Valve-sparing aortic root replacement in children: intermediate-term results

Valve-sparing root replacement (VSRR) is an attractive option for aortic aneurysm in children with low-operative risk, but mid- and late-term results are not yet known. Between 1997 and 2009, 56 children (mean age 11.5 years) underwent VSRR at our institution. Twenty-six (46.4%) had Marfan syndrome and 24 (42.8%) had Loeys-Dietz syndrome. Mean preoperative max sinus diameter was 4.2±0.8 cm (Z-score 7.7±2.9). Five (8.9%) had >2+ aortic insufficiency (AI). Two (3.6%) underwent David I reimplantation with a straight-tube, 12 (21.4%) had a Yacoub remodeling procedure, and 42 (75.0%) had reimplantation using a Valsalva-graft. There were one (1.8%) operative and three (5.4%) late deaths. One patient required reoperation for bleeding and one required late repair of a distal pseudoaneurysm. Mean follow-up was 5.2 years (range 0-12 years). No patients suffered thromboembolic events or had endocarditis. Of the 12 remodeling patients, four (33.3%) developed >2+ AI and required aortic valve repair or replacement. No patient developed >2+ AI after reimplantation. VSRR in children is a safe alternative to aortic root replacement with mechanical or biological prostheses. In this particular group of patients with connective tissue disorders and proclivity toward annular dilation and late AI, reimplantation is superior to remodeling.     

CT Reveals a High Incidence of Osseous Abnormalities in Hips with Labral Tears

Background  

Acetabular labral tears are being diagnosed with increasing frequency and there is a growing consensus that these tears rarely occur in the absence of osseous abnormalities.     

Posttraumatic Stress Disorder and Negative Symptoms of Schizophrenia

Posttraumatic stress disorder (PTSD) is highly comorbid with schizophrenia and may be associated with higher levels or lower levels of negative symptoms. In the current study, we attempted to clarify the relationship between PTSD and negative symptoms by examining the proportion of patients meeting various negative symptom criteria in a sample of patients diagnosed with schizophrenia alone or schizophrenia and comorbid PTSD. Results indicated that the presence of PTSD in schizophrenia was associated with increased secondary negative symptoms, with the deficit syndrome (DS) and primary negative symptoms associated with lower rates of current and lifetime diagnoses of PTSD. Furthermore, the deficit/nondeficit classification provided greater differentiation of PTSD symptoms than did negative symptoms defined more broadly using the Scale for the Assessment of Negative Symptoms or primary vs secondary distinctions. These findings suggest that DS patients are at a uniquely low risk for PTSD.     

