bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood Pressure Control in the Patient With Difficult‐to‐Control Hypertension: Which Agent for Which Patient?
Authors: Bakris George L. , Sowers James R. , Ferdinand Keith C.
Published: February 2008

On November 16, 2007, an expert panel was convened to discuss the patient with difficult‐to‐control hypertension. The panel was moderated by George L. Bakris, MD, from the University of Chicago in Chicago, IL. Discussants included James R. Sowers, MD, from the University of Missouri, Columbus, MO, and Keith C. Ferdinand, MD, from Emory University and the Association of Black Cardiologists, Atlanta, GA. This expert panel discussion was supported by Boehringer Ingelheim, and each author received an honorarium from Boehringer Ingelheim for time and effort spent participating in the discussion and reviewing the transcript for intellectual content before publication. The authors maintained full control of the discussion and the resulting content of this article.
Predictors of Blood Pressure Response to Angiotensin Receptor Blocker/Diuretic Combination Therapy: A Secondary Analysis of the Irbesartan/Hydrochlorothiazide Blood Pressure Reductions in Diverse Patient Populations (INCLUSIVE) Study
Authors: Saunders Elijah , Cable Greg , Neutel Joel
Published: February 2008

The secondary analysis of the Irbesartan/Hydrochlorothiazide Blood Pressure Reductions in Diverse Patient Populations (INCLUSIVE) clinical trial investigated whether baseline demographic and clinical variables are predictive of different degrees of blood pressure reduction following an angiotensin II receptor blocker/diuretic treatment regimen. Irbesartan/hydrochlorothiazide and other angiotensin receptor blocker combinations with a diuretic have been shown to be effective in reducing systolic blood pressure in a diverse patient population previously uncontrolled on monotherapy. Ordinary least squares regression analysis was performed on the intent‐to‐treat population of the INCLUSIVE study to identify variables predictive of variations in blood pressure changes in response to irbesartan/hydrochlorothiazide combination therapy. Higher baseline systolic blood pressure, female sex, type 2 diabetes, and statin therapy were found to be predictive of additional blood pressure lowering with this combination. The impact of higher baseline systolic blood pressure and diabetic state on changes in systolic blood pressure were diminished in female patients compared with male patients. In conclusion, a significant correlation may exist between certain clinical/demographic characteristics and the extent of the therapeutic response with irbesartan/hydrochlorothiazide treatment.
Aortic Dissection and Third‐Degree Atrioventricular Block in a Patient With a Hypertensive Crisis
Authors: Lionakis Nikolaos , Moyssakis Ioannis , Gialafos Elias , Dalianis Nikolaos , Votteas Vassilios
Published: February 2008

A 55‐year‐old man with a history of uncontrolled hypertension was admitted because of an episode of severely elevated blood pressure. An electrocardiogram revealed complete atrioventricular block while imaging showed a dissecting aneurysm of the descending thoracic and abdominal aorta, type B according to the Stanford classification. Laboratory tests revealed significant increases in serum C‐reactive protein. Coronary arteriography was performed and was negative for coronary artery disease. A VDD pacemaker was placed, and a combination of 4 antihypertensive agents was used as treatment. Type B aortic dissection may present with a wide range of manifestations. The authors suggest that measurement of C‐reactive protein may be used in hypertensive patients to help reflect vascular injury and its degree, progression, and prognosis. Disorders of intraventricular conductivity are rarely seen in both types of dissection of the aorta (type A, B). Atrioventricular conductivity disorders that result in complete atrioventricular block have been reported only in patients with type A dissection (before the bifurcation of the subclavian artery). In this particular case, however, the authors diagnosed an atrioventricular conductivity disorder causing atrioventricular block in a patient with type B dissection. Consequently, the authors speculate that myocardial fibrosis, as a result of long‐standing hypertension, could be the main pathogenetic mechanism leading to the development of such phenomena, resulting from a potential expanding of the fibrotic process to the atrioventricular conduction system.
History of Gestational Hypertension Is Associated With the Metabolic Syndrome and Masked Hypertension But Not Arterial Stiffness in Women With Essential Hypertension
Authors: Mahmud Azra , Jatoi Mehnaz , Chee Yei Roi , Feely John
Published: February 2008

The underlying mechanisms of subsequent increased risk of cardiovascular disease with a history of gestational hypertension (GH) are not known. Untreated hypertensive women (n=155, age 43±1 years) underwent ambulatory blood pressure (BP) monitoring and assessment of aortic pulse wave velocity (PWV) and augmentation index (AIx). Despite identical clinic BP readings, the group of women with GH (n=54) had higher (P=.002) ambulatory daytime systolic BP levels and a greater number of extreme nocturnal dippers (P=.005) than the group without GH. Women with GH had higher body mass index (P=.003), greater waist circumference (P=.02), higher levels of triglycerides (P=.002), lower levels of high‐density lipoprotein cholesterol (P=.004), a higher prevalence of the metabolic syndrome (P<.05) and microalbuminuria (P=.004), higher plasma renin activity (P=.03), and higher aldosterone levels (P=.01). There was no significant difference in PWV and AIx between the 2 groups. The higher prevalence of the metabolic syndrome, microalbuminuria, masked hypertension, and activation of the renin‐angiotensin‐aldosterone system but not arterial stiffness may explain the subsequent propensity to high BP and cardiovascular disease in women with GH.
The Treatment of Hypertension in the Elderly
Authors: Moser Marvin , Cushman William C. , Ziegler Michael G.
Published: February 2008

