Beta-blockers: a time for reappraisal

Recent studies have shown that SPECT bone scintigraphy is valuable to detect meniscal tears of the knee. This has not been formally assessed in a prospective study, and no substantive study has compared bone SPECT with other noninvasive diagnostic methods. One hundred consecutive patients referred to an orthopedic surgeon with undiagnosed knee pain were assessed by clinical examination, MRI, SPECT bone scintigraphy, and arthroscopy. The MRI and SPECT bone scan findings were reported blinded to other information. Using arthroscopy as a gold standard, both MRI and SPECT showed high diagnostic ability to detect meniscal tears, with respective sensitivity rate, specificity rates, and positive and negative predictive accuracies of 80%, 71%, 84%, and 71% for MRI and 84%, 80%, 88%, and 76% for SPECT. Some meniscal tears were detected by MRI alone (n = 5) or SPECT alone (n = 8). SPECT bone scintigraphy is a suitable alternative to MRI to detect meniscal tears. The comparable diagnostic ability of SPECT bone scintigraphy implies that it can be used successfully when MRI is unavailable or unsuitable.     

Migraine preventive medications: a reappraisal

Newer acute care migraine medications demonstrate improved rapidity of action, consistent effectiveness, excellent safety profiles, and rarely cause rebound headaches. Their use could decrease the need for migraine-preventive medication. The present analysis derives a formula that can be used by practitioners to determine the cost-effectiveness of various migraine-preventive medications relative to selected acute-care medications. We propose a measure called the cost-equivalent number (CEN), the number of headaches per month at which the cost of the preventive medication equals the cost savings in acute-care treatment realized by using the preventive medication. The use of the CEN individualizes the decision of whether to use a migraine-preventive medication, weighing both the efficacy and cost of the preventive medication against the cost of the acute-care medication. A CEN lower than the migraine frequency suggests that use of a preventive medication will be cost-effective.     

The head-to-abdomen circumference ratio: a reappraisal

Our objective was to assess the clinical significance of the sonographically derived head-to-abdomen circumference ratio in small-for-gestational-age (SGA) fetuses. The head-to-abdomen ratio was determined in 134 singleton SGA fetuses without ultrasound evidence of malformations at 26-40 weeks' gestation. Data were collected regarding antenatal surveillance, umbilical artery Doppler velocimetry and neonatal outcome. In SGA fetuses, the head-to-abdomen ratio, adjusted for gestational age, had a normal frequency distribution, positively skewed with regard to fetuses with normal birth weight. An elevated head-to-abdomen ratio was found in 56 SGA fetuses (42%), and was associated with increased perinatal mortality (odds ratio 3.27; 95% confidence internal 1.04-9.34), lower birth weight (1533 +/- 635 g vs. 2022 +/- 655 g, p < 0.0001) and lower gestational age at delivery (34 +/- 3.6 weeks vs. 36.3 +/- 3.6 weeks, p < 0.005). However, logistic regression revealed that the most powerful antenatal determinants of pregnancy outcome were Doppler velocimetry of the umbilical artery, followed by biophysical profile, while no independent correlation was found with the head-to-abdomen ratio. The existence of two distinct categories of SGA fetuses, 'symmetric' and 'asymmetric', remains uncertain. An elevated head-to-abdomen ratio is an adverse risk factor for pregnancy outcome. However, this parameter has no clearcut clinical value when umbilical artery Doppler velocimetry and biophysical antenatal testing are available.     

Relaxin and decidualization in mice: a reappraisal

The nature of the physiological stimulus inducing decidualization in the endometrium is unknown. In this study we attempted to verify a recent report that relaxin can induce decidualization in intact mice primed with a high dose of estradiol valerate (5 micrograms) and a low dose (10 micrograms) of medroxyprogesterone acetate. In our study, neither s.c. nor intrauterine relaxin, nor intraluminal arachis oil, (an established deciduogenic stimulus) were able to induce decidualization. In addition, while oil was able to induce decidualization (increased uterine weight, and positive Pontamine Sky Blue and stromal alkaline phosphatase reactions) in ovariectomized mice treated with a regimen of estradiol and medroxyprogesterone acetate designed to produce optimum uterine sensitivity, no decidualization occurred in response to either s.c. or intraluminal relaxin. This study fails to provide any support for a role for relaxin as a deciduogenic stimulus.     

Paroxysmal tonic upgaze: a reappraisal of outcome

Intramuscular injection of plasmid constructs promises to be an effective way of carrying out gene therapy for muscle disorders as well as using muscle as an in vivo expression system for disorders that involve the gene product being secreted into the bloodstream. The effectiveness of this method depends on the design of the cassette used for the expression of the cDNA of the introduced gene. We tested the levels of expression achieved by a number of muscle-specific promoters and a myosin light chain enhancer when spliced to the reporter gene chloramphenicol acetyltransferase (CAT), in vitro and in vivo by injection into fast and slow muscles of the mouse. The results show that the highest levels of expression are achieved by a combination of a truncated myosin heavy chain promoter and the enhancer, and that a whole range of expression levels is obtained with the other combinations tested. The data show that a cassette based on these elements should provide efficient vectors for the introduction and expression of genes following intramuscular injection of naked DNA.     

