Function In Young Patients Research Articles

Control study on executive function in adolescents with bipolar disorder before and after therapy

Objective To study the executive function and the related factors before and after therapy.Methods Thirty adolescents with depressed bipolar patients and 30 adolescents with manic bipolar patients (study group),thirty health adolescents controls(control group)were assessed for executive function using the Wisconsin Card Sorting Test(WCST),the Stroop Color Word Test(SCW),the Tower of London Test,the Digital Sequence Test and Spatial Span Test.Neuropsychological assessment was performed respectively in the 1st week of entering the group and the end of the 8th week.Results Before and after the treatment the study group performed poorer on all of the neuropsyehological tests than control group(P＜0.01).Furthermore,follow-up assessment revealed that although study group demonstrated an overall improvement,the deficits in executive functions remain.Manic bipolar patients showed the worse performance than depressed bipolar patients on subtests reflecting inhibitory control before treatment(NRPE:27.30±5.19 vs 31.77±6.13;R F:30.60±7.41 vs 35.33±9.06;RTA:(53.40±8.97)s vs(63.63±8.85)s;RTB:(81.93±8.44)s vs(93.87±6.98)s;RTC:(127.27±12.52)s vs(160.27±13.70)s;SIE:(45.33±13.90)s vs(66.40±13.56)s,P＜0.01 or P＜0.05).After 8 weeks treatment,there were remarkable differences between depressed bipolar group and mania bipolar group on RF,TOL,RTA,RTB,RTC,SIE(P＜0.01 or P＜0.05).Self-comparison of the depressed bipolar on nenropsychological performance before and after treatment showed significant difference(P＜0.01),except RTA and RTB of the SCW (P＞0.05).Self-comparisen of the manic bipolar on neuropsychological performance before and after treatment showed significant difference(P＜0.01).The Tower of London test and the number of categories of WCST were negatively correlated to the course of disease(P＜0.05);Perseverative Errors score,Non-Perseverative Errors score and the Responses of Finishing the first Category of WCST and the Interference of Stroop were positive correlated to the course of disease(P＜0.05).Conclusion The impairment of executive function in young patients with bipolar disorder is observed in the period of disease,which could improve after treatment. Key words: Adolescents; Bipolar disorder; Executive function; Control study

Custom Cementless Stem Improves Hip Function in Young Patients at 15-year Followup

THA in young patients is challenging regarding restoration and survival because patients are young, active, and tend to have disturbed anatomy. We asked whether a three-dimensional custom cementless stem could restore hip function, decrease osteolysis and wear, and enhance stem survival in young patients. We retrospectively reviewed 212 patients (233 hips) younger than 50 years (mean, 40 years) at a followup of 5 to 16 years (mean, 10 years). The Merle D'Aubigné-Postel and Harris hip scores improved at last followup. No thigh pain was recorded for any of the patients; 187 of the 212 patients (88%) had full activity recovery, 206 had full range of motion, and 151 had a score greater than 80 points for all five categories of the Hip disability and Osteoarthritis Outcome score. Five patients had femoral osteolysis not associated with pain. With revision for any reason as an end point, the survivorship was 87% (range, 77%-97%) at 15 years, and considering stem revision only, the survivorship was 93% (confidence interval, 90%-97%) at 15 years. Our data compare favorably with those from series using standard cementless stems at the same followup with a high percentage of patients achieving functional restoration and a low rate of complications. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Normalization of Autonomic Function in Children With Coarctation of the Aorta After Surgical Correction in Infancy

