +/- 1.6 cm/y in the Noonan syndrome group and by 3.6 +/- 1.3 cm/y in the Turner syndrome group. Height SDS for chronological age in the Noonan syndrome group increased by 0.53 +/- 0.46 (p < 0.001). In the Noonan syndrome patients the changes in height velocity were positively related to birthweight (r = 0.48, p < 0.05). The changes in height velocity or height SDS were not related to the age, height deficit or a delay in bone age maturation at start of treatment. In neither the patients with Noonan syndrome nor Turner syndrome was an acceleration of bone maturation found. We conclude that treatment with recombinant human growth hormone in pre-pubertal NS patients induces an increase in height velocity and height SDS comparable to that observed in Turner syndrome girls.

Contains fulltext : 47776.pdf (Publisher’s version ) (Closed access) A 23-year-old man was diagnosed with pulmonary alveolar proteinosis at the age of 11 months, and primary hypothyroidism gradually developed during infancy. He had delayed developmental milestones and severe hypotonia that evolved into non-progressive chorea during childhood. He died from large cell lung carcinoma at the age of 23 years. A de novo heterozygous insertion mutation 859-860insC in the TITF-1 gene was demonstrated. CONCLUSION: TITF-1 gene mutations should be considered in paediatric and adult patients with unexplained (combinations of) chorea, mental retardation, primary hypothyroidism, and chronic lung disease. Introduction of a name for the disorder, e.g. Brain-Thyroid-Lung syndrome, would probably facilitate further recognition. Whether the TITF-1 gene mutation in this patient predisposed to the development of lung cancer remains speculative.

In 2010, the Society of Behavioral Medicine heightened its priority to take an even more active role in influencing health-related public policy. Here we discuss the importance of behavioral medicine presence in public policy initiatives, review a brief history of SBM’s involvement in public policy, describe steps SBM is now taking to increase its involvement in health-related public policy, and finally, put forth a call to action for SBM members to increase their awareness of and become involved in public policy initiatives.

The availability of 20-h N-acetylcysteine (NAC) infusion for low-risk acetaminophen (APAP) overdose enabled our center to implement an Emergency Department observation unit (OU) protocol as an alternative to hospitalization. Our objective was to evaluate our early experience with this protocol. This retrospective cohort study included all patients treated for low-risk APAP overdose in our academic hospital between 2006 and 2011. Cases were identified using OU and pharmacy records. Successful OU discharge was defined as disposition with no inpatient admission. Differences in medians with 95 % confidence intervals were used for comparisons. One hundred ninety-six patients received NAC for APAP overdose with a mean age of 35 years (SD 14); 73 % were white, and 43 % were male. Twenty (10 %) received care in the OU; 3/20(15 %) met criteria for inclusion in the OU protocol and 13/20(65 %) were discharged successfully. Out of the 196 patients, 10 met criteria for inclusion in the OU protocol but instead received care in the inpatient setting. The median total length of stay from presentation to ED discharge was 41 h for all patients treated in the OU, compared to 68 h for ten patients who met criteria for inclusion in the OU protocol but who were admitted (difference 27 h, 95 % CI 18–72 h). ED observation for APAP overdose can be a viable alternative to inpatient admission. Most patients were successfully discharged from the OU. This evaluation identified both over- and under-utilization of the OU. OU treatment resulted in shorter median length of stay than inpatient admission.