Following a hypertension symposium in San Francisco in September 2007, an expert panel was convened to discuss the treatment of hypertension in the elderly. Based on recent data, new recommendations may be indicated. The session was moderated by Marvin Moser, MD, Clinical Professor of Medicine at Yale University, New Haven, CT. Participants were William Cushman, MD, Professor of Preventive Medicine and Medicine at the University of Tennessee in Memphis, and Michael Ziegler, MD, Professor of Medicine, University of California at San Diego. The discussion was supported by Novartis Pharmaceuticals and Merck & Company, and each author received an honorarium from Novartis Pharmaceuticals and Merck & Company for time and effort spent participating in the discussion and reviewing the transcript for intellectual content before publication. The authors maintained full control of the discussion and the resulting content of this article.
What Factors Contribute to the Inadequate Control of Elevated Blood Pressure?
Authors: Elliott William J.
Published: February 2008

Inadequate control of blood pressure may be attributed to both provider‐related and patient‐related factors. Health care provider‐related factors may include an excessive reliance on monotherapy and reluctance to increase drug doses or add additional antihypertensive agents to the treatment regimen. The primary patient‐related factor is nonadherence with the prescribed antihypertensive medication. Although the high cost of therapy is sometimes a reason for poor adherence, drug side effects or dosing considerations may be more important factors. Better adherence with antihypertensive medication is associated with a significantly greater likelihood of achieving blood pressure control and, consequently, with lower costs and reduced utilization of health care resources. Therefore, strategies that improve long‐term adherence should be adopted. Single‐pill, or fixed‐dose, combination therapy is one approach that improves adherence, while also providing the antihypertensive efficacy needed to help patients achieve their blood pressure goals.
Risk‐Based Classification of Hypertension and the Role of Combination Therapy
Authors: Weir Matthew R.
Published: February 2008

The recognition of a continuous relationship between elevated blood pressure (BP) and cardiovascular risk has influenced national and international guidelines for the classification, prevention, and management of hypertension. The most recent report (2003) of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure uses BP thresholds to define categories of normal, prehypertension, and hypertension. A new definition proposed by the Hypertension Writing Group in 2005 offers an approach to diagnosis and management based on global or total risk. Thus, even in the absence of sustained elevations in BP, patients may have a moderate to high risk of vascular events due to the presence of additional cardiovascular risk factors, disease markers, and target organ damage. The 2007 European guidelines continue to classify hypertension based on cutoffs while also placing emphasis on multivariate formulations for cardiovascular risk assessment and goals of therapy. All 3 sets of guidelines acknowledge the necessity of using ≥2 antihypertensive agents to attain BP goals in many patients.
Prompt, Aggressive BP Lowering in High‐Risk Patients
Authors: Jamerson Kenneth A. , Basile Jan
Published: February 2008

Various populations with hypertension have been singled out by current treatment guidelines as requiring more specific treatment. These include patients with stage 2 hypertension, black patients, and patients with coexistent diabetes mellitus and coronary heart disease. Hypertension in these groups is often associated with higher risk of cardiovascular morbidity and mortality. This article reviews current knowledge regarding hypertension in high‐risk patient populations, with a particular focus on the importance of prompt, aggressive treatment to lower blood pressure and prevent cardiovascular disease progression. Such treatment includes the early use of multiple‐drug therapy with agents that have complementary blood pressure‐lowering mechanisms and provide protection from target organ damage. While 2‐ or 3‐drug antihypertensive therapy in these high‐risk groups has typically included a diuretic, other combinations of agents may be indicated. Evidence suggests that therapy with a calcium channel blocker and an inhibitor of the renin‐angiotensin system is one effective strategy for lowering blood pressure and improving outcomes in these populations.
Joint Effects of Adiposity and Physical Activity on Incident Mobility Limitation in Older Adults
Authors: Koster Annemarie , Patel Kushang V. , Visser Marjolein , Van Eijk Jacques Th. M. , Kanaya Alka M. , De Rekeneire Nathalie , Newman Anne B. , Tylavsky Frances A. , Kritchevsky Stephen B. , Harris Tamara B. ,   for the Health, Aging and Body Composition Study
Published: February 2008

OBJECTIVES: To examine joint associations of physical activity and adiposity measures (body mass index (BMI), waist circumference, percentage body fat) with incident mobility limitation.

DESIGN: Prospective observational cohort study.

SETTING: Memphis, Tennessee and Pittsburgh, Pennsylvania.

PARTICIPANTS: Two thousand nine hundred and eighty‐two black and white men and women aged 70 to 79 participating in the Health, Aging and Body Composition (Health ABC) study.

MEASUREMENTS: Mobility limitation was defined as reported difficulty walking one‐quarter of a mile or climbing 10 steps during two consecutive semiannual assessments over 6.5 years. Three measures of adiposity were included in this study: BMI, total percentage body fat, and waist circumference. Physical activity was assessed using a modified leisure‐time physical activity questionnaire.

