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Psychotherapists who have received minimal training in neuropsychology do not consider cognitive rehabilitation among the treatment options for their clients who have mild traumatic brain injury (mTBI). Historical perspectives on mTBI did not acknowledge brain plasticity and/or rehabilitation, yet rehabilitation might provide a necessary foundation for a client to be able to benefit from traditional feminist psychotherapy. This article provides an overview of two treatment modalities, biofeedback and neuropsychologically-informed feminist psychotherapy, for women with mTBI who sought relief from interstitial cystitis and headaches. Assessment for neuropsychological treatment planning and monitoring is illustrated with the employment of the Ackerman-Banks Neuropsychological Rehabilitation Battery. Clinical examples are provided to demonstrate a variety of manifestations of mTBI and responses to treatment. [ABSTRACT FROM AUTHOR]

Objective: Genome-wide association studies have uncovered a large number of genetic variants associated with type 2 diabetes or related phenotypes. In many cases the causal gene or polymorphism has not been identified, and its impact on response to anti-hyperglycemic medications is unknown. The Study to Understand the Genetics of the Acute Response to Metformin and Glipizide in Humans (SUGAR-MGH, NCT01762046) is a novel resource of genetic and biochemical data following glipizide and metformin administration. We describe recruitment, enrollment, and phenotyping procedures and preliminary results for the first 668 of our planned 1,000 participants enriched for individuals at risk of requiring anti-diabetic therapy in the future., Methods: All individuals are challenged with 5 mg glipizide × 1; twice daily 500 mg metformin × 2 days; and 75-g oral glucose tolerance test following metformin. Genetic variants associated with glycemic traits and blood glucose, insulin, and other hormones at baseline and following each intervention are measured., Results: Approximately 50% of the cohort is female and 30% belong to an ethnic minority group. Following glipizide administration, peak insulin occurred at 60 minutes and trough glucose at 120 minutes. Thirty percent of participants experienced non-severe symptomatic hypoglycemia and required rescue with oral glucose. Following metformin administration, fasting glucose and insulin were reduced. Common genetic variants were associated with fasting glucose levels., Conclusions: SUGAR-MGH represents a viable pharmacogenetic resource which, when completed, will serve to characterize genetic influences on pharmacological perturbations, and help establish the functional relevance of newly discovered genetic loci to therapy of type 2 diabetes., Trial Registration: ClinicalTrials.gov NCT01762046.

Context/objective: The variant rs13266634 in SLC30A8, encoding a β-cell-specific zinc transporter, is associated with type 2 diabetes. We aimed to identify other variants in SLC30A8 that increase diabetes risk and impair β-cell function, and test whether zinc intake modifies this risk. DESIGN/OUTCOME: We sequenced exons in SLC30A8 in 380 Diabetes Prevention Program (DPP) participants and identified 44 novel variants, which were genotyped in 3445 DPP participants and tested for association with diabetes incidence and measures of insulin secretion and processing. We examined individual common variants and used gene burden tests to test 39 rare variants in aggregate., Results: We detected a near-nominal association between a rare-variant genotype risk score and diabetes risk. Five common variants were associated with the oral disposition index. Various methods aggregating rare variants demonstrated associations with changes in oral disposition index and insulinogenic index during year 1 of follow-up. We did not find a clear interaction of zinc intake with genotype on diabetes incidence., Conclusions: Individual common and an aggregate of rare genetic variation in SLC30A8 are associated with measures of β-cell function in the DPP. Exploring rare variation may complement ongoing efforts to uncover the genetic influences that underlie complex diseases.

Objective: Elevated circulating levels of branched chain and aromatic amino acids (BCAA/AAAs) are associated with insulin resistance and incident type 2 diabetes (T2D). BCAA/AAAs decrease acutely during an oral glucose tolerance test (OGTT), a diagnostic test for T2D. It is unknown whether changes in BCAA/AAAs also signal an early response to commonly used medical therapies for T2D., Materials and Methods: A liquid chromatography-mass spectrometry approach was used to measure BCAA/AAAs in 30 insulin sensitive (IS) and 30 insulin resistant (IR) subjects before and after: (1) one dose of a sulfonylurea medication, glipizide, 5 mg orally; (2) two days of twice daily metformin 500 mg orally; and (3) a 75-g OGTT. Percent change in BCAA/AAAs was determined after each intervention., Results: Following glipizide, which increased insulin and decreased glucose in both subject groups, BCAA/AAAs decreased in the IS subjects only (all P<0.05). Following metformin, which decreased glucose and insulin in only the IR subjects, 4 BCAA/AAAs increased in the IR subjects at or below P=0.05, and none changed in the IS subjects. Following OGTT, which increased glucose and insulin in all subjects, BCAA/AAAs decreased in all subjects (P<0.05)., Conclusions: BCAA/AAAs changed acutely during glipizide and metformin administration, and the magnitude and direction of change differed by the insulin resistance status of the individual and the intervention. These results indicate that BCAA/AAAs may be useful biomarkers for monitoring the early response to therapeutic interventions for T2D., (© 2013.)