Congenital isolated growth hormone deficiency (IGHD) is a rare endocrine disorder that presents with severe proportionate growth failure. Dominant (type II) IGHD is usually caused by heterozygous mutations of GH1. The presentation of newly affected family members in 3 families with dominant IGHD in whom previous genetic testing had not demonstrated a GH1 mutation or had not been performed, prompted us to identify the underlying genetic cause.GH1 was sequenced in 3 Caucasian families with a clinical autosomal dominant IGHD.All affected family members had severe growth hormone (GH) deficiency that became apparent in the first 2 years of life. GH treatment led to a marked increase in height SDS. So far, no other pituitary dysfunctions have become apparent. In the first family a novel splice site mutation in GH1 was identified (c.172-1GC, IVS2-1GC). In two other families a previously reported splice site mutation (c.291+1GA, IVS3+1GA) was found.These data show that several years after negative genetic testing it was now possible to make a genetic diagnosis in these families with a well-defined, clearly heritable, autosomal dominant IGHD. This underscores the importance of clinical and genetic follow-up in a multidisciplinary setting. It also shows that even without a positive family history, genetic testing should be considered if the phenotype is strongly suggestive for a genetic syndrome. Identification of pathogenic mutations, like these GH1 mutations, has important clinical implications for the surveillance and genetic counseling of patients and expands our knowledge on the genotype-phenotype correlation.

Protein kinase B/AKT is critically involved in murine placental development and migration of human placental trophoblasts into maternal uterine tissue. However, localization of the three AKT isoforms within human placenta and their roles in extravillous trophoblasts have not been elucidated. Therefore, we analyzed the expression pattern and function of AKT1, AKT2, and AKT3 in migratory human trophoblasts using SGHPL-5 cell pools stably expressing small-hairpin microRNA (shRNAmir) against AKT1, AKT2, or AKT3 as a model. Western blot analyses using isoform-specific antibodies revealed ubiquitous expression of AKT1, AKT2, and AKT3 in primary villous and extravillous trophoblasts and the trophoblastic cell lines JEG-3, HTR-8/SVneo, and SGHPL-5. Immunofluorescence of first-trimester placentae localized AKT2 and AKT3 to the cytoplasm and nucleus, respectively, in all subtypes of cytotrophoblasts, whereas AKT1 was detected in both cellular compartments. A similar distribution of AKT isoforms was detectable in SGHPL-5 cells. Gene silencing using shRNAmir decreased protein expression of AKT1, AKT2, and AKT3 to 16%, 8%, and 11%, respectively, in SGHPL-5 cells. Compared with shRNAmir controls, proliferation and camptothecin-induced apoptosis were not affected in the different AKT knockdown cells. However, basal and epidermal growth factor (EGF)-induced trophoblast migration was significantly reduced in AKT1 and AKT3 gene-silenced cells, whereas downregulation of AKT2 was not effective. Accordingly, a decrease in EGF-stimulated phosphorylation of AKT (Ser473 and Thr308) and its downstream target mTORC1 (Ser2448) was noticed in AKT1 and AKT3 shRNAmir cell pools. In summary, the results suggest that the AKT isoforms 1 and 3 promote basal as well as EGF-induced trophoblast migration.

ObjectiveShort stature is a prominent feature of Turner syndrome (TS), which is partially overcome by GH treatment. We have previously reported the results of a trial on the effect of oxandrolone (Ox) in girls with TS. Ox in a dose of 0.03 mg/kg per day (Ox 0.03) significantly increased adult height gain, whereas Ox mg/kg per day (0.06) did not, at the cost of deceleration of breast development and mild virilization. The aim of this follow-up study in adult participants of the pediatric trial was to investigate the long-term effects of previous Ox treatment.Design and methodsDuring the previous randomized controlled trial, 133 girls were treated with GH combined with placebo (Pl), Ox 0.03, or Ox 0.06 from 8 years of age and estrogen from 12 years. Sixty-eight women (Pl,n=23; Ox 0.03,n=27; and Ox 0.06,n=18) participated in the double-blind follow-up study (mean age, 24.0 years; mean time since stopping GH, 8.7 years; and mean time of Ox/Pl use, 4.9 years). We assessed height, body proportions, breast size, virilization, and body composition.ResultsHeight gain (final minus predicted adult height) was maintained at follow-up (Ox 0.03 10.2±4.9 cm, Ox 0.06 9.7±4.4 cm vs Pl 8.0±4.6 cm). Breast size, Tanner breast stage, and body composition were not different between groups. Ox-treated women reported more subjective virilization and had a lower voice frequency.ConclusionOx 0.03 mg/kg per day has a beneficial effect on adult height gain in TS patients. Despite previously reported deceleration of breast development during Ox 0.03 treatment, adult breast size is not affected. Mild virilization persists in only a small minority of patients. The long-term evaluation indicates that Ox 0.03 treatment is effective and safe.