Evaluation of EX: a national mass media smoking cessation campaign

Objectives. We used longitudinal data to examine the relationship between confirmed awareness of a national, branded, mass media smoking cessation campaign and cessation outcomes.Methods. We surveyed adult smokers (n = 4067) in 8 designated market areas (“media markets”) at baseline and again approximately 6 months later. We used multivariable models to examine campaign effects on cognitions about quitting, quit attempts, and 30-day abstinence.Results. Respondents who demonstrated confirmed awareness of the EX campaign were significantly more likely to increase their level of agreement on a cessation-related cognitions index from baseline to follow-up (odds ratio [OR] = 1.6; P = .046). Individuals with confirmed campaign awareness had a 24% greater chance than did those who were not aware of the campaign of making a quit attempt between baseline and follow-up (OR = 1.24; P = .048).Conclusions. A national, branded, mass media smoking cessation campaign can change smokers'' cognitions about quitting and increase quit attempts. We strongly recommend that federal and state governments provide funding for media campaigns to increase smoking cessation, particularly for campaigns that have been shown to impact quit attempts and abstinence.Mass media campaigns can be used to change smoking-related cognitions and to prompt quitting behavior, particularly when combined with other tobacco control efforts.^1,2 Media campaigns at the national, community, and city level have been effectively used to increase smoking cessation among adults.^3–8 The EX campaign (National Alliance for Tobacco Cessation, Washington, DC) was designed as a branded, mass media campaign aimed to encourage adult smokers to quit.^9,10 This campaign was pilot tested in 4 US cities in 2006 and 2007.¹⁰ In a longitudinal pilot study, confirmed campaign awareness was associated with statistically significant change in campaign-related cognitions over approximately 6 months.¹⁰ Given these findings, in the spring of 2008 the National Alliance for Tobacco Cessation (NATC)—a partnership of states, national public health organizations, foundations, and corporations—launched EX as a national campaign.The EX campaign is grounded in behavior change theory^11–13 and the evidence regarding effective mass media campaigns.^1,14–18 Given the evidence that branding can enhance the impact of a public health campaign, all messages are branded “EX.”^19,20 The target audience was defined as “smokers who are open to quitting but may not know how to successfully quit.” The campaign message strategy was based on qualitative data from smokers at various stages in the quitting process, derived from more than 40 focus groups (more than 300 participants), 48 in-depth interviews, and a national survey of more than 1000 smokers. Messages are characterized by an empathetic, smoker-to-smoker voice that encourages smokers to relearn their life without cigarettes. Emphasis is placed on disassociating smoking from common daily activities that would otherwise function as smoking cues, such as driving or drinking coffee.During the 6-month national campaign period, March 31 through September 28, 2008, EX advertisements aired on cable television at 549 average quarterly targeted rating points (TRPs). TRPs are the standard unit of measurement for media delivery and reflect both the reach and the frequency of an advertisement. Reach describes the total percentage of the targeted population that is exposed to the advertisement; frequency describes the number of times individuals in the targeted population saw the advertisement, on average. TRPs are identical to gross rating points (GRPs), except that they are delivered to, and measured within, a specific and defined audience.² EX advertising was not evenly distributed across the campaign period; 68% of the EX TRPs aired in the first 3 months of the campaign. Pfizer''s My Time to Quit campaign aired nationally at 382 average quarterly TRPs during the same period as the national EX campaign. The Phillip Morris campaign, Quit Assist, did not air during the study period; however, because it aired nationally in 2007 awareness of the campaign was measured and was included as a covariate in the present study to control for any residual campaign effects. No local or state-level tobacco control media was airing in 6 of the 8 designated market areas (DMAs) from which the study sample was drawn. In one DMA, occasional public service announcements aired; in another, no information was available as to whether public service announcements would air. Public service announcements generally air at a low TRP level.According to the Centers for Disease Control and Prevention, campaigns that deliver 1200 or more average quarterly TRPs during the introductory year of a campaign can expect to reach 75% to 85% of the target audience, in which case evaluators may expect to detect campaign awareness at 6 months, attitude change at 12 to 18 months, and behavior change at 18 to 24 months.² Given funding constraints, the total media delivery of the EX campaign was approximately 47% of the level recommended by the Centers for Disease Control and Prevention.² Nevertheless, on the basis of the findings noted in the evaluation of the EX pilot campaign we hypothesized that EX awareness would be associated with significant change in campaign-related cognitions and behaviors despite the lower media delivery level. To test this hypothesis, we examined a longitudinal cohort of adult smokers drawn from 8 DMAs, with control for baseline and contextual variables.     

Maternal antibodies to rotavirus: could they interfere with live rotavirus vaccines in developing countries?

Introduction

Past experience with live oral vaccines including licensed rotavirus vaccines demonstrates a trend towards reduced vaccine efficacy in developing countries compared with developed countries. The reasons behind this disparity are not well understood. Transplacental transfer of maternal antibodies and breast milk ingestion may attenuate vaccine responses in infants in developing countries where rotavirus infections are endemic, and maternal antibody levels are high. We examined the prevalence and level of rotavirus antibody in maternal and cord serum, colostrum and breast milk in a developing country setting.

Methods

100 mother-infant pairs were prospectively recruited from December 2008 to February 2009 at Dr. Sardjito Hospital, Yogyakarta, Indonesia. Maternal and cord sera were collected during delivery. Colostrum and transitional breast milk were collected between day 0-3 and day 7-10 postpartum respectively. Rotavirus-specific IgA and IgG were estimated for all specimens and virus neutralization assays were conducted on a subset of milk specimens.

