Obesity and the pubertal transition in girls and boys.

Childhood obesity has become a major health concern in recent decades, especially with regard to metabolic abnormalities that impart a high risk for future cardiovascular disease. Recent data suggest that excess adiposity during childhood may influence pubertal development as well. In particular, excess adiposity during childhood may advance puberty in girls and delay puberty in boys.

Ultrasound provides a reliable test of local anesthetic spread.

Background And Objectives: We predicted that practitioners could identify injectate spread in a model of ultrasound-guided peripheral nerve block.

Methods: Both novices and experts in ultrasound-guided peripheral nerve block were asked to recognize the spread of local anesthetic in a gelatin ultrasound phantom. In a blinded and randomized fashion, these participants were observed to either successfully or unsuccessfully state whether an injection had been made.

Maturation of sleep-wake gonadotrophin-releasing hormone secretion across puberty in girls: potential mechanisms and relevance to the pathogenesis of polycystic ovary syndrome.

Neuroendocrine mechanisms underlying the progression of sleep-wake gonadotrophin-releasing hormone (GnRH) pulse secretion across puberty have remained enigmatic. Here, the changes of sleep-wake luteinising hormone (LH) (and, by inference, GnRH) pulse secretion across puberty in normal girls are reviewed, primarily focusing on available human data. It is suggested that the primary control of GnRH pulse frequency changes across puberty, with sex steroid feedback exerting minimal control during childhood, but primary control during adulthood.

Hyperandrogenemia in obese peripubertal girls: correlates and potential etiological determinants.

Obesity in peripubertal girls is associated with hyperandrogenemia (HA), which can represent a forerunner of polycystic ovary syndrome (PCOS). However, not all obese girls demonstrate HA, and determinants of HA in obese girls remain unclear. We hypothesized that insulin and luteinizing hormone (LH) are independent predictors of free testosterone (T) concentration in obese girls.

Evidence basis for the use of ultrasound for upper-extremity blocks.

This article qualitatively assesses and summarizes randomized, controlled studies regarding benefits of ultrasound (US) for brachial plexus block and also examines those studies that have compared different brachial plexus block techniques using US.Studies were identified by a search of PUBMED and EMBASE databases using the MeSH terms anesthetic techniques, brachial plexus, and ultrasound. Included studies were limited to randomized trials that compared a US technique with another accepted method of performing brachial plexus block or those studies that compared 2 different US-guided techniques.

The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: Executive summary.

Objectives: The American Society of Regional Anesthesia and Pain Medicine charged an expert panel to examine the evidence basis for ultrasound guidance as a nerve localization tool in the clinical practices of regional anesthesia and interventional pain medicine.

Methods: The panel searched, examined, and assessed the literature of ultrasound-guided regional anesthesia (UGRA) from the past 20 years. The qualities of studies were graded using the Jadad score.

Isolation of Streptococcus thoraltensis from rabbit faeces.

Bacteria were isolated from rabbit faeces using equine caecal fluid as a growth medium. Two new isolates of the genus Streptococcus are described in terms of their biochemical properties. One of these has a 16S rRNA gene with 97.

Hyperandrogenaemia in adolescent girls: origins of abnormal gonadotropin-releasing hormone secretion.

Polycystic ovarian syndrome is a common disorder characterized by ovulatory dysfunction and hyperandrogenemia (HA). Its origins begin peripubertally, as adolescent HA commonly leads to adult HA and decreased fertility. HA reduces inhibition of gonadotropin releasing hormone pulse frequency by progesterone, causing rapid LH pulse secretion and further increasing ovarian androgen production.

Compared with dual nerve stimulation, ultrasound guidance shortens the time for infraclavicular block performance.

Purpose: The success rate for infraclavicular brachial plexus block using nerve stimulation reportedly ranges from 60 to 80%. Ultrasound guidance may be associated with greater success. This study compared ultrasound guided infraclavicular block with a dual motor endpoint nerve stimulation technique.

The immune response and fertility of koalas (Phascolarctos cinereus) immunised with porcine zonae pellucidae or recombinant brushtail possum ZP3 protein.

