bluuebunny/crossref_metadata_2025 huggingface dataset:
Stellenwert der Immunglobuline in der Therapie neurologischer Erkrankungen
Authors: Lindner A. , Zierz S.
Published: May 2009

Hochdosierte intravenös verabreichte 7-S-Immunglobuline (ivig) werden in der Therapie verschiedener autoimmun be-dingter neurologischer Erkrankungen eingesetzt und stellen eine wertvolle Ergänzung oder Alternative der konventionellen Immunsuppression insbesondere bei neuromuskulären Erkrankungen dar. Therapieansätze finden sich aber auch bei Erkrankungen des zentralen Nervensystems, bei denen eine Autoim-mungenese diskutiert wird. Bei akut lebensbedrohlichen Situa-tionen, die bei der myasthenen Krise oder beim Guillain-Barré-Syndrom durch den Befall der Atemmuskulatur oder bulbären Muskelgruppen auftreten, sind die rasche Anwendbarkeit und der schnelle Wirkungseintritt von besonderer Bedeutung. Die Mehrzahl der Patienten mit myasthener Krise und Guillain-Barré-Syndrom profitieren von einer Therapie mit ivig. Beim Guillain-Barré-Syndrom sind ivig der Plasmapherese mögli-cherweise überlegen. Während in der Therapie der chronisch inflammatorisch demyelinisierenden Polyneuritis mit ivig über unterschiedliche Ergebnisse berichtet wurde, scheint deren Wirksamkeit bei der relativ seltenen multifokalen motorischen Neuropathie erwiesen. Nach erfolgloser Therapie der Dermato-bzw. Polymyositis mit konventionellen Immunsuppressiva be-währen sich ivig ebenso wie bei fulminant verlaufenden For-men. Bei der therapeutisch schwer zu beeinflussenden Ein-schluβkörpermyositis ist deren Einsatz stets gerechtfertigt. In der Therapie der multiplen Sklerose müssen die Ergebnisse prospektiver placebokontrollierter Doppelblind-Studien zur endgültigen Beurteilung abgewartet werden, da bislang erst in einigen kleineren, offenen Studien ein positiver Effekt belegt werden konnte. Eine Behandlung mit Immunglobulinen bietet prinzipiell Vorteile. Sie sind überall rasch anwendbar, insbesondere bei Kindern und älteren, multimorbiden Patienten, einfacher als die Plasmapherese und im Vergleich zu den konventionellen Immunsuppressiva deutlich nebenwirkungsärmer.
Intravenöse Immunglobulintherapie bei Autoimmunerkrankungen
Authors: Walger P. , Vetter H.
Published: May 2009

In den letzten Jahren haben sich die Vorstellungen über die immunmodulatorischen Wirkungsmechanismen der Immunglobuline erheblich erweitert. Entsprechend wurden Immunglobuline bei immer mehr Erkrankungen mit vermuteter oder nachgewiesener Immunpathogenese therapeutisch eingesetzt. Vielversprechenden Einzelfallbeobachtungen stehen jedoch nur wenige abgesicherte Indikationen gegenüber. Aktuelle Empfehlungen für einen gesicherten Einsatz von Immunglobu-linen beinhalten lediglich zwei Indikationen aus der Pädiatrie: spezielle Formen der immunthrombozytopenischen Purpura (ITP) und das Kawasaki-Syndrom. Nach wie vor gibt es keine gesicherte Indikation für eine Initialtherapie mit i.v.-Immunglobulinen (IVlg) im Erwachsenenalter. In der Regel handelt es sich um Indikationen bei Versagen der konventionellen im-munsuppressiven Standardtherapie oder in Ergänzung dazu, bei schweren lebensbedrohlichen Verläufen, bei Kontraindika-tionen zur Standardtherapie oder zur Erzielung kurzzeitiger Effekte vor invasiven Eingriffen oder Operationen. Ein verbessertes Verständnis der Pathologie von Autoimmunerkrankungen und der Wirkmechanismen therapeutischer Interventionen ist nötig, um klinische Studien für solche Erkrankungen zu planen, bei denen vorliegende Daten einen potentiellen Nutzen vermuten lassen. Gegen einen ungezielten Einsatz bei Autoimmunerkrankungen sprechen nicht nur Kostenaspekte und das Risiko von Nebenwirkungen, sondern auch Beobachtungen, daβ sich der Verlauf unter Immunglobulinen verschlechtern kann.
Infektionsprophylaxe mit i.v.-lmmunglobulinen in der Knochenmarktransplantation
Authors: Schuler U. , Bornhäuser M. , Ehninger G.
Published: May 2009

Aus mehreren Gründen sind Knochenmarktransplantations-Patienten durch lebensbedrohliche Infektionen gefährdet. Nach einer neutropenischen Phase erfordert das allogene Transplantat eine kontinuierliche Immunsuppression zur Verhütung der Graft-versus-Host-Krankheit (GvHD). Die Beobachtung fallender Immunglobulinspiegel führte schon früh zu Versuchen des passiven Immuntransfers. In erster Linie sollte hiermit die Zytomegalievirus(CMV)-Infektion oder -Reaktivierung verhindert werden. Bei autolog transplantierten Patienten konnte allerdings kein wesentlicher Vorteil beobachtet werden. Für Hochrisikogruppen von allogen transplantierten Patienten gilt inzwischen als sehr wahrscheinlich, daß eine Immunglobulin-prophylaxe im Hinblick auf eine Reduktion der Inzidenz und Schwere sowohl von CMV-Infektionen als auch der GvHD von Vorteil ist.
Risk Factors Preventing Success of a Minilaparotomy Approach in the Resection of Colorectal Cancer
Authors: Nakagoe Tohru , Matsuo Toshikazu , Nakamura Shirou , Ryu Chusei , Murakami Goushi , Arisawa Kokichi
Published: June 2009