RESULTS: Forty‐six percent of the cohort developed mobility limitation. White and black men with a high BMI (≥30 kg/m2), high total percentage body fat (>31.3%), or high waist circumference (≥102 cm) had an approximately 60%, 40%, and 40%, respectively, higher risk of incident mobility limitation than those with low adiposity. In women, high adiposity was also associated with a significantly higher mobility limitation risk than in those with low adiposity. Low physical activity (lowest quartile) was associated with a 70% higher risk of mobility limitation in all groups. Persons with high adiposity and low physical activity were at particularly high risk of mobility limitation. People with high adiposity who were physically active had an equally high risk of mobility limitation as inactive people with low adiposity.

CONCLUSION: High adiposity and low self‐reported physical activity predicted the onset of mobility limitation in well‐functioning older persons. Preventing weight gain in old age and promoting physical activity in obese and non‐obese older persons may therefore be effective strategies to prevent mobility loss and future disability.
Ventricular Metastasis without Atrial or Caval Involvement: A Rare Presentation
Authors: Satpathy Ruby , Lynch Joseph , Mohiuddin Syed M.
Published: February 2008

Right ventricular metastases from renal cell carcinoma without inferior vena cava (IVC) or right atrium involvement are rare. We discuss a 44‐year‐old male who presented with a left thigh mass, which was resected and the pathology revealed an epithelial sarcoma or a possible metastasis from another organ. His preradiotherapy cardiac evaluation showed mass in the right and left ventricles, which was confirmed by transesophagial echocardiogram. Computed tomography revealed a right renal mass in addition to the ventricular masses without any involvement of IVC or the atria. The patient underwent right radical nephrectomy without complications and systemic chemotherapy with interleukin‐1 for metastatic renal cell carcinoma. He is doing well and follow‐up echocardiogram showed significant reduction in the size of the cardiac metastases, even without surgical resection of these tumors. Thus, our article presents this unique case of asymptomatic ventricular metastases of renal cell carcinoma without any atrial or caval involvement and provides a new insight into the management of this syndrome.
Tacrolimus in Dermatology—Pharmacokinetics, Mechanism of Action, Drug Interactions, Dosages, and Side Effects: Part I
Authors: Sehgal Virendra N. , Srivastava Govind , Dogra Sunil
Published: February 2008

The advent of tacrolimus at the end of the preceding century in the armamentarium of atopic dermatitis management was hailed as a breakthrough advance. It was, therefore, thought worthwhile to precisely review its origin and mechanism of action. Its topical application in the form of 0.03% to 0.1% ointments is rapidly effective and safe in pediatric and adult patients. Its use in atopic dermatitis ever since has been approved in Japan, the United States, Europe, and the Indian subcontinent. Thus, its local immunosuppressive action was fairly intriguing. Accordingly, its indications/uses were extended to cover several inflammatory dermatoses. Vitiligo, psoriasis, alopecia areata, contact hypersensitivity, lichen planus, pyoderma gangrenosum, ichthyosis linearis circumflexa, and skin grafting/transplant are a few unapproved indications and uses, in addition to miscellaneous dermatoses. At present, its therapeutic efficacy other then atopic dermatitis is confined to case studies, and large studies are warranted. At this point in time, therefore, it is conceivable that tacrolimus use should be carefully evaluated and used only when the conventional treatment has failed to yield favorable results. It deserves sizable caution for use in various dermatologic conditions pending its long‐term safety and efficacy data in large patient populations.
Dermatofibroma on the Palmar Surface of the Hand
Authors: Gencoglan Gulsum , Karaarslan Isil Kilinc , Dereli Tugrul , Kazandi Ali Can
Published: February 2008

Case 1: A 58‐year‐old man presented with a solitary asymptomatic nodule on his thumb (Figure A). After trauma with a rusty nail approximately 20 years ago, he had developed a small papule, which had enlarged gradually for a few days initially before stabilizing. His personal and family medical histories were unremarkable. Dermatologic examination revealed a 1‐cm crater‐like nodule on the left palmar area. This was a firm and nontender lesion that was fixed to the overlying skin but moved freely from underlying structures. There were no similar lesions elsewhere on his body. Case 2: A 52‐year‐old man presented with a nodular lesion on the left palmar surface of his thumb. The 0.8‐cm lesion was lightly colored, with a central cup‐shaped epidermal depression and thin epidermis. The patient described an insect bite to the area 15 years earlier as the precipitating event. The firm and nontender lesion was fixed to the overlying skin but moved freely from underlying structures (Figure B). Case 3: A 36‐year‐old man consulted for a nodular lesion, located on his left palmar surface, that had not enlarged or changed since appearing 3 years ago. He described mechanical trauma to the area as precipitating the lesion. Clinical examination revealed a 0.6‐cm, well‐circumscribed nodule, with a dome shape and colored skin. Clinically, the nodular lesion appeared to be a benign tumor (Figure C). In each case, the nodule was excised totally and histopathologic examination revealed a well‐circumscribed, nonencapsulated nodule within the mid‐dermis. Thick, acellular collagen bundles were arranged randomly in short fascicles through the center of the lesion. Cellular areas consisting of histiocytes and fibroblasts with a storiform pattern at the periphery of lesion were observed, but nuclear atypia and mitotic activity were not. Results of immunohistochemical stain with CD34 were negative, but in all cases were strongly positive for Factor XIIIa. Slight epidermal hyperplasia was present with orthokeratotic hyperkeratosis and flattened rete ridges in the overlying epidermis (Figure A‐1, Figure B‐1, Figure C‐1). The subcutaneous fat and adjacent skin were normal. No folliculosebaceous units at the periphery of the lesion were seen, but a few eccrine sweet glands were noted. No recurrence appeared in 18 months of follow‐up.

