bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of Serum Total IgE and Cell-Mediated Immunity in Patients with Hodgkin’s Disease
Authors: Rubinstein Elliot , Sokal Joseph E. , Reisman Robert E. , Arbesman Carl E.
Published: July 2009

Thymus-derived lymphocytes have been shown to play a role in the regulation of IgE synthesis in the rat. Both anergy and elevated serum IgE levels may be present in patients with Hodgkin’s disease. Cell-mediated immunity (CMI) was investigated by measurement of delayed skin test reactions with five common antigens. Serum IgE levels were determined at the same time. Impaired CMI was more prevalent in patients in stage III (13 of 15) and IV (15 of 19), as compared to patients in stage I and II (9 of 17). All 12 patients with elevated serum IgE levels (> 300 U/ml) had impaired CMI. These findings strongly suggest a relationship between impaired CMI and serum IgE in Hodgkin’s disease patients.
Occurrence of Specific Precipitins against Bovine Whey Proteins in Serum from Children with Gastrointestinal Disorders
Authors: Løwenstein H. , Krasilnikoff P.A. , Bjerrum O.J. , Gudmand-Høyer E.
Published: July 2009

Children with cow’s milk intolerance, clinically non-confirmed cow’s milk intolerance, coeliac disease, non-confirmed malabsorption, other gastrointestinal disorders, and normal children were investigated for the presence of precipitins against 40 individual bovine whey proteins by means of the crossed immunoelectrophoresis with intermediate gel technique. In the various groups of children the amount and specificity of bovine whey precipitins were neither connected with the various gastrointestinal disorders nor with alternating diet and challenge with milk. Bovine whey-specific IgE could not be detected in any of the patients clinically suspected for cow’s milk intolerance by cutaneous test, RAST or CRIE. The immunoglobulin level of the patients investigated did not differ significantly from the normal ranges. It is concluded that investigations of serum precipitins against bovine whey proteins do not give any significant information concerning cow’s milk intolerance.
Anaphylactoid Responses in Rats
Authors: West G.B.
Published: July 2009

The relative activities of dextran, mannan and ovomucoid as agents inducing anaphylactoid responses in rats vary with the route of injection, mannan being the most active especially by the intradermal route. All of these responses are potentiated by pre-treatment with insulin and inhibited by glucose. Carrageenan and concanavalin A are also active but only by the subcutaneous route. Whereas the concanavalin A response is potentiated by insulin, that of carrageenan is reduced. There are therefore at least three classes of agents capable of inducing anaphylactoid responses in rats.
Bone Marrow Angiotensin AT
1
Receptor Regulates Differentiation of Monocyte Lineage Progenitors From Hematopoietic Stem Cells
Authors: Tsubakimoto Yoshinori , Yamada Hiroyuki , Yokoi Hirokazu , Kishida Sou , Takata Hiroki , Kawahito Hiroyuki , Matsui Akihiro , Urao Norifumi , Nozawa Yoshihisa , Hirai Hideyo , Imanishi Jiro , Ashihara Eishi , Maekawa Taira , Takahashi Tomosaburo , Okigaki Mitsuhiko , Matsubara Hiroaki
Published: July 2009

Background—

The angiotensin II (Ang II) type 1 (AT
1
) receptor is expressed in bone marrow (BM) cells, whereas it remains poorly defined how Ang II regulates differentiation/proliferation of monocyte-lineage cells to exert proatherogenic actions.

Methods and Results—

We generated BM chimeric apoE
−/−
mice repopulated with AT
1
-deficient (Agtr1
−/−
) or wild-type (Agtr1
+/+
) BM cells. The atherosclerotic development was significantly reduced in apoE
−/−
/BM-Agtr1
−/−
mice compared with apoE
−/−
/BM-Agtr1
+/+
mice, accompanied by decreased numbers of BM granulocyte/macrophage progenitors (GMP:c-Kit
+
Sca-1
−
Lin
−
CD34
+
CD16/32
+
) and peripheral blood monocytes. Macrophage-colony-stimulating factor (M-CSF)–induced differentiation from hematopoietic stem cells (HSCs:c-Kit
+
Sca-1
+
Lin
−
) to promonocytes (CD11b
high
Ly-6G
low
) was markedly reduced in HSCs from Agtr1
−/−
mice. The expression of M-CSF receptor c-Fms was decreased in HSCs/promonocytes from Agtr1
−/−
mice, accompanied by a marked inhibition in M-CSF–induced phosphorylation of PKC-δ and JAK2. c-Fms expression in HSCs/promonocytes was mainly regulated by TNF-α derived from BM CD45
−
CD34
−
stromal cells, and Ang II specifically regulated the TNF-α synthesis and release from BM stromal cells.

Conclusions—

Ang II regulates the expression of c-Fms in HSCs and monocyte-lineage cells through BM stromal cell–derived TNF-α to promote M-CSF–induced differentiation/proliferation of monocyte-lineage cells and contributes to the proatherogenic action.
Circulating Endothelial Progenitor Cells and Age-Related White Matter Changes
Authors: Jickling Glen , Salam Abdul , Mohammad Askar , Hussain Muhammad S. , Scozzafava James , Nasser Abdul Majeed , Jeerakathil Thomas , Shuaib Ashfaq , Camicioli Richard
Published: July 2009

Background and Purpose—

The objective was to evaluate the relationship between circulating endothelial progenitor cells (EPC) and age-related white matter changes (ARWMC). Endothelial dysfunction plays a role in the development of ARWMC. EPC incorporate into sites endothelial damage and are thought to be involved in the repair of vascular risk factor induced endothelial injury. ARWMC can be evaluated using CT or MRI.

