Showing papers by "Jewish Hospital published in 2009"

SpekCalc: a program to calculate photon spectra from tungsten anode x-ray tubes.

Abstract: A software program, SpekCalc, is presented for the calculation of x-ray spectra from tungsten anode x-ray tubes. SpekCalc was designed primarily for use in a medical physics context, for both research and education purposes, but may also be of interest to those working with x-ray tubes in industry. Noteworthy is the particularly wide range of tube potentials (40-300 kVp) and anode angles (recommended: 6-30 degrees) that can be modelled: the program is therefore potentially of use to those working in superficial/orthovoltage radiotherapy, as well as diagnostic radiology. The utility is free to download and is based on a deterministic model of x-ray spectrum generation (Poludniowski 2007 Med. Phys. 34 2175). Filtration can be applied for seven materials (air, water, Be, Al, Cu, Sn and W). In this note SpekCalc is described and illustrative examples are shown. Predictions are compared to those of a state-of-the-art Monte Carlo code (BEAMnrc) and, where possible, to an alternative, widely-used, spectrum calculation program (IPEM78).

A quality indicator set for systemic lupus erythematosus.

Abstract: Objective To systematically develop a quality indicator (QI) set for systemic lupus erythematosus (SLE) Methods We used a validated process that combined available scientific evidence and expert consensus to develop a QI set for SLE We extracted 20 candidate indicators from a systematic literature review of clinical practice guidelines pertaining to SLE An advisory panel revised and augmented these candidate indicators and, through 2 rounds of voting, arrived at 25 QIs These QIs advanced to the next phase of the project, in which we employed a modification of the RAND/UCLA Appropriateness Method A systematic review of the literature was performed for each QI, linking the proposed process of care to potential improved health outcomes After reviewing this scientific evidence, a second interdisciplinary expert panel convened to discuss the evidence and provide final ratings on the validity and feasibility of each QI Results The final expert panel rated 20 QIs as both valid and feasible Areas covered included diagnosis, general preventive strategies (eg, vaccinations, sun avoidance counseling, and screening for cardiovascular disease), osteoporosis prevention and treatment, drug toxicity monitoring, renal disease, and reproductive health Conclusion We employed a rigorous multistep approach with systematic literature reviews and 2 expert panels to develop QIs for SLE This new set of indicators provides an opportunity to assess health care quality in patients with SLE and represents an initial step toward the important goal of improving care in this patient population

Symptomatology of MS: results from the German MS Registry

Abstract: Since 2002, an MS Registry has been implemented by the German MS Society in more than 100 German MS centres. The objective is to provide information about disease characteristics, and to monitor the health care situation in a large population of patients. The aim of this report is to give detailed results on MS symptoms. By October 2008, data sets from 16,554 patients were recorded by 86 centres. A strikingly high number of persons suffered from fatigue and other “invisible” symptoms during early and late stages of the disease, underscoring the negative impact of these symptoms on quality of life in MS patients.

Swimming as a model of task-specific locomotor retraining after spinal cord injury in the rat

Abstract: BACKGROUND: The authors have shown that rats can be retrained to swim after a moderately severe thoracic spinal cord contusion. They also found that improvements in body position and hindlimb activity occurred rapidly over the first 2 weeks of training, reaching a plateau by week 4. Overground walking was not influenced by swim training, suggesting that swimming may be a task-specific model of locomotor retraining. OBJECTIVE: To provide a quantitative description of hindlimb movements of uninjured adult rats during swimming, and then after injury and retraining. METHODS: The authors used a novel and streamlined kinematic assessment of swimming in which each limb is described in 2 dimensions, as 3 segments and 2 angles. RESULTS: The kinematics of uninjured rats do not change over 4 weeks of daily swimming, suggesting that acclimatization does not involve refinements in hindlimb movement. After spinal cord injury, retraining involved increases in hindlimb excursion and improved limb position, but the velocity of the movements remained slow. CONCLUSION: These data suggest that the activity pattern of swimming is hardwired in the rat spinal cord. After spinal cord injury, repetition is sufficient to bring about significant improvements in the pattern of hindlimb movement but does not improve the forces generated, leaving the animals with persistent deficits. These data support the concept that force (load) and pattern generation (recruitment) are independent and may have to be managed together with respect to postinjury rehabilitation.

