Healthy Body, Healthy Mind: A Mindset Intervention for Obese Youth

As growth mindset intervention research continues to develop, more work is needed to understand how to most effectively implement these interventions to encourage healthy cognitions and behaviors. The present study details the initial testing of a single-session, online mindset intervention (Healthy Body, Healthy Mind) for obese children and adolescents enrolled in obesity treatment clinics. Using a pre to post-test design, results indicated that growth mindsets of health and cognitions related to health behavior (nutrition and exercise self-efficacy and perceived control) increased significantly. However, despite efforts to mitigate feelings of culpability, blame also increased from pretest to post-test. Yet, body dissatisfaction decreased significantly. Intrinsic value for health behaviors remained unchanged from pretest to post-test. Analysis of narratives suggests that youth were engaged with the intervention content. Additionally, when youth's narratives incorporated themes related to the changeable nature of the attribute, they also self-reported stronger growth mindsets. In the discussion, we note implications of findings for the development of large-scale health-based growth mindset interventions that are developmentally-appropriate for children and adolescents.

Outcomes and safety of concomitant nevirapine and rifampicin treatment under programme conditions in Malawi

SETTING

Thyolo District Hospital, rural Malawi.

OBJECTIVES

To report on 1) clinical, immunological and virological outcomes and 2) safety among human immunodeficiency virus (HIV) infected patients with tuberculosis (TB) who received concurrent nevirapine (NVP) and rifampicin (RMP) based treatment.

DESIGN

Retrospective cohort study.

METHODS

Analysis of programme data, June-December 2007.

RESULTS

Of a total of 156 HIV-infected TB patients who started NVP-based antiretroviral treatment, 136 (87%) completed TB treatment successfully, 16 (10%) died and 5 (4%) were transferred out. Mean body weight and CD4 gain (adults) were respectively 4.4 kg (95%CI 3.3-5.4) and 140 cells/mm(3) (95%CI 117-162). Seventy-four per cent of patients who completed TB treatment and had a viral load performed (n = 74) had undetectable levels (<50 copies/ml), while 17 (22%) had a viral load of 50-1000 copies/ml. Hepatotoxicity was present in 2 (1.3%) patients at baseline. Two patients developed Grade 2 and one developed Grade 3 alanine transaminase enzyme elevations during TB treatment (incidence rate per 10 years of follow-up 4.2, 95%CI 1.4-13.1). There were no reported deaths linked to hepatotoxicity.

CONCLUSIONS

In a rural district in Malawi, concomitant NVP and RMP treatment is associated with good TB treatment outcomes and appears safe. Further follow-up of patients would be useful to ascertain the longer-term effects of this concurrent treatment.

Taste perception after lingual nerve repair

PURPOSE

This retrospective study evaluates patients' perception of taste after lingual nerve injury and repair. It is hypothesized that return of taste is a distinct neurophysiologic phenomenon related to specialized taste physiology and it does not correlate with specific, objective sensory return.

PATIENTS AND METHODS

During 1995 to 1996, 30 patients underwent microsurgical repair of lingual nerve injuries. Of these, 22 patients met the inclusion criteria for this study. Chart review documented the date and cause of injury, sensory examination, injury classification, procedures, operative findings, and postoperative sensory examination. A telephone questionnaire addressed whole mouth taste perception with normal daily eating. The questions asked were: 1) Was your sense of taste changed or abnormal after your nerve injury? and 2) Did your sense of taste recover after nerve repair?

RESULTS

All patients had a postinjury, prerepair sensory deficit on levels A, B, and C testing: neurotmesis (n = 14); and axonotmesis (n = 8). The mean time from injury to repair was 16 weeks (range, 3 to 41 weeks). Operative findings confirmed 12 Sunderland Class IV (partial transection) injuries and 10 Class V (complete transection) injuries. All patients had primary microsurgical repair without a nerve graft or entubulization. Postoperatively, 18 patients showed marked improvement in sensory testing at levels A, B and C, and 4 patients showed no significant change. A telephone interview regarding whole mouth taste perception indicated that 20 of 22 patients perceived changed, abnormal taste postinjury and pre-repair. Two patients reported normal taste perception. Postrepair, only 7 of 20 patients reported an increase or return of taste perception to a more normal level. The mean follow-up time was 80 weeks.

