Patterns of African American parents' educational involvement: associations with adolescents' academic performance and motivational beliefs.

The current study used survey data from 786 African American mother-adolescent (M = 12.29 years; 48% female) dyads to examine profiles of 7th-grade parental educational involvement and their associations with adolescents' 11th-grade academic performance, academic self-concept, and educational aspirations. Using latent profile analyses, four patterns emerged: (a) Low Involvers; (b) Helpers, Low Providers; (c) Providers, Low Helpers; and (d) More Involved Helpers and Providers. The More Involved Helpers and Providers had adolescents with higher grades than the Helpers, Low Providers and the Low Involvers. The Providers, Low Helpers also had adolescents with higher educational aspirations than other profiles except for the More Involved Helpers and Providers. Findings suggest multiple pathways through which African American parents can enhance adolescents' academic outcomes.

Dietary Fructose Promotes Prostate Cancer Growth.

Clinical localization of primary tumors and sites of metastasis by PET is based on the enhanced cellular uptake of 2-deoxy-2-[18F]-fluoro-D-glucose (FDG). In prostate cancer, however, PET-FDG imaging has shown limited clinical applicability, suggesting that prostate cancer cells may utilize hexoses other than glucose, such as fructose, as the preferred energy source. Our previous studies suggested that prostate cancer cells overexpress fructose transporters, but not glucose transporters, compared with benign cells. Here, we focused on validating the functional expression of fructose transporters and determining whether fructose can modulate the biology of prostate cancer cells in vitro and in vivo. Fructose transporters, Glut5 and Glut9, were significantly upregulated in clinical specimens of prostate cancer when compared with their benign counterparts. Fructose levels in the serum of patients with prostate cancer were significantly higher than healthy subjects. Functional expression of fructose transporters was confirmed in prostate cancer cell lines. A detailed kinetic characterization indicated that Glut5 represents the main functional contributor in mediating fructose transport in prostate cancer cells. Fructose stimulated proliferation and invasion of prostate cancer cells in vitro. In addition, dietary fructose increased the growth of prostate cancer cell line-derived xenograft tumors and promoted prostate cancer cell proliferation in patient-derived xenografts. Gene set enrichment analysis confirmed that fructose stimulation enriched for proliferation-related pathways in prostate cancer cells. These results demonstrate that fructose promotes prostate cancer cell growth and aggressiveness in vitro and in vivo and may represent an alternative energy source for prostate cancer cells. SIGNIFICANCE: This study identifies increased expression of fructose transporters in prostate cancer and demonstrates a role for fructose as a key metabolic substrate supporting prostate cancer cells, revealing potential therapeutic targets and biomarkers.

Insecticides Resistance Status of An. gambiae in Areas of Varying Agrochemical Use in Côte D'Ivoire.

BACKGROUND: Insecticide resistance monitoring of the malaria vectors to different classes of insecticides is necessary for resistance management. Malaria vector control management approaches are essentially based on IRS and LLINs. However, insecticide resistance is caused by several sources of selection and in case the selection pressure is from agricultural practices, then measures need to be taken to avoid a failure of the control methods put in place. The current study was undertaken to monitor the susceptibility of vectors to different classes of insecticides in areas of varying agrochemical use patterns. METHODS: A survey to determine the agricultural chemical use pattern was undertaken in ten localities across Côte d'Ivoire. In addition, WHO susceptibility tests were carried out on adults Anopheles gambiae s.l. mosquitoes emerging from collected larvae from the sites surveyed. Four insecticides from each class of the four classes of insecticides were evaluated using the standard susceptibility test methods. Furthermore, the target site mutations involved in resistance mechanisms were identified following the Taqman assay protocols and mosquito species were identified using SINE-PCR. RESULTS: The mortalities of all the An. gambiae s.l populations were similar regardless of the pesticide use pattern. The vectors were resistant to DDT, deltamethrin, and bendiocarb in all localities. In contrast, mosquitoes showed high susceptibility to malathion. High frequency of the Kdr-West gene allele was observed (70-100%). A single Kdr-East mutation was identified in a mosquito that harboured both Ace-1 and Kdr-West genes. CONCLUSION: Cultivated marshlands representing good habitats for mosquito development may deeply contribute to the selection of resistance genes given the intensive use of agrochemical for crop protection. In view of these, special attention must be given to them to mitigate mosquito resistance to insecticides.

Increase in susceptibility to insecticides with aging of wild Anopheles gambiae mosquitoes from Côte d'Ivoire.

