bluuebunny/crossref_metadata_2025 huggingface dataset:
Chromoendoscopy Detects More Adenomas than Colonoscopy Using Intensive Inspection without Dye Spraying
Authors: Stoffel Elena M. , Turgeon D. Kim , Stockwell David H. , Normolle Daniel P. , Tuck Missy K. , Marcon Norman E. , Baron John A. , Bresalier Robert S. , Arber Nadir , Ruffin Mack T. , Syngal Sapna , Brenner Dean E. ,   for Great Lakes New England Clinical Epidemiology and Validation Center of the Early Detection Research Network (GLNE-EDRN)
Published: December 2008

Conventional colonoscopy misses some neoplastic lesions. We compared the sensitivity of chromoendoscopy and colonoscopy with intensive inspection for detecting adenomatous polyps missed by conventional colonoscopy.

Fifty subjects with a history of colorectal cancer or adenomas underwent tandem colonoscopies at one of five centers of the Great Lakes New England Clinical Epidemiology and Validation Center of the Early Detection Research Network. The first exam was a conventional colonoscopy with removal of all visualized polyps. The second exam was randomly assigned as either pan-colonic indigocarmine chromoendoscopy or standard colonoscopy with intensive inspection lasting >20 minutes. Size, histology, and numbers of polyps detected on each exam were recorded.

Twenty-seven subjects were randomized to a second exam with chromoendoscopy and 23 underwent intensive inspection. Forty adenomas were identified on the first standard colonoscopies. The second colonoscopies detected 24 additional adenomas: 19 were found using chromoendoscopy and 5 were found using intensive inspection. Chromoendoscopy found additional adenomas in more subjects than did intensive inspection (44% versus 17%) and identified significantly more missed adenomas per subject (0.7 versus 0.2, P < 0.01). Adenomas detected with chromoendoscopy were significantly smaller (mean size 2.66 ± 0.97 mm) and were more often right-sided. Chromoendoscopy was associated with more normal tissue biopsies and longer procedure times than intensive inspection. After controlling for procedure time, chromoendoscopy detected more adenomas and hyperplastic polyps compared with colonoscopy using intensive inspection alone.

Chromoendoscopy detected more polyps missed by standard colonoscopy than did intensive inspection. The clinical significance of these small missed lesions warrants further study.
Pancreatic Cancer: Translating Lessons from Mouse Models and Hereditary Syndromes
Authors: Wescott Melanie P. , Rustgi Anil K.
Published: December 2008

Pancreatic ductal adenocarcinoma is the overwhelmingly predominant form of pancreatic cancer and the second most common type of gastrointestinal cancer (behind colorectal cancer) in the United States. Recent exciting advances in two areas of pancreatic ductal adenocarcinoma (i.e., the development and characterization of genetically engineered mouse models and the dissection of the genetic basis of hereditary forms in families) have been illuminating. These preclinical models and clinical syndromes provide the first tangible basis for progress in screening and prevention in high-risk populations and in the development of molecular diagnostics and experimental therapeutics.
Sleep Quality and Associated Daytime Consequences in Patients with Idiopathic Pulmonary Fibrosis
Authors: Mermigkis C. , Stagaki E. , Amfilochiou A. , Polychronopoulos V. , Korkonikitas P. , Mermigkis D. , Bregou M. , Kouris N. , Bouros D.
Published: December 2008

Objective: The aim of this study was to describe sleep quality and associated daytime consequences in idiopathic pulmonary fibrosis (IPF). Subjects and Methods: Fifteen patients with IPF and 15 control subjects matched on age and anthropometric variables were included in the study. Sleep quality and its daytime consequences were assessed by clinical interview, the Pittsburgh Sleep Quality Index (PSQI), the Functional Outcomes in Sleep Questionnaire (FOSQ), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale and attended all-night polysomnography. Results: Polysomnography revealed a decrease in sleep efficiency and slow wave sleep, and an increase in stage 1 sleep and arousal index in IPF patients compared to controls. Daytime tachypnea persisted during sleep. Oxygen saturation below 90% was observed during 34.3 ± 37.3% of the total sleep time (TST). Quality of sleep and daytime function were moderately to significantly impaired based on the PSQI and FOSQ. The total FOSQ score was negatively correlated with TST with oxygen saturation below 90% (p = 0.01, r = –0.62). FSS scores were correlated with TST at oxygen saturation below 90% and mean oxygen saturation during sleep (p = 0.002, r = 0.74, and p = 0.007, r = –0.66, respectively). Conclusions: Our data suggest significant sleep disruption and consequent impairment of physical and social functioning in patients with IPF. In the absence of effective treatments for IPF, the improvement of sleep quality should be a primary therapeutic goal.
Contralateral Subdural Effusion Secondary to Decompressive Craniectomy Performed in Patients with Severe Traumatic Brain Injury: Incidence, Clinical Presentations, Treatment and Outcome
Authors: Yang X.F. , Wen L. , Li G. , Zhan R.Y. , Ma L. , Liu W.G.
Published: December 2008