Methods—

In 172 individuals, circulating EPC were defined by the surface markers CD31 and von Willebrand factor. ARWMC were rated on CT scan using the ARWMC scale and divided into 3 groups based on ARWMC scale score (ARWMC score 0 [none], score 1–10 [mild-to-moderate], score >10 [severe]). Severity of ARWMC was correlated with levels of EPC and vascular risk factors.

Results—

On univariate analysis, EPC were found to be significantly lower in patients with severe ARWMC (
P
=0.01). ARWMC were also associated with hypertension (
P
<0.001), age (
P
<0.001), creatinine clearance (
P
=0.031), C-reactive protein (
P
<0.001), and use of angiotensin-converting enzyme or angiotensin receptor blocker (
P
=0.004). Multiple logistic regression analysis identified EPC level, age, hypertension, and hypertriglyceridemia as significant independent predictors of severe ARWMC.

Conclusions—

Levels of circulating EPC were significantly lower in patients with severe ARWMC. Other variables significantly associated with severe ARWMC were age, hypertension, and hypertriglyceridemia. Further study is required to delineate the pathophysiological relationship between EPC, vascular risk factors, and ARWMC.
Delayed Hypoxic Postconditioning Protects Against Cerebral Ischemia in the Mouse
Authors: Leconte Claire , Tixier Emmanuelle , Freret Thomas , Toutain Jérôme , Saulnier Romaric , Boulouard Michel , Roussel Simon , Schumann-Bard Pascale , Bernaudin Myriam
Published: July 2009

Background and Purpose—

Inspired from preconditioning studies, ischemic postconditioning, consisting of the application of intermittent interruptions of blood flow shortly after reperfusion, has been described in cardiac ischemia and recently in stroke. It is well known that ischemic tolerance can be achieved in the brain not only by ischemic preconditioning, but also by hypoxic preconditioning. However, the existence of hypoxic postconditioning has never been reported in cerebral ischemia.

Methods—

Adult mice subjected to transient middle cerebral artery occlusion underwent chronic intermittent hypoxia starting either 1 or 5 days after ischemia and brain damage was assessed by T2-weighted MRI at 43 days. In addition, we investigated the potential neuroprotective effect of hypoxia applied after oxygen glucose deprivation in primary neuronal cultures.

Results—

The present study shows for the first time that a late application of hypoxia (5 days) after ischemia reduced delayed thalamic atrophy. Furthermore, hypoxia performed 14 hours after oxygen glucose deprivation induced neuroprotection in primary neuronal cultures. We found that hypoxia-inducible factor-1α expression as well as those of its target genes erythropoietin and adrenomedullin is increased by hypoxic postconditioning. Further studies with pharmacological inhibitors or recombinant proteins for erythropoietin and adrenomedullin revealed that these molecules participate in this hypoxia postconditioning-induced neuroprotection.

Conclusions—

Altogether, this study demonstrates for the first time the existence of a delayed hypoxic postconditioning in cerebral ischemia and in vitro studies highlight hypoxia-inducible factor-1α and its target genes, erythropoietin and adrenomedullin, as potential effectors of postconditioning.
Homocysteine and Pulsatility Index of Cerebral Arteries
Authors: Lim Mi-Hye , Cho Young I. , Jeong Seul-Ki
Published: July 2009

Background and Purpose—

A pulsatility index (PI) represents vascular resistance distal to an examined artery. The purpose of the present study was to evaluate an association between plasma total homocysteine (tHcy) and PIs of the cerebral arteries in patients with ischemic stroke.

Methods—

Consecutive patients with ischemic stroke referred to a neurovascular ultrasound laboratory were evaluated from March 2007 to February 2008. PI was defined as (peak systolic velocity−end-diastolic velocity)/mean flow velocity as recommended. Transcranial Doppler was examined in both middle cerebral arteries and vertebral arteries, and basilar arteries. All patients with ischemic stroke were subdivided according to the presence of proximal internal carotid arterial steno-occlusion (ICS).

Results—

The numbers of patients enrolled for the present analysis as ischemic stroke without and with ICS were 272 and 92, respectively. PIs measured in the cerebral arteries did not show a significant difference in the two groups, in spite of the fact that mean flow velocities of both basilar arteries and vertebral arteries were significantly elevated in the patients with ICS. Plasma tHcy was found to be independently associated with graded increases of PIs in all cerebral arteries in the patients without ICS, even adjusted for the potential confounders. However, there was no association between tHcy and PI in the patients with ICS.

Conclusion—

Plasma tHcy was directly associated with increased cerebral arterial resistance. But in clinical situations when the cerebral arterial hemodynamics were altered as in the patients with ICS, the effect of tHcy on arterial remodeling could be obscured.
Sites of Rupture in Human Atherosclerotic Carotid Plaques Are Associated With High Structural Stresses
Authors: Tang Dalin , Teng Zhongzhao , Canton Gador , Yang Chun , Ferguson Marina , Huang Xueying , Zheng Jie , Woodard Pamela K. , Yuan Chun
Published: July 2009

Background and Purpose—

It has been hypothesized that high structural stress in atherosclerotic plaques at critical sites may contribute to plaque disruption. To test that hypothesis, 3D fluid-structure interaction models were constructed based on in vivo MRI data of human atherosclerotic carotid plaques to assess structural stress behaviors of plaques with and without rupture.