Results

All maternal and cord serum samples were positive for rotavirus-specific IgG antibodies with a strong correlation between levels of rotavirus-specific IgG in mothers and levels transferred to infants in cord blood (r = 0.86; p = 0.001). 78% of colostrum and 67% of transitional breast milk specimens were positive for rotavirus-specific IgA. There was a median 4-fold decrease in rotavirus-specific IgA from colostrum to transitional breast milk. Neutralizing antibodies were present in 56% of colostrum specimens assayed (19/34) and in 41% of transitional milk specimens assayed (14/34).

Conclusions

Maternal serum and breast milk antibodies to rotavirus are highly prevalent in a developing country setting. Evaluation of the impact of maternal anti-rotavirus serum and breast milk antibody upon vaccine immunogenicity would help to inform rotavirus vaccination strategies, especially in developing settings.     

Alcohol, violence, and the Alcohol Myopia Model: preliminary findings and implications for prevention

This experiment provided a preliminary test of whether the Alcohol Myopia Model (AMM; Steele & Josephs, 1990) would provide a guiding framework for the prevention of alcohol-related violence. The model contends that alcohol has a "myopic" effect on attentional capacity that presumably facilitates violence by focusing attention onto more salient provocative, rather than less salient inhibitory, cues in hostile situations. Participants were 16 intoxicated male social drinkers who completed a laboratory task in which electric shocks were received from, and administered to, a fictitious opponent under the guise of a competitive reaction-time task while they were exposed to either violence-promoting (n=8) or violence-inhibiting (n=8) cues. Aggression was operationalized as the intensity and duration of shocks administered by the participant to his "opponent." Despite being equally intoxicated, participants exposed to violence-inhibiting cues were dramatically less aggressive (d=1.65) than those exposed to the violence-promoting cues. Our data suggest that the AMM holds a great deal of promise to help develop effective prevention interventions for alcohol-related violence.     

Acute upper arm ischaemia: a rare presentation of non-Hodgkin’s lymphoma

Digital ischaemia has been sparsely reported in current literature. Its association with lymphomatous conditions has been described in even more exceptional occurrences. We present the first case of upper arm ischaemia associated with non-Hodgkin’s lymphoma. A brief literature review of this rare phenomenon is also accompanied with it.     

Family-based cognitive-behavioral therapy for pediatric obsessive-compulsive disorder: comparison of intensive and weekly approaches

OBJECTIVE: To examine the relative efficacy of intensive versus weekly cognitive-behavioral therapy (CBT) for children and adolescents with obsessive-compulsive disorder (OCD). METHOD: Forty children and adolescents with OCD (range 7-17 years) were randomized to receive 14 sessions of weekly or intensive (daily psychotherapy sessions) family-based CBT. Assessments were conducted at three time points: pretreatment, posttreatment, and 3-month follow-up. Raters were initially blind to randomization. Primary outcomes included scores on the Children's Yale-Brown Obsessive-Compulsive Scale, remission status, and ratings on the Clinical Global Impression-Severity and Clinical Global Improvement scales. Secondary outcomes included the Child Obsessive Compulsive Impact Scale-Parent Rated, Children's Depression Inventory, Multidimensional Anxiety Scale for Children, and Family Accommodation Scale. Adjunctive pharmacotherapy was not an exclusion criterion. RESULTS: Intensive CBT was as effective as weekly treatment with some advantages present immediately after treatment. No group differences were found at follow-up, with gains being largely maintained over time. Although no group x time interaction was found for the Children's Yale-Brown Obsessive-Compulsive Scale (F(1,38) = 2.2, p = .15), the intensive group was rated on the Clinical Global Impression-Severity as less ill relative to the weekly group (F(1,38) = 9.4, p < .005). At posttreatment, 75% (15/20) of youths in the intensive group and 50% (10/20) in the weekly group met remission status criteria. Ninety percent (18/20) of youths in the intensive group and 65% (13/20) in the weekly group were considered treatment responders on the Clinical Global Improvement (chi1(2) = 3.6, p = .06). CONCLUSIONS: Both intensive and weekly CBT are efficacious treatments for pediatric OCD. Intensive treatment may have slight immediate advantages over weekly CBT, although both modalities have similar outcomes at 3-month follow-up.