BACKGROUND: Appropriate monitoring of vector insecticide susceptibility is required to provide the rationale for optimal insecticide selection in vector control programs. METHODS: In order to assess the influence of mosquito age on susceptibility to various insecticides, field-collected larvae of An. gambiae s.l. from Tiassalé were reared to adults. Females aged 1, 2, 3, 5 and 10 days were exposed to 5 insecticides (deltamethrin, permethrin, DDT, malathion and propoxur) using WHO susceptibility test kits. Outcome measures included the LT50 (exposure time required to achieve 50% knockdown), the RR (resistance ratio, i.e. a calculation of how much more resistant the wild population is compared with a standard susceptible strain) and the mortality rate following 1 hour exposure, for each insecticide and each mosquito age group. RESULTS: There was a positive correlation between the rate of knockdown and mortality for all the age groups and for all insecticides tested. For deltamethrin, the RR50 was highest for 2 day old and lowest for 10 day old individuals. Overall, mortality was lowest for 2 and 3 day old individuals and significantly higher for 10 day old individuals (P < 0.05). With permethrin, the RR50 was highest for 1 to 3 day old individuals and lowest for 10 day old individuals and mortality was lowest for 1 to 3 day old individuals, intermediate for 5 day old and highest for 10 day old individuals. DDT did not display any knockdown effect and mortality was low for all mosquito age groups (<7%). With malathion, the RR50 was low (1.54 - 2.77) and mortality was high (>93%) for all age groups. With propoxur, no knockdown effect was observed for 1, 2 and 3 day old individuals and a very low level of mortality was observed (< 4%), which was significantly higher for 5 and 10 day old individuals (30%, P < 0.01). CONCLUSION: Results indicate that for An. gambiae s.l. adults derived from wild-collected larvae, there was an influence of age on insecticide susceptibility status, with younger individuals (1 to 3 days old) more resistant than older mosquitoes. This indicates that the use of 1 - 2 day old mosquitoes in susceptibility assays as recommended by the WHO should facilitate detection of resistance at the stage where the highest rate of the resistance phenotype is present.

MRI evaluation of rotational alignment and synovitis in patients with pain after total knee replacement.

Component malalignment can be associated with pain following total knee replacement (TKR). Using MRI, we reviewed 50 patients with painful TKRs and compared them with a group of 16 asymptomatic controls to determine the feasibility of using MRI in evaluating the rotational alignment of the components. Using the additional soft-tissue detail provided by this modality, we also evaluated the extent of synovitis within these two groups. Angular measurements were based on the femoral transepicondylar axis and tibial tubercle. Between two observers, there was very high interobserver agreement in the measurements of all values. Patients with painful TKRs demonstrated statistically significant relative internal rotation of the femoral component (p = 0.030). There was relative internal rotation of the tibial to femoral component and combined excessive internal rotation of the components in symptomatic knees, although these results were significant only with one of the observers (p = 0.031). There was a statistically significant association between the presence and severity of synovitis and painful TKR (p < 0.001). MRI is an effective modality in evaluating component rotational alignment.

Status epilepticus and wide-complex tachycardia secondary to diphenhydramine overdose.

OBJECTIVE: Diphenhydramine is an H1 histamine antagonist that is commonly used for allergic reactions, colds and cough, and as a sleep aid. In addition to anticholinergic and antihistaminergic effects, sodium channel blockade becomes evident following diphenhydramine overdose. While seizures may occur following overdose of a diphenhydramine, status epilepticus is distinctly uncommon. We report a case with both status epilepticus and wide-complex dysrhythmias following an intentional diphenhydramine overdose. CASE REPORT: A 36-year-old woman with a medical history of hypothyroidism on levothyroxine was brought to the emergency department with active seizures by emergency medical services after what was later determined to be a diphenhydramine overdose. One hour after an argument with her husband he found her lethargic in a locked room. Initial vital signs were: blood pressure, 90/55 mmHg; heart rate, 160 beats/min; respiratory rate 18 breaths/min; room air oxygen saturation, 99%; temperature, 99.8°F; rapid point-of-care glucose, 130 mg/dL. The generalized seizures continued for duration of 30 min, despite the intravenous administration of 8 mg of lorazepam. The patient underwent endotracheal intubation and a propofol infusion terminated her seizures. An electrocardiogram after the status was terminated which revealed a wide-complex tachycardia with QRS duration of 127 ms. The QRS narrowed after 200 mEq of intravenous sodium bicarbonate was administrated. The patient was neurologically intact upon extubation on hospital day 2. The serum diphenhydramine concentration drawn on arrival to the ED was 1200 ng/mL (9-120 ng/mL); a tricyclic screen was negative. DISCUSSION: While seizures and sodium channel blockade are recognized complications of diphenhydramine toxicity, reported cases of status epilepticus from diphenhydramine overdose are rare. Elements of the patient's presentation were similar to a tricyclic overdose and management required aggressive control of her seizures, sodium bicarbonate therapy, and recognizing that physostigmine was contraindicated due to wide complex tachycardia. CONCLUSIONS: Diphenhydramine overdose may cause status epilepticus and wide-complex tachycardia. Management should focus on antidotal therapy with sodium bicarbonate and supportive neurological management with appropriate anticonvulsants and airway protection if clinically indicated.