Objective: This study was performed to better understandpostoperative contralateral subdural effusion, an uncommon but serious complication secondary to decompressive craniectomy in patients with head trauma. Subjects and Methods: Data from medical records of 169 patients who underwent decompressive craniectomy after head trauma between 2003 and 2006 were collected. The data included demographics, clinical presentations, treatment and outcome. Results: Of the 169 patients, 11 (6.5%) had contralateral subdural effusion. On the average, this complication was found 14 days after decompressive craniectomy. Of the 11 patients, conservative treatment was effective in 7 with a gradual resolution which lasted 52.7 days on average. The effusion in the remaining 4 patients led to progressive deterioration of clinical presentation, and surgical intervention was necessary: subduroperitoneal shunting in 3 cases and burr hole drainage in the remaining 1 case. Conclusions: Our findings confirmed that postoperative contralateral subdural effusion was not an uncommon complication secondary to decompressive craniectomy. Most contralateral subdural effusions resolved spontaneously after conservative management, but surgical management may be necessary if the patients develop deteriorating clinical manifestations or the subdural effusion has an apparent mass effect.
Assessment of Self-Medication of Antibiotics in a Jordanian Population
Authors: Sawair Faleh A. , Baqain Zaid H. , Abu Karaky Ashraf , Abu Eid Rasha
Published: December 2008

Objective: To assess the extent of self-medication with antibiotics (SMA) in a Jordanian population, and to evaluate the sociodemographic factors affecting this behaviour. Subjects and Methods: Face-to-face interviews were conducted with 477 patients aged 16–65 years attending the Department of Dentistry, University of Jordan Hospital. Socio-demographic data were collected and interviewees were asked about their SMA behaviour during the last 6 months, the reasons and motives for this behaviour, and the source and dose of the antibiotics were noted. Results: The prevalence rate of SMA in the sample during the 6 months preceding the interview was 40.7% (194/477). Patients aged 36–55 years and those in the middle-class income group were most likely to perform SMA. SMA was mainly for sore throats, common colds and dental infections, and community pharmacies were the major source (104, 53.6% cases). Amoxicillin was the most commonly used antibiotic, and only 73 (37.6%) patients followed the correct dosage guidelines. Previous experience with similar illness and saving time were the most common reasons for SMA. Ninety-four (19.7%) patients admitted that they consulted another physician to obtain antibiotics when their first physician did not prescribe any. Conclusion: The findings showed that SMA was a frequent practice among Jordanians, signifying the need for an educational campaign on the proper use of antibiotics in this population.
Knowledge, Attitudes, and Practice Related to Cervical Cancer Screening among Kuwaiti Women
Authors: Al Sairafi Mona , Mohamed Farida A.
Published: December 2008

Objectives: To assess the knowledge, attitude, and practice regarding cervical cancer screening among Kuwaiti women. Subjects and Methods: A total of 300 married Kuwaiti women were randomly selected from those who visited the clinics irrespective of reason(s) for the visit. A structured questionnaire covering sociodemographic characteristics, knowledge, attitude, and practice related to cervical cancer screening was administered. Results: Of the 300 women, complete information was collected from 281 (93.7%), the knowledge about the test was adequate in 147 (52.3%) women, while 86 (30.6%) had adequate attitude towards the test and only 67 (23.8%) had an adequate practice. The main reason given for not having had a Papanicolaou smear was that it was not suggested by the doctor. Among all the respondents 220 (78.7%) would prefer a female doctor to conduct the test. The level of education was the only significant factor independently associated with inadequate knowledge and attitude towards Papanicolaou smear test (p = 0.006 and p = 0.001, respectively) when adjusted for the effect of other factors in multivariate logistic regression analysis. However, age (p < 0.001), level of education (p = 0.028), and number of years since last visit with a gynaecologist (p = 0.005) were significant factors independently associated with inadequate practice of the test. Conclusion: Our findings showed that a well-designed health education programme on cervical cancer and benefits of screening would increase the awareness among Kuwaiti women.
Effects of Hormone Replacement Therapy on Insulin Resistance and Platelet Function Tests
Authors: Saraç Fulden , Saydam Güray , Sahin Fahri , Öztekin Kemal , Saygılı Fusun , Tüzün Mehmet , Yılmaz Candeger
Published: December 2008

Objectives: The aim of this study was to evaluate measures of insulin resistance and platelet function in postmenopausal women with oral or transdermal hormone replacement therapy (HRT). Subjects and Methods: Eighty women divided into four groups of 20 each were enrolled in the study. Group 1: postmenopausal hysterectomized women who received only transdermal estradiol (13.9 mg/12.5 cm2); group 2: women with intact uterus who were treated with estrogen-progestin combination (HRT); group 3: postmenopausal women who were treated with the selective estrogen receptor modulator tibolone, and group 4: women who were not taking any drugs for HRT were chosen as a control group (group 4). Results: In group 2, homeostasis model assessment of insulin resistance and fasting insulin levels were 2.90 ± 0.37 and 9.3 ± 3.0 µU/ml, respectively, prior to administration of HRT. These levels were reduced to 1.91 ± 0.41 (p = 0.001) and 7.1 ± 2.7 µU/ml (p = 0.002), respectively, after drug therapy. Mean levels of high-sensitivity C-reactive protein (hsCRP) were decreased with HRT only in group 2 (p = 0.002). No changes for biochemical and hematological parameters were observed in the other groups. Platelet function tests showed no differences after HRT in any group. Conclusions: Estrogen-progestin combination HRT decreased measures of insulin resistance and hsCRP levels, but had no effect on platelet function tests in postmenopausal women.
Postoperative Infection after Surgical Removal of Impacted Mandibular Third Molars: An Analysis of 110 Consecutive Procedures
Authors: Al-Asfour Adel
Published: December 2008