To the Editor: Systemic hypertension affects ≥20% of patients with coarctation of the aorta (CoA) by adolescence, despite early surgical repair.1 This leads to premature death and is arguably the most important outcome variable in these patients. We have previously demonstrated reduced spontaneous baroreceptor reflex sensitivity (BRS) and heart rate variability (HRV) in preoperative neonates with CoA compared with age-matched controls, suggesting early autonomic dysfunction.2 Altered BRS has also been demonstrated in older children after late surgical repair,3 however, little is known about BRS and autonomic function in younger patients after successful neonatal repair. In the current study, we re-evaluated spontaneous BRS, HRV, and blood pressure (BP) variability (BPV) from our initial cohort at 5 years on to determine whether there was persisting abnormality of cardiovascular autonomic variables as a precursor to arterial hypertension. We re-examined 6 of the 7 living CoA patients and 7 of the 12 living age- and sex-matched control patients from the initial cohort. The remaining 5 controls could no longer be traced, and 1 CoA patient was not included because of severe developmental delay. None of the subjects were taking medications. …

Effect of Ingested Interferon-α on β-Cell Function in Children With New-Onset Type 1 Diabetes

OBJECTIVETo evaluate the safety and efficacy of ingested human recombinant interferon-α (hrIFN-α) for preservation of β-cell function in young patients with recent-onset type 1 diabetes.RESEARCH DESIGN AND METHODSSubjects aged 3–25 years in whom type 1 diabetes was diagnosed within 6 weeks of enrollment were randomly assigned to receive ingested hrIFN-α at 5,000 or 30,000 units or placebo once daily for 1 year. The primary outcome was change in C-peptide secretion after a mixed meal.RESULTSIndividuals in the placebo group (n = 30) lost 56 ± 29% of their C-peptide secretion from 0 to 12 months, expressed as area under the curve (AUC) in response to a mixed meal. In contrast, children treated with hrIFN-α lost 29 ± 54 and 48 ± 35% (for 5,000 [n = 27] and 30,000 units [n = 31], respectively, P = 0.028, ANOVA adjusted for age, baseline C-peptide AUC, and study site). Bonferroni post hoc analyses for placebo versus 5,000 units and placebo versus 30,000 units demonstrated that the overall trend was determined by the 5,000-unit treatment group. Adverse events occurred at similar rates in all treatment groups.CONCLUSIONSIngested hrIFN-α was safe at the doses used. Patients in the 5,000-unit hrIFN-α treatment group maintained more β-cell function 1 year after study enrollment than individuals in the placebo group, whereas this effect was not observed in patients who received 30,000 units hrIFN-α. Further studies of low-dose ingested hrIFN-α in new-onset type 1 diabetes are needed to confirm this effect.

Acute graft-versus-host disease transiently impairs thymic output in young patients after allogeneic hematopoietic stem cell transplantation

AbstractLong-term T-cell reconstitution after hematopoietic stem cell transplantation (HSCT) is dependent on patient thymic function and affected by graft-versus-host disease (GVHD). To assess the impact of acute GVHD (aGVHD) on thymic function, we followed a cohort of 93 patients who received HSCT from a human histocompatibility leukocyte antigen-identical sibling, mainly for hematologic malignancies. Thymic output was measured by signal-joint T-cell receptor excision circles (sjTREC) real-time polymerase chain reaction. Absolute sjTREC number was lower at 6 months in patients with aGVHD (P = .014), associated with lower absolute counts of naive CD4 T cells at 6 and 12 months (P = .04 and .02), and persistent abnormalities in T-cell repertoire diversity. Age and aGVHD affected thymic function independently in multivariate analysis. In patients less than 25 years of age, thymic function recovered almost totally at 1 year. As a marker of thymocyte proliferation, we quantified the βTREC generated during the T-cell receptor β-chain recombination, in a group of 20 age-matched patients. Mean βTREC level was reduced at 6 months in patients with aGVHD, indicating an impact on early thymic differentiation rather than on intrathymic proliferation. These data show that aGVHD or its treatment has a transient impact on thymic function in younger patients in the first months after HSCT.