CONCLUSION

Most patients (20 of 22) with lingual nerve injuries in this study perceived whole mouth taste as abnormal. After nerve repair, although 82% (18 of 22) of patients had improvement in somatosensory function, whole mouth taste was perceived as improved by only 35% (7 of 20). It is proposed that the perception of whole mouth taste may not be related to the ability to perceive multiple sensory modalities, but rather to special sensory (taste) modality perception. Also, central changes may occur in the special sensory fibers that impact on the brainstem nucleus for taste (nucleus solitarius) and therefore the patient's perception of taste.

Gestational diabetes: is a higher cesarean section rate inevitable?

OBJECTIVE

To determine the rate of and indication for cesarean section for women with gestational diabetes mellitus (GDM) compared with glucose-tolerant women.

RESEARCH DESIGN AND METHODS

From a consecutive series of women with GDM seen over a 9-year period for medical management, women who had had a cesarean section were identified and the reason for the section determined from a review of the medical record. A control group of women who had had a section were obtained from an existing database of glucose-tolerant women.

RESULTS

The section rate for women with GDM was higher at 19.8% than the 15.6% for glucose-tolerant women. However, after adjustment for age and parity, no significant differences were found. There were also no differences found for the primary indication for section.

CONCLUSIONS

In our health area of New South Wales, Australia, women with GDM do not have a higher section rate compared with glucose-tolerant women. Concerns about the diagnosis of GDM leading to an increased rate of obstetric intervention should not be generalized.

Use of complementary and alternative medicine among Dominican emergency department patients

This small, pilot study examined presenting complaint, brief health history, use of complementary and alternative medicine (CAM), and sociodemographic characteristics, among patients attending the emergency department (ED) of a large urban hospital. The sample (n = 50) was primarily Dominican and of low socioeconomic status. Almost half had used CAM for their presenting complaint or another health problem during the past year, most commonly in the form of medicinal plants made into herbal teas. CAM users were more likely to be female, longer-term residents of the United States, and to have also used religious practices for health problems. Subjects who had used CAM for any problem other than the presenting complaint during the past year rated its effectiveness higher than subjects who had used CAM for their presenting complaint. In conclusion, it is likely that a significant proportion of Dominican ED patients use CAM, suggesting that they should be asked about their CAM use during triage.

The 75-g glucose tolerance test in pregnancy: a reference range determined on a low-risk population and related to selected pregnancy outcomes

OBJECTIVE

To determine a reference range for the 75-g glucose tolerance test (GTT) in pregnancy using a group of women at low risk for gestational diabetes mellitus (GDM) and to determine the validity of this reference range by examining selected pregnancy outcomes for glucose-tolerant women with a 2-h result on the GTT up to 1.0 mmol/l below the diagnostic level for GDM compared with treated women with GDM.

RESEARCH DESIGN AND METHODS

The reference range for the GTT was determined in 573 Caucasian women with an age <25 years and a BMI of <25 kg/m2. Selected pregnancy outcomes were compared between 272 treated women with GDM (diagnosed on the basis of a 2-h glucose level > or =8.0 mmol/l) and 308 women with a 2-h glucose level of 7.0-7.9 mmol/l.

RESULTS

There was 95% confidence that at least 95% of all the fasting glucose levels are < or =5.1 mmol/l(92 mg/dl) and 95% confidence that at least 95% of all the 2-h glucose levels were < or =7.8 mmol/l (140 mg/dl). Treated women with GDM had a significantly reduced rate of large-for-gestational-age infants compared with glucose-tolerant women, without any increase in the rate of small-for-gestational-age infants or obstetric interventions.

CONCLUSIONS

The reference range for the GTT in pregnancy should be determined on a low-risk population rather than on a total population. Consideration should be given to lowering the fasting glucose level to 5.0 mmol/l (90 mg/dl) and the 2-h level to 7.8 mmol/ (140 mg/dl). Glucose-tolerant women below this relatively low reference range have an increased rate of large-for-gestational-age infants and may benefit from treatment.