Technology and cost-effectiveness in knee arthroplasty: computer navigation and robotics.

Abstract: Our aim in this article is to describe the impact that navigation technology has had on the market share of a community hospital and, specifically, to determine whether a high-volume surgeon using these technologies actually costs the hospital more than other surgeons at the same hospital and more than national means. In addition, we develop a comparable cost-effectiveness model for robotic technology in unicompartmental knee arthroplasty to demonstrate the potential cost-effectiveness at the same hospital.

Pediatric triglycerides predict cardiovascular disease events in the fourth to fifth decade of life.

Abstract: To assess relationships between pediatric lipids and subsequent cardiovascular disease (CVD) in the fourth to fifth decades, we conducted 22- to 31-year follow-up studies (1998-2003) in former schoolchildren first studied in 1973-1976 The follow-up included 53% of eligible former subjects We compared pediatric and adult body mass (in kilograms per square meter) and lipids in 19 cases with at least 1 CVD event and in 789 CVD event-free subjects Mean +/- SD age was 123 +/- 33 years at entry and 385 +/- 38 years at follow-up Mean age at the first CVD event was 371 +/- 49 years The major novel finding of our study was that childhood triglycerides (TG) were consistently and independently associated with young adult CVD The distributions of both childhood and adult TG were shifted to higher levels in the cases than controls Of the 19 cases, 7 (37%) had childhood TG greater than the pediatric 95th percentile (153 mg/dL); and 6 of these 7 had high TG (>/=150 mg/dL) at adult follow-up Overall, 61% of cases had high TG as adults After adjusting for age, sex, and race, by analysis of variance, cases had higher TG levels both in childhood and in young adulthood A bootstrapping method and the Cox proportional hazard analysis were used to predict CVD in the cohort with explanatory variables sex; race; childhood body mass index, low-density lipoprotein, log high-density lipoprotein cholesterol, and log TG; and adult cigarette smoking and type 2 diabetes mellitus Childhood TG level was a significant, independent explanatory variable for young adult CVD hazard (hazard ratio, 535; 95% confidence interval, 169-200 for each 1-unit increase in natural logarithm scale) along with adult type 2 diabetes mellitus (hazard ratio, 194; 95% confidence interval, 424-1142) Pediatric hypertriglyceridemia appears to be a significant, independent, potentially reversible correlate of young adult CVD

Coronary heart disease risk factors in adult premenopausal white women with polycystic ovary syndrome compared with a healthy female population.

Abstract: Our specific aim was to determine whether coronary heart disease (CHD) risk factors in polycystic ovary syndrome (PCOS) patients were independent of their higher body mass index (BMI) and centripetal obesity. In adult, premenopausal, white women, CHD risk factors were compared between 488 patients with well-defined PCOS and 351 healthy free-living population controls from the Princeton Follow-up Study (PFS). After excluding women with irregular menses (putative PCOS phenotypes), comparisons were also made between the 261 PFS women with a history of regular menses and the 488 women with PCOS. Fasting lipids, insulin, glucose, homeostasis model assessment of insulin resistance (HOMA-IR), HOMA insulin secretion, blood pressure, BMI, and waist circumference were measured. Compared with both the full cohort of 351 PFS women and the subgroup of 261 PFS women with regular menses, women with PCOS had higher BMI, waist circumference, total and low-density lipoprotein cholesterol, triglyceride, systolic blood pressure, diastolic blood pressure, insulin, glucose, and HOMA-IR (all Ps ≤ .005). After adjusting for age and BMI, women with PCOS, compared with the 351 and 261 PFS women, had lower high-density lipoprotein cholesterol (P < .0001, .0008) and higher systolic blood pressure (P = .0002, < .0001), insulin (P = .017, .039), HOMA-IR (P = .013, .032), and HOMA insulin secretion (P = .022, .037). The small subgroup of PCOS women with normal BMI (<25 kg/m2) (36/488, 7%) also had higher age-adjusted insulin, glucose, and HOMA-IR (all Ps < .005) than the subgroup of PFS women with BMI less than 25 kg/m2 (123/261, 47%). Increased CHD risk factors and high HOMA-IR in PCOS cannot be exclusively attributed to their preponderant centripetal obesity. Identification of women with clinical features of PCOS should alert the clinician to potentially increased risk for CHD and prompt CHD risk factor testing.