To evaluate the potential contraceptive effect of immunisation with zona pellucida antigens, 50 free-ranging koalas were immunised with either porcine zonae pellucidae (PZP), recombinant brushtail possum ZP3 (recBP-ZP3) or buffer, in complete Freund's adjuvant. A single booster immunisation in incomplete Freund's adjuvant was administered 3-5 months later. Where possible animals were recaptured, reproductive status was assessed and blood was collected at 1-3-month intervals for the next 33 months.

Estradiol and progesterone-induced slowing of gonadotropin-releasing hormone pulse frequency is not reversed by subsequent administration of mifepristone.

Subsequent to suppression of LH (GnRH) pulse frequency by progesterone (P) and estradiol (E(2)), LH pulse frequency remains slow for 7 days after P withdrawal if mid-luteal E(2) concentrations are maintained. This may reflect an ability of E(2) to potentiate the suppressive effects of low P levels. We explored this notion in a similar experimental paradigm by administering a P-receptor antagonist (mifepristone) after P withdrawal while continuing E(2).

Modulation of gonadotropin-releasing hormone pulse generator sensitivity to progesterone inhibition in hyperandrogenic adolescent girls--implications for regulation of pubertal maturation.

Context: Adult women with polycystic ovary syndrome (PCOS) have decreased GnRH pulse generator sensitivity to progesterone (P)-mediated slowing. This defect is androgen mediated because it is reversed with androgen receptor blockade. Adolescent hyperandrogenism often precedes PCOS.

Upper extremity regional anesthesia: essentials of our current understanding, 2008.

Brachial plexus blockade is the cornerstone of the peripheral nerve regional anesthesia practice of most anesthesiologists. As part of the American Society of Regional Anesthesia and Pain Medicine's commitment to providing intensive evidence-based education related to regional anesthesia and analgesia, this article is a complete update of our 2002 comprehensive review of upper extremity anesthesia. The text of the review focuses on (1) pertinent anatomy, (2) approaches to the brachial plexus and techniques that optimize block quality, (4) local anesthetic and adjuvant pharmacology, (5) complications, (6) perioperative issues, and (6) challenges for future research.

Immunocontraception of Eastern Grey kangaroos (Macropus giganteus) with recombinant brushtail possum (Trichosurus vulpecula) ZP3 protein.

This study examined the potential of a recombinant marsupial zona pellucida 3 protein as a contraceptive vaccine for the Eastern Grey kangaroo, a marsupial that is locally overabundant in several regions of eastern Australia. First, a pilot study using porcine zona pellucidae (PZP) demonstrated that ZP proteins, primarily the ZP3 component of PZP, are highly immunogenic in the grey kangaroo and produce a long-lasting humoral response to a single immunisation, as found in other marsupials. Immunisation with 300 microg of a non-glycosylated recombinant brushtail possum ZP3 (recBP-ZP3) protein in complete Freund's adjuvant produced a similar, significant and sustained antibody response, and none of the immunised kangaroos (n=7) produced offspring during the following breeding season compared with four out of the six control animals.

A controlled clinical interventional trial comparing 2% chloroprocaine-bupivicaine versus 2% lidocaine-bupivicaine for retrobulbar anesthesia in scleral buckling surgery.

Objective: We undertook this prospective study to compare the relative effectiveness of a bupivicaine mixture with either lidocaine or chloroprocaine for retrobulbar anesthesia in scleral buckling surgery, since chloroprocaine, in some types of nonocular nerve block anesthesia, has been demonstrated to be a more effective nerve block anesthetic.

Design: This prospective, randomized, double-blind, controlled, clinical, unicentre, interventional trial compared mixtures of lidocaine-bupivacaine with chloroprocaine-bupivacaine in scleral buckling surgery performed by 1 surgeon during a 12-month period.

Participants: A total of 136 patients who underwent scleral buckling surgery constituted the cases studied.

Maturation of luteinizing hormone (gonadotropin-releasing hormone) secretion across puberty: evidence for altered regulation in obese peripubertal girls.