ED use of etomidate for rapid sequence induction.

We present evidence-based clinical practice recommendations for the administration of etomidate for emergency department (ED) rapid sequence induction. We critically discuss indications and contraindications in typical ED patient subpopulations such as the traumatic, septic, neurologic, or pulmonary patient. Future research questions are considered.

Nutrition and immunological status in long-term follow up of children with short bowel syndrome.

BACKGROUND: Little is known about the long-term evolution, nutrition status, growth, and eventual deficiencies of patients with short bowel syndrome (SBS) adapted to oral feeding after parenteral nutrition (PN). Because there are not absolute criteria for weaning from parenteral or enteral nutrition to oral feeding, new nutrient deficiencies may develop. Subtle nutrition deficits could induce subclinical immune deficiencies; therefore, we studied long-term growth, nutrition status, and the state of the immune system in 10 patients with SBS after weaning PN for at least 2 years. METHODS: Ten children with SBS (3-12 years old; mean, 7.4 years) who had not received PN for at least 2 years were studied. Anthropometric measurements, hemoglobin values, and indicators of iron, zinc, copper, folate and vitamin B(12) nutrition status were evaluated, along with immunoglobulins, lymphocyte subpopulations, and polymorphonuclear candidicidal activity. RESULTS: Weight-for-height was normal in 8 children; height-for-age was low in 5 children whose SBS was established early in life. Fat body mass was also low in 5 subjects. Four children presented macrocytosis, 2 with anemia. Low serum levels of vitamin B(12) (1 child), folates (4 children), and ferritin (2 children) were observed. Diminished candidicidal activity (4 children) was the only remarkable immunological abnormality. CONCLUSION: Many biologic and growth deficiencies are frequently seen in patients with SBS, even in children adapted to enteral feeding. This finding and the existence of previously unreported decreased candidicidal activity in some patients with SBS deserve long-term clinical and biologic follow up.

Inhibition of release of taurine and excitatory amino acids in ischemia and neuroprotection.

Volume regulated anion channels (VRAC) have been extensively studied in purified single cell systems like cell cultures where they can be activated by cell swelling. This provides a convenient way of analyzing mechanisms and will likely lead to the holy grails of the field, namely the nature or natures of the volume sensor and the nature or natures of VRACs. Important reasons for such an understanding are that these channels are ubiquitous and have important physiological functions which under pathological conditions convert to deleterious effects. Here we summarize data showing the involvement of VRACs in ischemia-induced release of excitatory amino acids (EAAs) in a rat model of global ischemia. Using microdialysis studies we found that reversal of the astrocytic glutamate transporter and VRACs contribute about equally to the large initial release of EAAs and together account for around 80% of the total release. We used the very potent VRAC blocker, tamoxifen, to see if such inhibition of EAA release via VRACs led to significant neuroprotection. Treatment in the focal rat MCA occlusion model led to around 80% reduction in infarct size with an effective post initiation of ischemia therapeutic window of three hours. However, the common problem of other effects for even the most potent inhibitors pertains here, as tamoxifen has other, potentially neuroprotective, effects. Thus it inhibits nitrotyrosine formation, likely due to its inhibition of nNOS and reduction of peroxynitrite formation. Although tamoxifen cannot therefore be used as a test of the "VRAC-excitotxicity" hypothesis it may prove successful for translation of basic stroke research to the clinic because of its multiple targets.

Anilinoquinazoline inhibitors of fructose 1,6-bisphosphatase bind at a novel allosteric site: synthesis, in vitro characterization, and X-ray crystallography.

The synthesis and in vitro structure-activity relationships (SAR) of a novel series of anilinoquinazolines as allosteric inhibitors of fructose-1,6-bisphosphatase (F16Bpase) are reported. The compounds have a different SAR as inhibitors of F16Bpase than anilinoquinazolines previously reported. Selective inhibition of F16Bpase can be attained through the addition of appropriate polar functional groups at the quinazoline 2-position, thus separating the F16Bpase inhibitory activity from the epidermal growth factor receptor tyrosine kinase inhibitory activity previously observed with similar structures. The compounds have been found to bind at a symmetry-repeated novel allosteric site at the subunit interface of the enzyme. Inhibition is brought about by binding to a loop comprised of residues 52-72, preventing the necessary participation of these residues in the assembly of the catalytic site. Mutagenesis studies have identified the key amino acid residues in the loop that are required for inhibitor recognition and binding.

