bluuebunny/crossref_metadata_2025 huggingface dataset:
Single-Lead Electrocardiographic Variables in the Detection of Prior Myocardial Infarction with Respect to Q-Wave Status and Infarct Age
Authors: Vesterinen Paula , Väänänen Heikki , Hänninen Helena , Korhonen Petri , Tierala Ilkka , Husa Terhi , Mäkijärvi Markku , Toivonen Lauri
Published: September 2007

Objectives: Conventionally, the detection of prior myocardial infarction (MI) is based on QRS abnormalities, which may ignore non-Q-wave MI (NQMI). We aimed at finding automatically applicable quantitative ECG variables for diagnosing prior MI. Methods: Body surface potential mapping (BSPM) was registered and automatically analyzed in 144 patients with prior MI and in 75 healthy controls. The MI was defined according to its age as recent or old, and Q-wave status as Q-wave MI (QMI) or NQMI. Results: The QRSSTT integral, the STT integral and the T-wave apex amplitude applied in single, selected leads were found to be the optimal parameters in the detection of prior MI. The areas under the receiver-operating characteristic curves (AUC) were 89% for each, and detection was equal in old and recent MI (AUCs from 87 to 90%), and in QMI and NQMI (AUCs from 88 to 90%). Conclusions: The quantitative, automatically applicable single-lead variables comprising ventricular repolarization was effective in detecting prior MI, irrespective of the time elapsed from MI or the Q-wave status. These variables could be suitable for population studies and health screening purposes and are applicable to automatic ECG diagnostics of prior MI.
Prediction of Early Pulmonary Artery Stenosis after Arterial Switch Operation: The Role of Intraoperative Transesophageal Echocardiography
Authors: Chen Yih-Sharng , Tsai Shen-Ko , Chang Chung-I , Chiu Ing-Sh , Wang Jou-Ko , Wu Mei-Hwan , Wang Ming-Jiuh
Published: September 2007

Objectives: To investigate prospectively the prediction of the neopulmonary stenosis (neo-PS) after arterial switch operation (ASO) for transposition of the great artery (TGA) with intraoperative transesophageal echocardiography (TEE). Methods: Infants with TGA undergoing the ASO were prospectively studied over 5 years. The neo-PS was defined when the peak flow velocity was over 3 m/s at the neo main pulmonary artery (neo-MPA) after ASO by TEE (TEEPS). Catheterization was performed if estimated peak neo-PS pressure gradient was over 40 mm Hg by transthoracic echocardiography. Balloon angioplasty was tried first and surgical reoperation was reserved for those with failed angioplasty. Results: In total 49 consecutive patients were enrolled into the cohort study. TEEPS was identified in 21 patients. For patients with TEEPS, freedom from reintervention was 28% at 1 year and 23% at 2 years. For patients without TEEPS, freedom from reintervention for PS was 92% at 1 year and 78% at 2 years. The time interval from ASO to reintervention was significantly shorter in patients with TEEPS than without TEEPS. Existence of TEEPS and non-Lecompte method were main risk factor for reintervention. Conclusion: The present study demonstrated that the application of intraoperative TEE for infants undergoing ASO is very helpful in predicting the development of early postoperative neo-PS.
Accuracy of N-Terminal Probrain Natriuretic Peptide to Predict Mortality or Detect Acute Ischemia in Patients with Coronary Artery Disease
Authors: Ndrepepa Gjin , Braun Siegmund , Mehilli Julinda , Schömig Albert , Kastrati Adnan
Published: September 2007

Objective: The aim of the study was to assess the accuracy of N-terminal probrain natriuretic peptide (NT-proBNP) to predict mortality or detect acute ischemia in patients with coronary artery disease (CAD). Methods: This study included 1,552 patients with stable (n = 1,059) or unstable (n = 493) CAD undergoing percutaneous coronary intervention. NT-proBNP was measured before percutaneous coronary intervention. The primary endpoint of the study was mortality. Patients were followed for 3.6 years. Results: There were 171 deaths (11%) during follow-up. In the entire group of patients, NT-proBNP had the best accuracy to predict mortality (area under receiver operating characteristic curve 0.76, 95% CI 0.72–0.80). In patients without congestive heart failure (n = 760) there were 46 deaths (6%). The area under receiver operating characteristic curve of NT-proBNP was reduced to 0.70 (95% CI 0.63–0.79) which was not better than the area under curve of age (p = 0.981) or C-reactive protein (p = 0.082) regarding mortality. NT-proBNP showed limited power to detect patients with acute ischemia (area under curve 0.63, 95% CI 0.60–0.66) among consecutive patients with stable and unstable CAD. Conclusions: NT-proBNP has a moderate accuracy to predict mortality and does not assist in the diagnosis of acute myocardial ischemia in patients with CAD.
Atrial Fibrillation and Antithrombotic Therapy in a 75-Year-Old Population
Authors: Tveit Arnljot , Abdelnoor Michael , Enger Steve , Smith Pal
Published: September 2007

