bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of ecdysone receptor gene switch ligands on endogenous gene expression in 293 cells
Authors: Panguluri Siva K. , Li Bing , Hormann Robert E. , Palli Subba R.
Published: October 2007

Regulated gene expression may substantially enhance gene therapy. Correlated with structural differences between insect ecdysteroids and mammalian steroids, the ecdysteroids appear to have a benign pharmacology without adversely interfering with mammalian signaling systems. Consequently, the ecdysone receptor‐based gene switches are attractive for application in medicine. In the present study, the effect of inducers of ecdysone receptor switches on the expression of endogenous genes in HEK 293 cells was determined. Four ligand chemotypes, represented by a tetrahydroquinoline (RG‐120499), one amidoketone (RG‐121150), two ecdysteroids [20‐hydroxyecdysone (20E) and ponasterone A (Pon A)], and four diacylhydrazines (RG‐102240, RG‐102277, RG‐102398 and RG‐100864), were tested in HEK 293 cells. The cells were exposed to ligands at concentrations of 1 µm (RG‐120499) or 10 µm (all others) for 72 h and the total RNA was isolated and analyzed using microarrays. Microarray data showed that the tetrahydroquinoline ligand, RG‐120499 caused cell death at concentrations ≥ 10 µm. At 1 µm, this ligand caused changes in the expression of genes such as TNF, MAF, Rab and Reprimo. At 10 µm, the amidoketone, RG‐121150, induced changes in the expression of genes such as v‐jun, FBJ and EGR, but was otherwise noninterfering. Of the two steroids tested, 20E did not affect gene expression, but Pon A caused some changes in the expression of endogenous genes. At lower concentrations pharmacologically relevant for gene therapy, intrinsic gene expression effects of ecdysteroids and amidoketones may actually be insignificant. A fortiori, even at 10 µm, the four diacylhydrazine ligands did not cause significant changes in expression of endogenous genes in 293 cells and therefore should have minimum pleiotropic effects when used as ligands for the ecdysone receptor gene switch.
Substrate recognition by glycoside hydrolase family 74 xyloglucanase from the basidiomycete Phanerochaete chrysosporium
Authors: Ishida Takuya , Yaoi Katsuro , Hiyoshi Ayako , Igarashi Kiyohiko , Samejima Masahiro
Published: October 2007

The basidiomycete Phanerochaete chrysosporium produces xyloglucanase Xgh74B, which has the glycoside hydrolase (GH) family 74 catalytic domain and family 1 carbohydrate‐binding module, in cellulose‐grown culture. The recombinant enzyme, which was heterologously expressed in the yeast Pichia pastoris, had high hydrolytic activity toward xyloglucan from tamarind seed (TXG), whereas other β‐1,4‐glucans examined were poor substrates for the enzyme. The existence of the carbohydrate‐binding module significantly affects adsorption of the enzyme on crystalline cellulose, but has no effect on the hydrolysis of xyloglucan, indicating that the domain may contribute to the localization of the enzyme. HPLC and MALDI‐TOF MS analyses of the hydrolytic products of TXG clearly indicated that Xgh74B hydrolyzes the glycosidic bonds of unbranched glucose residues, like other GH family 74 xyloglucanases. However, viscometric analysis suggested that Xgh74B hydrolyzes TXG in a different manner from other known GH family 74 xyloglucanases. Gel permeation chromatography showed that Xgh74B initially produced oligosaccharides of degree of polymerization (DP) 16–18, and these oligosaccharides were then slowly hydrolyzed to final products of DP 7–9. In addition, the ratio of oligosaccharides of DP 7–9 versus those of DP 16–18 was dependent upon the pH of the reaction mixture, indicating that the affinity of Xgh74B for the oligosaccharides of DP 16–18 is affected by the ionic environment at the active site.
An unusual cause of ulceration: ainhum (dactylolysis spontanea)
Authors: Jemmott Timothy , Foster Alethea V , Edmonds Michael E
Published: October 2007