Client satisfaction with the nutrition education component of the California WIC program.

Past evaluation research has documented improved nutritional outcomes resulting from participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). However, these evaluations have not examined the program from the clients' perspective, nor have they examined the independent effect of the nutrition education component. The purpose of this study was to quantitatively and qualitatively examine client satisfaction with the nutrition education component of the California WIC program. The methodology consisted of two phases. During phase I of the study (the quantitative component), participants completed Client Satisfaction Surveys immediately following attendance of one nutrition class. During phase II (the qualitative component), four focus groups were conducted. All subjects were participants in the California WIC program. Client Satisfaction Surveys were completed by 2138 participants, and the focus groups included 29 participants. Results from both phases of the study indicated that client satisfaction with the nutrition education component of the California WIC program was high. Between 80% and 95% of participants responded positively to five satisfaction questions, and focus group participants unanimously agreed that the nutrition education was an essential component of the program. Hispanic participants were more likely than non-Hispanic Caucasians, Asians, or African Americans to respond positively to three of the five satisfaction questions. For two of the questions, the frequency of positive responses increased as age increased and decreased as education level increased. A small segment of clients reported some dissatisfaction by responding negatively to one or more of the satisfaction questions (4% to 20% of respondents). Some suggestions for improvement were made by survey respondents. Identification of some WIC participants who are not completely satisfied with the nutrition education that they have received, paired with differences in satisfaction across demographic variables, suggests the need for a personalized approach to WIC nutrition education.

Surgical treatment of the rheumatoid elbow. An overview.

Surgical treatment of the patient with rheumatoid arthritis continues to evolve. Synovectomy continues to be an effective palliative procedure, preferred in the early stages of disease. Further investigation into the use of arthroscopic techniques may result in decreased morbidity and a quicker recovery. Total elbow replacement by experienced surgeons employing contemporary designs and surgical techniques is associated with a high degree of success approaching that for total hip and knee replacement.

Closed posteromedial dislocation of the tibiotalar joint without fracture or diastasis: a case report.

Tibiotalar dislocation without fracture is an unusual injury. Seventy-three cases have been reported in the literature. Closed posteromedial dislocation of the tibiotalar joint without fracture or diastasis is a very rare phenomenon. Eight cases have been reported. A case of this unique injury is presented, along with a literature review of purely ligamentous ankle dislocations. The proposed mechanism and classification of these injuries are summarized.

The use of porous prostheses in delayed reconstruction of total hip replacements that have failed because of infection.

Between March 1984 and March 1989, thirty-four patients who had an infection at the site of a cemented total hip prosthesis were managed with resection arthroplasty and delayed implantation of a porous total hip prosthesis without cement. The interval from the time of the resection arthroplasty to the implantation of another prosthesis averaged eight months (range, three to nineteen months). At an average of forty-seven months (range, twenty-four to seventy-two months) after the reimplantation, six patients (18 per cent) had recurrence of the infection. Patients who had rheumatoid arthritis were at significantly higher risk for the development of a recurrent infection (p < 0.01). Of the twenty-eight patients who did not have a recurrent infection, six had definite radiographic evidence of loosening of the femoral component at the latest follow-up evaluation. For twenty-five of the twenty-eight patients, sufficient data were available for calculation of the Mayo Clinic hip score; only fourteen (56 per cent) of these patients had a satisfactory functional outcome. The high (68 per cent) rate of complications and the long-term durability of the prosthesis in these patients remain a concern. The fact that 18 per cent of the patients had a recurrent infection suggests that avoidance of the use of bone cement does not improve the rate of resolution of infection after a delayed revision operation in patients who have an infection following a total hip arthroplasty.

Ligamentous reconstruction for posterolateral rotatory instability of the elbow.

Eleven consecutively seen patients who had posterolateral rotatory instability of the elbow joint were managed operatively. The radial collateral-ligament complex was advanced and imbricated in three of them. In seven patients, the ulnar band of the radial collateral ligament (the lateral ulnar collateral ligament) was reconstructed with the palmaris longus tendon and in two of the seven, the reconstruction was augmented with a prosthetic ligament. The ligament was reconstructed with the lateral one-third of the triceps fascia in the remaining patient. Stability was obtained in ten patients, and seven patients had an excellent functional result. There was one failure in one of the patients in whom the ulnar band of the radial collateral ligament had been reconstructed with the palmaris longus tendon and augmented with a prosthetic ligament.