Aims: To find the true prevalence of diagnosed and undiagnosed atrial fibrillation (AF) in a population aged 75 years in 2 municipalities in Norway, and to study the use of antithrombotic therapy in this group. Methods: All 1,117 citizens in Asker and Baerum municipalities in eastern Norway born in 1930 were invited to participate in a prevalence study of AF. Nine hundred and sixteen subjects (82%) were examined by electrocardiogram, and blood pressure and pulse rate were measured. Comorbidity and current medication were recorded. Results: AF was present in 92 subjects (10%; 95% CI 8.2–12.1%), including 33 with ECG-documented, paroxysmal AF. In addition, 8 subjects had a history of a single, transient episode of AF. AF was previously undiagnosed in 10 out of 916 (1.1%). In 77 of 82 patients with previously diagnosed AF (93.9%), antithrombotic therapy was compliant with international guidelines. Conclusion: Ten percent (95% CI 8.2–12.2%) in this 75-year-old population had AF. Compliance with international guidelines regarding antithrombotic therapy was high. Previously undiagnosed AF was found in only 10 out of 916 (1.1%).
Influence of Vigilance and Learning on Prefrontal Activation in Schizophrenia
Authors: Esslinger Christine , Gruppe Harald , Danos Peter , Lis Stefanie , Broll Jochen , Wiltink Joerg , Gallhofer Bernd , Kirsch Peter
Published: September 2007

Background: Executive functions, which are neuroanatomically associated with the frontal lobe, are known to be impaired in schizophrenia. It is, however, still unclear whether the underlying functional disturbance is due to a hyper- or a hypoactivation of the dorsolateral prefrontal cortex (DLPFC) or neither. Methods: To address this question, we examined the brain activation of 21 schizophrenic patients on atypical antipsychotic medication and 21 healthy control subjects during a mental maze task by means of fMRI. Results: We found no significant overall difference in cerebral activation between the groups, but differences in the change in DLPFC activation from the first to the second half of the experiment. In the maze compared to the control task, there was a decrease in activation in the DLPFC in the patients and an almost significant increase in the controls. The change in activation in the patient group correlated with a change in subjective sleepiness, while the increase in activation in the controls could be attributed to learning processes. Conclusion: We hypothesized that differential temporal influences on brain activation could lead to either hyper- or hypoactivation of the DLPFC in schizophrenia.
Depressive Symptoms Are Related to Decreased Low-Frequency Heart Rate Variability in Older Adults with Decompensated Heart Failure
Authors: Guinjoan Salvador M. , Castro Mariana N. , Vigo Daniel E. , Weidema Hylke , Berbara Carlos , Fahrer Rodolfo D. , Grancelli Hugo , Nogués Martín , Leiguarda Ramón C. , Cardinali Daniel P.
Published: September 2007

Background/Aims: Depression has been associated with increased mortality among individuals with heart failure, but the mechanism for this association is unsettled. Depression is often found to result in autonomic dysfunction which, if present in heart failure, might help explain worsened outcomes. Methods: This study was a cross-sectional evaluation of the relationship between depressive symptoms and cardiac autonomic function, as assessed by short-term heart rate variability (HRV) analysis in aged patients with acute/decompensated heart failure of coronary origin (CHF). A 21-item Hamilton Depression score and measures of short-term HRV were obtained in 31 inpatients ≧65 years of age, 24–72 h after admission to the coronary care unit with a diagnosis of CHF. Results: Clinical depression was present in 22.6% of participants. In the sample as a whole, increasing depressive symptoms were associated with decreased low-frequency HRV. Conclusion: These results may be important in light of recent indications that decreased low-frequency HRV is a predictor of mortality in patients with heart failure.
Radiographic Evaluation of Children with Growth Disorders
Authors: Kant S.G. , Grote F. , de Ru M.H. , Oostdijk W. , Zonderland H.M. , Breuning M.H. , Wit J.M.
Published: September 2007

Short stature as well as tall stature can have a wide variety of causes. Tall stature is usually experienced as a less important problem than short stature, but for both clinical presentations it is important to make a correct diagnosis as to etiology. The identification of the diagnosis frequently relies on radiological criteria. However, no international uniformity exists with respect to the radiographic evaluation of children with growth problems. We recommend that in patients with a possible diagnosis of a skeletal dysplasia a skeletal survey must be performed. In patients with a proportionate stature, radiographic analysis of the hand and wrist will be sufficient in most cases. However, whenever there are clinical abnormalities with a possible underlying bone anomaly, a modified skeletal survey is appropriate. The combination of clinical and biochemical features and an appropriate skeletal survey can often lead to the correct diagnosis and/or guide the subsequent molecular analysis.
Iron Stores and HFE Genotypes Are Not Related to Increased Risk of Ischemic Stroke
Authors: Ekblom Kim , Hultdin Johan , Stegmayr Birgitta , Johansson Ingegerd , Van Guelpen Bethany , Hallmans Göran , Weinehall Lars , Johansson Lars , Wiklund Per-Gunnar , Marklund Stefan L.
Published: September 2007

Background: High iron levels can increase the formation of noxious oxygen radicals, which are thought to contribute to cerebrovascular disease. The aim of this prospective study was to determine if iron status and HFE genotypes constitute risk factors for stroke. Methods: First-ever stroke cases (231 ischemic and 42 hemorrhagic) and matched double referents from the population-based Northern Sweden cohorts were studied in a nested case-referent setting. Results: For total iron binding capacity, an increased risk of ischemic stroke was seen in the highest quartile (OR 1.80; 95% CI 1.14–2.83; p for trend 0.012). The highest quartile of transferrin iron saturation showed a decreased risk of ischemic stroke in men (OR 0.44; 95% CI 0.22–0.87; p for trend 0.028), but not in women. There was an increased risk of hemorrhagic stroke in the second (OR 4.07; 95% CI 1.09–15.20) and third quartile (OR 4.22; 95% CI 1.08–16.42) of ferritin. Neither quartiles of plasma iron concentrations nor the HFE C282Y and H63D genotypes were associated with ischemic or hemorrhagic stroke. Conclusions: Iron stores were not positively related to increased risk of ischemic stroke. Furthermore, HFE genotypes did not influence the risk of ischemic or hemorrhagic stroke.
Modeling Parkinsonian Circuitry and the DBS Electrode
Authors: Arle J.E. , Mei L.Z. , Shils J.L.
Published: September 2007