Laparoscopic ovarian transposition in patients with early cervical cancer

The aim of this study was to evaluate the feasibility, efficacy, and morbidity of laparoscopic ovarian transposition on the preservation of hormonal function in patients younger than 45 years operated for early cervical cancer. According to risk factors on pathologic evaluation of the specimen, some of them will receive postoperative pelvic radiotherapy. This subset of patients could benefit from taking the ovaries away from the irradiation field in an effort to preserve their functionality. This prospective study included 28 FIGO stage IB1 cervical cancer patients, 45 years old or younger, maintaining menstrual cycles, who were considered suitable for conservation of the ovaries. The ovarian transposition was performed by laparoscopy as a part of the same celio-Schauta operation. Twelve patients underwent adjuvant pelvic radiotherapy. No intraoperative or postoperative morbidity related to the ovarian transposition was observed, and the procedure only entailed a minimum delay of the operative time. There were no cases of ovarian metastasis. At a mean follow-up of 44 months, 63.6% of patients receiving radiotherapy and 93% of those who nonirradiated maintained normal ovarian function. Two patients developed benign ovarian cysts, requiring oophorectomy, but no other long-term adverse effects of the transposition were identified. To the best of our knowledge, this is the largest series of the laparoscopic procedure reported to date in this setting. According to our results, laparoscopic ovarian transposition is a safe and effective procedure for the preservation of ovarian function in young patients with early cervical cancer undergoing adjuvant radiotherapy after surgery.

Early impairment of myocardial function in young patients with β‐thalassemia major

One of the chief causes of death in patients with beta-thalassemia major (TM) remains heart failure due to iron overload. We investigated possible differences in myocardial function between a population of young asymptomatic patients with TM and healthy controls all of whom underwent an echocardiographic study, including tissue Doppler (TDI) and strain imaging (SI) analysis and cardiac magnetic resonance imaging (MRI). 30 young asymptomatic patients with TM (16 taking deferoxamine and 14 taking deferiprone) and 30 healthy subjects underwent a cardiac MRI with T2* technique and an echocardiographic evaluation including systolic myocardial velocities (Sm), early (Em) and late (Am) diastolic velocities and systolic strain (S) at the level of basal segments of the lateral left ventricle (LV), interventricular septum (Septal) and lateral right ventricle (RV) wall. The differences in T2* values and echocardiographic parameters were also compared in patients with TM subgrouped according to iron chelation therapy. The following TDI and SI measures were lower in patients than in controls: LV-Sm (P < 0.05), S-LV (P < 0.001), Septal-Sm (P < 0.05), Septal-Em (P < 0.001), S-Septal (P < 0.001), RV-Sm (P < 0.001), RV-Em (P < 0.001), RV-Em/Am (P < 0.05) and S-RV (P < 0.05). Myocardial function was better in the patients receiving deferiprone than those receiving deferoxamine. T2* values were higher in controls than in patients with TM and in those treated with deferiprone than those treated with deferoxamine. MRI data well correlated with SI parameters. Study underlines that, even in a population of young, asymptomatic and well-chelated patients with TM, there is an impairment of myocardial function and that this condition could be easily detected by more advanced ultrasound techniques such as TDI and SI. The better indices of myocardial function in patients treated with deferiprone clearly needs confirmation from larger prospective studies.

382 – Negative symptoms and verbal memory as predictors of psychosocial functioning in young patients with schizophrenia

382 – Negative symptoms and verbal memory as predictors of psychosocial functioning in young patients with schizophrenia

Potential effects of cyclosporin a on coronary vasomotor function in young patients with systemic lupus erythematosus: Comment on the article by Hirata et al

Potential effects of cyclosporin a on coronary vasomotor function in young patients with systemic lupus erythematosus: Comment on the article by Hirata et al