This systematic review of studies compared magnetic resonance imaging (MRI), 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), FDG-PET with computerized tomography (PET-CT) and CT with whole body X-Ray (WBXR) or (whole body) CT in order to provide evidence-based diagnostic guidelines in multiple myeloma bone disease. A comprehensive search of 3 bibliographic databases was performed; methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria (score 1-14). Data from 32 directly comparative studies were extracted. The mean QUADAS score was 7·1 (3-11), with quality hampered mainly by a poor description of selection and execution criteria. All index tests had a higher detection rate when compared to WBXR, with up to 80% more lesions detected by the newer imaging techniques; MRI (1·12-1·82) CT (1·04-1·33), PET (1·00-1·58) and PET-CT (1·27-1·45). However, the modern imaging techniques detected fewer lesions in the skull and ribs. In a direct comparison CT and MRI performed equally with respect to detection rate and sensitivity. This systematic review supports the International Myeloma Working Group guidelines, which recommend that WBCT can replace WBXR. In our opinion, the equal performance of MRI also indicates that it is a valuable alternative. As lesions of the skull and ribs are underdiagnosed by modern imaging techniques we advise additional X-rays of these regions. The consequences of this approach are discussed. © 2013 John Wiley & Sons Ltd.

To identify outcome predictors for multidisciplinary treatment in patients with chronic widespread pain (CWP) or fibromyalgia (FM).A systematic literature search in PubMed, PsycINFO, CINAHL, Cochrane Library, EMBASE and Pedro. Selection criteria included: age over 18; diagnosis CWP or FM; multidisciplinary treatment; longitudinal study design; original research report. Outcome domains: pain, physical functioning, emotional functioning, global treatment effect and 'others'. Methodological quality of the selected articles was assessed and a qualitative data synthesis was performed to identify the level of evidence.Fourteen studies (all with FM patients) fulfilled the selection criteria. Six were of high quality. Poorer outcome (pain, moderate evidence; physical functioning and quality of life, weak evidence) was predicted by depression. Similarly, poorer outcome was predicted by the disturbance and pain profile of the Minnesota Multiphasic Personality Inventory (MMPI), strong beliefs in fate and high disability (weak evidence). A better outcome was predicted by a worse baseline status, the dysfunctional and the adaptive copers profile of the Multidimensional Pain Inventory (MPI), and high levels of pain (weak evidence). Some predictors were related to specific multidisciplinary treatment (weak evidence). Inconclusive evidence was found for other demographic and clinical factors, cognitive and emotional factors, symptoms and physical functioning as predictors of outcome.It was found that a higher level of depression was a predictor of poor outcome in FM (moderate evidence). In addition, it was found that the baseline status, specific patient profiles, belief in fate, disability, and pain were predictors of the outcome of multidisciplinary treatment. Our results highlight the lack of high quality studies for evaluating predictors of the outcome of multidisciplinary treatment in FM. Further research on predictors of multidisciplinary treatment outcome is needed.