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson’s disease (PD) has become routine over the past decade, utilizing microelectrode recordings to ensure accurate placement of the stimulating electrodes. The clinical benefits of STN DBS for PD are well documented, but the mechanisms by which DBS achieves these results remain elusive. We have created a closed-form mathematical function of the potential field generated by a typical 4-contact DBS electrode and inserted this function into a computational model designed to simulate individual neurons and neural circuitry of significant portions of the basal ganglia. We present the mathematical function representing the potential field itself and the basis for the neural circuitry modeling in this paper.
Modeling Parkinsonian Circuitry and the DBS Electrode
Authors: Shils J.L. , Mei L.Z. , Arle J.E.
Published: September 2007

Treatment with deep brain stimulation (DBS) for Parkinson’s disease (PD) has become routine over the past decade, particularly using the subthalamic nucleus (STN) as a target and utilizing microelectrode recordings to ensure accurate placement of the stimulating electrodes. The clinical changes seen with DBS in the STN for PD are consistently beneficial, but there continues to be only marginal understanding of the mechanisms by which DBS achieves these results. Using an analytical model of the typical DBS 4-contact electrode and software developed to simulate individual neurons and neural circuitry of the basal ganglia we compare the results of the model to those of data obtained during DBS surgery of the STN. Firing rate, interspike intervals and regularity analyses were performed on the simulated data and compared to results in the literature.
Assessment of Brain Shift Related to Deep Brain Stimulation Surgery
Authors: Khan Muhammad Faisal , Mewes Klaus , Gross Robert E. , Škrinjar Oskar
Published: September 2007

Deep brain stimulation (DBS) surgery can significantly improve the quality of life for patients suffering from movement disorders, but the success of the procedure depends on the implantation accuracy of the DBS electrode array. Pre-operative surgical planning and navigation are based on the assumption that the brain tissue is rigid between the time of the acquisition of the pre-operative image set and the time of surgery. A shift of deep brain structures by only a few millimeters can potentially increase the number of required microelectrode and/or macroelectrode tracks and decrease implantation accuracy. We studied 25 subjects that underwent DBS surgery and analyzed brain shift between pre-operative and post-operative 3D MRI scans. Brain shift of up to 4 mm was observed in deep brain structures. On average, the recorded shift was in the direction of gravity, with deeper structures experiencing smaller shift than more superficial structures. The main conclusion of the study is that the brain shift is comparable to the size of the targets in deep brain stimulation surgery and should not be ignored. Techniques that minimize the amount of brain shift may therefore lead to increased accuracy of DBS lead implantation.
Octreotide in the Management of Chemoradiotherapy-Induced Diarrhea Refractory to Loperamide in Patients with Rectal Carcinoma
Authors: Topkan Erkan , Karaoglu Aziz
Published: September 2007

Objective: To evaluate the efficacy of octreotide in the treatment of chemoradiotherapy (CRT)-induced diarrhea (CRTID) refractory to conventional loperamide treatment in this pilot study. Methods: Forty-two rectal carcinoma (T3–4N0–2M₀) patients with grade 2 or 3 diarrhea refractory to loperamide were enrolled to receive octreotide. Eligible patients were treated with pelvic radiotherapy combined with bolus 5- fluorouracil CRT. Octreotide was administered subcutaneously, 150 µg three times daily, for 5 consecutive days. Only complete resolution of diarrhea was considered as therapeutic success. Results: Diarrhea mainly occurred in the first 4 weeks of CRT (83.3%) and completely resolved in 34 patients (80.9%) following octreotide administration. Mean time to response was 2.7 days: 27 patients (64%) responded during the first 3 days, and the remaining 7 (17%) on days 4 and 5. No significant side effect was reported. Eight patients (19.1%) with refractory diarrhea were hospitalized for additional treatment. No treatment delay was reported in complete responders, whereas an average 7.7-day delay was observed in refractory patients. Antidiarrheal treatment was administered on an outpatient basis in the response group, whereas refractory patients were hospitalized for an average of 8.8 days. Conclusion: Daily subcutaneous octreotide administration (150 µg t.i.d.) for 5 days is apparently an effective, tolerable treatment modality for concurrent CRTID refractory to loperamide.
Transcriptional Upregulation of Breast Cancer Resistance Protein by 17β-Estradiol in ERα-Positive MCF-7 Breast Cancer Cells
Authors: Zhang Yuhua , Zhou Gengyin , Wang Huaiping , Zhang Xiaofang , Wei Fulan , Cai Yongping , Yin Deling
Published: September 2007