Background: A minilaparotomy approach is technically feasible for the resection of colorectal cancer in select patients. The aim of this study was to clarify the risk factors preventing the success of a minilaparotomy in the resection of colorectal cancer. Methods: Between April 2005 and August 2008, 141 consecutive patients were enrolled in this prospective study and scheduled to undergo resection of colorectal cancer using a minimal skin incision. The minilaparotomy involved a colorectal resection performed through a skin incision <7 cm in length. Neither a hand-port nor a laparoscope was used. Results: A minilaparotomy was successful in 74 (52.5%) of 141 patients. Multivariate logistic regression analysis revealed that the failure of the minilaparotomy in the remaining 67 (47.5%) was independently related to gender (male), BMI (≥25.5), tumor location (splenic flexure and rectum), tumor adhesion/invasion on/into adjacent organs and the maximum tumor diameter (≥7.0 cm). Conclusion: Gender (male), BMI (≥25.5), tumor location (splenic flexure and rectum) and tumor aggressiveness [tumor adhesion/invasion on/into adjacent organs and maximum tumor diameter (≥7.0 cm)] were independent risk factors preventing the success of the minilaparotomy approach in the resection of colorectal cancer.
The IκB Kinase β/Nuclear Factor κB Signaling Pathway Protects the Heart From Hemodynamic Stress Mediated by the Regulation of Manganese Superoxide Dismutase Expression
Authors: Hikoso Shungo , Yamaguchi Osamu , Nakano Yuko , Takeda Toshihiro , Omiya Shigemiki , Mizote Isamu , Taneike Manabu , Oka Takafumi , Tamai Takahito , Oyabu Jota , Uno Yoshihiro , Matsumura Yasushi , Nishida Kazuhiko , Suzuki Keiichiro , Kogo Mikihiko , Hori Masatsugu , Otsu Kinya
Published: May 2009

Cardiomyocyte death plays an important role in the pathogenesis of heart failure. The nuclear factor (NF)-κB signaling pathway regulates cell death, however, the effect of NF-κB pathway on cell death can vary in different cells or stimuli. The purpose of the present study was to clarify the in vivo role of the NF-κB pathway in response to pressure overload. First, we subjected C57Bl6/J mice to pressure overload by means of transverse aortic constriction (TAC) and examined the activity of the NF-κB pathway in response to pressure overload. IκB kinase (IKK) and NF-κB were activated after TAC. Then, we investigated the role of the activation using cardiac-specific IKKβ-deficient mice (CKO). CKO displayed normal global cardiac structure and function compared with control littermates. We subjected CKO and control mice to pressure overload. One week after TAC, CKO showed cardiac dilation, dysfunction, and lung congestion, which are characteristics of heart failure. The number of apoptotic cells in the hearts of CKO mice increased significantly after TAC. The levels of manganese superoxide dismutase mRNA and protein expression in CKO after TAC were significantly attenuated compared with control mice. The levels of oxidative stress and c-Jun N-terminal kinase (JNK) activation in CKO after TAC were significantly greater than those in control mice. Isoproterenol-induced cell death of isolated adult CKO cardiomyocytes was inhibited by treatment with either a manganese superoxide dismutase mimetic or a JNK inhibitor. Thus, the IKKβ/NF-κB signaling pathway plays a protective role in cardiomyocytes because of the attenuation of oxidative stress and JNK activation in a setting of acute pressure overload.
MIF Deficiency Reduces Chronic Inflammation in White Adipose Tissue and Impairs the Development of Insulin Resistance, Glucose Intolerance, and Associated Atherosclerotic Disease
Authors: Verschuren Lars , Kooistra Teake , Bernhagen Jürgen , Voshol Peter J. , Ouwens D. Margriet , van Erk Marjan , de Vries-van der Weij Jitske , Leng Lin , van Bockel J. Hajo , van Dijk Ko Willems , Fingerle-Rowson Günter , Bucala Rick , Kleemann Robert
Published: May 2009