Objective: The aim of this study was to evaluate the rate of postoperative infection and other complications after the surgical removal of impacted mandibular third molars. Subjects and Materials: Medical records of 110 consecutive patients with 130 consecutive surgical extractions of impacted lower third molar teeth performed under local anesthetic using strict aseptic techniques were reviewed and analyzed. No systemic antibiotics were administered or prescribed after the surgery. The rates of postoperative infection and other complications were evaluated clinically. Results: Of the 130 surgical removals, 110 in 90 patients met the inclusion criterion of nonuse of antibiotics. Fifty-nine were female and the remaining 31 were male. Average age was 25.2 years. Of the 110 surgeries, postoperative infection occurred in 6 (5.5%). Other complications were alveolar osteitis (n = 9, 8.2%), pain lasting more than 1 week (n = 5, 4.3%) and sensory dysfunction of the inferior alveolar nerve (n = 2,0.8%). Conclusion: The low rates of postoperative infection and other complications observed in this study encouraged us to continue surgical removal of impacted mandibular third molars without routine prescription of antibiotics unless indicated for other medical reasons.
Gemcitabine-Induced Acute Coronary Syndrome: A Case Report
Authors: Ozturk Banu , Tacoy Gulten , Coskun Ugur , Yaman Emel , Sahin Giray , Buyukberber Suleyman , Yildiz Ramazan , Kaya Ali O. , Topal Salih , Ozdemir Murat , Benekli Mustafa
Published: December 2008

Objectives: To report a case of metastatic leiomyosarcoma, in which a patient developed chest pain accompanied by acute left bundle-branch block (LBBB) after gemcitabine infusion. Clinical Presentation and Intervention: A 59-year-old woman admitted with bilateral pulmonary nodules had classic risk factors for coronary heart disease and coronary stenosis as demonstrated by previous coronary angiography. She was treated with gemcitabine infusion, and 30 min later she experienced severe chest pain accompanied by acute LBBB confirmed by ECG. We suspected gemcitabine-induced coronary vasospasm exacerbated by the preexisting coronary artery disease as the cause of the acute coronary syndrome. The patient was subsequently treated with antianginal therapy and percutaneous coronary intervention. Her chest pain resolved and LBBB disappeared. She was discharged 2 days later without any further cardiac events. No additional cancer therapy was given and she died 5 months later, due to disease progression. Conclusion: This case showed that chemotherapeutic agents must be administered with intensive cardiac monitoring especially in patients with cardiac disease and well-known risk factors to prevent the development of cardiac complications, despite an agent not being known to be ‘cardiotoxic’.
Violence among Street-Involved Youth: The Role of Methamphetamine
Authors: Martin Ian , Palepu Anita , Wood Evan , Li Kathy , Montaner Julio , Kerr Thomas
Published: December 2008

Aims: This study investigated a possible association between violence and the use of drugs, particularly methamphetamine and alcohol. Methods: Cross-sectional, baseline data were derived from the At-Risk Youth Study, a prospective cohort of street-involved youth in Vancouver, Canada. Subjects were asked whether they had suffered or perpetrated violence in the 6 months prior to the interview. Results: In total, 478 youth were enrolled, with a median age of 22 years (interquartile range = 20.0–23.9); 230 (48%) reported having been victims of violence, while 165 (34.5%) reported having perpetrated violence. Daily methamphetamine use was not associated with either outcome. In a multivariate analysis, daily alcohol consumption was significantly associated with being a victim (adjusted odds ratio = 2.10) and a perpetrator (adjusted odds ratio = 2.02) of violence. A history of abuse, failing a grade, and dealing drugs were also independently associated with violence, while having a regular partner was protective. Conclusion: Contrary to popular media reports that methamphetamine causes violence, we found no association. The association of alcohol with violence, though, has implications for screening and intervention programs.
Clinical Manifestation of Alcohol Withdrawal Symptoms Related to Genetic Polymorphisms of Two Serotonin Receptors and Serotonin Transporter
Authors: Lee Young-Sik , Choi Sam-Wook , Han Doug-Hyun , Kim Dai-Jin , Joe Keun-Ho
Published: December 2008

Aim: The purpose of this study was to investigate the role of serotonergic genes in the development of alcohol dependence. The manifestation of alcohol withdrawal symptoms related to serotonergic polymorphisms in alcoholics was also examined. Methods: The role of polymorphisms in the serotonin receptor 1A (5-HT1A), serotonin receptor 2A (5-HT2A), and the serotonin transporter gene (5-HTT) promotor region (5-HTTLPR) in the manifestation of individual alcohol withdrawal symptoms was investigated in 97 Korean male inpatients with alcohol dependence and 76 Korean healthy male subjects. The patient’s alcohol withdrawal symptoms were assessed with the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Results: In the 5-HT1A receptor, the frequency of G– genotype (CC) was significantly higher in patients with alcohol dependence than in normal controls (χ2 = 5.03, p = 0.025). The CIWA-Ar subscale scores of nausea, anxiety, and headache, and total CIWA-Ar scale scores were significantly higher in G+ genotypes (CG+ GG) than in G– genotype (p = 0.005, p = 0.004, p = 0.008, and p = 0.008, respectively). Conclusion: The results suggest that the genetic polymorphism of the 5-HT1A receptor may play a role in alcohol dependence and polymorphisms of serotonergic genes may be important in withdrawal symptoms of patients with alcohol dependence.
Practitioners’ Attitudes concerning Evidence-Based Guidelines in Belgian Substance Abuse Treatment
Authors: Autrique Mieke , Vanderplasschen Wouter , Broekaert Eric , Sabbe Bernard
Published: December 2008