Objectives: Breast cancer resistance protein (BCRP) confers resistance to certain anticancer drugs such as mitoxantrone, topotecan and SN-38. A putative estrogen response element (ERE) was located in the promoter region of the BCRP gene. The present study aimed to investigate whether human BCRP expression is regulated pretranscriptionally by 17β-estradiol. Methods: Two recombinant plasmids (pcDNA3-promoter-BCRP and pcDNA3-CMV-BCRP) were designed to express the full-length BCRP cDNA enforced driven by its endogenous promoter containing a functional ERE and a control constitutive cytomegalovirus (CMV) promoter, respectively, which were transfected into estrogen receptor α (ERα)-positive MCF-7 and ERα-negative MDA-MB-231 breast cancer cell lines. Results: 17β-Estradiol significantly upregulated BCRP mRNA and protein expression in a dose-dependent manner, and the effect was abolished by the antiestrogen tamoxifen. Furthermore, electrophoretic mobility shift assays demonstrated that the putative ERE in the promoter region of the BCRP gene and ERα are essential for transcriptional activation of BCRP by 17β-estradiol. Conclusions: Taken together, our findings indicate that BCRP expression is upregulated by 17β-estradiol via a novel pretranscriptional mechanism which might be involved in 17β-estradiol-ER complexes binding to the ERE of BCRP promoter via the classical pathway to activate transcription of the BCRP gene.
Efficacy of Low-Density Lipoprotein Apheresis in Patients with Peripheral Arterial Occlusive Disease Undergoing Hemodialysis Treatment
Authors: Morimoto Satoshi , Yano Yutaka , Maki Kei , Sawada Katsunori , Iwasaka Toshiji
Published: September 2007

Background: Low-density lipoprotein (LDL) apheresis is effective in the treatment of peripheral arterial occlusive disease (PAOD). In the present study, we attempted to determine whether LDL apheresis is effective even for PAOD patients undergoing hemodialysis, who tend to be refractory to any treatment, and if so, to determine the mechanism of its efficacy. Methods: Serum levels of lipids and vascular growth factors, leg symptom, and endothelium-dependent vasodilation were investigated before and after 10 sessions of LDL apheresis in 11 PAOD patients undergoing hemodialysis. Results: Serum levels of total cholesterol, LDL cholesterol, and triglyceride exhibited drastic reduction, which completely disappeared 4 weeks after the final apheresis. Resting leg pain was improved in 6 cases even 4 weeks after final apheresis. Endothelium-dependent vasodilation was significantly increased 4 weeks after final apheresis (1.6 ± 0.6 to 4.7 ± 1.0%, p < 0.05). Levels of vascular growth factors, hepatocyte growth factor and vascular endothelial growth factor were not changed during treatment. Conclusions: These findings suggested that LDL apheresis is effective even in PAOD patients undergoing hemodialysis. Our findings suggest that its mechanisms of efficacy include improvement of vascular endothelial dysfunction, in addition to drastic but acute reduction of lipid levels. Since PAOD patients undergoing hemodialysis tend to be resistant to any treatment and are at high risk for lower-extremity amputation, LDL apheresis could be a useful strategy for treatment of them.
Mitogen-Activated Protein Kinases in Heart Development and Diseases
Authors: Wang Yibin
Published: September 2007

Mitogen-activated protein (MAP) kinases belong to a highly conserved family of Ser-Thr protein kinases in the human kinome and have diverse roles in broad physiological functions. The 4 best-characterized MAP kinase pathways, ERK1/2, JNK, p38, and ERK5, have been implicated in different aspects of cardiac regulation, from development to pathological remodeling. Recent advancements in the development of kinase-specific inhibitors and genetically engineered animal models have revealed significant new insights about MAP kinase pathways in the heart. However, this explosive body of new information also has yielded many controversies about the functional role of specific MAP kinases as either detrimental promoters or critical protectors of the heart during cardiac pathological processes. These uncertainties have raised questions on whether/how MAP kinases can be targeted to develop effective therapies against heart diseases. In this review, recent studies examining the role of MAP kinase subfamilies in cardiac development, hypertrophy, and survival are summarized.
Exergy Sustainability Indicators as a Tool in Industrial Ecology
Authors: Zvolinschi Anita , Kjelstrup Signe , Bolland Olav , van der Kooi Hedzer J.
Published: September 2007

Abstract: Life‐cycle assessment is an established tool for industrial ecology. An analysis of the energy use in the chemical and other energy‐intensive industries is still under discussion in this field. We argue that the concept of exergy can play a role in industrial ecology, using a recent Norwegian power production policy question as illustration. The question is whether to build a standard natural gas‐ or a hydrogen‐fired gas‐turbine combined‐cycle power plant to meet increased needs for electricity in Norway. Several indicators are relevant for this discussion, and we calculate three based on exergy calculations, as proposed in the literature. The indicators are exergy renewability, exergy efficiency, and environmental compatibility. We show how these indicators can be used to evaluate paths for sustainable power production in two gas‐fired combined‐cycle power plants. We found that the two plants in question were equivalent, as judged by their exergy renewability and their environmental compatibility, but not by their exergy efficiency. This indicator favored the standard power plant, possibly in combination with carbon dioxide (CO2) sequestration in a depleted gas reservoir. The analysis suggested that the present situation for power production in gas‐fired combined‐cycle power plants is such that one may have to choose in general between power production with a high exergy efficiency, but low renewability indicator, or the opposite, low exergy efficiency and high renewability indicator. The general importance of exergy analysis was demonstrated by this example. It enables communication between different professional groups. The technological details, understood by the engineers, can be transposed to meaningful aggregated indicators for decision makers.
Calculation of the“Net Additions to Stock” Indicator for the Czech Republic Using a Direct Method
Authors: Kovanda Jan , Havranek Miroslav , Hak Tomas
Published: September 2007

Abstract: Net additions to stock (NAS) are an indicator based on economy‐wide material flow accounting and analysis. NAS, a measure of the physical growth rate of an economy, can be used for estimates of future waste flows. It is calculated using two methods: The indirect method of calculation is a simple difference between all input and output flows, whereas the direct method involves measuring the amounts of materials added to particular categories of physical stock and the amounts of waste flows from these stocks.