We describe a case of ainhum, a mutilating condition, usually seen in peoples of West African origin. A patient presented at the Diabetic Foot Clinic, Kings College Hospital, with a painful infected ulcer between the fourth and fifth toe of his right foot. He was a 43‐year‐old Nigerian and did not have diabetes. He reported that his left fifth toe had autoamputated some months before. Radiograph of the right fifth toe showed absorption of the proximal and intermediate phalanges, and a diagnosis of ainhum was made. Ainhum or dactylolysis spontanea is a rare condition of unknown aetiology in which a groove or fissure of constricting tissue forms around the proximal end of the fifth toe. Eventually, the groove extends to encircle the toe, the underlying structures are absorbed and the toe autoamputates. It may present as chronic fissuring at the base of the fifth toe or as foot ulceration. This condition is seldom seen in the United Kingdom, but it is likely that this condition is underdiagnosed. It is important that wound care specialists be aware of the diagnosis.
Risk factors in the development of pressure ulcers in an intensive care unit in Pontianak, Indonesia
Authors: Suriadi  , Sanada Hiromi , Sugama Junko , Kitagawa Atsuko , Thigpen Brian , Kinosita Sachiko , Murayama Shizuko
Published: October 2007

The purpose of this study was to identify risk factors associated with the presence of pressure ulcer development in adult patients at an intensive care unit hospital in Indonesia. The prospective cohort design was conducted in this study. A total of 105 patients participated and a pressure ulcer developed in 35 patients. The initial analysis identified several variables as significant risk factors for pressure ulcer development (interface pressure, fecal incontinence, skin moisture, diastolic blood pressure, smoking and body temperature). However, when entered into a final multivariate analysis, four factors, interface pressure [odds ratio (OR) 17·6, 95% confidence interval (CI) 4·1, 74·3], skin moisture (OR 8·2, 95% CI 2·2, 30·9), smoking (12·7, 95% CI 2·8, 56·7) and body temperature (OR 102·0, 95% CI 7·7, 98·8) were found to be significant. The results suggest that interface pressure measured using a multipad pressure evaluator, skin moisture measured by a moisture checker, thermometer for body temperature and smoking status are adequate instruments for the prediction of pressure ulcer development.
The biomechanics of sitting‐acquired pressure ulcers in patients with spinal cord injury or lesions
Authors: Gefen Amit
Published: October 2007

Sitting‐acquired pressure ulcers (SAPU) in permanent wheelchair users with traumatic or non traumatic disorders of the central nervous system (CNS) are a great medical challenge. The purpose of this review is to summarise what is currently known concerning the aetiology of SAPU, particularly in its severe form, which may now be classified as a ‘deep tissue injury’ according to the US National Pressure Ulcer Advisory Panel. Specifically, this review focuses on biomechanical aspects of deep SAPU and describes the relevant bioengineering methodologies and research evidence. It discusses the unique biomechanical conditions in deep tissues, which are caused by chronic sitting associated with CNS disorders, and overall, the present review indicates that avoiding interface pressures above 32 mmHg in such patients is not necessarily a ‘pressure relief.’
The use of recombinant human epidermal growth factor to promote healing for chronic radiation ulcer
Authors: Lee Sang‐wook , Moon Sue Young , Kim Yeun Hwa , Hong Joon Pio
Published: October 2007

This case report describes the first successful use of recombinant human epidermal growth factor (rh‐EGF) in radiation‐induced chronic wound of bone and skin which remains to be difficult to treat. Such wound on the chest of a 59‐year‐old female patient is presented lasting 3 years despite flap surgery and conventional treatment. The treatment with rh‐EGF achieved healing within 16 weeks but further study to evaluate its potential for radiation‐induced chronic wounds is warranted.
The effect of pressure‐relieving surfaces on the prevention of heel ulcers in a variety of settings: a meta‐analysis
Authors: Nicosia Gisella , Gliatta Angela E , Woodbury M. Gail , Houghton Pamela E
Published: October 2007