Contains fulltext : 118184.pdf (Publisher’s version ) (Closed access) This systematic review of studies compared magnetic resonance imaging (MRI), (18) F-fluorodeoxyglucose positron emission tomography (FDG-PET), FDG-PET with computerized tomography (PET-CT) and CT with whole body X-Ray (WBXR) or (whole body) CT in order to provide evidence-based diagnostic guidelines in multiple myeloma bone disease. A comprehensive search of 3 bibliographic databases was performed; methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria (score 1-14). Data from 32 directly comparative studies were extracted. The mean QUADAS score was 7.1 (3-11), with quality hampered mainly by a poor description of selection and execution criteria. All index tests had a higher detection rate when compared to WBXR, with up to 80% more lesions detected by the newer imaging techniques; MRI (1.12-1.82) CT (1.04-1.33), PET (1.00-1.58) and PET-CT (1.27-1.45). However, the modern imaging techniques detected fewer lesions in the skull and ribs. In a direct comparison CT and MRI performed equally with respect to detection rate and sensitivity. This systematic review supports the International Myeloma Working Group guidelines, which recommend that WBCT can replace WBXR. In our opinion, the equal performance of MRI also indicates that it is a valuable alternative. As lesions of the skull and ribs are underdiagnosed by modern imaging techniques we advise additional X-rays of these regions. The consequences of this approach are discussed. 12 p.

Het Bloom-syndroom (BS) is een zeldzame DNA-reparatiestoornis. Dit beeld kan op jonge leeftijd herkend worden aan de hand van de meest kenmerkende symptomen: pre- en postnatale groeiachterstand en een vlindervormig erytheem in het gelaat. De diagnose BS wordt niet altijd tijdig gesteld.We bespreken de symptomen die geleid hebben tot de diagnose bij zeven patie¨nten met BS. Bij BS bestaat er een groot risico op het ontwikkelen van een maligniteit. Vanwege een mogelijk toegenomen risico op maligniteiten valt behandeling met groeihormoon bij BS te ontraden, omdat de voordelen van lengtewinst niet opwegen tegen het mogelijk extra risico op het ontwikkelen van een maligniteit.

When subjects make 'odd/even' and 'low/high' decisions about digits, information about the digit's magnitude can interfere with the decision about the digit's parity. The present experiment used a psychophysiological approach to examine whether this interference arises at the level of response processing. Subjects performed a choice-reaction time task involving low/high and odd/even judgements about the digits 2 through 9. The data point to a response locus for the interference effect with the size of the effect being dependent on the ease with which magnitude information can be used to prime the appropriate response. This, in turn, is influenced by the 'naturalness' of the mapping between magnitude and response hand as well as by the distance of a digit to the low/high cut-point.

Statural growth during puberty was studied longitudinally in 28 patients treated for acute lymphoblastic leukaemia. All patients received prophylactic cranial irradiation. The age at diagnosis was below 7 years, the age at final investigation was above 16 years for girls and above 18 years for boys. Growth was analysed using the Kernel estimation. In girls the onset of puberty and menarche was at a younger age, as compared to reference values, and the duration of the pubertal growth spurt was shorter. Compared to early maturing girls, the growth velocity at peak height velocity was lower. This resulted in a final height which was shorter than expected on the basis of the height standard deviation score before the start of puberty. In boys the duration of the pubertal growth spurt was shorter and the height gain during the growth spurt less than in the reference population. In both sexes the bone age development was accelerated.

Mutations in the androgen receptor gene in 46,XY individuals can be associated with the androgen insensitivity syndrome, of which the phenotype can vary from a female phenotype to an undervirilized or infertile male phenotype. We have studied the androgen receptor gene of androgen insensitivity patients to get information about amino acid residues or regions involved in DNA binding and transcription activation. Genomic DNA was analysed by PCR-SSCP under two different conditions. Three new mutations were found in exon 1 of three patients with a female phenotype. A cytosine insertion at codon 42 resulted in a frameshift and consequently in the introduction of a premature stop at codon 171. Deletion of an adenine at codon 263 gave rise to a premature stop at codon 292. In both these cases, receptor protein was not detectable and hormone binding was not measurable. In a third patient, a guanine-to-adenine transition at codon 493 converted a tryptophan codon into a stop codon. Genital skin fibroblasts from this patient were not available. In exon 2 of the androgen receptor gene of a patient with receptor-positive androgen insensitivity, a cytosine-to-adenine transition, converting alanine 564 into an aspartic acid residue, resulted in defective DNA binding and transactivation. In three other receptor-positive androgen insensitivity patients no mutations were found with PCR-SSCP.