Exploring genetic pleiotropy can provide clues to a mechanism underlying the observed epidemiological association between type 2 diabetes and heightened fracture risk. We examined genetic variants associated with bone mineral density (BMD) for association with type 2 diabetes and glycemic traits in large well-phenotyped and -genotyped consortia. We undertook follow-up analysis in ∼19,000 individuals and assessed gene expression. We queried single nucleotide polymorphisms (SNPs) associated with BMD at levels of genome-wide significance, variants in linkage disequilibrium (r(2) > 0.5), and BMD candidate genes. SNP rs6867040, at the ITGA1 locus, was associated with a 0.0166 mmol/L (0.004) increase in fasting glucose per C allele in the combined analysis. Genetic variants in the ITGA1 locus were associated with its expression in the liver but not in adipose tissue. ITGA1 variants appeared among the top loci associated with type 2 diabetes, fasting insulin, β-cell function by homeostasis model assessment, and 2-h post-oral glucose tolerance test glucose and insulin levels. ITGA1 has demonstrated genetic pleiotropy in prior studies, and its suggested role in liver fibrosis, insulin secretion, and bone healing lends credence to its contribution to both osteoporosis and type 2 diabetes. These findings further underscore the link between skeletal and glucose metabolism and highlight a locus to direct future investigations.

The allatostatins comprise three structurally distinct peptide families that regulate juvenile hormone production by the insect corpora allata. A-type family members contain the C-terminal motif -YXFGLamide and have been found in species from numerous arthropod taxa. Members of the B-type family exhibit a -WX(6)Wamide C-terminus and, like the A-type peptides, appear to be broadly conserved within the Arthropoda. By contrast, members of the C-type family, typified by the unblocked C-terminus -PISCF, a pyroglutamine blocked N-terminus, and a disulfide bridge between two internal Cys residues, have only been found in holometabolous insects, i.e. lepidopterans and dipterans. Here, using transcriptomics, we have identified SYWKQCAFNAVSCFamide (disulfide bridging predicted between the two Cys residues), a known honeybee and water flea C-type-like peptide, from the American lobster Homarus americanus (infraorder Astacidea). Using matrix assisted laser desorption/ionization Fourier transform mass spectrometry (MALDI-FTMS), a mass corresponding to that of SYWKQCAFNAVSCFamide was detected in the H. americanus brain, supporting the existence of this peptide and its theorized structure. Furthermore, SYWKQCAFNAVSCFamide was detected by MALDI-FTMS in neural tissues from five additional astacideans as well as 19 members of four other decapod infraorders (i.e. Achelata, Anomura, Brachyura and Thalassinidea), suggesting that it is a broadly conserved decapod peptide. In H. americanus, SYWKQCAFNAVSCFamide is capable of modulating the output of both the pyloric circuit of the stomatogastric nervous system and the heart. This is the first demonstration of bioactivity for this peptide in any species.

This article presents a case study of a 39-year-old European American married woman with a history of child and adolescent incest,marital rape, and physical abuse from her husband for more than 10 years. She was referred to a pain clinic for treatment of headaches and Tourette's syndrome. The client was evaluated with the Ackerman-Banks Neuropsychological Rehabilitation Battery to identify neuropsychological strengths and weaknesses. The Vulnerability to Stress Audit was used to identify life events that were positively and negatively influencing her life. The client was treated for mild traumatic brain injury, post-traumatic stress disorder,cognitive difficulties, impulsivity, confabulation, low frustration tolerance, and inability to evaluate and make decisions about socially appropriate behaviors. Treatment involved traditional psychotherapy, hypnosis, cognitive rehabilitation, biofeedback training, electromyography, finger temperature, and blood pressure.