This meta‐analysis investigated the effectiveness of a pressure‐relieving intervention on the incidence of heel pressure ulcers in a variety of settings. Literature searches of Cumulative Index to Nursing and Allied Health Literature, MEDLINE, PubMed, EMBASE and Cochrane databases were conducted for English‐language articles that investigated the effect of pressure relief interventions with or without concurrent prevention programs on the number of heel ulcers occurring on adult humans in a controlled clinical design. Full articles were selected from citations based upon consensus between at least two independent reviewers. Methodological quality of each study was assessed using the Jadad and PEDro scales. A quantitative analysis was performed to determine and compare relative risk (RR) between pressure relief programs/devices that were classified according to similarity of interventions. Fourteen studies that involved a total of 1457 subjects were selected from a total of 105 full articles reviewed. Pressure‐reducing/relieving surfaces were associated with a significantly lower incidence of heel ulcers compared with standard hospital mattresses (RR = 0·50, 95% CI = 0·26–0·93, P < 0·03). Foam mattresses also significantly reduced the risk of developing heel ulcers. There is evidence to support the use of certain air or foam mattresses/overlays in the prevention of heel pressure ulcers when compared with a standard hospital mattress. There is insufficient research available at this time to determine if heel‐protective devices can prevent heel pressure ulcers. These results need to be interpreted with caution given the relatively low number and poor quality of research articles available to date.
Evidence‐based medicine: vacuum‐assisted closure in wound care management
Authors: Hunter Judith E , Teot Luc , Horch Raymond , Banwell Paul E
Published: October 2007

A review of the evidence base for the use of vacuum‐assisted closure (VAC) therapy is presented, analysing both experimental and clinical data.
Patent Protection for Computer Programs in India: Need for a Coherent Approach
Authors: Pai Yogesh Anand
Published: October 2007

The 2002 amendment to the Indian Patents Act, 1970, allowed computer program‐related inventions to be patentable, save for certain specific exclusions. The Patent (Amendment) Ordinance of 2004 tried to expand the scope of computer program patentability by melting down those specific exclusions. In 2005, the Indian Parliament categorically rejected the amendments as suggested in the Ordinance, thereby maintaining the status quo on the issue. The new legislative context advocated that a proper interpretation fostering the Parliament's intention be undertaken. Interestingly, the persistent policy of the Indian Patent Office is in favor of expanding notions of computer program patentability, as reflected in its draft manuals, suggesting interpretations quite contrary to the legislative intention and the statutory mandate. The need recommends that the Indian Patent Office does not fall in line with its US and EU counterparts, which are now being accused of granting “questionable patents”, thereby taciturnly mooting for a serious patent law reform. The current taste of disapproval for intrinsic patentability of computer programs is corroborative of the original interpretations suggested here, as connoting the exact intention of the Indian Parliament.
The nature of the FSA policy of rule use: a critical overview
Authors: Georgosouli Andromachi
Published: October 2007

The function and effectiveness of legal rules as instruments of social organisation have become an important focus of attention for those interested in financial architecture. This paper offers a critical overview of the policy of rule use of the Financial Services Authority (FSA) in the UK and considers the background of this policy, its nature and some problems pertaining to its implementation. The aim is twofold: first, to describe how current policy trends interact with and shape the FSA's policy of rule use and, secondly, to assess the impact of these trends on the effectiveness of this policy. Special attention will be given to developments such as the policy of making more intensive use of rules termed in a high level of abstractness and generality, the fostering of a discursive and participatory character of regulation, the shift towards meta-regulation and the adoption of a risk-based approach to regulation.
A case of Mollitias and Fragilitas Ossium – unusual presentation of hairy cell leukaemia followed by the diagnosis of nonsecretory myeloma
Authors: BESSER M. W. , GOONETILEKE C. , MIN M. S. YOUNG , THOMAS D. W.
Published: October 2007