(A‐C) Palmar dermatofibromas. (A‐1–C‐1) Sections show thick, cellular collagen bundles arranged randomly in short fascicles through the center of each lesion; other cellular areas consist of histiocytes and fibroblasts with a storiform pattern at the lesion periphery (hematoxylineosin stain, original magnification ×100).

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An Unusual Presentation of Mucous Membrane Pemphigoid
Authors: De Dipankar , Dogra Sunil , Saikia Uma Nahar , Kanwar Amrinder Jit
Published: February 2008

A 68‐year‐old woman presented with recurrent mucocutaneous blisters of 6 years' duration and progressive loss of scalp hair of 2 years' duration. The disease had started as tense blisters associated with a burning sensation over the lower part of her back, gradually followed by involvement of her chest, upper part of her back, and arms. The blisters persisted for weeks before rupturing spontaneously. Four years later, she developed tense oral blisters, resulting in painful persistent erosions. At about the same time, blisters on her scalp developed, followed by erosions and hair loss. No other mucosal sites were involved. She had no symptoms of photosensitivity, joint pain, dysphagia, weight loss, or other systemic complaints. On examination, multiple tense bullae and well‐defined deep erosions were seen over the hard and soft palates (Figure 1). Cutaneous examination revealed a few tense bullae on normal‐looking skin over her abdomen (Figure 2 inset) and arms and areas of scarring at the site of healed lesions on her back. Her scalp had bullae of similar morphology, crusted erosions, and cicatricial alopecia at the site of previous lesions involving a large area of scalp (Figure 2). Examination of the other mucosae did not reveal any abnormality. Histologic studies with hematoxylin and eosin stain of a skin biopsy specimen revealed deroofed subepidermal bullae with dense dermal inflammatory infiltrate predominantly composed of eosinophils (Figure 3). Direct immunofluorescence of a biopsy specimen from perilesional skin revealed linear deposits of immunoglobulins M and G and of C3 at the dermoepidermal junction which was consistent with mucous membrane pemphigoid. This patient was prescribed prednisolone 30 mg daily and dapsone 100 mg daily, following which there were no new blisters. At 3 months' follow‐up, previous erosions had partially healed.

Tense intact blisters and erosions visible over the hard palate.

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Cicatricial alopecia. Note crusted erosion over the vertex. Inset shows a tense blister over the abdomen.

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Skin biopsy specimen taken from the margin of a blister shows deroofed subepidermal blister with dense eosinophilic infiltrate in the dermis (hematoxylineosin stain, original magnification ×550).

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Pityriasis Rubra Pilaris in a HIV‐Positive Patient (Type 6 PRP)
Authors: De Dipankar , Dogra Sunil , Narang Tarun , Radotra Bishan Dass , Kanwar Amrinder Jit
Published: February 2008

A 45‐year‐old previously healthy man presented with minimally itchy spiny papular lesions of 3 years' duration and discharging nodular cystic lesions for the past 2 years. Initially, lesions appeared on his ears, followed by the gradual appearance of similar lesions over his face, back, and extremities. The lesions were not associated with photosensitivity. Over the years, the patient continued to have similar lesions without any significant response to various topical medications and oral antibiotics. There was no history of fever or any other systemic complaints and the patient denied any other significant medical problems in the past. Cutaneous examination revealed multiple, grouped, spiny papular lesions coalescing to form plaques at places over the ears, extremities, and trunk (Figure 1). Elongated, horny, follicular spires were noted on the top of the papular lesions. Multiple discharging nodular lesions with crusting were seen predominantly over the chest, abdomen, and back (Figure 2), and closed comedonal lesions were noted on the face and trunk. Multiple orange‐brown scaly plaques were seen over the extensor aspect of the patient's thighs (Figure 1, inset). A few nails showed wedge‐shaped thickening without subungual hyperkeratosis or other nail changes. Palms, soles, and oral mucosa were normal. Considering the atypical cutaneous findings, the clinical possibility of pityriasis rubra pilaris (human immunodeficiency virus [HIV]‐associated type 6 PRP) was considered. Hematoxylin and eosin stain of skin biopsy specimens taken from the spiny papular and plaque lesions revealed marked hyperkeratosis with alternating orthokeratosis and parakeratosis with follicular keratotic plugging (Figure 3; Figure 3, inset). Irregular broad acanthosis was also detected in the epidermis. Dermis showed moderate perivascular lymphomononuclear inflammatory infiltrate. Thus, the skin biopsy was consistent with PRP. HIV serology by enzyme‐linked immunosorbent assay (ELISA) with 3 different kits was found to be positive for HIV‐1. The patient denied any risk factors associated with acquiring HIV infection, and laboratory values for complete blood cell count, routine serum biochemical profile, and lipid profile were normal. The patient was prescribed oral isotretinoin and asked to come for follow‐up for CD4 T‐cell count, but did not return.

Spiny follicular papules with hyperkeratosis spires emerging from top over the ear. Closed comedones can be appreciated on the face. (Inset) Psoriasiform plaques with spiny follicular papules over left thigh.

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Nodules with discharge and crust over back.