Methods—

In vivo MRI data of carotid plaques from 12 patients scheduled for endarterectomy were acquired for model reconstruction. Histology confirmed that 5 of the 12 plaques had rupture. Plaque wall stress (PWS) and flow maximum shear stress were extracted from all nodal points on the lumen surface of each plaque for analysis. A critical PWS (maximum of PWS values from all possible vulnerable sites) was determined for each plaque.

Results—

Mean PWS from all ulcer nodes in ruptured plaques was 86% higher than that from all nonulcer nodes (123.0 versus 66.3 kPa,
P
<0.0001). Mean flow maximum shear stress from all ulcer nodes in ruptured plaques was 170% higher than that from all nonulcer nodes (38.9 versus 14.4 dyn/cm2,
P
<0.0001). Mean critical PWS from the 5 ruptured plaques was 126% higher than that from the 7 nonruptured ones (247.3 versus 108 kPa,
P
=0.0016 using log transformation).

Conclusion—

The results of this study show that plaques with prior ruptures are associated with higher critical stress conditions, both at ulcer sites and when compared with nonruptured plaques. With further validations, plaque stress analysis may provide additional stress indicators helpful for image-based plaque vulnerability assessment.
Methicillin-Resistant Staphylococcus aureus in Middle Ear Fluid of Children
Authors: Klein Joel , Chan Shannon
Published: July 2009

Background: Methicillin-resistant Staphylococcus aureus (MRSA) infections and colonization in children have increased in recent years. Objective: This study examined the possible effect of this increase on MRSA isolation from middle ear fluid (MEF) of children. Method: A retrospective descriptive study was performed using the electronic medical records of children cared for at the Alfred I. duPont Hospital for Children from 2003 to 2007. All MEF isolates obtained at tympanostomy tube placement for recurrent or chronic otitis media or from spontaneous drainage were tabulated and analyzed. Records of children who’s MEF grew S aureus comprised our database. Results: A total of 920 MEF isolates were reviewed, of which 121 patients with S aureus in the MEF were identified. Twenty were excluded per protocol. In the cohort of 101 patients, 76 had methicillin-sensitive Staphylococcus aureus (MSSA; 75.3%) and 25 had MRSA (24.7%). Conclusion: In this retrospective study, the authors demonstrated that among children with S aureus in the MEF, younger children (<3 years) were more likely to have MRSA.
The Pace of Signs and Symptoms of Blunt Abdominal Trauma to Children
Authors: Pariset Jacquelyn M. , Feldman Kenneth W. , Paris Carolyn
Published: July 2009

The authors describe the types, signs, and symptoms of blunt abdominal injury. Record reviews of children <5 years old were carried out at a regional children’s hospital or level 1 trauma center between 1994 and 1999. Recognized cases of child abuse, penetrating trauma, or children with an unavailable chart were excluded. The mean age was 38 months (n = 42; range 11-59). Motor vehicle trauma caused most of the injuries (72%); 64% had isolated solid organ, 14% isolated hollow viscous, and 21% both organ injuries. Multisystem trauma included closed head injury (29%) and fractures (43%). Scene reports documented that 80% of those assessed immediately had abdominal pain. Average time taken to arrive at the emergency department was 66 minutes (range 15-420). Hollow viscous perforations were symptomatic from onset. The overall mortality rate was 12%, related to multitrauma. Most children suffering unintentional blunt abdominal trauma have immediate and ongoing injury. Caretakers promptly seek emergency care, and solid organ injuries predominate. The series mortality was low compared with that for abusive abdominal injuries.
Cardiac Autonomic Control During Simulated Driving With a Concurrent Verbal Working Memory Task
Authors: Lenneman John K. , Backs Richard W.
Published: July 2009

Objective: The objective of the study was to illustrate sensitivity and diagnosticity differences between cardiac measures and lane-keeping measures of driving performance. Background: Previous research suggests that physiological measures can be sensitive to the effects of driving and side task performance and diagnostic of the source of the attentional demands. We hypothesized that increases in side task difficulty would elicit physiological change without reduction of driving task performance and that the side task demands would elicit patterns of autonomic activity that map to specific attentional processing resources. Method: Separately and concurrently, thirty-two participants performed a simulated driving task and verbal working memory task (with two levels of difficulty, 0 back and 3 back) separately and concurrently. Attentional demands were assessed through physiological and performance measures. Results: Cardiac measures reflected changes in attentional demand from single- to dual-task driving with an n-back task, whereas lane-keeping measures did not. Furthermore, patterns of autonomic activity elicited by driving, n-back task, and dual-task driving with a 3-back task were consistent with our predictions about autonomic activity. Conclusion: Changes in cardiac measures without changes in lane-keeping measures provide evidence that cardiac measures can be sensitive to hidden costs in attention that do not manifest in coarse measures of driving performance. Furthermore, correct predictions regarding the patterns of autonomic activity elicited suggests that cardiac measures can serve as diagnostic tools for attention assessment. Application: Because of the demonstrated differences in sensitivity and diagnosticity, researchers should consider the use of cardiac measures in addition to driving performance measures when studying attention in a driving simulator environment.
Cognitive Models of the Influence of Color Scale on Data Visualization Tasks
Authors: Breslow Leonard A. , Ratwani Raj M. , Trafton J. Gregory
Published: July 2009