The study described in this article had one leading objective: to make available direct NAS data for the Czech Republic, which could later be used for predicting future waste flows. Two additional objectives emerged from the first: (1) to develop a method for direct NAS calculation from data availability in the Czech Republic; (2) to calculate NAS directly, compare the results with those achieved in indirect NAS calculation, and discuss the identified differences.

The NAS for the Czech Republic calculated by the direct method is equal to approximately 65 million tonnes on average in 2000–2002 and is approximately 27% lower than the NAS acquired by the indirect method of calculation. The actual values of directly calculated NAS and its uncertainties suggest that the indirect NAS is more likely to be an overestimation than an underestimation. Durables account for about 2% of the total direct NAS, whereas the rest is attributed to infrastructure and buildings. The direct NAS is dominated by nonmetal construction commodities such as building stone and bricks, which equal approximately 89% of the total direct NAS.

Calculation of NAS by the direct method has been proved to be feasible in the Czech Republic. Moreover, uncertainties related to direct NAS are lower than those related to indirectly acquired NAS.
Environmental Assessment of Waste‐Solvent Treatment Options
Authors: Capello Christian , Hellweg Stefanie , Badertscher Beat , Betschart Hugo , Hungerbühler Konrad
Published: September 2007

Abstract: The software tool ecosolvent is presented that allows for comparative environmental assessment of treatment technologies for specific, user‐defined, waste‐solvent mixtures. The tool is composed of models for waste‐solvent distillation as well as for thermal treatment in hazardous waste‐solvent incinerators and cement kilns. It was designed with a tiered structure in order to allow for a high flexibility regarding informational needs. The life‐cycle assessment method was used to assess the environmental impact. The applicability of the tool is shown with two case studies from industry. In these case studies, various waste‐solvent treatment technologies are compared for two specific waste‐solvent mixtures. Potential use of the ecosolvent tool for its role in practical decision making in chemicals industries is illustrated by two case studies of waste‐solvent systems. In the ethyl acetate case study, the tool indicates that solvent recovery by distillation is clearly better than incineration of the waste solvent. The results from the methanol case study are less clear‐cut. In the subsequent article (part II), the ecosolvent tool will be used to derive general rules of thumb and specific recommendations for 45 important solvents used in chemical industries. Additionally, a framework will be presented that provides quick and easy decision support regarding environmentally optimized waste‐solvent management.
A Dynamic Model for Determining the Temporal Distribution of Environmental Burden
Authors: Levine Stephen H. , Gloria Thomas P. , Romanoff Eliahu
Published: September 2007

Abstract: In an article on the role of temporal information in life‐cycle assessment in this journal, Field and colleagues argued that frequently it is not the single product but the “fleet” (or cohort) of products that “is the appropriate unit of analysis,” and that in focusing on the fleet one “explicitly introduces the notion of time as a critical element of comparative life‐cycle assessments. …” Major transitions, such as replacement of one fleet of products by an alternative fleet, correspond to a system in a transient rather than steady state, and explicit consideration of time is central to transient analysis.

One tool increasingly used as part of life‐cycle assessment, economic input‐output (EIO) analysis, at best deals with time in an implicit fashion. This article illustrates how the sequential interindustry model (SIM), a formulation of the EIOmodel that explicitly represents time, might be utilized in life‐cycle assessment. SIM introduces this temporal component by explicitly accounting for the time required by production activities and the resulting sequencing of the inputs. This can be thought of as engineering rather than accounting information. The data demands of such a model are not likely to be met at present or at any time in the near future. Even so, simulation methods and the use of so‐called synthetic data have a history of productive use in a number of fields, including the social sciences.

SIM also utilizes the contribution of Joshi on the application of the EIO model to environmental impact and the inclusion of the use as well as the production phases of a product in EIO analysis. The possibility of accounting for discounting of future events, with its impact on decision making, is also briefly discussed.
The Waste Input‐Output Approach to Materials Flow Analysis
Authors: Nakamura Shinichiro , Nakajima Kenichi , Kondo Yasushi , Nagasaka Tetsuya
Published: September 2007

Abstract: A general analytical model of materials flow analysis (MFA) incorporating physical waste input‐output is proposed that is fully consistent with the mass balance principle. Exploiting the triangular nature of the matrix of input coefficients, which is obtained by rearranging the ordering of sectors according to degrees of fabrication, the material composition matrix is derived, which gives the material composition of products. A formal mathematical definition of materials (or the objects, the flow of which is to be accounted for by MFA) is also introduced, which excludes the occurrence of double accounting in economy‐wide MFAs involving diverse inputs. By using the model, monetary input‐output (IO) tables can easily be converted into a physical material flow account (or physical input‐output tables [PIOT]) of an arbitrary number of materials, and the material composition of a product can be decomposed into its input origin. The first point represents substantial saving in the otherwise prohibitive cost that is associated with independent compilation of PIOT. The proposed methodology is applied to Japanese IO data for the flow of 11 base metals and their scrap (available as e‐supplement on the JIE Web site).
Screening of Metals in Waste Electrical and Electronic Equipment Using Simple Assessment Methods
Authors: Tasaki Tomohiro , Oguchi Masahiro , Kameya Takashi , Urano Kohei
Published: September 2007