Background/Aim: Evidence-based guidelines for substance abuse treatment are available in many European countries. In Belgium, no such guidelines have been developed yet at a national level although their need has repeatedly been emphasized. This study aims to assess Belgian practitioners’ attitudes concerning evidence-based guidelines for substance abuse treatment. Methods: A survey was conducted with clinical coordinators in a representative sample of 60 agencies dispensing specialized treatment to alcohol and drug abusers. Results: The study revealed that evidence-based guidelines are rarely used in substance abuse treatment in Belgium, but that many agencies use self-developed guidelines. The attitude concerning evidence-based guidelines is mainly positive. Practitioners’ concerns mostly relate to the risk of disregarding their clients’ needs and the constraining character of using evidence-based guidelines. The study also reveals some barriers concerning the implementation of evidence-based guidelines and suggests some strategies to overcome them. Conclusion: Practitioners appear to be prepared to work with evidence-based guidelines. When developing, adapting and implementing evidence-based guidelines for substance abuse treatment, it is important for policy makers to take into account the state of the art in clinical practice as well as practitioners’ needs and requirements.
Hypoxic Stress Exacerbates Hyperoxia-Induced Lung Injury in a Neonatal Mouse Model of Bronchopulmonary Dysplasia
Authors: Ratner Veniamin , Slinko Siarhei , Utkina-Sosunova Irina , Starkov Anatoly , Polin Richard A. , Ten Vadim S.
Published: December 2008

Background: Premature infants with lung injury often experience intermittent episodes of hypoxemia. Objective: This study investigates whether intermittent hypoxemia exacerbates oxidative stress and lung injury in neonatal mice in a hyperoxia-induced model of bronchopulmonary dysplasia (BPD). Methods: For the BPD model, 3-day-old C57Bl/6J mice were exposed to hyperoxia (65% O2) for 4 weeks (O2 group) or to hyperoxia and intermittent (10 min daily) hypoxia (O2 + H group). Upon completion of O2 or O2 + H exposure, the degree of pulmonary alveolarization and granulocytic infiltration were examined. The severity of oxidative injury in lungs was defined by tissue glutathione and protein carbonyl content. Data were compared to those in naïve mice and mice subjected only to intermittent hypoxia. Results: Hyperoxia-exposed mice exhibited a dramatic (p < 0.0001) decrease of alveolarization, significantly increased granulocytic infiltration (p < 0.0001) and increased protein carbonyl content (p = 0.04) compared to naïve mice. However, O2 + H mice demonstrated significantly (p = 0.03) fewer alveoli compared to their O2 counterparts. This was associated with a significantly (p = 0.02) decreased pulmonary total/oxidized glutathione ratio and a significant (p = 0.03) elevation of protein carbonyl content. Conclusions: Thus, intermittent hypoxic stress during hyperoxic induction of BPD in mice potentiates oxidative stress in lung tissue and exacerbates alveolar developmental arrest.
Nerve Growth Factor and Its Monocyte Receptors Are Affected in Kidney Disease
Authors: Antonucci Maria Teresa , Bonofiglio Renzo , Papalia Teresa , Caruso Francesco , Caroleo Maria Cristina , Mancuso Domenico , Aloe Luigi
Published: December 2008

Nerve growth factor (NGF) plays a critical role in both physiological and pathological conditions. Their biological effects are mediated by two receptors (NGF-R): TrkA and p75. We previously reported NGF and NGF-R overexpression in various renal disorders. The aim of the study was to determinate NGF levels and NGF-R expression in peripheral blood mononuclear cells from subjects affected by glomerulonephritis (GN) and by end-stage renal disease before and after hemodialysis (HD). We enrolled 48 patients with biopsy-proven diagnosis of GN and 16 patients undergoing chronic HD. 25 subjects were enrolled as controls (C). Quantification of NGF in the serum samples was performed using NGF immunoassay. We demonstrated, for the first time, an increased NGF concentration in GN and HD patients compared to C. HD is able to restore serum NGF concentration. In GN, TrkA is overexpressed, whereas p75 did not show any difference versus C. By contrast in HD, TrkA expression is associated with increased p75 levels. In conclusion, NGF can act as protective factor against cytotoxic injuries. p75 plays a role in both survival and death of cells, depending on absence of ligand, cytoplasmic/ligand interaction and interaction with TrkA. The present findings suggest that cell survival during cellular damage is dependent on co-expression of TrkA and p75 and independent of NGF concentration. Further studies are required to confirm these observations.
Renal Viability Evaluated by the Multiprobe Assembly: A Unique Tool for the Assessment of Renal Ischemic Injury
Authors: Luger-Hamer Merav , Barbiro-Michaely Efrat , Sonn Judith , Mayevsky Avraham
Published: December 2008