Objective: Computational models of identification and relative comparison tasks performed on color-coded data visualizations were presented and evaluated against two experiments. In this context, the possibility of a dual-use color scale, useful for both tasks, was explored, and the use of the legend was a major focus. Background: Multicolored scales are superior to ordered brightness scales for identification tasks, such as determining the absolute numeric value of a represented item, whereas ordered brightness scales are superior for relative comparison tasks, such as determining which of two represented items has a greater value. Method: Computational models were constructed for these tasks, and their predictions were compared with the results of two experiments. Results: The models fit the experimental results well. A multicolored, brightness-ordered dual-use scale supported high accuracy on both tasks and fast responses on a comparison task but relatively slower responses on the identification task. Conclusion: Identification tasks are solved by a serial visual search of the legend, whose speed and accuracy are a function of the discriminability of the color scales. Comparison tasks with multicolored scales are performed by a parallel search of the legend; with brightness scales, comparison tasks are generally solved by a direct comparison between colors on the visualization, without reference to the legend. Finally, it is possible to provide users a dual-use color scale effective on both tasks. Application: Trade-offs that must typically be made in the design of color-coded visualizations between speed and accuracy or between identification and comparison tasks may be mitigated.
Lack of Pharmacokinetic Interactions Between Transdermal Rotigotine and Oral Levodopa/Carbidopa
Authors: Braun Marina , Cawello Willi , Andreas Jens‐Otto , Math Dipl , Boekens Hilmar , Horstmann Rolf
Published: July 2009

This open‐label phase I trial assessed potential pharmacokinetic interactions between oral levodopa/carbidopa and transdermal rotigotine treatment at steady state. Twenty‐four participants with idiopathic restless legs syndrome (12 per group) received levodopa/carbidopa (100 mg/25 mg bid) and rotigotine (initial dose 2 mg/24 h for 3 days, followed by 4 mg/24 h) in a randomized sequence as monotherapy and in combination during hospitalization for 13 days. Primary pharmacokinetic parameters were AUCss and Cmax,ss of levodopa, carbidopa, and rotigotine at steady state. Mean concentration‐time profiles of the 3 agents were similar during monotherapy and combination treatment. The point estimate for the ratio of geometric means (combined vs monotherapy) for AUCss and Cmax,ss for levodopa (0.98 and 1.04), carbidopa (1.03 and 1.06), and unconjugated rotigotine (1.02 and 0.98) was near unity. All 90% confidence intervals were within the acceptance range for bioequivalence (0.8, 1.25). The most frequently documented adverse events were application site reactions (itching and reddening at application site) and headache. Most adverse events were mild to moderate in intensity, but 2 were of severe intensity (headache and extrasystoles); no serious adverse events occurred. The data presented indicate that rotigotine and levodopa/carbidopa can be coadministered without pharmacokinetic interactions between the compounds.
A Randomized Comparison of the Terms Estimated Average Glucose Versus Hemoglobin A1C
Authors: Brick Jessica C. , Derr Rachel L. , Saudek Christopher D.
Published: July 2009

Purpose

The purpose of this study was to evaluate the hypothesis that using estimated average glucose (eAG) while instructing patients yields better knowledge retention than using the term hemoglobin A1C (A1C).

Methods

Patients with diabetes who had poor baseline understanding of A1C (determined by a 4-question survey) were randomized into 1 of 2 groups: A1C or eAG. Depending on randomization, providers discussed patients' current status and personal targets for glycemic control using either the term A1C or estimated average glucose. Patients had a telephone survey 3—4 weeks later, assessing change in knowledge of glycemic control.

Results

The 80 participants who completed follow-up had similar baseline characteristics, including poor understanding of A1C and poor recall of previous A1C values. At the 3—4 week follow-up, average score for each survey question improved significantly in both groups, with mean composite score increasing in the A1C group by 32% and in the eAG group by 33%. There was no suggestion of a difference in degree of improvement between groups.

Conclusions

Patients previously unfamiliar with the meaning of A1C, using either term (A1C or eAG) resulted in an equal improvement in knowledge. Within this study, eAG was not a more understandable term, or an easier concept for patients to remember. Further research is needed to test whether use of the term A1C should be replaced by eAG.
Bridge Jobs
Authors: Giandrea Michael D. , Cahill Kevin E. , Quinn Joseph F.
Published: July 2009

Are today's retirees following in the footsteps of their older peers with respect to gradual retirement? Recent evidence from the Health and Retirement Study (HRS) suggests that most older Americans with full-time career jobs late in life moved to other jobs prior to complete labor force withdrawal. The authors explored the retirement patterns of two cohorts of individuals from the HRS. One group (the war babies) was born between 1942 and 1947 and therefore aged 59 to 64 years at the time of their fifth biennial HRS interviews in 2006. The others (the original HRS respondents) were aged 59 to 64 in 2000 and therefore 6 years older. The war babies have followed the gradual-retirement trends of their predecessors. Traditional one-step retirement appears to be fading as the effects of changes in the retirement environment continue to unfold.
Labor Divided, Labor Defeated
Authors: Heery Edmund
Published: July 2009

These two books deal, respectively, with the division of the American labor movement in 2005 and the dramatic strike of graduate teaching assistants at New York University in the same year. They are also representative of a larger class of writing on “union revitalization” that deals with the condition of the labor movement and its prospects for renewal. In this review article, the author uses the two books to reflect on the dominant themes of this broader literature. These include an emphasis on the deep hostility of neoliberalism to organized labor, the failure of the existing labor movement, and the need for a neosyndicalist strategy to achieve revitalization.
Ethnic and Religious Tolerance in Poland
Authors: Gołębiowska Ewa
Published: July 2009