Weight for height of 92 patients (51 girls and 41 boys) treated for acute lymphoblastic leukemia (ALL) was evaluated in a longitudinal study. Fifty-four patients received cranial irradiation (CI) with a dose of 18 or 24 Gy and 38 patients did not receive CI. Seventy-seven patients were treated according to a normal-risk protocol and 15 patients received more intensive chemotherapy according to a high-risk protocol. In most of the patients the duration of follow-up was 12 years for irradiated patients and 4.5 years for the nonirradiated patients. Thirty of 92 patients were treated according to a protocol without CI, but with a difference in the use of corticosteroids: 19 patients received dexamethasone during the remission-induction and maintenance treatment and 11 patients received prednisone. The influence of dexamethasone vs. prednisone, sex, CI and high-dose vs. low-dose chemotherapy on weight for height was evaluated. Patients who received dexamethasone showed a significant increase in weight for height immediately after the start of therapy. In patients who received CI, weight for height significantly increased after the first year of treatment. The overweight in these patients persisted during the whole follow-up period. The weight for height of patients treated with prednisone and of patients who did not receive CI was below the mean of the normal population during treatment but was not different from normal after cessation of therapy. No difference in weight gain was seen between boys and girls and between patients who were treated with high vs. normal-risk protocols.

One hundred and thirty-one children with a median age of 5 years were administered Navoban(R) (tropisetron), a selective antagonist of the serotonin receptor (5-HT3), dosed once daily at 0.2 mg/kg (with a maximum of 5 mg daily) in a study aimed at evaluating the prevention of nausea and vomiting induced by anti-cancer chemotherapy. The most common malignancy (in 49% of patients) was acute lymphocytic leukaemia, Patients received Navoban(R) during one or more courses of emetogenic chemotherapy for a total of 455 courses administered intravenously or intravenously and intrathecally (IV + IT), Most patients (89%) had already received cytotoxic chemotherapy before enrolment for the trial, On Day 1, Navoban(R) was administered slowly and intravenously as a single dose before the start of chemotherapy, or by mouth as a single daily dose on subsequent days (median treatment duration = 5 days), On the first 5 days of each course of chemotherapy, response to Navoban(R) per 24-hour period was graded as: complete (absence of both nausea and vomiting), partial (1-4 vomits and/or less than 5 hours of nausea), or failure(more than; 4 vomits and/or at least 5 hours of nausea). Ninety-six per cent of the intravenous chemotherapy group and 97% of the IV + IT chemotherapy group had a complete (70% and 55% respectively) or partial(26% and 42% respectively) response during the first 24-hour period of the first course in which Navoban(R) was used. The second and subsequent courses yielded similar percentages. Delayed emesis was observed mainly during those courses employing the most emetogenic chemotherapy. No side effects of Navoban(R), other than one case of diarrhoea, were documented in this study.

Maternal uniparental disomy for the entire chromosome 7 has so far been reported in three patients with intrauterine and postnatal growth retardation. Two were detected because they were homozygous for a cystic fibrosis mutation for which only the mother was heterozygous, and one because he was homozygous for a rare COL1A2 mutation. We investigated 35 patients with either the Silver-Russell syndrome or primordial growth retardation and their parents with PCR markers to search for uniparental disomy 7. Four of 35 patients were found to have maternal disomy, including three with isodisomy and one with heterodisomy. The data confirm the hypothetical localization of a maternally imprinted gene (or more than one such gene) on chromosome 7. It is suggested to search for UPD 7 in families with an offspring with sporadic Silver-Russell syndrome or primordial growth retardation.