One of the first questions asked by new orthodontic patients is: How long will I need to wear my braces? A multitude of factors have the potential to influence the answer to this question. The purpose of this retrospective study was to identify some of the primary factors that influence orthodontic treatment duration. Few studies have attempted to evaluate these factors. Data were gathered from 140 consecutively completed, comprehensive treatment patient records in five orthodontic offices. Thirty-one variables related to patient characteristics, diagnostic factors, modality of treatment, and patient cooperation were evaluated. Average treatment time was 28.6 months with a range of 23.4 to 33.4 months among the five offices. Nearly half (46.9%) of the variation in treatment duration was explained by a five-step multiple regression analysis. Included in the regression equation were the number of missed appointments, the number of replaced brackets and bands, the number of treatment phases, the number of negative chart entries regarding oral hygiene, and the prescription of headgear wear during treatment. An additional 6.7% of the variance was explained by variation among the five offices. Six of the 31 variables examined made a statistically significant (alpha =.01) contribution to the explanation of variation in treatment time. The quality of the finished cases and the appropriateness of the original diagnosis and treatment plan were not evaluated. Developing an objective assessment to evaluate these areas may be important for increasing our understanding of treatment time variation.

Background: One-stage repair of interrupted aortic arch, ventricular septal defect, and severe subaortic stenosis represents a surgical challenge. Techniques that use extracardiac conduits to bypass the subaortic area or involve transaortic or transatrial resection of the conal septum have shown limitations and have failed to reduce the high mortality rate associated with subaortic obstruction., Methods and Results: A new operative approach was used in nine neonates (2.1 to 3.9 kg) who underwent one-stage repair of interrupted aortic arch (type B, eight patients; type C, one patient), ventricular septal defect, and severe subaortic stenosis. All patients had severe subaortic stenosis according to preoperative echocardiography (mean ratio of subaortic to descending aortic diameter, 0.63 +/- 0.08). With a transpulmonary (seven patients) or transatrial (two patients) approach and without resection of the conal septum, the ventricular septal patch was placed on the left side of the septum to deflect the conal septum anteriorly and away from the subaortic area. There were no early or late deaths. Median intensive care unit and hospital stays were 17 days (6 to 47 days) and 21 days (10 to 55 days), respectively. On follow-up echocardiography (1 to 29 months, median 12 months), no patients had significant residual subaortic obstruction and one patient had mild residual arch obstruction (20 mm Hg). Growth of the subaortic region was demonstrated in all patients (mean ratio of subaortic to descending aortic diameter, 1.20 +/- 0.10; < 0.001)., Conclusions: Relief of severe subaortic stenosis during one-stage neonatal repair of aortic arch interruption and ventricular septal defect can be accomplished successfully without resection of the conal septum.

The purpose of this study was to compare the bond strengths of three different adhesive systems when used alone and combined with a porcelain priming agent to bond ceramic brackets to porcelain surfaces. Sixty porcelain specimens were randomly assigned to the six different treatment groups. Half were bonded with the porcelain priming agent and one of the adhesive systems and the other half with one of the adhesive systems alone. The shear bond strengths of all specimens were tested, with an Instron testing machine, 10 minutes after being bonded. The surface of the porcelain and the bracket base were examined, with scanning electron microscopy (SEM) and qualitative energy dispersive x-ray analysis (EDS), to determine the bond failure patterns and to check the porcelain surface for the presence of cracks and fractures. There was a statistically significant difference within each adhesive between those samples with the priming agent and those without the priming agent. Differences between the three adhesives were not statistically significant (p < or = 0.05).

A 21-item Adult Children Of Alcoholics (ACOA) Index was statistically analyzed in an effort to develop a measure of identifying and assessing ACOAs. The ACOA Index, administered to a conference sample (n = 328), produced four factors suggesting rejection, impulsiveness, inconsistency, and deliberation. The ACOA Index was most highly correlated with indexes for mild depression and low self-esteem. ACOAs scored significantly higher on the ACOA Index than non-ACOAs with an overall correct classification of 67%. Test-retest procedure produced a Pearson r = .80 using a college student sample (n = 134), but only r = .40 for a sample of alcohol inpatients (n = 34). The alpha coefficient for the ACOA Index is .85.