Chronic inflammation in white adipose tissue (WAT) is positively associated with obesity, insulin resistance (IR) and the development of type 2 diabetes. The proinflammatory cytokine MIF (macrophage migration inhibitory factor) is an essential, upstream component of the inflammatory cascade. This study examines whether MIF is required for the development of obesity, IR, glucose intolerance, and atherosclerosis in the LDL receptor-deficient (Ldlr
−/−
) mouse model of disease. Ldlr
−/−
mice develop IR and glucose intolerance within 15 weeks, whereas Mif
−/−
Ldlr
−/−
littermates are protected. MIF deficiency does not affect obesity and lipid risk factors but specifically reduces inflammation in WAT and liver, as reflected by lower plasma serum amyloid A and fibrinogen levels at baseline and under inflammatory conditions. Conversely, MIF stimulates the in vivo expression of human C-reactive protein, an inflammation marker and risk factor of IR and cardiovascular disease. In WAT, MIF deficiency reduces nuclear c-Jun levels and improves insulin sensitivity; MIF deficiency also reduces macrophage accumulation in WAT and blunts the expression of two proteins that regulate macrophage infiltration (intercellular adhesion molecule-1, CD44). Mechanistic parallels to WAT were observed in aorta, where the absence of MIF reduces monocyte adhesion, macrophage lesion content, and atherosclerotic lesion size. These data highlight the physiological importance of chronic inflammation in development of IR and atherosclerosis and suggest that MIF is a potential therapeutic target for reducing the inflammatory component of metabolic and cardiovascular disorders.
Effect of Aging on Elastin Functionality in Human Cerebral Arteries
Authors: Fonck Edouard , Feigl Georg G. , Fasel Jean , Sage Daniel , Unser Michael , Rüfenacht Daniel A. , Stergiopulos Nikolaos
Published: May 2009

Background and Purpose—

Aging affects elastin, a key component of the arterial wall integrity and functionality. Elastin degradation in cerebral vessels is associated with cerebrovascular disease. The goal of this study is to assess the biomechanical properties of human cerebral arteries, their composition, and their geometry, with particular focus on the functional alteration of elastin attributable to aging.

Methods—

Twelve posterior cranial arteries obtained from human cadavers of 2 different age groups were compared morphologically and tested biomechanically before and after enzymatic degradation of elastin. Light, confocal, and scanning electron microscopy were used to analyze and determine structural differences, potentially attributed to aging.

Results—

Aging affects structural morphology and the mechanical properties of intracranial arteries. In contrast to main systemic arteries, intima and media thicken while outer diameter remains relatively constant with age, leading to concentric hypertrophy. The structural morphology of elastin changed from a fiber network oriented primarily in the circumferential direction to a more heterogeneously oriented fiber mesh, especially at the intima. Biomechanically, cerebral arteries stiffen with age and lose compliance in the elastin dominated regime. Enzymatic degradation of elastin led to loss in compliance and stiffening in the young group but did not affect the structural and material properties in the older group, suggesting that elastin, though present in equal quantities in the old group, becomes dysfunctional with aging.

Conclusions—

Elastin loses its functionality in cerebral arteries with aging, leading to stiffer less compliant arteries. The area fraction of elastin remained, however, fairly constant. The loss of functionality may thus be attributed to fragmentation and structural reorganization of elastin occurring with age.
Prevalence and Causes of Early-Onset Dementia in Japan
Authors: Ikejima Chiaki , Yasuno Fumihiko , Mizukami Katsuyoshi , Sasaki Megumi , Tanimukai Satoshi , Asada Takashi
Published: May 2009

Background and Purpose—

Few studies are available that have addressed the prevalence of early-onset dementia (EOD), including early-onset Alzheimer disease and other forms of dementia in Japan.

Methods—

A 2-step postal survey was sent to all of the 2475 institutions providing medical or care services for individuals with dementia in Japan’s Ibaraki prefecture (population, 2 966 000) requesting information on EOD cases. Data were then reviewed and collated.

Results—

We identified 617 subjects with EOD. The estimated prevalence of EOD in the target population was 42.3 per 100 000 (95% CI, 39.4 to 45.4). Of the illnesses that cause EOD, vascular dementia was the most frequent (42.5%) followed by Alzheimer disease (25.6%), head trauma (7.1%), dementia with Lewy bodies/Parkinson disease with dementia (6.2%), frontotemporal lobar degeneration (2.6%), and other causes (16.0%).

Conclusions—

The prevalence of EOD in Japan appeared to be similar to that in Western countries with the notable exception that vascular dementia was the most frequent cause of EOD in Japan.
Socioeconomic Differences in Stroke Incidence and Prognosis Under a Universal Healthcare System
Authors: Cesaroni Giulia , Agabiti Nera , Forastiere Francesco , Perucci Carlo Alberto
Published: May 2009

Background and Purpose—

Low socioeconomic position (SEP) is associated with high overall stroke mortality, but its contribution to stroke prognosis is unclear. We evaluated socioeconomic disparities in stroke incidence and poststroke outcomes.

Methods—

We collected hospital discharge and mortality data for all 35- to 84-year-old Rome residents who had a first acute ischemic or hemorrhagic stroke in 2001 to 2004. We used a small-area SEP index. We calculated age-adjusted incidence rates and rate ratios by SEP for fatal and nonfatal stroke subtypes using Poisson regression. Logistic regression was used to study outcomes by SEP (30-day mortality, and among 1-month survivors: 1-year mortality, hospital readmissions for a successive stroke, and cardiovascular diseases).

Results—

A total of 10 033 incident strokes (75% ischemic) were observed. Incidence rates (per 100 000) for ischemic and hemorrhagic stroke were: 104 and 34 in men and 81 and 28 in women, respectively. There were socioeconomic disparities in stroke incidence in both genders (rate ratios between extreme SEP categories in ischemic and hemorrhagic stroke: 1.76; 95% CI,1.59 to 1.95; 1.50; 95% CI, 1.26 to 1.80 in men; 1.72; 95% CI, 1.55 to 1.91; 1.37; 95% CI, 1.15 to 1.63 in women). No association was found for SEP and mortality after stroke. Men with low SEP with an ischemic event were more likely to be hospitalized for a new stroke than men with high SEP. Women with low SEP with hemorrhagic stroke were more likely to be hospitalized for cardiovascular disease compared with women with high SEP.