Bone marrow aspirate and biopsy: a pathologist's perspective. II. interpretation of the bone marrow aspirate and biopsy.

Abstract: Bone marrow examination has become increasingly important for the diagnosis and treatment of hematologic and other illnesses. Morphologic evaluation of the bone marrow aspirate and biopsy has recently been supplemented by increasingly sophisticated ancillary assays, including immunocytochemistry, cytogenetic analysis, flow cytometry, and molecular assays. With our rapidly expanding knowledge of the clinical and biologic diversity of leukemia and other hematologic neoplasms, and an increasing variety of therapeutic options, the bone marrow examination has became more critical for therapeutic monitoring and planning optimal therapy. Sensitive moleculartechniques, in vitro drug sensitivity testing, and a number of other special assays are available to provide valuable data to assist these endeavors. Fortunately, improvements in bone marrow aspirate and needle technology has made the procurement of adequate specimens more reliable and efficient, while the use of conscious sedation has improved patient comfort. The procurement of bone marrow specimens was reviewed in the first part of this series. This paper specifically addresses the diagnostic interpretation of bone marrow specimens and the use of ancillary techniques. J. Clin. Lab. Anal. 23:259–307, 2009. © 2009 Wiley-Liss, Inc.

A randomized, controlled evaluation of early intervention: the Born to Learn curriculum

Abstract: Background This study addressed the need for studies of the efficacy of the Born to Learn (BTL) curriculum. Methods Based on random assignment, 227 families of infants received the BTL curriculum conducted in monthly home visits, and 237 families received general child development education only. Results The BTL curriculum resulted in higher mastery motivation (task competence) at 36 months (P < 0.05) and greater effects for children from low (P < 0.01) versus high socio-economic status on mastery motivation and cognitive development at 24 months. No effects were found on a wide range of other developmental outcomes. Conclusion Future studies should document the BTL curriculum effectiveness in diverse settings and samples.

Efficacy, effectiveness and real life goal attainment of statins in managing cardiovascular risk

Abstract: Statins became available for the treatment of hypercholesterolemia in 1987. Multiple, well-designed, placebo-controlled, double-blind studies revealed that each 1% reduction in serum cholesterol level was associated with about 1% reduction in risk of cardiovascular events. Low-density lipoprotein (LDL) cholesterol reduction to less than 78 mg/dL may be associated with reduction of atheroma burden. Patients with high levels of high specificity C-reactive protein and having LDL cholesterol less than 3.4 mmol/L (130 mg/dL) in primary prevention settings benefited from aggressive LDL cholesterol reduction with rosuvastatin over a 2-year period. However, in real life practice, about half of patients who are prescribed statins discontinue the medication by the end of the year. Medication adherence is lower in younger patients, women, and absence of known coronary heart disease. Personal features of the prescribing physician and dispensing pharmacies also affect patients’ compliance. More studies are needed to evaluate if “compliance packets” would benefit patients in a real life situation.