Sex differences in olfactory function in young patients with psychotic disorders

Female superiority on many measures of olfactory function is well established, but debate remains as to whether this pattern extends to patients with psychotic disorders. The purpose of this large retrospective study was to re-examine whether male vs. female differences in olfactory identification exist in patients with psychotic disorders, and if so, whether any such differences were related to features of the psychotic disorder or could be explained by a generalized male–female difference. We examined 353 relatively young patients, recently diagnosed with a psychotic illness, (258 males and 95 females) and compared these with 89 healthy control subjects (45 males and 44 females). All individuals had been assessed birhinally using the University of Pennsylvania Smell Identification Test (UPSIT). Overall, females were superior to males, and patients underperformed healthy controls. No interaction was noted between these two variables, and there was no significant effect found as a result of age of the subjects. The data suggested that sex differences in olfactory identification ability exist in young patients with psychotic disorders. They do not appear to be related to exposure to antipsychotic medication or smoking habit. Therefore, it is likely that they represent basic male vs. female differences and not diagnosis-specific sex differences in olfactory performance—at least in those who are in the early stages of illness.

Altered coronary vasomotor function in young patients with systemic lupus erythematosus

Accelerated atherosclerosis is an important cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Altered coronary microvascular function may act as a marker of changes that predispose to the development of significant coronary vascular disease. The purpose of this study was to compare coronary flow reserve (CFR) in a group of premenopausal women with SLE and a group of age-, sex-, and race-matched healthy control subjects. Coronary flow velocity in 18 premenopausal women with SLE (mean +/- SD age 29.4 +/- 5.9 years) and 19 matched healthy controls (mean +/- SD age 28.2 +/- 4.3 years) was assessed by transthoracic Doppler echocardiography after an overnight fast. The CFR was calculated as the ratio of hyperemic to baseline coronary blood flow velocity in the left anterior descending coronary artery. Hyperemia was induced by intravenous administration of adenosine triphosphate. The mean +/- SD duration of SLE was 8.2 +/- 7.2 years (range 0.25-25 years), and the mean +/- SD score on the Systemic Lupus Erythematosus Disease Activity Index was 11.0 +/- 5.3 (range 4.0-21.0). Adequate recordings of flow velocity in the left anterior descending artery under both conditions were obtained using an ultrasound procedure in all study subjects. CFR was significantly lower in SLE patients as compared with control subjects (mean +/- SD 3.4 +/- 0.8 versus 4.5 +/- 0.5; P < 0.0001). These findings provide evidence that coronary vasomotor function is impaired in patients with SLE and support the notion that many of these young patients have subclinical coronary artery disease.

Cortical abnormalities and language function in young patients with basal ganglia stroke

We examined MRI abnormalities and language function in young patients with infarctions apparently confined to the basal ganglia to establish whether impaired performance was attributable to basal ganglia damage per se or to additional cerebral abnormalities. Seventeen stroke patients (10 with left- and 7 with right-hemispheric damage) and seventeen controls participated. MRI included perfusion imaging and voxel-based morphometry analyses of T1-weighted and diffusion data sets. Language was assessed using the CELF-III test. Analysis of CELF-III scores showed a main effect of presence or absence of stroke, with patients performing more poorly than controls. There was no evidence of differences between the left- and right-hemisphere groups. However individual patients with left-hemisphere lesions showed large variations in performance. In the patients with left-hemisphere damage, voxel-based morphometry showed significant relationships between language function and gray matter density in cortical language areas. The white matter analyses also showed correlations with language function, and in addition there were hemodynamic abnormalities in cortical language areas in the three patients with poorest language function. We suggest that language impairments following basal ganglia damage may be attributable primarily to abnormalities in cortical language areas that are too subtle to detect on conventional structural MRI.