Since its democratic revolution was set in motion, Poland has enjoyed tremendous progress in its degree of democratic consolidation. For example, significant institutional changes have taken place in the status of Poland's ethnic, national, and religious minorities. Yet, institutional protections alone do not fully capture the extent of openness to diversity. More comprehensive depictions of the quality of democracy need to encompass investigations of the democratic citizens' “hearts and minds.” In this article, using data from a recent nationally representative survey, the author examines the extent and sources of Poles' tolerance of ethnic and religious difference. She focuses on social tolerance of difference, using questions about acceptance of interethnic and interreligious marriage as the dependent variables. As part of the inquiry, the author compares and contrasts the levels and sources of tolerance of interreligious marriage over time and discusses the political implications of the findings and future research directions.
As If it Were Relevant
Authors: Rasche Andreas , Behnam Michael
Published: July 2009

This article discusses the concept of research relevance from a systems theoretical perspective. Based on the claim that many scholars still think of relevance as something that can be achieved and enhanced by choosing the “right” measures (e.g., “user-friendly” writing style), the authors argue that such a perspective obscures the self-referential status of “science” and “practice” as social systems in society. Our systems theoretical discussion, which is based on the work of German sociologist Niklas Luhmann, shows that, strictly speaking, science cannot produce relevant knowledge prior to application. Instead, practice has to make scientific knowledge relevant by incorporating it into the specific logic of its system. We argue that such an integration of knowledge is only possible by first acting as if the offered knowledge were relevant and to then modify and extend it according to the idiosyncrasies of the system. We characterize these as-if assumptions as fictions and show their significance for rethinking the concept of relevance.
Dynamics of Multiple Memories
Authors: Vakkayil Jacob D.
Published: July 2009

In this article, the author reflects on how a study on “organizational memory” in the context of software development firms in India brought forth a number of issues associated with choices in research. He proposes the conceptualization of organizational memory in heterogeneous, multiple kinds of ways, emphasizing its plurality and explores how this can be done along varied dimensions. He also demonstrates how these findings in turn influenced the ensuing doctoral work, including the framework chosen and the methodology adopted.
Delayed Superficial Femoral Artery Stent Erosion and Pseudoaneurysm Following Endovascular Therapy for Occlusive Disease
Authors: León Luis R. , Goshima Kaoru R.
Published: July 2009

A 78 year-old male with multiple serious medical comorbidities was diagnosed with a pseudoaneurysm of the proximal superficial femoral artery. He had undergone successful superficial femoral artery (SFA) stenting for limb salvage four months previously and a Duplex ultrasound had confirmed adequacy of the endovascular procedure two months after its execution. This was successfully treated with placement of a covered-stent at the proximal SFA and a balloon-expandable stent at the origin of the deep femoral artery. Unfortunately the patient expired six weeks after the last endovascular intervention, likely due to procedural-unrelated causes. We postulate delayed stent erosion of a proximal atherosclerotic SFA, causing the pseudoaneurysm. This is the first report of such a case in the literature.
Outcome of Carotid Endarterectomy for Acute Neurological Deficit
Authors: Mussa Firas F. , Aaronson Nicole , Lamparello Patrick J. , Maldonado Thomas S. , Cayne Neal S. , Adelman Mark A. , Riles Thomas S. , Rockman Caron B.
Published: July 2009

We reviewed our experience with urgent carotid intervention in the setting of acute neurological deficits. Between June 1992 and August 2008, a total of 3145 carotid endarterectomies (CEA) were performed. Twenty-seven patients (<1.0%) were categorized as urgent. The mean age was 74.1 years (range 56-93 years) with 16 (60%) men, and 11 (40%) women, Symptoms included extremity weakness or paralysis (n = 13), amaurosis fugax (n = 6), speech difficulty (n = 2), and syncope, (n = 3). Three patients exhibited a combination of these symptoms. Three open thrombectomy were performed. Regional anesthesia was used in 13 patients (52%). Seventeen patients (67%), required shunt placement. At 30-days, 2 patient (7%) suffered a stroke, and 1 (4%) died. Urgent CEA can be performed safely. A stroke rate of 7% is acceptable in those who may otherwise suffer a dismal outcome without intervention.
Novel Approach to a Type I Endoleak Following a Hybrid Repair of an Arch Aortic Aneurysm
Authors: Barnett Brad P. , Qazi Umair , Perler Bruce A. , Malas Mahmoud B.
Published: July 2009

Hybrid surgical and endovascular approaches such as open visceral vessel debranching and subsequent endovascular exclusion of thoracic abdominal aortic aneurysms (TAAA) represents a significant development in treatment of TAAAs. As compared to traditional endovascular aneurysm repair, hybrid repairs commonly have a higher rate of endoleak and other endograft-related complications. In this report, we present a 71 year-old man with significant comorbidities including chronic obstructive pulmonary disease, hypertension and prostate cancer. The patient after undergoing debranching of the thoracic arch followed by endograft repair of an arch aneurysm developed a proximal type I and type II endoleak fed by the previously ligated left subclavian artery. Despite coiling of the left subclavian artery and proximal extension of the endograft, a type I endoleak persisted. Several months after the left subclavian artery was coiled, a catheter was advanced through the coils and beyond the site of ligation directly into the aneurysmal sac. Once in the aneurysmal sac, multiple coils were deployed resulting in successful treatment of the type I endoleak. This report highlights the unique challenges in treating proximal descending thoracic aneurysms and represents the first report of the treatment of a type I endoleak with reaccess through a previously coiled vessel for deployment of embolics directly into the aneurysmal sac.
Recurrent Cystic Adventitial Disease of the Popliteal Artery: Successful Treatment With Percutaneous Transluminal Angioplasty
Authors: Maged Ismaeel M. , Kron Irving L. , Hagspiel Klaus D.
Published: July 2009