Background: One of the major causes of transplanted organs’ dysfunction is ischemia-reperfusion injury, where mitochondrial dysfunction is the primary contributor to cell damage. Mitochondrial NADH fluorescence reliably describes intracellular oxygen deficiency and mitochondrial function. Therefore, its monitoring at the tissue level, together with other physiological parameters, can serve to evaluate tissue vitality. Methods: The multiprobe assembly (MPA) enabled the assessment of renal blood flow (RBF) using laser Doppler flowmetry, mitochondrial NADH redox state using the fluorometric technique, and ionic homeostasis using specific mini-electrodes (K+ and H+). The MPA was utilized in two rat groups in which ischemia was induced for a period of 25–30 min (group 1) or for 60 min (group 2), and RBF and NADH were also monitored in a group of rats that underwent a complete kidney ischemia 24 h before the monitoring – a well-known model of acute renal failure. Results: During ischemia, the RBF was completely abolished, NADH and extracellular potassium levels increased, and extracellular pH decreased. Immediately after the reperfusion, full recovery was observed; however, in the rats undergoing 60-min ischemia followed by 24-hour reperfusion, the tissue hemodynamic and mitochondrial functions were significantly impaired. Conclusion: This study demonstrates the advantage of using the MPA for real-time evaluation of kidney physiological state, which may serve as a practical instrument for the evaluation of graft viability during transplantation procedures.
A Comparison of the Predictive Performance of Different Methods of Kidney Function Estimation in a Well-Characterized HIV-Infected Population
Authors: Barraclough Katherine , Er Lee , Ng Francisco , Harris Marianne , Montaner Julio , Levin Adeera
Published: December 2008

Background: Glomerular filtration rate (GFR) estimation equations have never been validated in the HIV population. This pilot study aimed to compare all currently available methods of kidney function assessment with nuclear GFR in HIV-infected adults. Methods: Patients underwent GFR measurement with 99mTc-diethylenetriaminepentaacetic acid (Tc-99m Pentetate), and measured values were compared with results of creatinine-based estimation equations [abbreviated 4-variable Modification of Diet in Renal Disease (MDRD) formula and Cockcroft-Gault (CG) formulae], 24-hour urine creatinine clearance and estimated cystatin C GFR. Results: Twenty-seven HIV-infected adults were studied. Most were male and Caucasian, with a mean age of 52 years. Median CD4 was 290 cells/mm3, 70% of patients had HIV RNA <50 copies/ml and all were receiving highly active antiretroviral therapy (median 5 drugs). Median Tc-99m Pentetate-GFR was 91 ml/min/1.73 m2. Despite greater bias and similar accuracy, the MDRD formula was more precise than the CG formula, regardless of whether CG estimations were corrected for ideal body weight or body surface area. Relative accuracy within 30% of nuclear GFR was greater for the MDRD formula than for all other methods. The performance of 24-hour urine creatinine clearance was similar to that of the MDRD formula for patients with GFR <90 ml/min/1.73 m2, although it performed less well at higher GFR. The performance of cystatin C GFR was inferior to that of all the creatinine-based methods. Conclusions: While no method of kidney function estimation performed highly, both 24-hour urine creatinine clearance and the MDRD formula performed with a level of precision and accuracy sufficient for clinical decision making. Our findings support the preferential use of the MDRD formula in the treated HIV population and suggest that there are no HIV-specific factors that limit equation applicability. Larger validation studies are needed to confirm our findings and allow generalization to the HIV population at large.
Modulation of Group III Metabotropic Glutamate Receptors by Hydrogen Ions
Authors: Levinthal Cynthia , Barkdull Lisa , Jacobson Pam , Storjohann Laura , Van Wagenen Bradford C. , Stormann Thomas M. , Hammerland Lance G.
Published: December 2008

Protons act as neuromodulators and produce significant effects on synaptic transmission. The molecular basis of neuromodulation by extracellular protons is partially explained by their effects on certain neurotransmitter receptors and ion channels. The metabotropic glutamate receptors (mGluRs) are a family of eight receptor subtypes that are widely expressed throughout the mammalian CNS. In this study, the effects of physiologically relevant changes in extracellular pH were examined in mammalian cells expressing the mGluR subtypes: human mGluR1a, mGluR4a, mGluR5d or mGluR8b. The signal transduction coupling properties of mGluR4a and mGluR8b were switched from the adenylate cyclase (Gi) pathway to the phospholipase C (Gq) pathway by coexpression of a promiscuous G protein. Fluorometric imaging plate reader was used to measure changes in cytoplasmic calcium concentrations in response to agonist. Extracellular acidification from pH 8.0 to pH 6.5 progressively diminished mGluR4 responsiveness to the agonists L-glutamate and (2S,1′S,2′R)-2-(carboxycyclopropyl)glycine (L-CCG-I), and this inhibition was characterized by insurmountable antagonism. By comparison, extracellular acidification did not significantly alter mGluR8 responses to agonists. Furthermore, agonist activation of mGluR1a and mGluR5d was virtually unaffected by changes in pH. Because mGluR4 is expressed presynaptically and its activation inhibits the release of neurotransmitters such as glutamate and GABA, we propose that the net effect of proton inhibition of mGluR4 would be to reverse or prevent that suppression of neurotransmitter release. As such, local decreases in pH could have significant effects on the regulation of transmitter release and synaptic tone via modulation of mGluR4.
Retrograde Ethanol Infusion in the Vein of Marshall
Authors: Valderrábano Miguel , Chen Harvey R. , Sidhu Jasvinder , Rao Liyun , Ling Yuesheng , Khoury Dirar S.
Published: December 2008

Background—

The vein of Marshall (VOM) is an attractive target during ablation of atrial fibrillation because of its autonomic innervation, its location anterior to the left pulmonary veins, and its drainage in the coronary sinus.