Abstract: Various toxic, useful, and/or scarce metals in waste electric and electronic equipment (WEEE) have rarely been assessed due to low data availability, except for the four metals regulated by the European Union's Directive on the Restriction of Hazardous Substances (RoHS). This article describes the results of screening 36 metals in WEEE using simple assessment methods for cases where the decision makers do not know for which substances in a product countermeasures should be taken and where data cannot be easily obtained. First, this study examines the decision‐making process and prerequisites for screening, classifies existing assessment methods, and presents three simple indices for screening (resource consumption, water pollution affecting human health, and aquatic biota conservation) so that screening can be readily started for many (20–36) metals. Following this, a case study is conducted for waste TV sets, revealing which metal in which product module or component should be targeted by environmental countermeasures. Finally, the screening results are compared with those of six other methods using diagrams devised to indicate the superiority of screening methods, and several screening techniques are discussed. The conclusions are that the EU RoHS Directive does not necessarily cover all of the toxic metals that could be of concern and the screening methods presented could help identify such metals; the selection of methods is critical; and a more detailed method does not necessarily provide more accurate results.
Books
Authors: Koehler Dinah A.
Published: September 2007

New Technologies and Environmental Innovation, by Joseph Huber Cheltenham, UK; Northhampton, MA Edward Elgar?

Industrial Ecology and Spaces of Innovation edited by Ken Green and RandlesCheltenham, UK; Northampton, MA Edward Elgar
Intracardiac Calcification Is a Marker of Generalized Atherosclerosis
Authors: Nemcsik János , Farkas Katalin , Kolossváry Endre , Járai Zoltán , Egresits József , Borgulya Gábor , Kiss István , Lengyel Mária
Published: September 2007

Aortic valve calcification (AVC) and carotid artery calcification (CAC) are considered to be markers of generalized atherosclerosis. However, the role of intracardiac calcification (ICC) (valvular and perivalvular calcification) is unclear. The objective of this retrospective study was to analyze the relationship between ICC and CAC, risk factors, and clinical atherosclerotic disease. Risk factors included age, sex, diabetes mellitus, hypercholesterolemia, and hypertension; clinical atherosclerosis comprised stroke, coronary artery disease, and peripheral artery disease. Between January 1, 2001, and January 1, 2004, all consecutive patients were enrolled into the study who underwent both carotid ultrasonography and transthoracic echocardiography examinations within 2 months. Patients with renal failure, substantial aortic stenosis, and carotid artery occlusion were excluded. There were 320 patients (104 men; mean ± SEM age, 66.6 ± 0.76 years). Positive results on carotid ultrasonography are defined as any CAC. Patients were categorized as having mild, moderate, or severe CAC. Positive results on transthoracic echocardiography were defined as any ICC; AVC was defined as mitral anulus calcification (MAC) or both. Intracardiac calcification was found in 181 patients, AVC in 51 patients, MAC in 48 patients, and calcification of both structures in 82 patients. Using multiple logistic regression analysis, ICC (odds ratio, 1.9), age (10-year periods) (odds ratio, 2.0), and the presence of peripheral artery disease (odds ratio, 1.7) were independent predictors of CAC. Carotid ultrasonography results were positive in 227 patients. For CAC, the sensitivities of AVC, MAC, both, and any ICC were 52.4%, 52.0%, 33.5%, and 71.2%, respectively, and the specificities were 84.9%, 87.1%, 92.5%, and 78.5%, respectively. The extension of ICC as 0, 1 location (AVC or MAC) , or 2 locations (AVC and MAC) was associated with the severity of CAC (P < .001, τ = 0.42). There was no difference between patients with AVC vs patients with MAC in the presence of different stages of CAC (P = .62). Intracardiac calcification (MAC or AVC) is an independent predictor of CAC as a marker of atherosclerosis, although the lack of ICC does not rule out atherosclerosis. Intracardiac calcification is related to CAC, with high specificity. The extension of ICC is related to the severity of atherosclerosis. Based on our results, antiatherothrombotic therapy should be considered in patients with ICC even before obtaining a positive carotid ultrasonography result.
Subarachnoid Hemorrhage Following Chronic Dural Venous Sinus Thrombosis
Authors: Pradhan Sunil , Yadav Ramakant , Diwakar Himanshu , Phadke Rajendra V.
Published: September 2007

Subarachnoid hemorrhage (SAH) in older individuals is most often due to aneurysmal rupture. Other vascular lesions are known to rarely cause SAH. In this article, we report a case of chronic dural sinus thrombosis with recurrent SAH, most probably due to raised venous pressure in draining venous tributaries. No aneurysm was detected on magnetic resonance angiography or on digital subtraction angiography. The patient improved with conservative management. The case report emphasizes inclusion of magnetic resonance venography in the diagnostic workup of SAH, particularly in those cases in which aneurysm is not detected.
Rhabdomyolysis and Unilateral Renal Infarction After a Motor Vehicle Crash
Authors: Sanai Toru , Yokoyama Masaaki , Murata Akinari , Ukon Kei , Fuchigami Kazumi
Published: September 2007