Postsurgical etoposide-ifosfamide regimen in poor-risk nonmetastatic osteogenic sarcoma

This prospective study was designed to test the activity of an ifosfamide-etoposide (VP-16) regimen on poor-risk, nonmetastatic, osteogenic sarcoma. A total of 13 patients with nonmetastatic osteogenic sarcoma with a poor histologic response to primary high-dose methotrexate-doxorubicin (Adriamycin)-cisplatinum chemotherapy received a total of six 5-day courses of ifosfamide (1,800 mg/m2) and etoposide (100 mg/m2) at three weekly intervals. The protocol was well tolerated, with only one case of transient renal failure. At present, eight patients (62%) have been in sustained complete remission with no evidence of recurrent disease for a mean follow-up of 3.4 years (range, 1.5-7.0 years). One patient is alive with lung metastases, and four have died of progressive disease. This prospective, albeit small, study confirms the efficacy of an ifosfamide-VP-16-based regimen in poor-risk, extremity, nonmetastatic osteogenic sarcoma. The demonstrated activity should spark large trials of ifosfamide-containing regimens in osteogenic sarcoma.

Multifocal desmoid tumor in childhood: report of two cases and review of the literature

We present two cases of multifocal desmoid tumors arising in two teenagers. Different, separate lesions developed in the same limb over a period of several years, one of which recurred on several occasions. The literature regarding the therapeutic aspects of multifocal fibromatosis is reviewed and discussed.

Hemodynamic effects of intrathecal fentanyl in nonlaboring term parturients

STUDY OBJECTIVE

To determine the effect of intrathecal fentanyl on maternal hemodynamics.

DESIGN

Prospective.

SETTING

Labor and delivery suite of a university medical center.

PATIENTS

23 ASA status I nonlaboring term parturients presenting for elective cesarean section.

INTERVENTIONS

Patients were given either 1,200 ml lactated Ringer's Solution (Group 1, n = 12) or no intravenous (i.v.) fluid (Group 2, n = 11). A combined spinal-epidural technique was then performed. Fentanyl 25 micrograms was administered intrathecally through a 24-gauge Sprotte or 25-gauge Whitacre spinal needle. After completion of the hemodynamic study, a catheter was threaded into the epidural space for local anesthetic administration.

MEASUREMENTS AND MAIN RESULTS

Baseline hemodynamic data [systolic (SBP), diastolic, and mean arterial pressure, heart rate, stroke volume, cardiac output, end-diastolic volume, and ejection fraction] were obtained in triplicate using noninvasive blood pressure monitoring and impedance cardiography. After administration of intrathecal fentanyl, hemodynamic measurements were recorded at 3-minute intervals for 30 minutes. These values were compared with baseline for both groups. Ten patients in each group completed the study. Intrathecal fentanyl administration did not result in any maternal hemodynamic changes in Group 1, and a few small statistically significant changes in Group 2. Measured SBP was always greater than 100 mmHg in all patients during the study.

CONCLUSION

Intrathecal administration of fentanyl 25 micrograms in nonlaboring term parturients does not produce clinically important maternal hemodynamic changes.

Rhabdomyosarcoma: invading the orbit in an adult

Sites in the head and neck region are among the most frequent locations of rhabdomyosarcoma (RMS) in patients younger than 15 years. However, comparable neoplasms in adults are very uncommon. We present a case report of a 27-year-old man who was diagnosed as having RMS. RMS rarely presents in the head and neck of adults, but should be considered in the differential diagnosis of a small cell neoplasm in patients during the third and fourth decades of life.

Angiostatin: a novel angiogenesis inhibitor that mediates the suppression of metastases by a Lewis lung carcinoma

The phenomenon of inhibition of tumor growth by tumor mass has been repeatedly studied, but without elucidation of a satisfactory mechanism. In our animal model, a primary tumor inhibits its remote metastases. After tumor removal, metastases neovascularize and grow. When the primary tumor is present, metastatic growth is suppressed by a circulating angiogenesis inhibitor. Serum and urine from tumor-bearing mice, but not from controls, specifically inhibit endothelial cell proliferation. The activity copurifies with a 38 kDa plasminogen fragment that we have sequenced and named angiostatin. A corresponding fragment of human plasminogen has similar activity. Systemic administration of angiostatin, but not intact plasminogen, potently blocks neovascularization and growth of metastases. We here show that the inhibition of metastases by a primary mouse tumor is mediated, at least in part, by angiostatin.