Context: Peripubertal obesity (body mass index-for-age >or= 95%) in girls is associated with hyperandrogenemia. LH likely contributes to this relationship, but overnight LH secretion in obese girls is poorly characterized.

Objective: The aim of the study was to evaluate LH pulse characteristics in obese girls throughout pubertal maturation.

Inheritance of Race-Specific Resistance to Mycosphaerella graminicola in Wheat.

ABSTRACT Mycosphaerella graminicola causes Septoria tritici blotch of hexaploid and tetraploid wheat. The inheritance of high-level resistance to Septoria tritici blotch was studied in controlled environment experiments. Intraspecific reciprocal crosses were made between hexaploid wheat lines Salamouni, ST6, Katepwa, and Erik, and the tetraploid wheat lines Coulter and 4B1149.

Effect of local anaesthetic volume (20 vs 5 ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block.

Background: Interscalene brachial plexus block (ISBPB) is an effective nerve block for shoulder surgery. However, a 100% incidence of phrenic nerve palsy limits the application of ISBPB for patients with limited pulmonary reserve. We examined the incidence of phrenic nerve palsy with a low-volume ISBPB compared with a standard-volume technique both guided by ultrasound.

Evolution of ultrasound guided axillary brachial plexus blockade: retrospective analysis of 662 blocks.

Purpose: Ultrasound (US) is being used increasingly to guide needle placement during axillary brachial plexus blockade (AXB). This retrospective study investigated whether US guidance can increase the success rate, decrease block onset time, and reduce local anesthetic (LA) volume for AXB compared to a traditional (TRAD) approach, namely, peripheral nerve stimulation (PNS) and transarterial (TA) techniques.

Methods: The anesthetic records, operative reports, discharge summaries, and surgical consultation notes of all patients who had undergone AXB for surgical anesthesia at the Toronto Western Hospital, between October 2003 and November 2006 were, retrospectively reviewed for evidence of block success and associated complications.

Regional anesthesia for the management of limb injuries in space.

Traumatic injuries continue to present a threat to the success of current and future spaceflight missions. The magnitude of this threat will grow as the frequency of extravehicular activities is increased and missions venture beyond low Earth orbit and further away from terrestrial medical support. The capability to render definitive treatment to crewmembers who suffer a serious traumatic injury while in space is relatively limited at present.

Polycystic ovary syndrome in adolescence.

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive-aged women and is characterized by hyperandrogenemia, menstrual dysfunction, and polycystic ovarian morphology. The hormonal abnormalities inherent in PCOS often begin in adolescence and include hyperinsulinemia and rapid luteinizing hormone (LH) pulse frequency, both of which mediate ovarian and adrenal overproduction of androgens. Although differences exist regarding the diagnostic criteria for PCOS, we believe that hyperandrogenemia is the final common pathway for the development of adolescent PCOS, and we propose a hypothesis to illustrate such.

Decision analysis of discordant thyroid nodule biopsy guideline criteria.

Context: Recently published guidelines are discordant regarding diagnostic approaches to small (10-14 mm) thyroid nodules.

Objective: The objective of the study was to explore the relative desirability of alternative diagnostic approaches to small thyroid nodules using decision analysis.

Design: Four diagnostic approaches to a 10- to 14-mm thyroid nodule are modeled: 1) observation only, consistent with American Thyroid Association guidelines; 2) routine fine-needle aspiration biopsy (FNAB), an approach traditionally chosen by many endocrinologists and consistent with American Thyroid Association guidelines; 3) FNAB only when microcalcifications are present, as recommended by Society of Radiologists in Ultrasound guidelines; and 4) FNAB only when the nodule is hypoechoic and has at least one other ultrasonographic risk factor, as endorsed by American Association of Clinical Endocrinologists guidelines.

Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa.

Background And Objectives: Real time ultrasound guidance is a recent development in the area of peripheral nerve blockade. There are limited data from prospective randomized trials comparing its efficacy to that of traditional nerve localization techniques. In the present study, we tested the hypothesis that ultrasound guidance improves the success rate of sciatic nerve block at the popliteal fossa when compared with a nerve stimulator-guided technique.