Determinants of baroreflex function in juvenile end-stage renal disease

Arterial baroreflex sensitivity (BRS) is markedly reduced in middle-aged patients with end-stage renal disease (ESRD), due to the combined effects of aging, arterial stiffening, and autonomic neuropathy. Much less is known about the effects of ESRD on arterial baroreflex in juvenile patients. Therefore, we investigated baroreflex function and its relation to carotid artery elasticity and heart rate variability in children and young adults with ESRD. We studied 42 subjects (9-30 years): 14 patients on maintenance hemodialysis (HD), 14 renal transplant recipients (RT), and 14 healthy control subjects (C). Baroreflex function was determined by pharmacological (BRS) and spontaneous (sequence and spectral indices) techniques. Carotid artery elasticity was characterized by stiffness index beta. Heart rate variability was assessed using time and frequency domain measures. Data are expressed as mean+/-s.d. BRS was markedly reduced in HD as compared to C (10.0+/-4.2 vs 25.7+/-5.9 ms/mm Hg); spontaneous indices were reduced to similar extent. Carotid artery stiffness was approximately 50% higher in HD than in C and was inversely related to BRS. Heart rate variability was also compromised in HD, and was directly related to spontaneous indices. No significant differences existed in any of these variables between RT and C. Decreased baroreflex function in juvenile HD is partly due to loss of carotid artery elasticity and partly due to impaired heart rate variability. Renal transplantation may partly prevent impairment or improve compromised baroreflex function in young patients with ESRD.

Executive functions in young patients with unipolar depression

Neuropsychological deficits associated with unipolar depression are seen in a broad range of cognitive domains. Executive deficits may be prominent in depression. Investigation of executive functions in younger adult patients with unipolar depression has been the focus of our study. Twenty-two consecutively depressive inpatients (24-36 years) and 21 healthy control subjects, matched on age, gender, education and verbal IQ were included in the study. Neuropsychological tests for executive functions were applied to all subjects. Unipolar young depressives showed significantly reduced number of completed categories and more trials for completion of the first category on Wisconsin Card Sorting Test (WCST). No difference of tasks assessing the short-term memory, total errors on WCST, perseverative and non-perseverative errors, and of both phonemic and semantic conditions of verbal fluency was found between groups. The results suggested that unipolar depressives had specific cognitive style characterized by "negative cognitive set" (stronger negative reaction to negative feedback) and by failure to use negative feedback to improve their performance.

Diastolic Function in Young Patients with Beta‐Thalassemia Major: An Echocardiographic Study

We aimed to evaluate myocardial diastolic function in patients with beta-thalassemia major (beta-TM) using pulsed-tissue Doppler imaging (TDI) and flow propagation (VP), in relation to BNP levels. We enrolled 192 consecutive patients with beta-TM (88 men (25 +/- 6 years) and 104 women (26 +/- 6 years), with normal left ventricular (LV) systolic function. By TDI, diastolic myocardial velocities were sampled at the lateral section of the mitral annulus (Smv, Emv, Amv). From the apical four-chamber view diastolic transmitral flow velocities, including measures of E- and A-waves were performed. The propagation velocity of early flow into the LV cavity was measured by color M-mode Doppler. Plasma BNP levels were measured in all patients. A nonlinear relationship was found between BNP levels and E/A ratio (beta coefficient for the second-order term = 1.4 +/- 0.4, P = 0.001). We also found a positive association of BNP levels with Amv (r = 0.28, P = 0.023), and a reverse with Smv (r =-0.59, P = 0.01) and Emv/Amv (r =-0.36, P = 0.019). Moreover, an inverse relationship was observed between BNP and Vp (r =-0.43, P = 0.012) levels. Finally, a strong positive linear relationship was found between E/Vp ratio and BNP levels (r = 0.76, P < 0.001). A U-curved association of E/A ratio of transmitral Doppler velocity was revealed with BNP levels, while the tissue Doppler of the Emv/Amv of the mitral annulus movement showed a negative linear association with BNP levels.