Methods and Results—

We studied 17 dogs. A coronary sinus venogram showed a VOM in 13, which was successfully cannulated with an angioplasty wire and balloon. In 5 dogs, electroanatomical maps of the left atrium were performed at baseline and after ethanol infusion in the VOM, which demonstrated a new crescent-shaped scar, extending from the annular left atrium toward the posterior wall and left pulmonary veins. In 4 other dogs, effective refractory periods (ERP) were measured at 3 sites in the left atrium, before and after high-frequency bilateral vagal stimulation. The ERP decreased from 113.6�35.0 to 82.2�25.4 ms (
P
<0.05) after vagal stimulation. After VOM ethanol infusion, vagally-mediated ERP decrease was eliminated (from 108.6�24.1 to 96.4�16.9 ms,
P
=NS). The abolition of vagal effects was limited to sites near the VOM (ERP, 104�14 versus 98.6�12.2 ms postvagal stimulation;
P
=NS), as opposed to sites remote to VOM (ERP, 107.2�14.9 versus 78.6�14.7 ms postvagal stimulation;
P
<0.05). To test feasibility in humans, 6 patients undergoing pulmonary vein antral isolation had successful VOM cannulation and ethanol infusion; left atrial voltage maps demonstrated new scar involving the inferoposterior left atrial wall extending toward the left pulmonary veins.

Conclusions—

Ethanol infusion in the VOM achieves significant left atrial tissue ablation, abolishes local vagal responses, and is feasible in humans.
Cardiac Mechanics Revisited
Authors: Buckberg Gerald , Hoffman Julien I.E. , Mahajan Aman , Saleh Saleh , Coghlan Cecil
Published: December 2008

The keynote to understanding cardiac function is recognizing the underlying architecture responsible for the contractile mechanisms that produce the narrowing, shortening, lengthening, widening, and twisting disclosed by echocardiographic and magnetic resonance technology. Despite background knowledge of a spiral clockwise and counterclockwise arrangement of muscle fibers, issues about the exact architecture, interrelationships, and function of the different sets of muscle fibers remain to be resolved. This report (1) details observed patterns of cardiac dynamic directional and twisting motions via multiple imaging sources; (2) summarizes the deficiencies of correlations between ventricular function and known ventricular muscle architecture; (3) correlates known cardiac motions with the functional anatomy within the helical ventricular myocardial band; and (4) defines an innovative muscular systolic mechanism that challenges the previously described concept of “isovolumic relaxation.” This new knowledge may open new doors to treating heart failure due to diastolic dysfunction.
When Staff Create the Organisational Culture
Authors: Rey Pino Juan M. , Gardey Gonzalo Sánchez , Hagen Ingunn
Published: December 2008

Emergency units suffer from continuous overload because all types of users demand the service. The literature shows that in general, the percentage of non-urgent users varies from 20 per cent to 80 per cent, depending on the type of centre analysed, the research approach or the methodology. While some studies have analysed this phenomenon focusing on the users, the current research adopts a different perspective. In this article, we try to explain how the break-down in the emergency services affects the work that the staff do. Drawing on evidence obtained from a six-month ethnographic study in two Spanish public hospitals, we conclude that in this overloaded context, official definitions of emergencies and formal classification protocols are completely useless. Exploring the staff's perceptions about the users and the service itself we try to re-create the process by which the diverse health care workers informally re-define symbols, concepts and behaviour patterns, creating a specific internal culture that helps them cope with the complexity of the service and the excessive demand.
Patient Safety, Knowledge Creation and the Absorptive Capacity of Rural Hospitals
Authors: Godkin Lynn , Adcock Madeline , Duva Tara , Verrett Debbie , Godkin Jennie
Published: December 2008

Patient safety is a priority issue in health care and rural hospitals face unique circumstances in this arena. This article applies the concepts of organisational learning in general and absorptive capacity in particular to the efforts by rural hospitals to continuously improve patient safety performance. Strategies are discussed through which rural hospitals might better identify patient safety related information, techniques and technologies and convert them to organisational use.
Is Lifestyle Influencing Morbidity among Elderly?
Authors: Mutharayappa R. , Bhat T.N.
Published: December 2008

The main focus of the article was to examine the type of lifestyle adopted by the elderly and its effects on their health conditions and this was based on the data available from the National Family Health Survey–2 (NFHS–2). The study found that lifestyle adversely affected health and increased morbidity conditions among the elderly. Lifestyles such as alcohol consumption, regular smoking and tobacco chewing had adverse effects on one's ability to control diseases. It was observed that asthma was higher among the elderly who smoked regularly, consumed alcohol and chewed tobacco. About 144 persons per 1,000 population who consumed alcohol were suffering from asthma. Similarly, 143 persons who smoked regularly and 97 persons who chewed tobacco were suffering from asthma. Though TB was related to the lifestyle of a person, it was less among tobacco chewers and alcohol drinkers, but it was higher among those who smoked regularly. Smoking led to higher Illness Prevalence Rate (IPR). The IPRs of smokers and non-smokers by age group showed that in every age group, smokers had higher IPR than the non-smokers. The increase in prevalence of illness among smokers was particularly high in the case of the elderly. Old people were also generally susceptible to various cardiovascular disorders and other extraneous factors such as consumption of alcohol and tobacco chewing. The elderly morbidity due to alcohol abuse was 8.6 per cent.
Translation of the Philadelphia chromosome into therapy for CML
Authors: Druker Brian J.
Published: December 2008