Importance Effective policies have potential to improve diet and reduce obesity. School food policies reach most children in the United States. Objective To assess the nutritional quality of foods chosen by students and meal participation rates before and after the implementation of new school meal standards authorized through the Healthy Hunger-Free Kids Act. Design, Setting, and Participants This descriptive, longitudinal study examined changes in the nutritional quality of 1 741 630 school meals at 3 middle schools and 3 high schools in an urban school district in Washington state. Seventy two hundred students are enrolled in the district; 54% are eligible for free and reduced-price meals. Student food selection data were collected daily from January 2011 through January 2014 during the 16 months prior to and the 15 months after implementation of the Healthy Hunger-Free Kids Act. Exposure The Healthy Hunger-Free Kids Act. Main Outcomes and Measures Nutritional quality was assessed by calculating monthly mean adequacy ratio and energy density of the foods selected by students each day. Six nutrients were included in the mean adequacy ratio calculations: calcium, vitamin C, vitamin A, iron, fiber, and protein. Monthly school meal participation was calculated as the mean number of daily meals served divided by student enrollment. Mean monthly values of mean adequacy ratio, energy density, and participation were compared before and after policy implementation. Results After implementation of the Healthy Hunger-Free Kids Act, change was associated with significant improvement in the nutritional quality of foods chosen by students, as measured by increased mean adequacy ratio from a mean of 58.7 (range, 49.6-63.1) prior to policy implementation to 75.6 (range, 68.7-81.8) after policy implementation and decreased energy density from a mean of 1.65 (range, 1.53-1.82) to 1.44 (range, 1.29-1.61), respectively. There was negligible difference in student meal participation following implementation of the new meal standards with 47% meal participation (range, 40.4%-49.5%) meal participation prior to the implemented policy and 46% participation (range, 39.1%-48.2%) afterward. Conclusions and Relevance Food policy in the form of improved nutrition standards was associated with the selection of foods that are higher in nutrients that are of importance in adolescence and lower in energy density. Implementation of the new meal standards was not associated with a negative effect on student meal participation. In this district, meal standards effectively changed the quality of foods selected by children.

Item does not contain fulltext Meier-Gorlin syndrome (MGS) is a rare autosomal recessive disorder characterized by primordial dwarfism, microtia, and patellar aplasia/hypoplasia. Recently, mutations in the ORC1, ORC4, ORC6, CDT1, and CDC6 genes, encoding components of the pre-replication complex, have been identified. This complex is essential for DNA replication and therefore mutations are expected to impair cell proliferation and consequently could globally reduce growth. However, detailed growth characteristics of MGS patients have not been reported, and so this is addressed here through study of 45 MGS patients, the largest cohort worldwide. Here, we report that growth velocity (length) is impaired in MGS during pregnancy and first year of life, but, thereafter, height increases in paralleled normal reference centiles, resulting in a mean adult height of -4.5 standard deviations (SD). Height is dependent on ethnic background and underlying molecular cause, with ORC1 and ORC4 mutations causing more severe short stature and microcephaly. Growth hormone therapy (n = 9) was generally ineffective, though in two patients with significantly reduced IGF1 levels, growth was substantially improved by GH treatment, with 2SD and 3.8 SD improvement in height. Growth parameters for monitoring growth in future MGS patients are provided and as well we highlight that growth is disproportionately affected in certain structures, with growth related minor genital abnormalities (42%) and mammary hypoplasia (100%) frequently present, in addition to established effects on ears and patellar growth. (c) 2012 Wiley Periodicals, Inc.

Relative to abstract words, concrete words typically elicit faster response times and larger N400 and N700 event-related potential (ERP) brain responses. These effects have been interpreted as reflecting the denser links to associated semantic information of concrete words and their recruitment of visual imagery processes. Here, we examined whether there are ERP differences between concrete and abstract stimuli controlled for a large number of factors including context availability (i.e., richness of semantic associations) and imageability. We found that abstract words elicited faster behavioral responses but that concrete words still elicited larger N400 and N700 responses. We propose that once all other factors, including imageability and context availability are controlled, abstract words may trigger a larger number of superficial linguistic associations that can be quickly used for response decisions. The ERP differences, however, would index the greater semantic processing (integration of multimodal information) for concrete than abstract words during meaning activation.