396 Diastolic function in young patients with beta-Thalassaemia major: an echocardiographic study

396 Diastolic function in young patients with beta-Thalassaemia major: an echocardiographic study

Severely Depressed Left Ventricular Function in Young Patients with New-onset Congestive Heart Failure

Severely Depressed Left Ventricular Function in Young Patients with New-onset Congestive Heart Failure

Effect of age on atrial contribution to ventricular filling after balloon mitral valvuloplasty in mitral stenosis

Objective: Ventricular filling takes place during the conduit and pump functions of the atrium. While studying whether relief of mitral valve obstruction improves atrial filling, the effect of age on atrial contribution to ventricular filling was studied before and after balloon mitral valvuloplasty (BMV) and on follow-up at 1 year. Methods: Patients with mitral stenosis (MS) and sinus rhythm ( n=59) were divided into group I (<18 years, n=13), group II (<30 years, n=29) and group III (>30 years, n=17). Two-dimensional mitral valve area (MVA in cm 2), transmitral mean gradient (MG in mm Hg), velocity time integral (VTI in cm) of mitral valve flow, VTI contributed by atrial systole (A-VTI), difference between total VTI and A-VTI (E-VTI), percentage contribution of A-VTI to the total VTI (A-%) and difference between A-% before and after BMV (δ-A-%) were noted. Follow-up data was obtained at 1 year. The change in A-% at follow-up (A-%-FU) was calculated as the difference between A-% before BMV and A-% at follow-up. Results: There was a similar increase in MVA with a reduction in MG among the three groups. Among the three groups, total VTI and E-VTI before and after BMV were similar. Before BMV, in all the groups, A-VTI and A-% were similar. After BMV, there was increase in A-VTI and A-% in all the groups with a trend to be more in younger patients. A-VTI was significantly higher in group I only. But E-VTI had decreased significantly in all groups and tended to be less in younger patients. In younger patients, δ-A-% after BMV was significantly higher (13.2±7.6, 7.9±5.1 and 6.5±4.5, respectively, in groups I, II and III; p<0.01). Correlation coefficient of age against δ-A-% was −0.55 ( p<0.01). Correlation coefficients of δ-A-% against post-BMV-MVA and MG were not good. At follow-up of 11.3±1.2 months, changes achieved in total VTI, A-VTI, E-VTI and A-% were maintained. Total VTI, A-VTI, E-VTI and A-% were similar at the time of follow-up on comparing the three groups. But younger patients had significantly higher A-%-FU (12.1±5.8, 9.4±4.6 and 7.3±3.1, respectively, in groups I, II and III; p<0.01). Conclusions: Prior to BMV, there is an age related reduction in atrial contribution to ventricular filling that improves with relief of MS. Advancing age reduces the immediate and late recovery of atrial contribution after BMV. This may be due to increasing left atrial fibrosis with age that prevents an improvement in atrial pump function. The differential improvement in atrial function in younger patients warrants earlier intervention in MS to achieve better recovery of atrial function.

1171-200 Real-time three-dimensional echocardiographic evaluation of global and regional left ventricular systolic function in young patients paced for congenital complete heart block

1171-200 Real-time three-dimensional echocardiographic evaluation of global and regional left ventricular systolic function in young patients paced for congenital complete heart block

Effects of Cancer Treatment on Reproduction and Fertility

Objective: (1) To review the effects of cancer treatment on reproduction and fertility in both women and men and (2) to review current and new techniques that could be used to preserve fertility and hormone production in women who have undergone cancer treatment.Data Sources: Entries to MEDLINE and CANCERLIT through to October 2001 were searched for evidence relevant to this article.Methods of Study Selection: This document is primarily based on large retrospective cohort series and case reports, as no randomized trials were available.Tabulation, Integration, and Results: The first part of this review article focuses on the effects of radiation and chemotherapy on reproductive function and innovative medical and surgical techniques employed to minimize these effects. The second part of this article describes conservative methods of managing cervical, endometrial, and ovarian cancer for women who wish to preserve their fertility.Conclusions: Over the last decade, there has been a trend toward trying to preserve reproductive function in young patients with malignancy. Information acquired over the last century on the reproductive effects of radiation and chemotherapy has enabled us to tailor our treatment of various malignancies affecting young patients. As we learn more about the biology and clinical behaviour of gynaecologic malignancies, we are able to modify surgical management to preserve fertility in select cases. All of these trends are in keeping with our goal to optimize quality of life in cancer care without compromising safety or survival.