Epidemiological studies have suggested that deep overbite is associated with symptoms of temporomandibular dysfunction (TMD). This finding was directly tested by deliberately constituted groups of deep and normal overbite subjects matched for age and sex. Eighty-one subjects participated. Dependent measures included the TMJ Scale test; measures of muscle activity in the right and left frontalis, temporalis, and masseter muscles; and pressure threshold meter readings for the same sites. The results showed no differences between deep and normal overbite subjects for all the dependent measures studied. The role of overbite alone in producing TMD symptoms is questioned.

This research attempts to identify the factors that differentiate adult children of alcoholics (ACOAs). A national purposive sample of ACOAs (n = 500) was administered an ACOA index measuring ACOA symptoms. An ANOVA analysis for the ACOA index scores showed gender, minority race or ethnicity, rating of parents' relationship, receiving help as a child, and seeking treatment as an adult to have significant effects. Notably, minorities scored significantly lower on the ACOA index, and seeking treatment increased the scores, even in interaction with parents' relationship and receiving help as a child. These findings point to the need for differentiating treatment for ACOAs and developing more effective treatment in general. They also confirm the importance of offering even informal support to children in troubled families.

This study compared counterrotational-action power toothbrushing with manual toothbrushing in effectiveness on plaque control and gingival health in 20 randomly selected orthodontic patients at the University of Missouri-Kansas City. A blind two-group crossover design was used. Gingival and plaque scores were recorded, and a prophylaxis was given to bring the plaque score to zero. Ten subjects received counterrotational power brushes, and ten subjects received manual brushes. Instructions appropriate to each brushing method were given by a hygienist. At 30 and 60 days, plaque and gingival scores were recorded and a prophylaxis was given. At 60 days the subjects who were using power brushes were switched to manual brushes, and the subjects who were using manual brushes were switched to power brushes. At 30 and 60 days, plaque and gingival scores were recorded and a prophylaxis was given. Plaque and gingival scores were significantly less (p less than 0.01) after brushing 2 months with the counterrotational power brush than with the manual brush. This finding was irrespective of the sequence in which the brushes were used.

User-calibrated cephalometric templates have been presented for boys and girls at the ages of 6, 8, 10, 12, 14, and 16 years. The templates were derived by geometric triangulation from normative data published in An Atlas of Craniofacial Growth. A technique for using the templates diagnostically has also been presented.

This article summarizes the use of rare earth screen technology to achieve high-quality panoramic and cephalometric radiographs with sizable reductions in patient radiation dosage. Collimation, shielding, quality control, and darkroom procedures are reviewed to further reduce patient risk and improve image quality.

Posteruptive tooth migration between 6 and 14 years involves both total arch displacement and intra-alveolar tooth movement. Central incisors, canines, and permanent first molars all drift forward within the alveolar bone. The molars, and to a lesser extent the incisors, drift occlusally. With respect to lingual arch contour, lateral movement of molars and canines is negligible.

Bracket recycling has emerged concurrently with the practice of direct bonding. This study was undertaken to determine the effect of recycling on the retention of mesh-backed stainless steel brackets. Mesh strand diameter was measured on forty new brackets. These brackets were bonded to recently extracted human premolar teeth, and the tensile force required to fracture each bond was recorded. The brackets were then reconditioned by a thermal process. The mesh strand size was remeasured and the tensile test was repeated. It was found that (1) mesh strand diameter decreased 7 percent during the reconditioning process (93.89 microns +/- 3.17 S.D. compared to 87.07 microns +/- 4.76 S.D., z = 17.62, P less than 1 X 10(-5) ), (2) new bracket bonds were 6 percent stronger than recycled bracket bonds (43.88 pounds +/- 7.98 S.D. bond strength), and (3) reduction in mesh strand diameter during the reconditioning process did not correlate with changes in bond strength between initial and recycled bonding (Pearson r = 0.038).

Using radioactive substrate, thin-layer chromatography and recrystallization methods as well as differential centrifugation, gel filtration and electrophoresis, testosterone metabolism was investigated in male rat epiphyseal growth plate. 5alpha-androstane 3alpha-17beta-diol was found to be a major metabolite in vitro; lesser amounts of androstenedione and androstanedione, and a very small amount of 5alpha-dihydrotestosterone were also identified. Radioactivity was recovered in epiphyseal subcellular fractions 30 minutes following in vivo administration of tritiated 5alpha-dihydrotestosterone; within 2 hours radioactivity had fallen to essentially background level in all fractions but the cytosol. A testosterone binding protein could not be identified within epiphyseal cytosol.