Gigantic lipomas

Two cases of unusually giant lipomas--weighting 5070 and 4000 gm--are described. Tumors were present for 5 years on the back in a 55-year-old man and for 20 years at the anterior compartment of the thigh in an 80-year-old woman. Difficulty in fitting clothes was the first patient's sole complaint, and social pressure was actually the reason that brought him to his doctor. The second patient suffered from pain during the last 2 years. The weight of the bigger tumor was calculated preoperatively from the uptake of technetium-99m DTPA during scanning. Dissection of the tumors from the surrounding tissues was extremely easy in both cases. At 5 years and 1 year following surgery, there is no evidence of recurrence.

The role of segmentation in prospective and retrospective time estimation processes

In five experiments, we investigated the effects of the segmentation level of an interval on its perceived duration. A prospective paradigm and an absolute time estimation method were used in two experiments, and in two others we used a retrospective paradigm and a comparative estimation method. A positive relationship was obtained between segmentation level of the estimated interval and its perceived duration under retrospective-comparative conditions for both auditory and tactual stimuli, but no relationship was found under prospective-absolute conditions. The paradigm, estimation method, and segmentation level were jointly manipulated in the fifth experiment. The impact of segmentation was significant under retrospective (both absolute and comparative) and close to significant under prospective-comparative conditions. These findings suggest that high-priority events are perceived and coded as contextual changes and that the impact of segmentation on time estimation is mediated by memory processes.

MR diagnosis of tears of anterior cruciate ligament of the knee: importance of ancillary findings

OBJECTIVE

Detection of tears of the anterior cruciate ligament with MR is usually based on the appearance of the ligament. However, other MR findings may be useful to establish the diagnosis. We assessed the utility of these ancillary MR findings for detecting tears and for differentiating partial from complete tears of the anterior cruciate ligament.

MATERIALS AND METHODS

MR images of 68 patients who had arthroscopic correlation were retrospectively reviewed by two radiologists who did not know the arthroscopic findings. The reviewers noted the presence and location of bone bruises (nonlinear low signal in the bone marrow on T1-weighted images), assessed posterior displacement of the posterior horn of the lateral meniscus, and measured the posterior cruciate ligament angle. At arthroscopy, 39 patients had tears of the anterior cruciate ligament (24 complete, 15 partial) and 29 had intact anterior cruciate ligaments.

RESULTS

The presence of bone bruising in the posterolateral tibial plateau had sensitivities of 50% and 46%, with corresponding specificities of 97% and 97% for the two reviewers. Posterior displacement of the posterior horn of the lateral meniscus had a sensitivity of 56% for both reviewers, with 100% and 97% specificities. An angle of the posterior cruciate ligament less than 105 degrees had sensitivities of 72% and 74%, with corresponding specificities of 79% and 86%. The prevalence of these findings was similar in patients with partial tears and those with complete tears.

CONCLUSION

Ancillary MR imaging findings may be helpful for diagnosing tears of the anterior cruciate ligament when diagnosis based on the MR appearance of the ligament is equivocal. Ancillary findings cannot be used to differentiate patients with partial tears from those with complete tears. The presence of bone bruising in the posterior aspect of the tibial plateau and posterior displacement of the posterior horn of the lateral meniscus are highly specific for a torn anterior cruciate ligament; therefore, the presence of either of these findings should be considered strong evidence of a tear of the anterior cruciate ligament.

Environmental equity and pesticide exposure

Although people of color and low-income groups bear a disproportionate share of the health risks from exposure to pesticides, research attention has been meager, and data on acute and chronic health effects related to their toxic exposures are generally lacking. Increased resources are needed both to study this issue and to mitigate problems already identified. People of color should be a major research focus, with priority on long-term effects, particularly cancer, neurodevelopmental and neurobehavioral effects, long-term neurological dysfunction, and reproductive outcome. Suitable populations at high risk that have not been studied include noncertified pesticide applicators and seasonal and migrant farm workers, including children.