Cystic Adventitial Disease (CAD) is a rare vascular condition that most commonly affects the popliteal artery. Percutaneous transluminal angioplasty (PTA) is generally not considered a valid therapeutic option due to high recurrence rate. We report a case of CAD of the popliteal artery that recurred after surgical cyst enucleation that was successfully treated with PTA. To the best of our knowledge, this is the first case of successful PTA for the treatment of recurrent CAD of the popliteal artery.
Back on the Swagger
Authors: Caudill Jonathan W.
Published: July 2009

Extant literature suggests gang affiliates are at higher risk of a number of deleterious consequences compared to nongang affiliates, including recidivism following release from institutionalization. Although insightful, little is known as to when gang affiliates are at higher risk of recidivism postincarceration compared to their nongang counterparts. This research explores the effect of gang affiliation on recidivism by examining the time to rearrest for a cohort of 2,436 state incarcerated delinquents 5 years following their release from incarceration. Utilizing event history analysis, results indicate that gang affiliates are at a significantly higher risk of recidivism within 6 months postrelease, but risk ratios converged with nongang affiliates shortly thereafter. Implications for research and practice are explored.
Gastroesophageal reflux leads to esophageal cancer in a surgical model with mice
Authors: Hao Jing , Liu Ba , Yang Chung S , Chen Xiaoxin
Published: July 2009

Background

Esophago-gastroduodenal anastomosis with rats mimics the development of human Barrett's esophagus and esophageal adenocarcinoma by introducing mixed reflux of gastric and duodenal contents into the esophagus. However, use of this rat model for mechanistic and chemopreventive studies is limited due to lack of genetically modified rat strains. Therefore, a mouse model of esophageal adenocarcinoma is needed.

Methods

We performed reflux surgery on wild-type,p53A135Vtransgenic, andINK4a/Arf+/-mice of A/J strain. Some mice were also treated with omeprazole (1,400 ppm in diet), iron (50 mg/kg/m,i.p.), or gastrectomy plus iron. Mouse esophagi were harvested at 20, 40 or 80 weeks after surgery for histopathological analysis.

Results

At week 20, we observed metaplasia in wild-type mice (5%, 1/20) andp53A135Vmice (5.3%, 1/19). At week 40, metaplasia was found in wild-type mice (16.2%, 6/37),p53A135Vmice (4.8%, 2/42), and wild-type mice also receiving gastrectomy and iron (6.7%, 1/15). Esophageal squamous cell carcinoma developed inINK4a/Arf+/-mice (7.1%, 1/14), and wild-type mice receiving gastrectomy and iron (21.4%, 3/14). Among 13 wild-type mice which were given iron from week 40 to 80, twelve (92.3%) developed squamous cell carcinoma at week 80. None of these mice developed esophageal adenocarcinoma.

Conclusion

Surgically induced gastroesophageal reflux produced esophageal squamous cell carcinoma, but not esophageal adenocarcinoma, in mice. Dominant negativep53mutation, heterozygous loss ofINK4a/Arf, antacid treatment, iron supplementation, or gastrectomy failed to promote esophageal adenocarcinoma in these mice. Further studies are needed in order to develop a mouse model of esophageal adenocarcinoma.
9-aminoacridine Inhibition of HIV-1 Tat Dependent Transcription
Authors: Guendel Irene , Carpio Lawrence , Easley Rebecca , Van Duyne Rachel , Coley William , Agbottah Emmanuel , Dowd Cynthia , Kashanchi Fatah , Kehn-Hall Kylene
Published: July 2009

As part of a continued search for more efficient anti-HIV-1 drugs, we are focusing on the possibility that small molecules could efficiently inhibit HIV-1 replication through the restoration of p53 and p21WAF1 functions, which are inactivated by HIV-1 infection. Here we describe the molecular mechanism of 9-aminoacridine (9AA) mediated HIV-1 inhibition. 9AA treatment resulted in inhibition of HIV LTR transcription in a specific manner that was highly dependent on the presence and location of the amino moiety. Importantly, virus replication was found to be inhibited in HIV-1 infected cell lines by 9AA in a dose-dependent manner without inhibiting cellular proliferation or inducing cell death. 9AA inhibited viral replication in both p53 wildtype and p53 mutant cells, indicating that there is another p53 independent factor that was critical for HIV inhibition. p21WAF1 is an ideal candidate as p21WAF1 levels were increased in both p53 wildtype and p53 mutant cells, and p21WAF1 was found to be phosphorylated at S146, an event previously shown to increase its stability. Furthermore, we observed p21WAF1 in complex with cyclin T1 and cdk9 in vitro, suggesting a direct role of p21WAF1 in HIV transcription inhibition. Finally, 9AA treatment resulted in loss of cdk9 from the viral promoter, providing one possible mechanism of transcriptional inhibition. Thus, 9AA treatment was highly efficient at reactivating the p53 – p21WAF1 pathway and consequently inhibiting HIV replication and transcription.
Gender and ethnic differences in chronic myelogenous leukemia prognosis and treatment response: a single-institution retrospective study
Authors: Lee Justin P , Birnstein Elliott , Masiello David , Yang Dongyun , Yang Allen S
Published: July 2009

Background

In the last decade the importance of ethnicity, socio-economic and gender differences in relation to disease incidence, diagnosis, and prognosis has been realized. Differences in these areas have become a major health policy focus in the United States. Our study was undertaken to examine the demographic and clinical features of chronic myelogenous leukemia (CML) patients presenting initially at the LAC+USC Medical Center, which serves an ethnically diverse population.