Conclusions—

Stroke incidence strongly differs between socioeconomic groups reflecting a heterogeneous distribution of lifestyle and clinical risk factors. Strategies for primary prevention should target less affluent people.
Cerebral Venous and Sinus Thrombosis in Women
Authors: Coutinho Jonathan M. , Ferro José M. , Canhão Patrícia , Barinagarrementeria Fernando , Cantú Carlos , Bousser Marie-Germaine , Stam Jan
Published: May 2009

Background and Purpose—

Little is known about the gender-specific manifestations of cerebral venous and sinus thrombosis, a disease that is much more common in women than men.

Methods—

We used data of the International Study on Cerebral Vein and Dural sinus Thrombosis (ISCVT), a multicenter prospective observational study, to analyze gender-specific differences in clinical presentation, etiology, and outcome of cerebral venous thrombosis.

Results—

Four hundred sixty-five of a total of 624 patients were women (75%). Women were significantly younger, had less often a chronic onset of symptoms, and had more often headache at presentation. There were no gender differences in ancillary investigations or treatment. A gender-specific risk factor (oral contraceptives, pregnancy, puerperium, and hormonal replacement therapy) was present in 65% of women. Women had a better prognosis than men (complete recovery 81% versus 71%l
P
=0.01), which was entirely due to a better outcome in female patients with gender-specific risk factors. Women without gender-specific risk factors are similar to men in clinical presentation, risk factor profile, and outcome. Logistic regression analysis confirmed that the absence of gender-specific risk factors is a strong and independent predictor of poor outcome in women with sinus thrombosis (OR, 3.7; CI, 1.9 to 7.4).

Conclusions—

Our study identified important differences between women and men in presentation, course, and risk factors of cerebral venous and sinus thrombosis and showed that women with a gender-specific risk factor have a much better prognosis than other patients.
Predictive Value of Clinical and EEG Features in the Diagnosis of Stroke and Hypoxic Ischemic Encephalopathy in Neonates With Seizures
Authors: Rafay Mubeen F. , Cortez Miguel A. , deVeber Gabrielle A. , Tan-Dy Cherrie , Al-Futaisi Amna , Yoon Woojin , Fallah Shafagh , Moore Aideen M.
Published: May 2009

Background and Purpose—

In neonates, the differentiation of stroke and hypoxic ischemic encephalopathy (HIE) is important. Neuroimaging presents technical challenges in unstable neonates, resulting in frequently delayed or missed diagnosis of stroke. Differentiating clinical and electroencephalographic (EEG) features would assist physicians in the timely diagnosis. We sought to determine, in neonates with seizures, clinical and EEG features that differentiate stroke and HIE.

Methods—

Retrospective cohort study comparing clinical, seizure, and EEG features in term neonates with ischemic stroke or HIE and seizures within 7 days after birth, admitted at The Hospital for Sick Children. Putative clinical and EEG predictors of stroke were analyzed with univariate and multivariate methods.

Results—

Sixty-two newborns with stroke (n=27) or HIE (n=35) were studied. With univariate analysis, predictors of stroke included delayed seizure onset (≥12-hours after birth) (
P
<0.0001; OR, 26.4; 95% CI, 6.8, 102.5), focal motor seizures (
P
=0.001; OR, 7.2; 95% CI, 2.0, 26.0) and pattern of neurological abnormalities (
P
<0.0001). With multivariate analysis, delayed seizure onset (
P
<0.0001; OR 39.7; 95% CI, 7.3, 217.0) and focal motor seizures (
P
=0.007; OR, 13.4; 95% CI, 2.1, 87.9) predicted stroke. Presence of both predictors had 100% positive predictive value and specificity, 61% negative predictive value and 37% sensitivity.

Conclusions—

In neonates, onset of seizures beyond 12 hours of birth and clinically observed focal seizures are predictive of stroke. These preinvestigation indicators of stroke may facilitate earlier diagnosis and institution of specific management strategies.
Associations Between Order Maintenance Policing and Violent Crime
Authors: Kane Robert J. , Cronin Shea W.
Published: May 2009

The present study examined the relationships between order maintenance arrests and violent crime across and within communities in a major metropolitan setting. Integrating the macro-deterrence and systemic model perspectives, the research tested the direct effects of vigorous disorder arrests on robbery and assault with a deadly weapon (i.e., violent street crime), as well as the interactive effects of Disorder Arrests × Residential Integration (mobility and owner-occupied dwelling) on violent crime. The research found no direct relationship between disorder arrests and violent crime, but it found that disorder arrests in conjunction with decreased residential integration was associated with violent crime reductions. The results suggest that police disorder arrests may produce the strongest violence reduction results in areas of decreased residential attachment; however, as residential integration increases, the effects of order maintenance arrests on violent crime diminish. The study discusses the implications for shared social control agency in communities, as well as future research directions.
Inclusion of Religion and Spirituality in the Special Education Literature
Authors: Ault Melinda Jones
Published: May 2009