Infrared CD of deoxy oligonucleotides. Conformational studies of 5'd(GCGC)3', 5'd(CGCG)3', 5'd(CCGG)3', and 5'd(GGCC)3' in low and high salt aqueous solution

Infrared (vibrational) circular dichroism (VCD) spectra have been obtained for the self-complementary tetranucleotides, 5'd(CGCG)3', 5'd(GCGC)3', 5'd(CCGG)3', and 5'd(GGCC)3'. In buffered aqueous solution at low salt concentration, these tetramers exhibit spectra associated with right-handed polymers, although the spectra differ significantly for the four species. In high salt solution, a B-->Z transition occurs in 5'd(CGCG)3', while the other tetranucleotides appear only slightly altered. Temperature dependent studies of these oligonucleotides reveal a greater amount of thermal stability for the tetramers in low salt than for the high salt solutions. VCD intensities computed via the exciton formalism are compared with observed results.

[Unilateral proptosis due to cholesterol granuloma]

Cholesterol granuloma is a rare cause of unilateral proptosis. We describe a 42-year-old man who presented with painless swelling of the left upper brow of a few months duration. Biopsy showed crystals of cholesterol surrounded by giant cells.

Radionuclide imaging of soft tissue masses with Tc-99m DTPA

A scintigraphic study was carried out on 48 patients presenting with palpable soft tissue masses. Imaging was carried out using Tc-99m DTPA in three phases (dynamic, blood pool after 5 minutes, followed by late scans after 2 hours). The resultant uptake of the agent was categorized as consistently positive (14 cases), initially positive but progressively negative (7 cases), initially negative but progressively positive (7 cases), and consistently negative (20 cases). Histopathologic examinations were carried out for all cases following biopsy. A variety of malignant and benign masses were found to localize DTPA, whereas all masses that did not concentrate the agent were proven to be lipomas. In order to determine whether the uptake of DTPA bore any relationship to blood flow, additional studies using Tc-99m labeled red cells were carried out on 15 patients with soft tissue tumors. There was no correlation between blood flow or pooling and the degree of Tc-99m DTPA uptake by the palpable masses. The sensitivity of DTPA uptake as indicative of nonlipomatous tissue was 100%, and its specificity was 91%. The predictive probability that a lesion was a liopoma if there was no DTPA uptake at any phase was 100%.

Biocompatible controlled release polymers for delivery of polypeptides and growth factors

The development of biocompatible, controlled release systems for macromolecules has provided the opportunity for researchers and clinicians to target and deliver, on site, biologically active factors. This advance has also facilitated the purification and characterization of a number of important biomolecules. These systems include controlled release delivery systems which release proteins through porous polymer matrices, degradable polymeric delivery systems, and modulated polymer release systems. These areas of research will be reviewed with regards to their design, release kinetics, and biocompatibilities. The utilization of these systems to release such biologically important polypeptides as growth factors (e.g., fibroblast growth factor, epidermal growth factor, transforming growth factor-B) as well as a number of important inhibitory factors (e.g., nitrosoureas, angiogenesis inhibitors) in both in vivo and in vitro studies will be discussed.

Pesticide-related health problems and farmworkers

1. Migrant and seasonal farmworkers are primarily ethnic minorities who are excluded from federal laws that protect other workers. Farmworkers live and work under substandard conditions that place them at increased risk of pesticide-related illness. 2. Agriculture uses 80% of all pesticides in the U.S. Handlers who mix, load and apply pesticides as well as workers cultivating and harvesting crops sprayed with them are at risk of acute poisoning or even death from their exposures. Drift and run-off of agricultural pesticides pollute the air, soil and water, creating additional hazards to workers' families, community residents, and the environment. 3. Chronic effects, including cancer in adults and children, adverse reproductive outcomes, delayed neuropathy and neurobehavioral effects, are also associated with occupational and environmental exposure to pesticides.

