Antiresorptive and anti-angiogenic drug therapy in the pediatric population with reference to medication-related osteonecrosis of the jaw.

The objective of this study was to identify the prevalence of osteonecrosis of the jaw in a pediatric population with systemic therapeutic exposure to an antiresorptive, anti-angiogenic, and/or immunomodulating drug (ARAID), and in particular in the subgroup of patients who had undergone invasive dental treatment. This was a retrospective cohort study performed at a single center. The investigation included pediatric patients who had undergone systemic therapy with ARAIDs and who began receiving ARAID therapy at ≤16 years of age. The study included 482 patients who received ARAIDs between January 2011 and January 2021. The most common medication class was bisphosphonates (45.0%), followed by mTOR inhibitors (30.1%) and anti-angiogenics (17.8%). No diagnosis of osteonecrosis of the jaw was observed. From this population, 26 patients were noted to have undergone invasive dental treatment. The duration from treatment to the invasive procedure ranged from 0 to 5.9 years. Medication-related osteonecrosis of the jaw is extremely rare among the pediatric population - much less common when compared to the adult population. Prospective cohort studies and continued evaluation will help determine the incidence and prevalence of medication-related osteonecrosis of the jaw in pediatric patients.

Effects of Methamphetamine Self-Administration and Extinction on Astrocyte Structure and Function in the Nucleus Accumbens Core.

Astrocytes provide support for neurons, regulate metabolic processes, and influence neuronal communication in a variety of ways, including through the homeostatic regulation of glutamate. Following 2-h cocaine or methamphetamine self-administration (SA) and extinction, rodents display decreased levels of basal glutamate in the nucleus accumbens core (NAcore), which transitions to elevated glutamate levels during drug seeking. We hypothesized that, like cocaine, this glutamate 'overflow' during methamphetamine seeking arises via decreased expression of the astroglial glutamate transporter GLT-1, and withdrawal of perisynaptic astroglial processes (PAPs) from synapses. As expected, methamphetamine self-administration and extinction decreased the level of contact made by PAPs in the NAcore, yet did not impact glutamate uptake, GLT-1 expression, or the general structural characteristics of astrocytes. Interestingly, systemic administration of N-acetylcysteine (NAC), a drug that both upregulates GLT-1 and promotes glial-glutamate release, reduced cued methamphetamine seeking. In order to test the impact of astrocyte activation and the induction of glial glutamate release within the NAcore, we employed astrocyte-specific expression of designer receptors exclusively activated by designer drugs (DREADDs). We show here that acute activation of Gq-coupled DREADDs in this region inhibited cued methamphetamine seeking. Taken together, these data indicate that cued methamphetamine seeking following two-hour SA is not mediated by deficient glutamate clearance in the NAcore, yet can be inhibited by engaging NAcore astrocytes.

Evaluation of cover crop and reduced cultivation for reducing nitrate leaching in Ireland.

Nitrate (NO(3)) loss from arable systems to surface and groundwater has attracted considerable attention in recent years in Ireland. Little information exists under Irish conditions, which are wet and temperate, on the effects of winter cover crops and different tillage techniques on NO(3) leaching. This study investigated the efficacy of such practices in reducing NO(3) leaching from a spring barley (Hordeum vulgare L.) system in the Barrow River valley, southeast Ireland. The study compared the effect of two tillage systems (plow-based tillage and noninversion tillage) and two over-winter alternatives (no vegetative cover and a mustard cover crop) on soil solution NO(3) concentrations at 90 cm depth over two winter drainage seasons (2003/04 and 2004/05). Soil samples were taken and analyzed for inorganic N. During both years of the study, the use of a mustard cover crop significantly reduced NO(3) losses for the plowed and reduced cultivation treatments. Mean soil solution NO(3) concentrations were between 38 and 70% lower when a cover crop was used, and total N load lost over the winter was between 18 and 83% lower. Results from this study highlight the importance of drainage volume and winter temperatures on NO(3) concentrations in soil solution and overall N load lost. It is suggested that cover crops will be of particular value in reducing NO(3) loss in temperate regions with mild winters, where winter N mineralization is important and high winter temperatures favor a long growing season.

The distribution of early recombination nodules on zygotene bivalents from plants.