Although traditionally not an area of service delivered by special educators, the area of religion and spirituality for persons with disabilities is receiving more attention as a quality-of-life outcome. This literature review examined the special education literature to determine the extent to which special educators are exposed to literature concerned with these issues. The results indicated that information is found in the literature but occurs most often as embedded references in articles on other topics. Information was most often included in articles focusing on diversity, and the majority of references to religion and spirituality were descriptions of religions. Religion and spirituality are linked to the overarching goals of the Individuals with Disabilities Education Improvement Act of 2004 and quality-of-life outcomes. Future research and roles for professionals are discussed.
On dying and human suffering
Authors: Kellehear A
Published: May 2009

This review compares and contrasts the major reoccurring themes in two sources of research literature – social studies of dying and human suffering. The purpose of such a comparison is to employ the major insights of each field as a useful method of critically evaluating the insights of the other. Critical exchanges and comparisons between the research area of dying studies and on human suffering have been modest to date. This article will explain that the experience of dying benefits from being situated and analysed in a broader context of cultural experience, as suggested by the theory and study of human suffering. Conversely, the theory and methods involved in studies of human suffering can gain from a mortal view of vulnerability, grief, social ambiguity and identity changes characteristic of experiences at the end of life.
Husbands' and Wives' Education and Divorce in the United States and Japan, 1946-2000
Authors: Ono Hiromi
Published: June 2009

How the relationship between status and divorce shifts over historical time among industrialized countries remains largely unknown. A socioeconomic growth hypothesis posits that a more recent marriage cohort (relative to a previous cohort) in an industrialized country exhibits (1) larger divorce-suppressive effects of husbands' and wives' higher level of education and (2) a shift from a pattern in which only husbands' education substantially influences the couples' likelihood of divorce to a pattern in which both spouses' education influences that likelihood. The author tests the need to modify this hypothesis to reflect the intervening influences of cultural-institutional arrangements using the United States and Japan. The author applies event history regressions to the U.S. Panel Study of Income Dynamics and the Japanese General Social Survey. Results from both countries suggest the needs for modifications and imply that divorce is increasingly tied to socioeconomic inequality in both industrialized countries, but in contrasting ways.
Quantitative structure activity relationship and risk analysis of some heavy metal residues in the milk of cattle and goat
Authors: Muhammad F , Akhtar M , Javed I , ZU-Rahman  , Jan I , Anwar MI , Hayat S
Published: May 2009

Milk of cattle and goat was collected from various localities of Faisalabad, Pakistan. Heavy metal concentration in milk was determined by atomic absorption spectrophotometer. Milk from both of the species was found richly contaminated with cadmium (Cd), chromium (Cr), nickel (Ni), and lead (Pb). Lead concentration in the milk of goat was significantly higher as compared to cattle milk. Quantitative structure activity relationship (QSAR) models were suggested to predict the residues of unknown heavy metals in the milk of cattle and goat using their known physicochemical properties such as molecular weight (MW), melting point (MP), and boiling point (BP) as well as the milk characteristics such as pH, % fat, and specific gravity (SG) of both of these species. The analysis revealed good correlation coefficients ( R2 = 0.759) and ( R2 = 0.876) for cattle and goat QSAR models, respectively. This analysis indicates the need to construct species specific QSAR models for residue prediction. The coefficients for SG for the studied metals were higher in both cattle and goat milk. This suggests that SG is a better determinant for heavy metal residue prediction in the milk of these animals. Risk analysis was conducted based upon the determined heavy metal residues and their provisional tolerable daily intakes. The daily intake of Cd, Cr, and Pb was found to be 1.6, 27, and 116 times higher, respectively, in cattle milk and 1.8, 29, 262 times higher respectively, in goat milk. This intake of heavy metal contaminated milk might pose health hazards to humans in this locality.
Enteral Nutrition: A Hard Look at Some Soft Evidence
Authors: Koretz Ronald L.
Published: May 2009

Those who read the medical literature should understand the principles of evidence‐based medicine. Even randomized trials can contain design or interpretative flaws that allow bias to produce, or exaggerate the size of, beneficial effects. Such problems beset the literature of enteral nutrition (EN). Investigators who have compared EN with parenteral nutrition (PN) have alleged that EN produces fewer adverse events, but such studies do not assess the absolute value of either therapy, and data exist suggesting that PN causes net harm. Trials comparing EN with no nutrition therapy have not yielded convincing evidence of efficacy because the study designs have failed to use methods to prevent bias from interfering with the observations. This same problem exists with trials that have assessed volitional feeding programs (eg, oral supplements). Thus, although systematic reviews have alleged that EN benefits patients undergoing surgery, patients in the critical care unit, patients with liver disease, and patients with pancreatitis, the presence of bias limits any positive conclusions. As a manifestation of this issue, when the various trials are separated into studies with high and low risks of bias, those with low risks have not shown any benefit. EN has been accepted and implemented despite the lack of convincing scientific support of efficacy.
Efficacy of intramuscular interferon beta-1a in patients with clinically isolated syndrome: analysis of subgroups based on new risk criteria
Authors: O’Connor P , Kinkel RP , Kremenchutzky M
Published: May 2009