A new method for the cytological analysis of autoantibody specificities using whole-mount, surface-spread meiotic nuclei

A new method for the cytological analysis of antinuclear antibody binding offers several advantages over conventional techniques. Nuclei in meiosis, prepared by surface-spreading spermatocytes, provide a detailed examination of the constituents of the nucleus--euchromatin, heterochromatin, sex chromatin, nucleoli, centromeres, and dense patches that seem related to RNA metabolism--and each of these structures can be seen to change in morphology and antibody labeling during the course of meiotic prophase. Results using sera from humans and mice with autoimmune disease, and using several mouse monoclonal antibodies, demonstrate the potential of this method for clinical and research applications, both for more common antibody types and for those that bind epitopes which are unique to germ cells.

Ewing's sarcoma metastatic to focal nodular hyperplasia of liver

A case is presented of a young woman discovered at thoracotomy to have Ewing's sarcoma of the left lower ribs with soft tissue extension to the diaphragm and thoracic wall. Laparotomy at the same operation showed a nodule of focal nodular hyperplasia of the liver with a focus of metastasis from the sarcoma within the area of hyperplasia. This is the first report of metastasis of any tumor to a hepatic lesion of this sort. Possible reasons for metastasis to this type of lesion are discussed.

Cutaneous histologic findings in chemical workers with and without chloracne with past exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin

Histopathologic examination of the skin in seventy-seven chemical workers with past exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) was performed in 1981 to determine whether changes specific for chloracne were present. Prior to biopsy, subjects had been classified as having clinical evidence of residual chloracne (48%), having a past history of chloracne but no current dermatologic evidence of it (24%), or never having had chloracne (27%). Follicular infundibular dilatation and/or comedones and cysts were found in 76%, 39%, and 32% of the current, past, and never chloracne groups, respectively; the differences were significant between current and never groups (p less than 0.001) and between current and past groups (p less than 0.01). A combined mean score of follicular infundibular dilatation, comedones, and cysts was significantly different only between the current and never groups (p less than 0.005). Solar elastosis, histologically present in all subjects, was related to age but not chloracne. No relationship was found between smoking habit and any of the histologic findings. Changes specific for chloracne were not found. Four-millimeter skin biopsy is unlikely to be either diagnostic or useful in persons with past exposure to TCDD that is ill defined or insufficient to produce chloracne.

Health status of workers with past exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin in the manufacture of 2,4,5-trichlorophenoxyacetic acid: comparison of findings with and without chloracne

Chloracne was found in 52% of 226 workers in a 1979 cross-sectional survey at a plant where 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) had been manufactured from 1948 to 1969. Mean duration of residual chloracne was 26 years, and in 29 subjects, it had been present for 30 years. A significant increased prevalence of abnormal gamma-glutamyl transpeptidase (GGT) and higher mean GGT were found in those with chloracne, compared to those without. Although mean triglyceride values were higher in those with chloracne, the difference was not statistically significant. Neurological examination showed a statistically significant higher prevalence of abnormal sensory findings in those with chloracne. Increased prevalence of angina and reported myocardial infarction in those with chloracne was not significant when age-adjusted. Increased prevalence of reported sexual dysfunction and decreased libido in those with chloracne compared to those without was statistically significant after age adjustment. No differences were found between those with and without chloracne in serum cholesterol, total urinary porphyrins, or in reproductive outcome.

Health status of cable splicers with low-level exposure to lead: results of a clinical survey

The results of a cross-sectional clinical field survey of 90 telephone cable splicers are presented. Despite the rare occurrence of clinically overt lead poisoning among cable splicers, the observed prevalence of symptoms was 29% for lead-associated central nervous system symptoms and 21% for gastrointestinal symptoms. These two groups of symptoms were directly related to zinc protoporphyrin (ZPP) levels but no relationship was found between them and blood lead concentrations. Only 5% of the workers had significantly elevated blood lead levels (greater than 40 microgram/100ml). Because of the intermittent lead exposure encountered in this trade, individuals were identified with "normal" blood lead levels associated with "elevated" zinc protoporphyrin concentrations, indicating the difference in biological significance between exposure-(blood lead) and biological-response tests (ZPP). Suggestion is made that both types of diagnostic tests be utilized in the medical surveillance of lead-exposured workers.