Early recombination nodules (ENs) are protein complexes approximately 100 nm in diameter that are associated with forming synaptonemal complexes (SCs) during leptotene and zygotene of meiosis. Although their functions are not yet clear, ENs may have roles in synapsis and recombination. Here we report on the frequency and distribution of ENs in zygotene SC spreads from six plant species that include one lower vascular plant, two dicots, and three monocots. For each species, the number of ENs per unit length is higher for SC segments than for (asynapsed) axial elements (AEs). In addition, EN number is strongly correlated with SC segment length. There are statistically significant differences in EN frequencies on SCs between species, but these differences are not related to genome size, number of chromosomes, or phylogenetic class. There is no difference in the frequency of ENs per unit length of SC from early to late zygotene. The distribution of distances between adjacent ENs on SC segments is random for all six species, but ENs are found at synaptic forks more often than expected for a random distribution of ENs on SCs. From these observations, we conclude that in plants: (1) some ENs bind to AEs prior to synapsis, (2) most ENs bind to forming SCs at synaptic forks, and (3) ENs do not bind to already formed SCs.

Health-related possible selves in young and middle adulthood.

The construct of possible selves was used to examine when, in the adult life span, health-related goals become dominant. It was predicted that by middle age most adults would have health-related possible selves and that the strength of self-regulatory variables associated with health-related possible selves would be related to reported health behaviors. Data collected from 171 young and middle-aged adults showed that health-related possible selves become predominant in midlife. In addition, both young and middle-aged adults reported more feared than hoped-for selves in the realm of health. Perceived self-efficacy and number of goal-oriented activities to avoid feared health-relevant selves were significant predictors of health behaviors. Results are discussed in relation to theoretical perspectives on self and health processes over the life span.

Mental and physical health of spouse caregivers: the role of personality.

Although personal resources of caregivers, such as coping skills and social support, have been shown to be important in understanding caregiver stress and health outcomes, personality traits have not previously been considered. The purpose of this study was to examine the association between the personality traits of neuroticism and dispositional optimism and mental and physical health outcomes. It was predicted that personality would have direct effects, and indirect effects through perceived stress, on health outcomes. Participants were spouse caregivers of patients diagnosed with Alzheimer's disease. Results showed that neuroticism and optimism were significantly related to mental and physical health. Furthermore, neuroticism had significant direct effects on all of the health outcomes, and substantial indirect effects, through perceived stress, on mental health outcomes. Optimism showed stronger indirect than direct effects on all health outcomes. These findings demonstrate the importance of including personality of the caregiver in theoretical and empirical models of the caregiving process.

Structure and variation of mood in individuals with Parkinson's disease: a dynamic factor analysis.

Mood structure was examined among individuals diagnosed with Parkinson's disease. Twelve individuals completed a measure of positive and negative affect for 70 consecutive days. Mood structure was determined by using dynamic factor analysis (DFA) models that account for both concurrent and lagged relationships in repeated measurements. Five individuals had sufficient variability in positive and negative affect to conduct DFA on both sets of variables. Results showed the presence of 2 2-factor 1-lag models, 2 1-factor 1-lag models, and a P-technique model. There was sufficient variability in positive affect to conduct DFA on positive affect for the entire sample. Two individuals displayed 2-factor 1-lag models, 6 individuals had 1-factor 1-lag models, and 4 individuals showed P-technique models. Implications of lagged relationships are discussed from substantive and methodological perspectives.

Personality and coping among caregivers of spouses with dementia.

Personality factors and coping strategies were examined among a sample of spouse caregivers. Fifty spouse caregivers of patients diagnosed with Alzheimer's disease or a related dementia completed the NEO-FFI, a personality inventory designed to measure traits identified in the five-factor trait model, and a revised measure of the Ways of Coping Checklist. Results from a series of multivariate regressions showed that personality traits explained 60% of the variance in emotion-focused coping, 30% of variance in problem-focused coping, and 15% of variance associated with social support coping. Discussion focuses on the usefulness of including personality characteristics of the caregiver in formulating models of the caregiving coping process.

Does type of disease matter? Gender differences among Alzheimer's and Parkinson's disease spouse caregivers.

PURPOSE OF STUDY: Mental health outcomes are widely reported among spouse caregivers, with wives generally faring worse than husbands. We hypothesized that gender differences would not be as strong in a cognitively intact group because caring for cognitively intact spouses may involve less severe reciprocity losses. We also examined gender differences in coping strategies within each group. DESIGN AND METHOD: 175 spouse caregivers for patients with Alzheimer's disease (AD; n = 88) and Parkinson's disease (PD; n = 87) were interviewed. Participants completed perceived stress (PSS), depression (CES-D), state anxiety (STAI, Form Y), and coping strategies (WCCL-R) measures. RESULTS: Wives in the AD group reported significantly worse mental health outcomes than husbands, while wives and husbands in the PD group showed no differences. AD caregiving wives were less likely than husbands to use problem-focused coping strategies. There were no significant gender differences in either group for social support or emotion-focused coping. IMPLICATIONS: Loss of reciprocity in marital relationships may affect women more negatively than men. Future studies that address underlying mechanisms of gender differences and focus on similar caregiving situations and contexts deserve attention.