Toward Early Diagnosis of Lung Cancer

Abstract: Our long term research goal is to develop a fully automated, image-based diagnostic system for early diagnosis of pulmonary nodules that may lead to lung cancer. In this paper, we focus on generating new probabilistic models for the estimated growth rate of the detected lung nodules from Low Dose Computed Tomography (LDCT). We propose a new methodology for 3D LDCT data registration which is non-rigid and involves two steps: (i) global target-to-prototype alignment of one scan to another using the learned prior appearance model followed by (ii) local alignment in order to correct for intricate relative deformations. Visual appearance of these chest images is described using a Markov---Gibbs random field (MGRF) model with multiple pairwise interaction. An affine transformation that globally registers a target to a prototype is estimated by the gradient ascent-based maximization of a special Gibbs energy function. To handle local deformations, we displace each voxel of the target over evolving closed equi-spaced surfaces (iso-surfaces) to closely match the prototype. The evolution of the iso-surfaces is guided by a speed function in the directions that minimize distances between the corresponding voxel pairs on the iso-surfaces in both the data sets. Preliminary results show that the proposed accurate registration could lead to precise diagnosis and identification of the development of the detected pulmonary nodules.

Applying the Stetler model of research utilization in staff development: revitalizing a preceptor program.

Abstract: Using a model for the utilization of research can aid and direct staff development educators in the appropriate application of existing research-based knowledge and help prevent the pitfalls of using research inaccurately. The Stetler Model of Research Utilization was applied to obtain support for and revitalize a preceptor program at one large metropolitan tertiary medical center. Applying the Stetler Model resulted in the improvement of nurses' satisfaction with their preceptors and a reduction in turnover rate.

Should high creatine kinase discourage the initiation or continuance of statins for the treatment of hypercholesterolemia

Abstract: Patients with high low-density lipoprotein cholesterol (LDLC) and asymptomatic high creatine kinase (CK) (>or=250 but or=250 but or=250 but statin patients, median CK fell from 353 to 301 (P = .0018) and was 287 (P = .015) after 4 months. After 1.3 months of follow-up in 20 no statin-->statin patients, median CK fell from 397 to 292 (P = .0094) and was 419 after 4.1 months. After 1.1 months of follow-up in 19 no statin-->no statin patients, median CK fell from 392 to 323 (P = .14) and was 271 (P = .029) after 4.2 months. By repeated-measures analysis, there were no differences in entry CK among the 3 treatment groups; CK fell (P = .04) in the no statin-->no statin patients. Despite high baseline CK (48 patients with CK 1-5x the UNL, 1 with CK 5-10x UNL), no patients during follow-up on statins developed CK greater than 10 times the UNL (2500 IU/L), none discontinued statins or reduced statin dose because of myalgia-myositis, and there was no rhabdomyolysis. High pretreatment CK, particularly 1 to 5 times the UNL, should not be an impediment to start or continue statins to lower LDLC.

A Novel 3D Joint Markov-Gibbs Model for Extracting Blood Vessels from PC---MRA Images

Abstract: New techniques for more accurate segmentation of a 3D cerebrovascular system from phase contrast (PC) magnetic resonance angiography (MRA) data are proposed. In this paper, we describe PC---MRA images and desired maps of regions by a joint Markov-Gibbs random field model (MGRF) of independent image signals and interdependent region labels but focus on most accurate model identification. To better specify region borders, each empirical distribution of signals is precisely approximated by a Linear Combination of Discrete Gaussians (LCDG) with positive and negative components. We modified the conventional Expectation-Maximization (EM) algorithm to deal with the LCDG. The initial segmentation based on the LCDG-models is then iteratively refined using a MGRF model with analytically estimated potentials. Experiments with both the phantoms and real data sets confirm high accuracy of the proposed approach.

Ocular vascular thrombotic events: a diagnostic window to familial thrombophilia (compound factor V Leiden and prothrombin gene heterozygosity) and thrombosis.