A 46-year-old man with no previous history of abnormal urinalysis findings or renal dysfunction was admitted to a local hospital because of a motor vehicle crash. An open laparotomy was performed to treat a perforation of the small intestine. After operation, oliguria and renal dysfunction developed, and he was admitted to our hospital because of acute renal failure after trauma. Acute renal failure was assumed to be due to rhabdomyolysis with elevated serum creatinine, blood urea nitrogen, and creatine kinase levels and myoglobinemia. Left flank pain occurred several days after admission, and the serum alkaline phosphatase level increased between days 5 and 12 following admission. Although hemodialysis was performed 9 times and the urine output was satisfactory, the creatinine clearance levels increased only to about 50 mL/min/1.73 m2 (0.84 mL/s/m2) at 6 weeks following admission. As a result, a diagnosis of renal infarction due to acute renal artery occlusion was considered. The left kidney was atrophic on an abdominal computed tomographic scan and was nonfunctioning on a renogram. This case shows the importance of not overlooking the possibility of a renal infarction associated with rhabdomyolysis after a motor vehicle crash. In particular, the changes in the serum alkaline phosphatase levels were important in making a correct diagnosis in this case.
Acute Lower Limb Ischemia in a Young Woman With Arterial Hypoplasia: A Case Report
Authors: Winckiewicz Marek , Stanišić Michał-Goran , Szajkowski Rafał , Staniszewski Ryszard
Published: September 2007

The most frequent causes for acute limb ischemia are arterial embolism, thrombosis (mainly in patients with atherosclerosis), and traumatic arterial injuries. Rarely, acute limb ischemia may be caused by the arterial spasm, when all other causes can be excluded. We present a case of a young woman with acute ischemia of her right lower extremity with diagnosed arterial hypoplasia in the calf. The suspected cause of the ischemia was a spasm of a single artery of the limb. Diagnostic procedures and treatment as well as differential diagnosis are discussed.
Effect of Chronic Venous Insufficiency on Activities of Daily Living and Quality of Life: Correlation of Demographic Factors With Duplex Ultrasonography Findings
Authors: Chiesa Roberto , Marone Enrico Maria , Limoni Costanzo , Volonté Marina , Schaefer Eckhard , Petrini Orlando
Published: September 2007

The study evaluates to what extent symptoms of chronic venous insufficiency (CVI) and functional venous incompetence as investigated using color-coded duplex ultrasonography may interfere with activities of daily living (ADLs). This study comprises a cross-sectional survey conducted in urban areas surrounding 24 Italian cities. A spontaneous sample of 5187 subjects (4457 women [mean age, 54 years] and 730 men [mean age, 61 years]), selected by advertising on television and in newspapers, underwent a clinical examination that included duplex ultrasonography in 3 vein segments in both legs to determine the presence and severity of venous reflux. Subjective perception of lower limb symptoms of CVI and the effect of leg problems on the ability to perform normal ADLs are assessed by means of a self-administered questionnaire. Most of the respondents have some CVI symptoms, with women being 1.5 to 3 times as likely as men to report leg symptoms. The risk of developing the most frequent subjective symptoms such as heaviness and tiredness in the legs is not statistically significantly different for younger subjects compared with older subjects. Advanced age is considered to be a relevant risk factor only for heat sensation and swollen legs. Persons living in southern Italy are at higher risk of almost all lower limb symptoms. Results of duplex ultrasonography performed on 3875 subjects show that fewer than 1 in 5 young persons, regardless of sex, manifest some degree of venous reflux (primarily mild symptoms). The risk of developing venous incompetence increases rapidly with age until it triples among subjects 50 years and older. Adjusting for all other factors, men are on average 1.5 times as likely as childless women to have venous reflux, and the risk increases in the case of family history of CVI or (among women) in the case of past pregnancies. More women than men report that their leg problems affect their ADLs. Pregnancy and living in the south contribute to a reduction in the ability to perform most heavy housework. Although milder lower limb symptoms such as evening heaviness and tiredness in the legs may begin early in life, venous reflux and related symptoms of heat sensation and swollen legs become more pronounced with age, and their severity can be disabling for those afflicted.
Circulating Hepatocyte Growth Factor Level but Not Basic Fibroblast Growth Factor Level Is Elevated in Angiography-Proven Symptomatic Peripheral Artery Disease
Authors: Lin Jiunn-Wen , Sheu Wayne Huey-Herng , Lee Wen-Jane , Chen Ying-Tsung , Liu Tsun-Jui , Ting Chih-Tai , Lee Wen-Lieng
Published: September 2007

Circulating vasogenic factors may be up-regulated in response to ischemia to promote angiogenesis in patients with peripheral artery disease (PAD). Studies on this are limited in number and size, and results are inconsistent, especially regarding basic fibroblast growth factor (bFGF) level. From March 1999 to April 2004, all consecutive patients with lower limb PAD having serum samples at the time of intervention were recruited. The diameter of the primary PAD lesion had to be at least 70% stenotic at the lower limb artery. Control subjects, who underwent angiography, were free of PAD, coronary disease, and other major medical diseases. Serum samples were analyzed for circulating hepatocyte growth factor (HGF) and bFGF levels. Patients with PAD (n = 60) had higher circulating HGF levels (mean ± SEM, 1544 ± 238 vs 970 ± 129 pg/mL; P = .04) but similar bFGF distribution tertiles (P = .55) compared with control subjects (n = 30). Thirty-six patients with summed PAD lesion lengths exceeding 5 cm demonstrated a significantly higher circulating HGF level compared with control subjects (mean ± SEM, 1701 ± 335 vs 970 ± 129 pg/mL; P = .048). Patients with concurrent coronary artery disease tend to have a higher circulating HGF level (mean ± SEM, 1606 ± 365 vs 970 ± 129 pg/mL; P = .06) but not a higher bFGF level compared with control subjects. Circulating HGF level, but not bFGF level, is significantly elevated in patients with symptomatic angiographically documented PAD, especially in those with more extensive involvement.
Systemic Peripheral Vascular Resistance as a Determinant of Functional Cardiac Reserve in Response to Exercise in Patients With Heart Disease
Authors: Akima Takashi , Takase Bonpei , Kosuda Shigeru , Ohsuzu Fumitaka , Kawai Toshiaki , Ishihara Masayuki , Akira Kurita
Published: September 2007