Personality counts for a lot: predictors of mental and physical health of spouse caregivers in two disease groups.

The purpose of this study were to examine the influence of personality on mental and physical health of spouse caregivers and to determine whether there were differences in such influences depending on disease context. The disease contexts compared were Alzheimer's disease (AD) and Parkinson's disease (PD; with no coexisting dementia)--both chronic, degenerative diseases of later life. It was predicted that personality would be related to mental and physical health, directly and indirectly, and that AD caregivers would have higher levels of perceived stress and worse mental and physical health outcomes. Participants in the study were 175 caregivers (88 AD; 87 PD) living at home with their ill spouses. The data provided an excellent fit to the hypothesized model of the relationships between personality, disease group, social support, perceived stress, and mental and physical health. Seventy-eight percent of the variance in mental health was accounted for and 35% of the variance in physical health was explained. Personality had significant direct and indirect effects on mental health and significant indirect effects on physical health. As predicted, AD caregivers had significantly worse mental health than PD caregivers; however, AD caregivers had better physical health than PD caregivers, controlling for other variables in the model. These results are discussed in relation to the existing caregiving and behavioral medicine literature. Future research should include different domains of personality--states and longer term self-regulatory processes in addition to traits--to advance models of caregiving processes further.

Possible selves and perceived health in older adults and college students.

Two studies were conducted to assess motivational aspects of the self by measuring hoped-for and feared possible selves among a sample of older adults and college students. It was predicted that health-related possible selves would be predominant among older adults, but not college students, and that self-regulatory aspects of possible selves would be related to perceived health. Data were collected through interviews and questionnaires. Older adults were significantly more likely to have possible selves in the realm of health than were college students. Regression analyses with the older sample indicate that outcome expectancy for a hoped-for self was positively related to perceived health, whereas amount of time spent thinking about a hoped-for possible self was negatively related to perceived health. However, these relationships were not significant when evaluated in relation to a feared possible self, indicating that there may be differences in the way self-regulatory processes operate in service of positive, as opposed to negative, goals for the self. Results are discussed with reference to theoretical models of self-efficacy and motivation over the life span.

Subterranean medicine: an inquiry into underground medical treatment protocols in cave rescue situations in national parks in the United States.

Caving and spelunking have become increasingly popular over the years, with hundreds of thousands of amateur spelunkers across the country visiting caves. National parks in the United States offer hundreds of caves for all levels of spelunkers and, in fact, many national parks boast caves as either their main or major attraction. In an effort to increase visitor safety and establish subterranean medical treatment protocols, we began an investigation into cave rescue, medical protocols, previously published recommendations concerning cave safety, and visitor and rescue statistics in the national parks. Our inquiry provided little guidance from either the literature or the present US National Parks database for treating underground injuries. However, 2 predominant trends did appear. First, despite the nearly 2 million visitors to the caves in the 14 parks surveyed, there were only about 200 total calls for medical care. The vast number of those calls were for minor injuries. Second, no strict evidence-based treatment protocols for underground injuries exist, probably because they are not feasible. A caving incident database for the national parks would facilitate suggestions for preventative measures for the minor injuries and would help catalog the creative solutions for the rare serious subterranean medical incident.

Stability and change in optimism: a study among spouse caregivers.

The extent to which caregivers (N = 30) for spouses with probable Alzheimer's disease show lability in optimism was explored. The relationship between caregivers' level of state optimism and level of affect was examined as well. The caregivers completed a measure of optimism and affect every day for 30 consecutive days. They showed variability in optimism over time, and their state optimism could be differentiated from their affect. In addition, we found individual differences in lead-lag relationships between optimism and affect over time. The results section clearly shows that most individuals did not show lead-lag relationships. These findings are integrated into the literature on caregiving.

Work ethic, daily activities, and retirement satisfaction.

Relationships among satisfaction in retirement, strength of the work ethic, and daily activities were examined. Seventy-six retired men and women aged 53 to 88 years (M = 69.6) completed two measures of retirement satisfaction (the Life Satisfaction Index-A and the Retirement Description Index), the Protestant Ethic scale, and kept activity diaries for 1 week, in which activities were rated for usefulness and pleasantness. Retirement satisfaction, work values, and usefulness ratings were related complexly such that the least satisfied retirees, as measured by the RDI, were those with high work values who did not perceive their activities as being useful and those with low work values who perceived their activities as being highly useful. Greater satisfaction, as measured by the LSI-A, was associated with higher usefulness ratings. The mean number of activities listed correlated negatively with Protestant Ethic scores, but positively with both measures of retirement satisfaction, suggesting that retirees with strong work values are not as active or as satisfied in retirement.

Caregiving and social support in two illness groups.