Abstract: In a 12-member, 3-generation kindred with conjoint inheritance of G1691A factor V Leiden (FVL) and G20210A prothrombin gene (PTG) mutations, identified through a proband with amaurosis fugax and his father with nonarteritic ischemic optic neuropathy (NAION), the authors' hypothesis was that ocular thrombosis was a diagnostic window to familial thrombophilia-thrombosis. The authors used polymerase chain reaction (PCR) measures for thrombophilia (FVL, PTG, C677T-A1298C methylenetetrahydrofolate reductase [MTHFR], platelet glycoprotein PLA1A2) and hypofibrinolysis (plasminogen activator inhibitor-1 4G4G). The 39-year-old white male proband, with amaurosis fugax and transient ischemic attacks (TIA), was found to be a compound heterozygote for FVL and PTG mutations. His symptoms resolved only after coumadin. His 44-year-old brother (deep venous thrombosis [DVT]) and 46-year-old sister (DVT, pulmonary embolus [PE]) were compound FVL-PTG gene heterozygotes. Of 4 asymptomatic children born to these 3 siblings, 2 were FVL heterozygotes and 2 PTG heterozygotes. The proband's 69-year-old father, with NAION and ischemic stroke, had PTG heterozygosity, familial high factor VIII, and compound MTHFR C677T-A1298C mutation with homocysteinemia. The proband's 61-year-old aunt had PTG heterozygosity, recurrent DVT, and mesenteric artery thrombosis. The proband's 67-year-old mother, free of thrombotic events, was a FVL heterozygote, had high factor VIII, and PAI-1 4G4G homozygosity. In this extended kindred, ocular thrombotic events (amaurosis fugax, NAION) were associated with variegated thrombotic events, including TIA, ischemic stroke, DVT, PE, and mesenteric artery thrombosis, and opened a diagnostic window to family screening and treatment for complex thrombophilias, which had previously been undiagnosed.

Prescriber fidelity to a medication management evidence-based practice in the treatment of schizophrenia.

Abstract: Objective: Medication Management Approaches in Psychiatry (MedMAP) is an evidence-based practice developed to guide the management and monitoring of psychotropic medications for individuals with schizophrenia. This article reports prescriber fidelity to MedMAP principles in a public mental health service system. Methods: This three-year longitudinal intervention study implemented MedMAP in six community mental health centers in Kentucky. Nine psychiatrists and five advanced practice psychiatric nurses with prescriptive authority participated in the study. Prescribers were trained in the use of MedMAP about one month before implementation, and MedMAP principles were reinforced throughout the study. Four posttraining assessments were conducted at each site at approximately four-month intervals over a period of 30 months. An 18item scale was used to assess baseline and posttraining prescriber fidelity over a period of 30 months in 900 randomly selected medical records. Results: Average fidelity scores improved significantly over baseline at each of the four postimplementation fidelity assessments. Training effects were most evident at the second posttraining fidelity assessment, but effects persisted over the course of the study. There was considerable variability in scores across items both at baseline and subsequently. Posttraining improvement was greatest in patient education, documentation of illness and medication history, and simplification of medication regimen. Conclusions: Implementation and monitoring of MedMAP were feasible in these community mental health settings. Additional implementation projects are crucial for advancing evidence-based practice in clinical settings. (Psychiatric Services 60:929–935, 2009)

Central osteosclerosis with ectodermal dysplasia: clinical, laboratory, radiologic, and histopathologic characterization with review of the literature.

Abstract: IBIDS is a syndrome characterized by ichthyosis, brittle hair, impaired intelligence, decreased fertility, and short stature, but unassociated with skeletal lesions. This condition is considered a form of trichothiodys-trophy because hair from several cases has been found to have a low sulfur content. We describe a 9-year and 10-month-old white boy whose clinical features resemble the IBIDS syndrome (ichthyosis, brittle hair, cataracts, and short stature), but who also has marked axial osteosclerosis and peripheral osteopenia. No abnormalities of mineral homeostasis were noted. Histopathologic assessment of nondecalcified bone specimens excluded osteopetrosis, but suggested slow skeletal remodeling. When subjected to polarized light microscopy, his hair exhibited the band-like pattern of birefringence described in trichothiodystrophy. Literature review disclosed 8 patients, 2 of whom had been diagnosed as trichothiodystrophy, with like clinical features including osteosclerosis. These skeletal abnormalities together with clinical features of the IBIDS/trichiodystrophy syndrome, we believe, reflect the prototype of a disorder that seems best described as central osteosclerosis with ectodermal dysplasia.