Resting cardiac function is a poor indicator of functional cardiac reserve that is invoked during exercise. The objective of this study was to investigate the relationship between functional cardiac reserve and systemic vascular resistance (SVR) using an ambulatory radionuclide monitoring system (the Vest system) in patients with heart disease. The study population consisted of 29 patients (all male [mean ± SD age, 63 ± 10 years]), 23 with coronary artery disease, 3 with dilated cardiomyopathy, and 3 with hypertensive heart disease. All patients underwent cardiopulmonary stress testing using a ramped treadmill protocol and the Vest system. The anaerobic threshold (AT) was autodetermined using the V-slope method. Systemic vascular resistance was calculated using the mean blood pressure and cardiac output as determined using the Vest system parameters. All patients exercised beyond the AT until exhaustion. Resting left ventricular ejection fraction, peak ejection ratio, and peak filling ratio increased with the AT (P < .01 for all). Resting SVR decreased with the AT (P < .01). The percentage changes from rest to the AT in SVR correlated with those from rest to the AT in ejection fraction, peak ejection ratio, and peak filling ratio (r = −0.735, r = −0.510, and r = −0.697, respectively; P < .01). These findings indicate that SVR as recorded using the Vest system is a good determinant of functional cardiac reserve in patients with heart disease. Therefore, cardiopulmonary function testing combined with the Vest system is a good modality for the evaluation of functional cardiac reserve.
The Optimal Cuff Width for Measuring Toe Blood Pressure
Authors: Påhlsson Hans-Ivar , Laskar Carolina , Stark Karin , Andersson Anna , Jogestrand Tomas , Wahlberg Eric
Published: September 2007

To determine the optimal cuff width for measuring toe blood pressure in patients with lower limb ischemia, this experimental prospective study examined 20 patients with symptoms of peripheral arterial disease referred for vascular examination or vascular surgery. Toe blood pressure was measured hydrostatically by the pole test using cuffs of different widths. Pole test reflects the true physiological blood pressure value and was the reference method. Blood pressures obtained using the cuffs were related to this value and to patients' toe circumference. With the 2.5-cm cuff, the patients had a mean pole test toe blood pressure of 28 mm Hg (range, 6-55 mm Hg). Compared with pole test results, the toe blood pressure was 15.6 mm Hg (95% confidence interval [CI], 8-23 mm Hg) higher when measured using the 2.0-cm cuff (P < .001) and 4.5 mm Hg (95% CI, 0-9 mm Hg) higher when measured using the 2.5-cm cuff (P = .07). Using the 1.5-cm and 3.0-cm cuffs, the differences were 27.0 mm Hg (95% CI, 13-43 mm Hg) and −2.0 mm Hg (95% CI, −11 to 8 mm Hg), respectively. The cuff width greatly affects the obtained toe blood pressure value, and larger cuffs correspond better to the hydrostatic pressure. For clinical use and as a reporting standard, we propose that toe blood pressure measurements should be made using a 2.5-cm-wide cuff.
Treatment of Iatrogenic Femoral Pseudoaneurysm by Ultrasound-Guided Compression Therapy and Thrombin Injection
Authors: Luedde Mark , Krumsdorf Ulrike , Zehelein Joerg , Ivandic Boris , Dengler Thomas , Katus Hugo A. , Tiefenbacher Christiane
Published: September 2007

Development of an arterial pseudoaneurysm is a common complication following cardiac catheterization. We analyzed data from 6300 patients who received left heart catheterization at our institution. One day after the procedure, approximately 10% of the patients were examined with duplex sonography. In 204 patients (3.0%), a pseudoaneurysm of the femoral artery was diagnosed. All patients underwent compression therapy. Thereby, 159 of the pseudoaneurysms could be treated successfully. The remaining 45 pseudoaneurysms had a maximal diameter of more than 1.5 cm. Forty-two patients underwent ultrasound and biopsy-line—guided thrombin injection without complications. This strategy resulted in a successful occlusion in 41 cases. Pseudoaneurysms smaller than 2 cm can be treated with compression therapy. Larger pseudoaneurysms can be occluded by thrombin injection using ultrasound guidance. Patients with a pseudoaneurysm with a wide “neck” should be treated surgically, because the risk of an arterial occlusion following thrombin injection cannot be excluded.
Global Linkages and Domestic Politics
Authors: Sinha Aseema
Published: September 2007

This article examines how the World Trade Organization (WTO) affects institutional development and policy responses in India. India is a country traditionally resistant to external pressures but in which participation in an international organization stimulated a transformation in trade policy processes and procedures and unleashed a new bureaucratic politics, institutional innovation, and activation of policy—expert linkages. The author argues that we go beyond zero-sum assumptions in understanding the relationship between globalization and national state institutions. Key rules of international organizations increase transaction and sovereignty costs for states, which may catalyze new domestic capacities and create the impetus for new governance mechanisms. The author demonstrates this argument with an analysis of India's engagement with the WTO and with illustrative evidence of the interaction of China, Brazil, Japan, and United States with the WTO. The evidence is drawn from 18-month fieldwork in India, Washington, D.C., and Geneva; a newspaper database; and reliance on 100 interviews.