Approximately 85% of multiple sclerosis (MS) cases begin as clinically isolated syndromes (CIS). Results from the Controlled High-Risk Subjects Avonex® Multiple Sclerosis Prevention Study (CHAMPS) demonstrated that, in patients with CIS, treatment with intramuscular (IM) interferon beta-1a (IFNβ-1a) 30 μg once weekly delayed conversion to clinically definite MS (CDMS) in the total population and in subgroups based on presenting syndromes and baseline magnetic resonance imaging (MRI) characteristics. Changes to clinical and MRI risk classification of presenting symptoms in recent studies prompted reanalysis of CHAMPS data. Presenting syndromes were assessed using a derived algorithm that stratifies patients into mono- or multifocal categories based on functional system scores. The ability of IM IFNβ-1a to delay progression to CDMS in subgroups based on clinical presentation and MRI characteristics was assessed. Reanalysis of CHAMPS patients showed that 30% could be classified by clinical criteria as having multifocal disease at baseline. IM IFNβ-1a initiated at a first demyelinating attack delayed CDMS in monofocal patients ( P = 0.0013), patients with or without gadolinium-enhancing lesions ( P = 0.0007, P = 0.0405) and patients with at least nine T2 lesions at baseline ( P = 0.0044). These data confirm that IM IFNβ-1a delays conversion to CDMS in patients with CIS.
Neurological disability, psychological distress, and health-related quality of life in MS patients within the first three years after diagnosis
Authors: Kern S , Schrempf W , Schneider H , Schultheiß T , Reichmann H , Ziemssen T
Published: May 2009

Background

Psychological distress and psychiatric co-morbidity are common in multiple sclerosis (MS) and is often associated with neurological disability as well as reduced quality of life.

Objectives

This study aimed to investigate psychological distress and the possible association with quality of life as well as neurological disability in MS patients within the first 3 years after diagnosis.

Methods

Psychological distress was measured using a standardized questionnaire (Symptom-Check-List-90-R; SCL-90-R) in 31 relapsing–remitting MS patients and 24 sex- and age-matched healthy controls.

Results

Psychological distress was significantly more pronounced in MS patients when compared to healthy controls. Interpersonal sensitivity and psychoticism were positively associated with neurological disability (Expanded Disability Status Scale [EDSS]). A high EDSS group (median split EDSS; 1.5) expressed significantly more psychological distress when compared to the low EDSS group and healthy controls. MS patients with minimal to no neurological disability (low EDSS group) also expressed significantly more emotional distress when compared to healthy controls. MS-related quality of life was positively associated with neurological disability as well as SCL-90-R scores. After adjusting for neurological disability, psychological distress was still significantly associated with quality of life.

Conclusions

Early stage MS patients significantly differ in their psychological distress when compared to healthy controls. Psychological distress in these patients is associated with neurological disability, but it is also present in patients with minimal to no neurological disability. Psychological distress was identified as an independent predictor for MS-related quality of life.
T2' imaging indicates decreased tissue metabolism in frontal white matter of MS patients
Authors: Holst B , Siemonsen S , Finsterbusch J , Bester M , Schippling S , Martin R , Fiehler J
Published: May 2009

Background and purpose

T2'-Magnetic resonance imaging (MRI) allows estimation of oxygen metabolism in normal appearing white and gray matter (NAWM and NAGM) and is sensitive to local iron deposition. We hypothesized that T2' imaging is feasible in routine use and reveals differences between MS patients and healthy subjects.

Methods

T2- and T2*-weighted images were acquired in 23 MS patients (Mean age: 36.8, range: 23–58 years) and 23 age-matched healthy subjects. Quantitative T2- and T2*-values were determined in six regions of interest (ROIs).

Results

The T2' values in thalamus and caudate nucleus were significantly lower in MS patients than in healthy subjects (139 ms vs 157 ms, P < 0.001 and 97 ms vs 115 ms, P < 0.01). The NAWM in the frontal lobe revealed significant higher T2' values than in healthy subjects (217 ms vs 170 ms, P < 0.001). The subcortical NAWM revealed significant lower T2' values than in healthy subjects (174 ms vs 187 ms, P < 0.028).

Conclusion

T2' values differed significantly between MS patients and healthy subjects. The reduced T2' values in the basal ganglia are presumably related to higher iron concentration whereas the increased T2' in frontal NAWM most probably reflects reduced tissue metabolism. T2' imaging is feasible for routine-use and promising for monitoring therapy effects.
The insertion/deletion polymorphism of the angiotensin-converting enzyme gene is associated with progression, but not development, of albuminuria in Iranian patients with type 2 diabetes
Authors: Nikzamir Abdolrahim , Esteghamati Alireza , Feghhi Mostafa , Nakhjavani Manouchehr , Rashidi Armin , Javad Zavar Reza
Published: June 2009

Introduction. The insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene has been shown to be associated with a number of complications of type 2 diabetes. Results on the development and progression of albuminuria, however, have remained controversial, with ethnic differences being a potential reason.The present study is the first report to examine Iranian patients. Methods. Patients (322; 162 males) with type 2 diabetes were categorised in this cross-sectional study into the following groups: normoalbuminuria (n=145), microalbuminuria (n=129) and macroalbuminuria (n=48).ACE gen I/D polymorphism genotypes were determined using the polymerase chain reaction method. Results. The distribution of ACE genotypes was significantly different among the groups (p<0.001), with the II genotype decreasing and the DD genotype increasing in frequency with increasing severity of albuminuria. Multivariate regression analysis showed that the ACE genotype did not change the odds of having microalbuminuria versus normoalbuminuria, while the D allele independently increased the odds of having macroalbuminuria versus microalbuminuria approximately threefold (p<0.01).