Homeostasis model assessment of insulin resistance*body mass index interactions at ages 9 to 10 years predict metabolic syndrome risk factor aggregate score at ages 18 to 19 years: a 10-year prospective study of black and white girls.

Abstract: If homeostasis model assessment of insulin resistance (HOMA-IR) interactions with obesity (body mass index [BMI]) at ages 9 to 10 years predict aggregate metabolic syndrome risk factors at ages 18 to 19 years, this would identify novel avenues for primary prevention of metabolic syndrome. Our hypothesis was that HOMA-IR*BMI interactions at ages 9 to 10 years would predict aggregate metabolic syndrome risk factor z scores at ages 18 to 19 years in prospective studies of a biracial population of girls. Two centers in the National Heart, Lung, and Blood Institute Growth and Health Study measured serum insulin and glucose at ages 9 to 10 years and 5 metabolic syndrome risk factors at ages 18 to 19 years (triglyceride, high-density lipoprotein cholesterol, systolic/diastolic blood pressure, waist circumference, and glucose). Studies in Cincinnati, OH, included girls from public and parochial schools in the inner city, within-city residential neighborhoods, and suburban areas; and those in Washington, DC, included girls from a health maintenance organization. Girls (194 white, 281 black) were studied first at ages 9 to 10 years, then at ages 18 to 19 years. We assessed HOMA-IR*BMI interactions at ages 9 to 10 years with race-specific z scores for 5 metabolic syndrome risk factors at ages 18 to 19 years. The lowest summed z score (mean ± SD) was observed for subjects in the lowest tertiles for both HOMA-IR and BMI (−1.15 ± 2.05), and the highest z score (2.58 ± 3.11) was for subjects in the highest tertiles for both HOMA-IR and BMI (P < .0001). For the top BMI tertile, there was a progressive increase in z score (increasing risk of metabolic syndrome) as HOMA-IR increased. Interaction of BMI with HOMA-IR at ages 9 to 10 years predicts aggregate metabolic risk score at ages 18 to 19 years, with progressive risk increments within the top BMI tertile as HOMA-IR increases, opening avenues for intervention to reduce both BMI and HOMA-IR at ages 9 to 10 years as a primary approach to prevention of metabolic syndrome at ages 18 to 19 years.

Insulin resistance and triglycerides.

Abstract: In 1385 adults with primary untreated hyperlipidemia and in a population study of 339 adults (Princeton Follow-up Study [PFS]), we hypothesized that homeostasis model assessment (HOMA) insulin resistance (IR) was a significant explanatory variable for triglycerides (TG) and that IR rose in a stepwise fashion, independent of age, race, sex, and body mass index (BMI), whereas TG categories rose from less than 150 to 150 to 200, to 200 to 500, and to more than 500 mg/dL. A third hypothesis was that TG, BMI, and the ratio of TG to high-density lipoprotein cholesterol (TG/HDL-C) were significant explanatory variables for IR and that IR was inversely associated with HDL-C quintiles and positively associated with non-HDL-C quintiles. By stepwise multiple regression with age, race, sex, BMI, and IR as explanatory variables, in the 1385 patients, positive explanatory variables for TG included BMI (partial R = 1.3%, P < 0.0001), sex (men higher, partial R = 1.1%, P = 0.0001), and IR (partial R = 0.4%, P = 0.012). In the 339 PFS subjects, positive explanatory variables for TG were IR (partial R = 11.4%, P < 0.0001), race (whites higher, partial R = 2.1%, P = 0.005), and sex (men higher, partial R = 1.4%, P = 0.019). After adjusting for age, race, sex, and BMI, in 1385 patients, HOMA IR rose while TG categories rose, with least square means of 2.64 for the TG category less than 150 mg/dL, 3.27 for 150 to 200 mg/dL, 3.85 for 200 to 500 mg/dL, and 4.12 for more than 500 mg/dL. Similarly, in the PFS, while TG categories rose, the least square means of HOMA IR rose, with 1.68 for the TG category less than 150 mg/dL, 2.34 for 150 to 200 mg/dL, and 3.03 for 200 to 500 mg/dL. Body mass index, TG, and TG/HDL-C were significant explanatory variables for IR. Homeostasis model assessment IR is a significant, potentially reversible explanatory variable for TG in patients referred because of hyperlipidemia and in population subjects.