Infarto segmentario primario e idiopático de epiplon mayor causa poco frecuente de abdomen agudo / Primary idiopathic segmental infarction of the greater omentum, uncommon cause of acute abdominal pain

Se informan 5 casos de infarto segmentario e idiopático de epiplón mayor, atendidos entre 1987 y 1989. Se trata de una causa infrecuente de abdomen agudo, caracterizada por dolor en el hemiabdomen derecho que simula apendicitis o colecistitis aguda. El diagnóstico preoperatorio correcto muy raramente es considerado. El tratamiento quirúrgico con exéresis de la zona infartada resuelve la dolencia sin evidencia de recidiva. Se analiza la probable etiología de origen embriológico que mejor explica el infarto epiploico y su zona de ocurrencia

Infarto segmentario primario e idiopático de epiplon mayor causa poco frecuente de abdomen agudo / Primary idiopathic segmental infarction of the greater omentum, uncommon cause of acute abdominal pain

Se informan 5 casos de infarto segmentario e idiopático de epiplón mayor, atendidos entre 1987 y 1989. Se trata de una causa infrecuente de abdomen agudo, caracterizada por dolor en el hemiabdomen derecho que simula apendicitis o colecistitis aguda. El diagnóstico preoperatorio correcto muy raramente es considerado. El tratamiento quirúrgico con exéresis de la zona infartada resuelve la dolencia sin evidencia de recidiva. Se analiza la probable etiología de origen embriológico que mejor explica el infarto epiploico y su zona de ocurrencia

Radiologic anatomy of the painful bunionette.

Radiographs were studied of 91 feet in 62 patients with the diagnosis of bunionette and no prior bunionette or hallux valgus operations. Various radiologic measurements were compared to a matched control group with no bunionette symptoms or previous forefoot operations. The bunionette group had a significantly increased metatarsophalangeal 5 angle, intermetatarsal 4-5 angle, and intermetatarsal 1-2 angle compared to the control group. Bunionettes were not commonly associated with lateral bowing of the fifth metatarsal or with an increased fifth metatarsal head width. Symmetry was noted between symptomatic and opposite asymptomatic feet, with the exception of an increased intermetatarsal 4-5 angle in the symptomatic feet.

Public funding of contraceptive, sterilization and abortion services, 1983.

In 1983, the federal and state governments spent +340 million to provide contraceptive services--four percent more than they spent during the previous year. Title X of the Public Health Service Act, still the leading source of funding, accounted for +117 million, or 34 percent of all public expenditures. Almost as important was the +108 million (32 percent of total expenditures) provided through Title XIX of the Social Security Act (Medicaid). Two block-grant programs--Social Services and Maternal and Child Health--provided +38 million and +19 million, respectively; together, the two were responsible for 17 percent of public support for contraceptive services. State governments, which spent +58 million of their own revenues, provided an additional 17 percent of funding. Some public expenditures for contraceptive services were made in all the states. Nearly all of the four percent increase in total public funds between 1982 and 1983 was due to a 15 percent rise in Medicaid reimbursements. The federal and state governments together spent +69 million to provide about 73,000 sterilizations in 1983. Ninety percent of sterilization expenditures were made by the federal government--86 percent through the Medicaid program. In addition, the states and the federal government spent +71 million to provide 216,000 abortions in 1983. Unlike public funding for either contraceptive services or sterilization, almost all of the funding for abortion came from the states rather than from the federal government.

PIP: In 1983, the federal and state governments spent US$340 million to provide contraceptive services--4% more than they spent during the previous year. Title X of the Public Health Service Act, still the leading source of funding accounted for US$117 million, or 34% of all public expenditures. Almost as important was the US$108 million (32% of total expenditures) provided through Title XIX of the Social Security Act (Medicaid). 2 block-grant programs--Social Services and Maternal and Child Health--provided US$38 million and US$19 million, respectively; together the 2 were responsible for 17% of public support for contraceptive services. State governments, which spent US$58 million of their own revenues, provided an additional 17% of funding. Some public expenditures for contraceptive services were made in all states. Nearly all of the 4% increase in total public funds between 1982 and 1983 was due to a 15% rise in Medicaid reimbursements. The federal and state governments together spent US$69 million to provide about 73,000 sterilizations in 1983. 90% of sterilization expenditures were made by the federal government--86% through the Mediciad program. In addition, the states and the federal government spent US$71 million to provide 216,000 abortions in 1983. Unlike public funding for either contraceptive services or sterilization, almost all of the funding for abortion came from the states rather than from the federal government.