Results

Patients were evenly split by gender, overwhelmingly Hispanic (60.9%), and quite young (median age 39, range 17–65) compared with previously reported CML patient populations. Previous CML studies identified significant anemia (Hgb <12 g/dl), significant thrombocytosis (platelets >450 × 109/l), and significant leukocytosis (WBC >50 × 109/l) as significant adverse pretreatment prognostic factors. Using these indicators, in addition to the validated Hasford and Sokal scores, patients were stratified and analyzed via gender and ethnicity. A significantly greater proportion of women presented with significant anemia (p = 0.019, Fisher's exact test) and significant thrombocytosis (p = 0.041, Fisher's exact test) compared to men, although no differences were found in risk stratification or treatment response. MCV values for women were significantly (p = 0.02, 2-sample t-test) lower than those for men, suggesting iron deficiency anemia. Focusing on ethnicity, Hispanics as a whole had significantly lower Hasford risk stratification (p = 0.046, Fisher's exact test), and significantly greater likelihood (p = 0.016, Fisher's exact test) of achieving 3-month complete haematological remission (CHR) compared with non-Hispanics at LAC+USC Medical Center, though differences in treatment outcome were no longer significant with analysis limited to patients treated with first-line imatinib.

Conclusion

Female CML patients at LAC+USC Medical Center present with more significant adverse pre-treatment prognostic factors compared to men, but achieve comparable outcomes. Hispanic patients present with lower risk profile CML and achieve better treatment responses compared to non-Hispanic patients as a whole; these ethnic differences are no longer significant when statistical analysis is limited to patients given imatinib as first-line therapy. Our patients achieve response rates inferior to those of large-scale national studies. This constellation of findings has not been reported in previous studies, and is likely reflective of a unique patient population.
The international PROGRESS registry of patients with severe sepsis: drotrecogin alfa (activated) use and patient outcomes
Authors: Martin Greg , Brunkhorst Frank M , Janes Jonathan M , Reinhart Konrad , Sundin David P , Garnett Kassandra , Beale Richard
Published: July 2009

Introduction

Since the launch of drotrecogin alfa activated (DrotAA), institutions and individual countries have published data on its use in clinical practice, based on audit or registry data. These studies were limited in size and geographic locale and included patients with greater disease severity and higher mortality than those in clinical trials. The purpose of this study was to compare baseline characteristics and clinical outcomes (using appropriate statistical adjustments) of patients treated or not treated with DrotAA from the international PROGRESS (Promoting Global Research Excellence in Severe Sepsis) cohort study of severe sepsis.

Methods

PROGRESS was a global, non-interventional, multi-center, prospective, observational study of patients having a diagnosis of severe sepsis treated in intensive care units at a participating institution. All treatment modalities were as per standard of care at the participating institutions. Baseline characteristics and hospital mortality were analyzed and regression techniques used to develop propensity and outcome models adjusted for baseline imbalances between groups.

Results

Overall, 14,543 patients from 37 countries were enrolled and 12,492 had complete data for analysis. Germany was the highest enrolling country (1,810; 14.5%) and the US had the most DrotAA patients (206, 23.3%); 882 (7%) overall received DrotAA therapy. DrotAA-treated patients were younger (median age 58 vs. 61 years), had greater organ dysfunction (cardiovascular: 90% vs. 74%; respiratory: 90% vs. 81%; renal: 60% vs. 45%; metabolic: 63% versus 42%; 3 or more organ dysfunctions: 84% vs. 67%) and had a higher median APACHE II score (26 vs. 23, all with P < 0.001). Although in-hospital mortality was similar for DrotAA and non-DrotAA-treated patients (49.6% vs. 49.7%, respectively), after adjusting for imbalances, patients receiving DrotAA had a 28% (0.60 to 0.86, 95% Confidence Intervals) reduction in the odds of death and a relative risk reduction of 17% (P = 0.0003).

Conclusions

In the PROGRESS registry, DrotAA-treated patients were younger, more severely ill, and had fewer co-morbidities than patients not treated with DrotAA. After adjustment for group differences, a significant reduction in the odds of death was observed for patients that received DrotAA compared with those that did not.
Midregional pro-Adrenomedullin in addition to b-type natriuretic peptides in the risk stratification of patients with acute dyspnea: an observational study
Authors: Potocki Mihael , Breidthardt Tobias , Reichlin Tobias , Morgenthaler Nils G , Bergmann Andreas , Noveanu Markus , Schaub Nora , Uthoff Heiko , Freidank Heike , Buser Lorenz , Bingisser Roland , Christ Michael , Mebazaa Alexandre , Mueller Christian
Published: July 2009

Introduction

The identification of patients at highest risk for adverse outcome who are presenting with acute dyspnea to the emergency department remains a challenge. This study investigates the prognostic value of the newly described midregional fragment of the pro-Adrenomedullin molecule (MR-proADM) alone and combined to B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) in patients with acute dyspnea.