Throughout its history, chronic myeloid leukemia (CML) has set precedents for cancer research and therapy. These range from the identification of the first specific chromosomal abnormality associated with cancer to the development of imatinib as a specific, targeted therapy for the disease. The successful development of imatinib as a therapeutic agent for CML can be attributed directly to decades of scientific discoveries. These discoveries determined that the BCR-ABL tyrosine kinase is the critical pathogenetic event in CML and an ideal target for therapy. This was confirmed in clinical trials of imatinib, with imatinib significantly improving the long-term survival of patients with CML. Continuing in this tradition of scientific discoveries leading to improved therapies, the understanding of resistance to imatinib has rapidly led to strategies to circumvent resistance. Continued studies of hematologic malignancies will allow this paradigm of targeting molecular pathogenetic events to be applied to many additional hematologic cancers.
Stem cell concepts renew cancer research
Authors: Dick John E.
Published: December 2008

Although uncontrolled proliferation is a distinguishing property of a tumor as a whole, the individual cells that make up the tumor exhibit considerable variation in many properties, including morphology, proliferation kinetics, and the ability to initiate tumor growth in transplant assays. Understanding the molecular and cellular basis of this heterogeneity has important implications in the design of therapeutic strategies. The mechanistic basis of tumor heterogeneity has been uncertain; however, there is now strong evidence that cancer is a cellular hierarchy with cancer stem cells at the apex. This review provides a historical overview of the influence of hematology on the development of stem cell concepts and their linkage to cancer.
Religion and Political Economy in Early-Nineteenth-Century France
Authors: Faccarello Gilbert , Steiner Philippe
Published: December 2008

There was in early-nineteenth-century France a widespread revival of religious sentiment, after the turmoil of the Revolution and the intellectual onslaught on religion so central to the French Enlightenment. Simultaneously, political economy became more prominent among “publicists”—educated people or theoreticians writing as journalists—and political elites. These two developments influenced those who sought to modernize society and who in their different ways expressed a new approach known as industrialisme. These writers put forward several versions of the links that should exist in industrial society between political economy and religion.

A truly a-religious political economy based on self-interested behavior and utilitarianism, such as the one presented in Jean-Baptiste Say's writings, gained acceptance for most people interested in the “new” science. This point of departure is important not only because Say's thought became a major reference for the different conceptions of industrialisme but also because it provided a utilitarian evaluation of religious institutions and feelings.

Some other conceptions of industrialisme can be found in the leading members of two distinct schools of thought: the Groupe de Coppet, with Germaine de Staël and Benjamin Constant; and the less homogeneous group formed by Claude-Henri Saint-Simon, the Saint-Simonians, and Auguste Comte. Both approaches presumed that self-interest was incapable of uniting the social body and emphasized religious feelings to explain how societies could function harmoniously.

We examine how Staël and Constant dealt with these issues and how, while they accepted the principle of competition in economic activity, their conception of the specific nature of liberty in a modern society led them to a critique of utilitarianism and morals based on interest and also to the idea that the harmonious functioning of industrial society requires a morality based on religion.

We then study how industrialisme was modified to fit the views of modern society held by Saint-Simon, the Saint-Simonians, and Comte. Political and civil liberty was not a central matter for these writers. Instead, they favored the creation of organizations capable of regulating a chaotic social order, and in this perspective new forms of religion were given a prominent place, specifically formed to suit the industrial social order and based on philanthropy or altruism.

In the conclusion we briefly note that, after all such criticism, some leading liberal economists reacted in defense of political economy and developed their own conceptions of the links between economics and religion: they rejected the idea of the necessity of a new religion and insisted instead on traditional Catholic ideas. As a result, political economy and religion were conceived as two pillars of a conservative order following the rise of socialist ideas.
The Changing Theological Context of Economic Analysis since the Eighteenth Century
Authors: Waterman A. M. C.
Published: December 2008

Economic analysis (as we understand the term today) first appeared in France at the end of the seventeenth century as a consequence of Jansenist theodicy. Throughout the eighteenth century, political economy (the study of wealth, and not to be confused with economic analysis) was supposed to be compatible with Christian belief and of service to Newtonian natural theology. This changed suddenly in 1798. Thomas Robert Malthus's first Essay inaugurated “economics” (the study of scarcity), seemingly incompatible with the Christian religion. Richard Whately's distinction between “scientific” and “religious” knowledge protected each from the other for a while. But Charles Darwin's evolutionary theory seemed to destroy that distinction, and so to discredit religion and theology. A variety of strategies for relating economics to theology has been adopted since that time by those economists who wish to remain religious believers.
“A Hard Battle to Fight”: Natural Theology and the Dismal Science, 1820–50
Authors: Maas Harro
Published: December 2008