Conclusions. In Iranian patients with type 2 diabetes, the D allele is associated with progression, but not development, of albuminuria.
Lack of genetic association between the angiotensin-converting enzyme gene insertion/deletion polymorphism and longevity in a Han Chinese population
Authors: Yang Jian-Kang , Gong Yuan-Ying , Liang Xie  , Lian Shi-Gang , Juan Yang  , Xu Liang-You , Gao Shou-Jun , Zhang Ya-Ping
Published: June 2009

Introduction. The insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE) gene has been reported to associate with human longevity. However, little information is available in a Han Chinese longevity population.Therefore, we investigated the association of the ACE gene insertion/ deletion polymorphism with longevity in a Han Chinese population.

Materials and methods. We compared the distribution of ACE insertion/deletion genotype and allele frequencies in two groups: a longevity group (399 subjects) aged over 90 years and a control group (302 subjects) aged less than 60 years.

Results. No difference in genotype and allele frequencies of the ACE gene insertion/deletion polymorphism was observed between the longevity group and the control group.When adjusting for gender, the difference between the longevity group and the control group was also not significant regarding the frequencies of the genotypes (male, p=0.994 and female, p=0.797) as well as allele frequencies (male, p=0.969 and female, p=0.884).

Conclusions. No association of the ACE gene insertion/deletion polymorphism with longevity was observed in our Han Chinese population.
Psychotherapies for Trauma and Substance Abuse in Women
Authors: Najavits Lisa M.
Published: May 2009

Women are subject to high rates of interpersonal violence. One frequent co-occurring issue is substance abuse, which may arise posttrauma as a way to cope. In this article, psychosocial therapies for co-occurring trauma and substance abuse are reviewed. Description of empirically studied models is provided, as well as results of the empirical studies. Overall, this area of work suggests positive growth in the availability of new models but very limited empirical work thus far for all but one model. Directions for the future include the need for greater study of treatments in this area, as well as the need to address issues beyond specific models (e.g., workforce issues, access to care, and changing the culture of treatment systems). Policy implications are also offered.
Pathophysiology of Coronary Heart Disease and Biological Mechanisms for the Cardioprotective Effects of Regular Aerobic Exercise
Authors: Leon Arthur S. , Bronas Ulf G.
Published: June 2009

Atherosclerosis, the underlying cause of coronary heart disease (CHD), is a chronic inflammatory condition involving the subendothelial layer of coronary as well as other large-and medium-sized arteries. This disease process is initiated early in life by multiple risk factors. Endothelial dysfunction and lipid infiltration are fundamental for the initiation and progression of the atherosclerotic process. After many asymptomatic decades, acute coronary syndromes are generally triggered by a coronary occlusion, caused by a thrombosis initiated by disruption of a vulnerable lipid-laden plaque with a thin, noncalcified fibrosis cap. Epidemiology studies over the past 50 years have consistently observed an inverse association between CHD and regular physical activity and/or cardiorespiratory fitness. Supporting evidence of causative relationships has been provided by exercise training studies demonstrating multiple, plausible, cardioprotective, biological mechanisms. These pleotropic effects may be classified as (1) direct antiatherosclerotic effects and indirect effects via reduction of other risk factors, (2) anti-ischemic effects by decreasing myocardial oxygen demands and increasing its vascular supply and by decreasing the severity of ischemic injuries by direct conditioning effects on cardiomyocytes, (3) antiarrhythmic effects by improving electrical stability of the heart, and (4) antithrombotic (and prothrombolytic) effects, reducing risk of a coronary thrombotic occlusion. It is concluded based on an impressive body of evidence that regular aerobic exercise attenuates the risk of CHD at all stages of the atherothrombotic process.
The 39-item Parkinson's Disease Questionnaire (PDQ-39): is it a unidimensional construct?
Authors: Hagell Peter , Nilsson Maria H.
Published: May 2009

The 39-item Parkinson's Disease Questionnaire, and particularly its summary index (PDQ-39SI) is a widely used patient-reported clinical trial endpoint. A basic assumption when summing items into a total score is that they represent a common variable. We therefore assessed the unidimensionality of the PDQ-39SI using Rasch and confirmatory factor analysis. Both analyses showed model misfit. Adjustment for differential item functioning and disordered response category thresholds did not improve model fit, and residual analyses showed deviation from unidimensionality. These data indicate multidimensionality and challenge the interpretation and validity of PDQ-39SI scores. Clinicians and investigators should use and interpret the PDQ-39SI with caution.
Review: Evidence-based drug treatment in amyotrophic lateral sclerosis and upcoming clinical trials
Authors: Ludolph Albert C. , Jesse Sarah
Published: May 2009

Amyotrophic lateral sclerosis/motor neuron disease is a severe neurodegenerative disease characterized by upper and lower motor neuron degeneration for which there is no truly effective treatment. Several therapies have shown promise in preclinical models of motor neuron disease; however, most of them failed in human studies, so that the noticeable progress in understanding the cellular mechanisms of motor neuron degeneration has not been matched with the development of therapeutic strategies to prevent disease progression or to extend survival longer than achieved by riluzole. We review treatment development in motor neuron disease and discuss the strengths and limitations of past as well as upcoming clinical trials.
Comparative genomic analysis and expression of the APETALA2-like genes from barley, wheat, and barley-wheat amphiploids
Authors: Gil-Humanes Javier , Pistón Fernando , Martín Antonio , Barro Francisco
Published: May 2009

Background

TheAPETALA2-like genes form a large multi-gene family of transcription factors which play an important role during the plant life cycle, being key regulators of many developmental processes. Many studies inArabidopsishave revealed that theAPETALA2(AP2) gene is implicated in the establishment of floral meristem and floral organ identity as well as temporal and spatial regulation of flower homeotic gene expression.