Accurate and fast 3D colon segmentation in CT colonography

Abstract: This paper introduces an adaptive level set method for 3D segmentation of colon tissue in CT colonography filled with air and opacified fluid. First, most of the opacified liquid is removed by a threshold value. The closed contours are propagated toward the desired 3D region boundaries through the iterative evolution of the adaptive level sets function. The proposed method has been tested on 22 real CT colonography datasets with various pathologies, and the segmentation accuracy has achieved 98.40%.

Does interleukin-1 affect intracellular calcium in osteoblast-like cells (UMR-106)?

Abstract: Interleukin-1 (IL-1) enhances bone resorption and formation in vitro, presumably through a primary action on osteoblasts, but the mechanism by which IL-1 activates bone cells is unknown. We investigated the possibility that the effect of IL-1 on osteoblasts is mediated through an increase in intracellular calcium [Ca++]i by studying the effects of purified human monocyte-derived IL-1 (hIL-1) and recombinant human IL-1 alpha (rhIL alpha) and beta (rhIL-1 beta) on [Ca++]i in the rat osteogenic sarcoma cell line UMR 106 using indo-1, a new-generation fluorescent Ca++-sensitive probe. hIL-1 (1 U/ml) resulted in an 85.5% rise in [Ca++]i over baseline that reached a peak after 30 seconds and returned to basal levels within 60 seconds. A similar transient rise in calcium was obtained upon exposure of the UMR cells to both the hIL-1 suspension buffer and to the concentration of fetal bovine serum present in the hIL-1 buffer. This effect was not abolished either by heat inactivation of both hIL-1 and serum or by pretreatment of hIL-1 with specific rabbit antihuman-IL-1 antibody. Moreover, exposure of the UMR cells to either rhIL-1 alpha or rhIL-1 beta or to a mixture of both at concentrations of 1 to 100 U/ml was not followed by any change in [Ca++]i. Our data do not support the idea that IL-1 can stimulate osteoblasts through a calcium-mediated pathway.

Laryngeal Squamous Cell Carcinoma in a 13 Year-Old Child Associated with Human Papillomaviruses 16 and 18: A Case Report and Review of the Literature

Abstract: Squamous cell carcinoma (SCC) of the larynx is extremely rare in adolescents and typically has an aggressive nature. The mechanism of laryngeal oncogenesis is complex and little is known about the role that human papillomavirus (HPV) plays in SCC in adolescents. We report a case of invasive laryngeal SCC that co-expressed HPV DNA subtypes 16 and 18 in a 13 year-old boy. Detection of HPV DNA types 6, 11, 16, 18, 31, 33, and 51 was performed by in situ hybridization, with confirmation by polymerase chain reaction. Immunohistochemical staining with p16 and HPV 16/18 revealed diffusely positive staining in the tumor cells. Coinfection by HPV DNA types 16 and 18 has not been previously reported, but our case suggests that HPV is a risk factor in developing laryngeal SCC in children and adolescents. Future studies evaluating HPV in the pathogenesis of these lesions is recommended to determine its prognostic significance.