William Whewell's and Richard Jones's criticism of Jeremy Bentham's and David Ricardo's “dismal” views on the relation of theory and evidence in political economy was motivated by the former's views on the structuring role of natural theology for questions of method and evidence in the sciences, including political economy. In comparison, natural theology was for Richard Whately as structuring on these issues as it was for the Cambridge men. Whately's view on natural theology, however, conformed with the Ricardian predilection for theory over facts. The differences between the Cambridge men and Whately became manifest after (or better: during) the publication of Jones's book on rent in 1831 and led to a somewhat acerbic exchange of views on the role of definitions in science and the use of history for establishing scientific evidence. As far as political economy was concerned, Whately's stance carried the day in Victorian England.
From Religious Revivals to Tariff Rancor: Preaching Free Trade and Protection during the Second American Party System
Authors: Meardon Stephen
Published: December 2008

The religious awakening of the early-nineteenth-century United States opened deep rifts in the generation that overlapped and followed it. The rifts emerged from questions of religious doctrine and evangelical method, then widened to encompass worldly politics and ideologies, including the tariff. Two authors and advocates who represent well the religious influence on the U.S. tariff controversy are the Reverend Joshua Leavitt (1794–1873) and the Reverend Calvin Colton (1789–1857). Both were swept up in the religious revivals of the 1820s, and both became, over the following two decades, leading contributors to the second party system's debates over slavery and the tariff. Their contributions to the tariff debate were to conjoin the arguments for free trade and protection, within and on the periphery of the Whig Party, to their religiously inspired views about the abolition of slavery.
Mobile Homes, Fallen Furniture, and the Dickens Cure
Authors: Ellison David A.
Published: December 2008

From the beginning of his career, Dickens conceived of the home and in particular the hearth as the reception point for his distinctive narrative transmissions. The relationship between writer and reader was imagined in terms of the most intimate and residentially entrenched exchanges even while Dickens contemplated the very profitable consequences of mass proliferation. In order to contextualize Dickens's entrenchment, this essay explores the means by which he fostered an aesthetic of domestic reception. Here the hearth is seen in lights both familiar and unfamiliar, as source and symbol of Victorian virtue, but also as an integral component of a discursive ensemble integrating reader, furnishings, and architecture. In novels like Dombey and Son, Dickens considers the vexing problem of domestic disquiet—the noisy and volatile insecurity of the middle classes at home—while offering a respite, a cure that briefly bound rapt readers to their chairs.
At Home with the Other Victorians
Authors: Marcus Sharon
Published: December 2008

Homosexuality and domesticity are both considered eminently Victorian, yet both are also considered to have been mutually exclusive during the nineteenth century. Scholars have conceptualized domesticity as an ideology that made the heterosexual family normative and homosexuality as a form of sexual dissidence opposed in every way to the social forms enshrined by domestic ideology. This essay explores what comes into view if we theorize domesticity as a class privilege with no necessary relationship to heterosexual marriage. By identifying gender-neutral facets of domesticity, such as interiority, privacy, aestheticism, and sentiment, the essay makes it possible to think about the domestic attachments and longings of individuals and couples outside the heterosexual norm. The examples include novels by George Moore, Eliza Linton, and Rhoda Broughton; the anonymous pornographic work Teleny; the memoirs of John Addington Symonds; and historical figures such as Charles Ricketts and Charles Shannon, Michael Field, and Ernest Boulton and Frederick Park.
Domestic Phantasmagoria: The Victorian Literary Domestic and Experimental Visuality
Authors: Groth Helen
Published: December 2008

In the first section of her Autobiography, Harriet Martineau recollects the first eight years of her life as a series of traumatic events in which illusion and reality merge. One event is prompted by an encounter with a domestic magic lantern. In its dismantled state, the lantern holds no mysteries for her. She recalls seeing it cleaned by daylight, handling all its parts, and “understanding its whole structure.” It was a different story at night, in a darkened room, when “my panics were really unaccountable. They were a matter of pure sensation without any intellectual justification whatever, even of the wildest kind.... such was my terror of the white circle on the wall, and of the moving slides.” Using Martineau's anecdote as a starting point, this essay considers the ways in which optical devices became an integral part of the “sensory structuring of experience” in the Victorian home, cultivating an active skepticism, effectively functioning as “furniture-to-think-with,” to quote Barbara Stafford. In this context, domestic space becomes integrated into an experimental process that tests the limits of the visual and introduces an element of doubt into the psychic structure of belief. This cultivated speculative mentality is both replicated and reinforced by Victorian literary narrative's structural and thematic illumination of the constructed nature of the real, down to its most banal everyday manifestations.
Home Truths: Some Notes on Radical America, 1637 to the Present
Authors: Thomson David Ker
Published: December 2008

Faced with the looming captivity of the formal archive in the late 1930s, Sigmund Freud consigned his most important work—the story of the unconscious rise of Mosaic doctrine that underwrote the West—to a secret archive, itself a sort of unconscious. “Where do we meet with a similar phenomenon?” Freud asked. This essay answers that question. Where else but America? In the late 1630s, the story of Anne Hutchinson's orthodoxy was consigned to a secret archive as the radicals came to power. We continue to radically misread Hutchinson and our past in part because the revolution of the 1630s was so successful. America's “Puritan” lettered city was never particularly Calvinist, religious, nor conservative, but emerged as an ongoing state of exception, marked by a kind of mosaic of secular, industrializing instincts under a pretense of Calvinism. This America radicalized the world, and it's a truth that can hit home almost anywhere.