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Hyperkeratosis with parakeratosis, irregular broad acanthosis, and follicular keratotic plugging at places (hematoxylineosin stain, original magnification ×10). (Inset) Parakeratotic plugging with perivascular lymphomononuclear infiltrate (hematoxylin‐eosin stain ×40).

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Facial Porokeratosis
Authors: Carranza Dafnis C. , Haley Jennifer C. , Chiu Melvin
Published: February 2008

A 34‐year‐old man from El Salvador was referred to our clinic with a 10‐year history of a pruritic erythematous facial eruption. He reported increased pruritus and scaling of lesions when exposed to the sun. He worked as a construction worker and admitted to frequent sun exposure. Physical examination revealed well‐circumscribed erythematous to violaceous papules with raised borders and atrophic centers localized to the nose (Figure 1). He did not have lesions on the arms or legs. He did not report a family history of similar lesions. A biopsy specimen was obtained from the edge of a lesion on the right ala. Histologic examination of the biopsy specimen showed acanthosis of the epidermis with focal invagination of the corneal layer and a homogeneous column of parakeratosis in the center of that layer consistent with a cornoid lamella (Figure 2). Furthermore, the granular layer was absent at the cornoid lamella base. The superficial dermis contained a sparse, perivascular lymphocytic infiltrate. No evidence of dysplasia or malignancy was seen. These findings supported a diagnosis of porokeratosis. The patient underwent a trial of cryotherapy with moderate improvement of the facial lesions.

Circumsribed erythematous papules with raised borders and atrophic centers.

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(A) Skin biopsy specimen from the edge of the right ala showing hyperkeratosis and focal porokerastosis (hematoxylineosin stain, original magnification ×200). (B) Typical cornoid lamella (hematoxylineosin stain, original magnification ×400).

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Delayed melatonin administration promotes neuronal survival, neurogenesis and motor recovery, and attenuates hyperactivity and anxiety after mild focal cerebral ischemia in mice
Authors: Kilic Ertugrul , Kilic Ülkan , Bacigaluppi Marco , Guo Zeyun , Abdallah Nada Ben , Wolfer David P. , Reiter Russel J. , Hermann Dirk M. , Bassetti Claudio L.
Published: February 2008

Abstract:  Melatonin is a potent antioxidant with neuroprotective activity in animal models of ischemic stroke, which based on its lack of serious toxicity has raised hopes that it might be used for human stroke treatment in the future. This study investigated how subacute delivery of melatonin, starting at 24 hr after stroke onset, and continuing for 29 days (4 mg/kg/day; via drinking water), influences neuronal survival, endogenous neurogenesis, motor recovery and locomotor activity in C57Bl6/j mice submitted to 30‐min middle cerebral artery occlusion. Histologic studies showed that melatonin improved neuronal survival and enhanced neurogenesis, even when applied 1 day after stroke. Cell survival was associated with a long‐lasting improvement of motor and coordination deficits, evaluated by the grip strength and RotaRod tests, as well as with attenuation of hyperactivity and anxiety of the animals as revealed in open field tests. The robust functional neurologic improvements encourage proof‐of‐concept studies with melatonin in human stroke patients.
Human γ‐aminobutyric acid A receptor α2 gene moderates the acute effects of alcohol and brain mRNA expression
Authors: Haughey H. M. , Ray L. A. , Finan P. , Villanueva R. , Niculescu M. , Hutchison K. E.
Published: February 2008

γ‐aminobutyric acid A (GABAA) receptors moderate several of the behavioral effects of alcohol. In fact, recent studies have shown an association between the gene for the α2‐subunit of the GABAA receptor (GABRA2) and alcoholism. In the present study, we examined the functional relevance of the GABRA2 gene in alcohol dependence by assessing brain GABRA2 mRNA and GABAAα2‐subunit protein levels in post‐mortem prefrontal cortical tissue collected from control and alcohol‐dependent individuals. In addition, using an endophenotype approach, we tested whether the GABRA2 gene moderates sensitivity to the acute effects of alcohol in two independent samples from distinct human alcohol challenge studies. Results indicated that GABRA2 mRNA levels significantly differed by GABRA2 genotype. GABRA2 single nucleotide polymorphisms (rs573400, rs279871 and rs279858) were significantly associated with sensitivity to the acute effects of alcohol. Specifically, there was a significant main effect of GABRA2 × breath alcohol concentration on several measures of subjective responses to alcohol, including the hedonic value of alcohol. Importantly, reanalysis of a previous intravenous alcohol administration study confirmed the results of the oral alcohol challenge study. In summary, these results extend previous findings and provide new insights into the putative biobehavioral mechanisms that may moderate the association between the GABRA2 gene, sensitivity to the acute effects of alcohol and ultimately alcohol dependence.
A review and meta‐analysis of the impact of intestinal worms on child growth and nutrition
Authors: Hall Andrew , Hewitt Gillian , Tuffrey Veronica , De Silva Nilanthi
Published: February 2008