Single point estimation of phenytoin dosing: a reappraisal

A previously proposed method for estimation of phenytoin dosing requirement using a single serum sample obtained 24 hours after intravenous loading dose (18 mg/Kg) has been re-evaluated. Using more realistic values for the volume of distribution of phenytoin (0.4 to 1.2 L/Kg), simulations indicate that the proposed method will fail to consistently predict dosage requirements. Additional simulations indicate that two samples obtained during the 24 hour interval following the iv loading dose could be used to more reliably predict phenytoin dose requirement. Because of the nonlinear relationship which exists between phenytoin dose administration rate (RO) and the mean steady state serum concentration (CSS), small errors in prediction of the required RO result in much larger errors in CSS.     

Feature detectors for speech: A critical reappraisal.

A review of the literature shows that in the past decade, most theoretical accounts of speech perception have stressed the role of feature detectors in mapping initial auditory transforms of the speech signal onto features or phonemes. Several types of experiments are often viewed as supporting the feature detector hypothesis. These include electrophysiological studies of the visual and auditory systems of nonhuman species, studies of categorical perception of speech sounds by human adults and infants, and especially, studies of selective adaptation to speech sounds. The present article argues that evidence for feature detectors in speech perception is equivocal at best and that there are compelling reasons to reject the detector hypothesis (e.g., lack of firm consensus regarding the nature of detector outputs). (3? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrated child development services scheme: need for reappraisal

The distribution of supplementary nutrition (SN) to beneficiaries is an issue of debate in the Integrated Child Development Services (ICDS) program, discussed in almost all fora in which the scheme is on the agenda. ICDS program managers rightly decided in 1975 to make SN a program component, and it should remain so. However, in areas which are relatively better off, where program beneficiaries do not require SN, the discontinuation of SN can be considered. More than 3 lakh Anganwadi Centers (AWCs) are operating in India. No solid data are available on how many AWCs are closed when SN is not available. Many Anganwadi workers are taking innovative approaches for the holistic development of children even without SN. Although the process of growth monitoring (GM) is not being conducted as it was conceptualized, experience is being gained in the field. Based upon feedback received from independent evaluating agencies, mid-course changes have been made to the ICDS. For example, training activities have been made more realistic.     

Honey revisited: a reappraisal of honey in pre-industrial diets

In pre-industrial times, honey was the main source of concentrated sweetness in the diets of many peoples. There are no precise figures for per capita consumption during most periods in history because honey was part of either a hunter-gatherer or subsistence economy. Until now, historians and food writers have proposed that it was a scarce commodity available only to a wealthy few. We do know, however, that in a cash economy honey was sold in large units (gallons and even barrels) and it was present in such abundance that mead, made from honey, was a common alcoholic drink. A reappraisal of the evidence from the Stone Age, Antiquity, the Middle Ages and early Modern times suggests that ordinary people ate much larger quantities of honey than has previously been acknowledged. Intakes at various times during history may well have rivalled our current consumption of refined sugar. There are implications therefore for the role of sugar in modern diets. Refined sugar may not have displaced more nutrient-rich items from our present-day diets but only the nutritionally comparable food, honey.     

Extraversion-introversion as a dimension of personality: A reappraisal.

The continued research interest in extraversion-introversion (EI) has centered around the unidimensionality of the construct and its relationship to adjustment. Research published since 1953 has failed to clarify these issues substantially, leaving the status of EI as a fruitful construct rather tenuous. (97 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The reaction between nitric oxide and alpha-tocopherol: a reappraisal

Recently Gorbunov et al. reported that nitric oxide (.NO) can directly oxidize alpha-tocopherol to alpha-tocopheroxyl radical (Gorbunov et al., Biochem. Biophys. Res. Commun., 219, 835-841, 1996). We have reinvestigated this reaction and report that a direct reaction between .NO and alpha-tocopherol does not occur. However, the reaction between .NO and oxygen generates an oxidant which oxidizes alpha-tocopherol to alpha-tocopheryl quinone. Exposure of alpha-tocopherol to a low flux of .NO generated from spermine NONOate (100 microM) results in no consumption of alpha-tocopherol under either aerobic or anaerobic conditions. A higher flux of .NO, generated from 1 mM spermine NONOate, oxidizes alpha-tocopherol only under aerobic conditions. Artifactual oxidation of alpha-tocopherol can be observed when using commercial .NO that is contaminated with higher oxides of nitrogen, such as dinitrogen trioxide and dinitrogen tetraoxide.     

Self-monitoring: Appraisal and reappraisal.

Theory and research on self-monitoring have accumulated into a sizable literature on the impact of variation in the extent to which people cultivate public appearances in diverse domains of social functioning. Yet self-monitoring and its measure, the Self-Monitoring Scale, are surrounded by controversy generated by conflicting answers to the critical question, Is self-monitoring a unitary phenomenon? A primary source of answers to this question has been largely neglected—the Self-Monitoring Scale's relations with external criteria. The authors propose a quantitative method to examine the self-monitoring literature and thereby address major issues of the controversy. Application of this method reveals that, with important exceptions, a wide range of external criteria tap a dimension directly measured by the Self-Monitoring Scale. The authors discuss what this appraisal reveals about what self-monitoring is and is not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)