Results

In this work, we have cloned and characterised theAP2-like gene from accessions ofHordeum chilenseandHordeum vulgare, wild and domesticated barley, respectively, and compared with otherAP2homoeologous genes, including the Q gene in wheat. TheHordeum AP2-like genes contain two plant-specific DNA binding motifs called AP2 domains, as does the Q gene of wheat. We confirm that theH. chilense AP2-like gene is located on chromosome 5Hch. Patterns of expression of theAP2-like genes were examined in floral organs and other tissues in barley, wheat and in tritordeum amphiploids (barley × wheat hybrids). In tritordeum amphiploids, the level of transcription of the barleyAP2-like gene was lower than in its barley parental and the chromosome substitutions 1D/1Hchand 2D/2Hchwere seen to modifyAP2gene expression levels.

Conclusion

The results are of interest in order to understand the role of theAP2-like gene in the spike morphology of barley and wheat, and to understand the regulation of this gene in the amphiploids obtained from barley-wheat crossing. This information may have application in cereal breeding programs to up- or down-regulate the expression ofAP2-like genes in order to modify spike characteristics and to obtain free-threshing plants.
Telephone reliability of the Frenchay Activity Index and EQ-5D amongst older adults
Authors: McPhail Steven , Lane Paul , Russell Trevor , Brauer Sandra G , Urry Steven , Jasiewicz Jan , Condie Peter , Haines Terry
Published: May 2009

Background

Older adults may find it problematic to attend hospital appointments due to the difficulty associated with travelling to, within and from a hospital facility for the purpose of a face-to-face assessment. This study aims to investigate equivalence between telephone and face-to-face administration for the Frenchay Activities Index (FAI) and the Euroqol-5D (EQ-5D) generic health-related quality of life instrument amongst an older adult population.

Methods

Patients aged >65 (n = 53) who had been discharged to the community following an acute hospital admission underwent telephone administration of the FAI and EQ-5D instruments seven days prior to attending a hospital outpatient appointment where they completed a face-to-face administration of these instruments.

Results

Overall, 40 subjects' datasets were complete for both assessments and included in analysis. The FAI items had high levels of agreement between the two modes of administration (item kappa's ranged 0.73 to 1.00) as did the EQ-5D (item kappa's ranged 0.67–0.83). For the FAI, EQ-5D VAS and EQ-5D utility score, intraclass correlation coefficients were 0.94, 0.58 and 0.82 respectively with paired t-tests indicating no significant systematic difference (p = 0.100, p = 0.690 and p = 0.290 respectively).

Conclusion

Telephone administration of the FAI and EQ-5D instruments provides comparable results to face-to-face administration amongst older adults deemed to have cognitive functioning intact at a basic level, indicating that this is a suitable alternate approach for collection of this information.
Expression of genes associated with immunity in the endometrium of cattle with disparate postpartum uterine disease and fertility
Authors: Herath Shan , Lilly Sonia T , Santos Natalia R , Gilbert Robert O , Goetze Leopold , Bryant Clare E , White John O , Cronin James , Sheldon I Martin
Published: May 2009

Background

Contamination of the uterine lumen with bacteria is ubiquitous in cattle after parturition. Some animals develop endometritis and have reduced fertility but others have no uterine disease and readily conceive. The present study tested the hypothesis that postpartum cattle that develop persistent endometritis and infertility are unable to limit the inflammatory response to uterine bacterial infection.

Methods

Endometrial biopsies were collected several times during the postpartum period from animals that were subsequently infertile with persistent endometritis (n = 4) or had no clinical disease and conceived to first insemination (n = 4). Quantitative PCR was used to determine the expression of candidate genes in the endometrial biopsies, including the Toll-like receptor (TLR 1 to 10) family of innate immune receptors, inflammatory mediators and their cognate receptors. Selected proteins were examined by immunohistochemistry.

Results

The expression of genes encoding pro-inflammatory mediators such as interleukins (IL1A, IL1B and IL6), and nitric oxide synthase 2 (NOS2) were higher during the first week post partum than subsequently. During the first week post partum, there was higher gene expression in infertile than fertile animals of TLR4, the receptor for bacterial lipopolysaccharide, and the pro-inflammatory cytokines IL1A and IL1B, and their receptor IL1R2. The expression of genes encoding other Toll-like receptors, transforming growth factor beta receptor 1 (TGFBR1) or prostaglandin E2 receptors (PTGER2 and PTGER4) did not differ significantly between the animal groups. Gene expression did not differ significantly between infertile and fertile animals after the first week postpartum. However, there were higher ratios of IL1A or IL1B mRNA to the anti-inflammatory cytokine IL10, during the first week post partum in the infertile than fertile animals, and the protein products of these genes were mainly localised to the epithelium of the endometrium.

Conclusion

Cattle may maintain fertility by limiting the inflammatory response to postpartum bacterial infection in the endometrium during the first week after parturition.