Table of ContentsSummary1191. Introduction119 1.1 The gastrointestinal ecosystem119 1.2 Groups of intestinal parasitic worms that infect humans121   1.2.1 Flukes or trematodes121   1.2.2 Tapeworms or cestodes122   1.2.3 Roundworms or nematodes123 1.3 How worms may affect human nutrition and growth126 1.4 Design of studies estimating the impact of worms128 1.5 Aims1282. Factors affecting the impact of intestinal worms128 2.1 Species of intestinal worm128 2.2 Prevalence of infection129 2.3 Number and distribution of worms132 2.4 Duration of infection135 2.5 Rate of reinfection135 2.6 Summary1363. Factors affecting the impact of treatment137 3.1 Study design: controls and randomization138 3.2 Anthelmintic drugs138 3.3 Intervals between treatments141 3.4 Duration of follow‐up142 3.5 Outcomes measured and the need for controls142 3.6 Initial nutritional status143 3.7 Age of subjects144 3.8 Remedial therapy after treatment144 3.9 Summary1454. Aims and methods of the meta‐analysis145 4.1 Search terms145 4.2 Inclusion criteria146 4.3 Exclusion criteria147 4.4 Meta‐analysis1475. Results of the meta‐analysis147 5.1 Geographic origin of studies150 5.2 Estimates of effects150 5.3 The figures and how to interpret them150 5.4 Sources of error or bias1506. Discussion153 6.1 Magnitude of effects153 6.2 Treatment alone is not enough159 6.3 The Cochrane Collaboration Review161 6.4 Characteristics of an ideal study162 6.5 Implications for programmes163 6.6 Conclusions166Acknowledgements167References167Appendix: Summary of papers identified for the review177

More than a half of the world's population are infected with one or more species of intestinal worms of which the nematodesAscaris lumbricoides,Trichuris trichiuraand the hookworms are the most common and important in terms of child health. This paper: (1) introduces the main species of intestinal worms with particular attention to intestinal nematodes; (2) examines how such worms may affect child growth and nutrition; (3) reviews the biological and epidemiological factors that influence the effects that worms can have on the growth and nutrition of children; (4) considers the many factors that can affect the impact of treatment with anthelmintic drugs; (5) presents the results of a meta‐analysis of studies of the effect of treating worm infections on child growth and nutrition; (6) discusses the results in terms of what is reasonable to expect that deworming alone can achieve; (7) describes some important characteristics of an ideal study of the effects of deworming; and (8) comments on the implications for programmes of recommendations concerning mass deworming.
An Exploratory Study of Family Member Characteristics and Involvement: Effects on Entrepreneurial Behavior in the Family Firm
Authors: Kellermanns Franz W. , Eddleston Kimberly A. , Barnett Tim , Pearson Allison
Published: February 2008

Family firms are essential for economic growth and development through new business startups and growth of existing family firms. Entrepreneurial behavior by the CEO is essential for such growth to occur. Entrepreneurial behavior can be influenced by inherent characteristics of the CEO, such as age and tenure, as well as by the degree of family influence in the firm, as indicated by the number of generations involved in the business. We assess the empirical relationships of these variables to both entrepreneurial behavior and subsequent firm growth.
Promoting Family: A Contingency Model of Family Business Succession
Authors: Royer Susanne , Simons Roland , Boyd Britta , Rafferty Alannah
Published: February 2008

Succession is a challenge to family businesses for a number of reasons, including the need to address the issue of intergenerational handover. This article focuses on one aspect of succession in family business by investigating when family members are preferred as successors. Results from 860 family businesses indicate that specific (tacit) knowledge characteristics combined with a favorable transaction atmosphere, in certain contexts, make a family member the most suitable successor. A conceptual model is presented that outlines when inside-family succession is preferred.
Professional Management in Family Businesses: Toward an Extended Understanding
Authors: Hall Annika , Nordqvist Mattias
Published: February 2008

Our purpose is to challenge the dominant meaning of professional management in family business research and to suggest an extended understanding of the concept. Based on a review of selected literature on professional management and with insights from cultural theory and symbolic interactionism, we draw on interpretive case research to argue that professional family business management rests on two competencies, formal and cultural, of which only the former is explicitly recognized in current family business literature. We elaborate on the meanings and implications of cultural competence and argue that without it a CEO of a family business is likely to work less effectively, no matter how good the formal qualifications and irrespective of family membership.
Evolutionary Psychology and Family Business: A New Synthesis for Theory, Research, and Practice
Authors: Nicholson Nigel
Published: February 2008

The article seeks to show that the ideas of evolutionary psychology have not only a unique contribution to make to the study of family business but have an overarching capacity to integrate theory, resolve empirical debates, and lead research in new directions. The article considers, first, what is different about family firms before outlining the Darwinian framework and its implications, and then moves on to an analysis of kinship dynamics as central to understanding the roots of cooperation and conflict in the family firm. The article concludes with a discussion of the scope for theoretical synthesis, practical implications, and the position this analysis leads us to about the unique performance potential and liabilities of the family firm.
Turnaround Strategies in Established Small Family Firms
Authors: Cater John , Schwab Andreas
Published: February 2008

This study employs a case-study approach to identify unique characteristics of established small family firms that affect their ability to initiate turnaround strategies when encountering an organizational crisis. In our case studies, we found evidence for family firms employing the standard strategies of top-management changes, infusion of external management expertise, and retrenchment that have been proposed in the general turnaround literature. The implementation of these strategies was, however, moderated by eight characteristics generally associated with family firms, including strong ties to the family firm, internal orientation, altruistic motives, and long-term goal orientation. The introduced framework contributes to a more fine-grained understanding of the turnaround challenges of established family firms and how they can be addressed. This is a topic of substantial practitioner interest considering the high failure rates of family firms.
Current issues on ageing in Japan: A comparison with Australia
Authors: Someya Yoshiko , Wells Yvonne
Published: February 2008