The authors analyzed whether spouse caregivers of people with noncognitive disorders such as Parkinson's disease or people with cognitive disorders such as Alzheimer's disease differed in their use and perception of social support resources. There were no differences between the groups on the Social Support Appraisal Scale. However, caregivers of spouses diagnosed with cognitive disorders were older, had fewer children, and had fewer financial resources, and their spouses had fewer years of formal education and more problems with activities of daily living. On average, caregivers of Alzheimer's patients had been dealing with their spouses' chronic illness for a significantly shorter time. Results from logistic regression analysis indicated that four variables distinguished Alzheimer's caregivers from Parkinson's caregivers: hours of assistance from family members, instrumental activities of daily living, physical activities of daily living, and availability of personal help in a crisis.

Effect of antimicrobial therapy on bowel flora.

The known patterns and functions of gastrointestinal flora and antimicrobial effects on flora are described, and the clinical implications of altered bowel flora are described. A major role of the normal endogenous intestinal flora is to inhibit gastrointestinal colonization and overgrowth by potentially pathogenic bacteria. Serious disruption of this protective mechanism may occur after the administration of various antimicrobial agents. Alteration of bacterial flora by antimicrobials is often the result of incomplete absorption after oral administration or of high concentrations in saliva, bile, or secretions from the intestinal flora. Suppression of endogeneous microflora after antimicrobial administration may permit overgrowth of pathogenic strains in the gastrointestinal tract, development or selection of antimicrobial-agent-resistant strains, and disruption of colonization resistance. The disruption of normal bowel flora can result in diarrhea, pseudomembranous colitis, and systemic infections or sepsis in immunocompromised patients. Agents that are well absorbed and have minimal biliary excretion should minimize the detrimental effects from altered flora. The choice of an antimicrobial agent that has a narrow spectrum, is specific for the infection, is not appreciably excreted in the bile, and is completely absorbed if given orally appears to be the most appropriate practice for preventing or minimizing alteration of bowel flora.

Health of spouse caregivers of dementia patients: the role of personality and social support.

Providing care to a spouse with dementia is a challenging activity. Why one spouse caregiver copes effectively whereas another becomes demoralized, unable to cope, and at heightened risk for negative health outcomes is not well understood. There is increasing evidence that individual differences associated with effects of caregiving through the subjective appraisal of the stressor are related to health outcomes. In this study, measures of social support and personality were examined to determine their influence on health outcomes for 51 spouse caregivers of dementia patients. The finding of a relationship between health outcomes and personality and social support may help practitioners target and improve interventions with dementia patients and their families.

Life goals, satisfaction, and self-rated health: preliminary findings.

Several recent studies have suggested that a better understanding of health and psychological well-being in later life requires insights into the life goals and motivations of research participants. However, goal importance has not been examined separately from goal achievement. This distinction is important for a more fine-grained analysis of how goals may relate to adaptive outcomes among older adults. Data from surviving respondents of the Duke Second Longitudinal Study were analyzed in order to replicate and extend results from previous studies. Interestingly, a differential pattern of predictors was found for health and satisfaction. The rated importance of goals accounted for a significant portion of the variance in health, but was not predictive of satisfaction, whereas rated achievement of goals was predictive of health and satisfaction. Results are discussed in relation to theories of motivation in later life.

Aminoglycoside combinations versus beta-lactams alone for penetrating abdominal trauma: a meta-analysis.

Despite several small comparative clinical trials, controversy persists over the best choice of antimicrobial therapy for penetrating abdominal trauma. Some still question whether single drug regimens are as effective as the traditional combinations containing an aminoglycoside. A meta-analysis was performed to address this issue. Meta-analysis is a relatively new statistical tool whereby data from a number of clinical trials is analyzed and pooled to produce useful and more reliable data. In this study, a meta-analysis of 17 published randomized trials was performed to assess the effectiveness of single beta-lactam antimicrobials versus combinations containing aminoglycoside when used for penetrating abdominal trauma. The overall summary odds ratio of the pooled results of these trials was 0.96 (p = 0.833) with a 95% confidence interval of 0.30-3.05. Since not significantly different from unity (1.0), we conclude that single beta-lactam antimicrobials are as effective as traditional combinations containing aminoglycoside in this setting.

Gila monster envenomation.

Envenomation from the bite of the Gila monster (Heloderma suspectum) has been reported in the medical literature only nine times since 1956. We present an additional four cases to better define the signs and symptoms of envenomation. Frequent clinical manifestations are pain, hypotension, tachycardia, nausea, and vomiting. Gila monster teeth remaining in the wound are not detectable by soft tissue radiography. In our series, hypotension responded well to i.v. crystalloid fluid administration. We recommend at least 6 hours of observation after the bite to assess the potential for systemic toxicity.