Item does not contain fulltext Although motor problems in Prader-Willi syndrome (PWS) are prominent in infants, and continue into childhood and adulthood, there is little insight into the factors important for clinical management. The literature was reviewed to: (1) provide an overview of the characteristics and prevalence of motor problems and (2) evaluate the effects of growth hormone (GH) treatment and physical training on motor performance. A systematic search revealed 34 papers: 13 on motor performance; 12 on GH treatment; and nine on physical training. In infants, motor development is 30-57% of the normal reference values, and children and adults also have significant problems in skill acquisition, muscle force, cardiovascular fitness, and activity level. GH treatment positively influenced motor performance in infants, children, and adults, although not all studies demonstrated an effect. All studies on physical training demonstrated beneficial effects in PWS patients. We suggest a combination of GH treatment and physical training to be started as soon as possible, especially in infants, to improve motor development as this will positively influence general development. 01 september 2012

Laying down new memories has long been thought to involve interactions between the hippocampus and multiple regions of the neocortex. Functional neuroimaging studies performed over the past four years provide evidence for this proposal. A recent electrophysiological study offers a possible mechanism by which interactions between brain regions take place during memory formation.

To assess cardiac anatomy and myocardial systolic function in children with Prader-Willi syndrome (PWS).Physical examination, electrocardiographic (ECG) recordings and transthoracic echocardiograms including two-dimensional speckle tracking echocardiography (2DSTE) were performed and evaluated in the Radboud University Hospital Nijmegen, the Netherlands. In total, 19 children diagnosed with PWS and 38 age-matched control subjects underwent cardiac evaluation.Abnormal ECG findings were detected in nine PWS patients. Echocardiography revealed mild structural cardiac abnormalities in two patients. Conventional echocardiographic findings did not indicate systolic left ventricular dysfunction, in contrast to 2DSTE examination. Global peak systolic strain (rate) measurements, in all three directions of contraction, were significantly lower in children with PWS (p0.001) compared with healthy age-matched children. In two-thirds of the patients, 2DSTE revealed abnormal systolic deformation (peak systolic strain as well as strain rate). T2P values in PWS patients were similar to control subject. Systolic myocardial function appears more affected in case of maternal uniparental disomy.Cardiac evaluation, including 2DSTE, detects frequent alterations in myocardial systolic function in children diagnosed with PWS, whose conventional echocardiographic findings did not indicate ventricular systolic dysfunction. Because cardiovascular morbidity and mortality is substantial in PWS, especially adults, we emphasize the need for cardiac assessment in PWS.

Background/Aims: In classical congenital adrenal hyperplasia (CAH), elevation of adrenal androgens leads to accelerated growth and bone maturation with compromised adult height. In untreated children with non-classical CAH (NC-CAH), in which adrenal androgens are generally only slightly increased, growth velocity may not be significantly elevated. Methods: Twenty-four patients were included and divided into a symptomatic and an asymptomatic group. Height was expressed as height standard deviation scores (HSDS) and corrected for target height (HSDS-THSDS). Bone maturation was expressed as bone age acceleration (BAc = bone age – calendar age). Linear mixed models with random factor patient were used for the analysis of growth and bone age. Results: In symptomatic patients (n = 17), HSDS-THSDS only slightly increased by 0.06 SDS per year (95% CI 0.02–0.10). Mean BAc was 2.21 years (SDS 0.66, p < 0.0001). In asymptomatic patients (n = 7), no significant growth acceleration or BAc was found. Conclusions: In untreated NC-CAH children, growth acceleration is small and generally not visible on their growth charts. BAc is more pronounced. Therefore, the absence of an increase in growth velocity does not exclude the diagnosis of NC-CAH. When considering this diagnosis, bone age acceleration should also be taken into account.