Japan's demography has changed dramatically, and with it, Japanese society and the circumstances of older people. These changes include shifts in family roles and functions, employment and social relations. Traditionally, families provided financial, physical and psychological support to their parents in the same household. While the proportion of older Japanese who live with adult children is still high in comparison to the rate in Western developed countries, patterns of care in Japan are gradually shifting towards the Western model. Public pensions supply financial support and the Long‐Term Care Insurance System (LCIS) provides substantial physical care for frail older people. This paper focuses on current issues for older people in Japan, and provides a brief comparison with the situation in Australia. Japan's LCIS provides a simpler and more consistent basis for funding long‐term care than Australia's system. On the other hand, Australia's pension system is comparatively robust.
Developing recommendations for implementing the Australian Pain Society's pain management strategies in residential aged care
Authors: McConigley Ruth , Toye Christine , Goucke Roger , Kristjanson Linda J
Published: February 2008

Objective:  This study aimed to develop recommendations and a related implementation resource ‘toolkit’ to facilitate implementation of pain management strategies in Australian Residential Aged Care Facilities (RACFs).

Methods:  This qualitative study used written materials, focus groups and individual interviews to gather data from participants. Thirty‐four health‐care professionals with experience in the aged care sector were recruited from five Western Australian RACFs. General practitioners who had an interest in aged care were contacted via local general practice networks.

Results:  Findings indicated that focused education sessions were needed to support implementation. A tailored toolkit was developed to assist the process. Funding and workforce constraints were found to be threats to complete implementation in some facilities.

Conclusions:  A multifaceted approach is needed to promote the implementation of pain management strategies in RACFs. In particular, unlicensed care workers, who may have responsibility for recognising and reporting signs of pain, require further education to support their role in the pain management process.
Correlates of housing affordability stress among older Australians
Authors: Temple Jeromey B
Published: February 2008

Objectives:  The purpose of this study was to examine the prevalence and correlates of housing affordability stress among community‐dwelling older Australians.

Methods:  The 2002 ABS General Social Survey was used to measure the prevalence of housing affordability stress. Rare event logistic regression was used to measure the potential correlates of housing affordability stress.

Results:  Almost 5% of Australians aged 55 years and older, and 20% of those younger than 55 years, are estimated to experience housing affordability stress. Men and women living alone are more likely to experience affordability stress when compared to couples. Low‐income earners, those with a consumer debt or who do not hold assets, are at a heightened risk of such stress. Home ownership, regardless of income, is the strongest buffer against housing affordability problems in old age.

Conclusion:  Although the prevalence of housing affordability stress is low among older Australians when compared to the younger population, a definite social gradient exists in those at risk.
Widowhood and self‐rated health among Chinese elders: The effect of economic condition
Authors: Krochalk Pamela C , Li Yawen , Chi Iris
Published: February 2008

Objective:  To examine the mediating effect of economic condition (income, work status, self‐rated financial situation and financial support) on widowhood and self‐rated health in elderly Chinese.

Methods:  The study sample consists of 17 556 married and widowed elders age 60 and older selected from the nationwide 2000 Sample Survey on Aged Population in Urban/Rural China. Path analysis is used to identify the direct and indirect relationships of economic condition between widowhood and self‐rated health.

Results:  Widowhood has a direct effect on self‐rated health for those widowed for more than 4 years. Work status and perceived financial situation mediate that relationship regardless of length of time widowed. Being older, male, less educated, and functionally healthy are associated with better self‐rated health among those widowed.

Conclusions:  Work status and perceived financial situation have a more significant effect on widowhood and self‐rated health than income and financial support. The findings have cross‐cultural implications for developing elder care programs.
Pharmaco‐epistemology for the prescribing geriatrician
Authors: Le Couteur David G , Kendig Hal
Published: February 2008

Clinicians are becoming more reliant on their interpretation of clinical trial information to guide prescribing rather than their clinical skills. Thus to improve prescribing, it is increasingly important for clinicians to have an appreciation of epistemology (the science of knowledge and its interpretation) and the broader social context of knowledge. The insights of epistemologists can be useful in understanding the different ways in which clinical trials data are interpreted.
Inpatient multidisciplinary rehabilitation after hip fracture for residents of nursing homes: A randomised trial
Authors: Uy Cesar , Kurrle Susan E , Cameron Ian D
Published: February 2008

Objective:  To determine the effectiveness of interdisciplinary rehabilitation for women with hip fracture who were residents of nursing homes.

Design:  Randomised controlled trial.

Subjects:  Eleven cognitively impaired women with hip fracture who were previously ambulant.

Methods:  Participants were randomly allocated to usual care (discharge back to the nursing home soon after surgery to the hip fracture) or an inpatient interdisciplinary rehabilitation program.

Results:  Participants were severely cognitively impaired and the majority used a walking aid prior to fracturing their hip. There was one early death, and at final follow up (4 months after hip fracture) median (range) Barthel Index was 28 (0–82) for control group and 68 (0–88) for the intervention group.