Methods

We conducted a prospective, observational cohort study in the emergency department of a University Hospital and enrolled 287 unselected, consecutive patients (48% women, median age 77 (range 68 to 83) years) with acute dyspnea.

Results

MR-proADM levels were elevated in non-survivors (n = 77) compared to survivors (median 1.9 (1.2 to 3.2) nmol/L vs. 1.1 (0.8 to 1.6) nmol/L; P < 0.001). The areas under the receiver operating characteristic curve (AUC) to predict 30-day mortality were 0.81 (95% CI 0.73 to 0.90), 0.76 (95% CI 0.67 to 0.84) and 0.63 (95% CI 0.53 to 0.74) for MR-proADM, NT-proBNP and BNP, respectively (MRproADM vs. NTproBNP P = 0.38; MRproADM vs. BNP P = 0.009). For one-year mortality the AUC were 0.75 (95% CI 0.69 to 0.81), 0.75 (95% CI 0.68 to 0.81), 0.69 (95% CI 0.62 to 0.76) for MR-proADM, NT-proBNP and BNP, respectively without any significant difference. Using multivariate linear regression analysis, MR-proADM strongly predicted one-year all-cause mortality independently of NT-proBNP and BNP levels (OR = 10.46 (1.36 to 80.50), P = 0.02 and OR = 24.86 (3.87 to 159.80) P = 0.001, respectively). Using quartile approaches, Kaplan-Meier curve analyses demonstrated a stepwise increase in one-year all-cause mortality with increasing plasma levels (P < 0.0001). Combined levels of MR-proADM and NT-proBNP did risk stratify acute dyspneic patients into a low (90% one-year survival rate), intermediate (72 to 82% one-year survival rate) or high risk group (52% one-year survival rate).

Conclusions

MR-proADM alone or combined to NT-proBNP has a potential to assist clinicians in risk stratifying patients presenting with acute dyspnea regardless of the underlying disease.
Band, Not-Band, orEthnie: Who Were the White Knife People (Tosawihi)? Resolution of a “Mereological” Dilemma
Authors: Clemmer Richard O.
Published: July 2009

The “White Knife” (Tosawihi) Shoshone present a classic case of the “rhetoric of classification.” They epitomize the long-standing and never-resolved debate over whether or not band organization existed in the aboriginal Great Basin. Referencing eyewitness accounts, letters of Indian agents, and diaries of emigrants, explorers, trappers, and other travelers and setting them against the received ethnographic images of the Shoshone, particularly the image of family-scale organization presented by Julian Steward, tests the validity of those images. I propose rethinking the neo-evolutionary category “band” in terms of ethnie. Rethinking “bandness” in terms of ethnie promises more fruitful results from analyzing domestic-scale societies such as hunter-gatherer-fishers.
Black Food: Subsistence, Diet, and Exchange in Yessei Yakut Society
Authors: Argounova-Low Tatiana
Published: July 2009

This article investigates the concept of black food among the Lake Yessei Yakut in Siberia. With reference to two sources, archival records from the Russian Polar North Census of 1926–27 and contemporary fieldwork material, I investigate the local diet based on subsistence fishing and hunting and the food exchanges it entails. The article looks into changes that affected the food habits and concludes with an analysis of the social meaning of the concept of black food.
The Single-Payer Option: A Reconsideration
Authors: Oliver Adam
Published: July 2009

This article discusses some of the merits and demerits of the single-payer model of health care financing, with particular reference to the English National Health Service (NHS). Specifically, it is argued that the main merits are that the model can directly provide universal health care coverage, thus eradicating or at least alleviating market failure and equity concerns, and that it can achieve this with relatively low total health care expenditure in general and—as compared to the commercial multiple insurance model—low administrative costs in particular. A perceived demerit of the single-payer model is that it can lead to excessive health care rationing, particularly in terms of waiting times, although it is argued here that long waits are probably caused by insufficient funding rather than by the single-payer model per se. Moreover, rationing of one form or another occurs in all health care systems, and single-payer models may be the best option if the aim is to incorporate structured rationing such that an entire population is subject to the same rules and is thus treated equitably. A further perceived disadvantage of the single-payer model is that it offers limited choice, which is necessarily true with respect to choice of insurer, but choice of provider can be, and increasingly is, a feature of centrally tax-financed health care systems. No model of health care funding is perfect; trade-offs are inevitable. Whether the merits of the single-payer model are judged to outweigh the demerits will typically vary both across countries at any point in time and within a country over time.
Single Payer as a Financing Mechanism
Authors: Glied Sherry
Published: July 2009

This article uses Organisation for Economic Co-operation and Development (OECD) data to assess whether a single-payer health system delivers more care at less cost than do other universal coverage models. Single-payer plans are defined as those that rely on a limited number of revenue sources and systems in which financing is concentrated and private insurance for hospital and medical services is limited. Single-payer advocates argue that this organizational model is best able to reduce administrative costs, control provider payments, and limit the supply of services. This analysis shows that single-payer-like systems do not do a consistently better job of controlling physician incomes but do achieve some administrative cost savings compared to more fragmented systems. Overall, single-payer systems are modestly less costly than their peers and spend a slightly smaller share of the gross domestic product (GDP) on health. There are, however, substantial variations both over time and across countries in the performance of the single-payer-like nations, as well as among the nations in the other universal coverage model categories. Overall, the differences in system performance among the universal coverage OECD countries are very small, while the difference between the performance of any one of these countries and the United States is enormous and persistent.