Conclusion:  No definite conclusion can be drawn about the effectiveness of the intervention because of its premature termination. However, the study established that it is feasible to provide an interdisciplinary rehabilitation for older people with hip fracture and severe disablement.
Transduced human PEP‐1–heat shock protein 27 efficiently protects against brain ischemic insult
Authors: An Jae J. , Lee Yeom P. , Kim So Y. , Lee Sun H. , Lee Min J. , Jeong Min S. , Kim Dae W. , Jang Sang H. , Yoo Ki‐Yeon , Won Moo H. , Kang Tae‐Cheon , Kwon Oh‐Shin , Cho Sung‐Woo , Lee Kil S. , Park Jinseu , Eum Won S. , Choi Soo Y.
Published: February 2008

Reactive oxygen species contribute to the development of various human diseases. Ischemia is characterized by both significant oxidative stress and characteristic changes in the antioxidant defense mechanism. Heat shock protein 27 (HSP27) has a potent ability to increase cell survival in response to oxidative stress. In the present study, we have investigated the protective effects of PEP‐1–HSP27 against cell death and ischemic insults. When PEP‐1–HSP27 fusion protein was added to the culture medium of astrocyte and primary neuronal cells, it rapidly entered the cells and protected them against cell death induced by oxidative stress. Immunohistochemical analysis revealed that, when PEP‐1–HSP27 fusion protein was intraperitoneally injected into gerbils, it prevented neuronal cell death in the CA1 region of the hippocampus in response to transient forebrain ischemia. Our results demonstrate that transduced PEP‐1–HSP27 protects against cell death in vitro and in vivo, and suggest that transduction of PEP‐1–HSP27 fusion protein provides a potential strategy for therapeutic delivery in various human diseases in which reactive oxygen species are implicated, including stroke.
Parkinson’s disease: recent development in therapies for advanced disease with a focus on deep brain stimulation (DBS) and duodenal levodopa infusion
Authors: Sydow Olof
Published: February 2008

Effective medical treatment for Parkinson’s disease has been available for almost 40 years. After several years of treatment with l‐dihydroxyphenylalanine (l‐dopa, levodopa), however, fluctuations often occur. The patient may then experience random variations of the motor symptoms during the day. The medication becomes increasingly complicated. New therapeutic methods, deep brain stimulation and duodenal infusion of l‐dopa, have proven to be very effective in stabilizing the fluctuations. A clinical update of Parkinson’s disease is presented together with a short review of these two methods.
Parkinson's disease: Levodopa‐induced dyskinesia and signal transduction
Authors: Santini Emanuela , Valjent Emmanuel , Fisone Gilberto
Published: February 2008

l‐3,4‐Dihydroxyphenylalanine (l‐dopa) remains the most effective pharmacological treatment for relief of the severe motor impairments of Parkinson’s disease. It is very effective in controlling parkinsonian symptoms in the initial phase of the disease, but its action wanes with time. Such ‘wearing‐off’ imposes an escalation in the dosage of the drug, which ultimately fails to provide stable control of motor symptoms and results in the appearance of abnormal involuntary movements or dyskinesia. ‘Peak‐dose’l‐dopa‐induced dyskinesia (LID) currently represents one of the major challenges in the treatment of Parkinson’s disease. Accumulating evidence suggests that LID derives from overstimulation of dopamine receptors located on the GABAergic medium spiny neurons (MSNs) of the dorsal striatum. These neurons form two distinct projection pathways, which exert opposite effects on motor activity: the direct, striatonigral pathway promotes locomotion, whereas the indirect, striatopallidal pathway depresses locomotion. In order to understand the mechanisms underlying LID, it is important to identify molecular adaptations produced by chronic administration of l‐dopa, at the level of one or the other of these two neuronal populations. This review summarizes the results of recent studies indicating that LID is associated with abnormal dopamine D1 receptor signaling affecting the MSNs of the direct pathway. The role of this pathological adaptation and of the consequent changes in signaling in the development and expression of LID are discussed.
ATP‐dependent modulation and autophosphorylation of rapeseed 2‐Cys peroxiredoxin
Authors: Aran Martin , Caporaletti Daniel , Senn Alejandro M. , Tellez de Iñon María T. , Girotti María R. , Llera Andrea S. , Wolosiuk Ricardo A.
Published: February 2008

2‐Cys peroxiredoxins (2‐Cys Prx) are ubiquitous thiol‐containing peroxidases that have been implicated in antioxidant defense and signal transduction. Although their biochemical features have been extensively studied, little is known about the mechanisms that link the redox activity and non‐redox processes. Here we report that the concerted action of a nucleoside triphosphate and Mg2+ on rapeseed 2‐Cys Prx reversibly impairs the peroxidase activity and promotes the formation of high molecular mass species. Using protein intrinsic fluorescence in the analysis of site‐directed mutants, we demonstrate that ATP quenches the emission intensity of Trp179, a residue close to the conserved Cys175. More importantly, we found that ATP facilitates the autophosphorylation of 2‐Cys Prx when the protein is successively reduced with thiol‐bearing compounds and oxidized with hydroperoxides or quinones. MS analyses reveal that 2‐Cys Prx incorporates the phosphoryl group into the Cys175 residue yielding the sulfinic‐phosphoryl [Prx‐(Cys175)‐SO2PO32−] and the sulfonic‐phosphoryl [Prx‐(Cys175)‐SO3PO32−] anhydrides. Hence, the functional coupling between ATP and 2‐Cys Prx gives novel insights into not only the removal of reactive oxygen species, but also mechanisms that link the energy status of the cell and the oxidation of cysteine residues.