Hairy cell leukaemia (HCL) is a B‐cell malignancy with a late developmental arrest. This report describes a patient that presented with leucocytosis and splenomegaly. The abnormal leucocytes showed typical morphology and expressed CD103, CD11c, CD19 and CD20 but not CD25 by immunophenotyping. The patient failed to respond to splenectomy and then developed lytic bone lesions and pathological fractures, which progressed despite a single course of cladribine chemotherapy. Review of the pathology of the bone reamings showed nonsecretory myeloma of the same kappa‐light chain isotype. He went on to receive induction chemotherapy in preparation for an autologous stem‐cell transplant but failed to mobilize sufficient numbers of stem cells. He has had two localized relapses with bony lesions, one within 6 weeks of stopping chemotherapy for which he received localized radiotherapy and thalidomide consolidation. Sequential myeloma has been described in HCL. There is controversy whether this represents clonal evolution or a secondary malignancy. An increased rate of secondary malignancies has been reported by some, but not other, authors in long‐term survivors of HCL. This case illustrates the value of a repeat pathological review in case of unexpected complications.
Instrumental Neutron and Photon Activation Analysis in the Geochemical Study of Phonolitic and Trachytic Rocks
Authors: Randa Zdenek , Frána Jaroslav , Mizera Jirí , Kucera Jan , Novák Jirí K. , Ulrych Jaromír , Belov Anatolij G. , Maslov Oleg D.
Published: October 2007

More than 130 samples of Tertiary phonolitic, trachytic and trachyandesitic rocks, representing evolved members of strongly and weakly alkaline volcanic rock series of the Ohre (Eger) Rift in the Bohemian Massif, Czech Republic, were analysed by instrumental neutron and photon activation analysis (INAA and IPAA, respectively). Forty‐two major and trace elements were determined to explain the origin of such evolved rocks. Specific features of INAA and IPAA of the silicic, highly alkaline rocks are discussed, and results for selected samples are given.
Autoreactive T‐cell responses in primary biliary cirrhosis are proinflammatory whereas those of controls are regulatory
Authors: Shimoda Shinji , Ishibashi Hiromi , Harada Mine
Published: October 2007

Background:  Autoreactive T cells that proliferate in response to autoantigens are found in both autoimmune diseases and controls but have important qualitative differences in relative activation states, costimulation signal requirements and pathogenetic significance.

Methods:  To understand the differences between autoreactive T cells in PBC versus controls, we have developed autoreactive T‐cell clones (TCC) from patients with PBC and healthy controls, and have used a peptide corresponding to the CD4 major autoantigen (Ag) to define the relative proliferative response. Peripheral blood mononuclear cells (PBMC) from PBC respond to the Ag in a costimulation‐independent manner, but PBMC from controls respond to the Ag in a costimulation‐dependent manner. Next, we established nine autoreactive TCC from patients with PBC and eight from healthy controls.

Results:  Among 17 TCC, eight were the costimulation‐dependent type and nine were independent. In addition, costimulation‐dependent autoreactive TCC became anergic after stimulation in the presence of APC that did not provide costimulatory signals. Finally, we observed that anergic TCC exhibit regulatory functions.

Conclusions:  In the case of regulatory dendritic cells, we could not induce TCC anergy. On the other hand, when using peptide analog in a costimulation‐deficient manner, we could induce TCC anergy, even though these TCC were costimulation independent.
Axiology, Realism, and the Problem of Evil*
Authors: CARSON THOMAS L.
Published: October 2007

Discussions of the problem of evil presuppose and appeal to axiological and metaethical assumptions, but seldom pay adequate attention to those assumptions. I argue that certain theories of value are consistent with theistic answers to the argument from evil and that several other well‐known theories of value, such as hedonism, are difficult, if not impossible, to reconcile with theism. Although moral realism is the subject of lively debate in contemporary philosophy, almost all standard discussions of the problem of evil presuppose the truth of moral realism. I explain the implications of several nonrealist theories of value for the problem of evil and argue that, if nonrealism is true, then we need to rethink and re‐frame the entire discussion about the problem of evil.
Population sex ratio shift from fledging to recruitment: consequences for demography in a philopatric seabird
Authors: H. Becker Peter , H.G. Ezard Thomas , Ludwigs Jan‐Dieter , Sauer‐Gürth Hedwig , Wink Michael
Published: October 2007

In many dimorphic bird species, offspring sex ratio is skewed towards the production of the smaller sex. Offspring sex ratio can be biased in monomorphic birds however, and the demographic consequences of such bias are unknown. Sex‐specific mortality and dispersal are fundamental mechanisms of sex ratio adjustment at the population level, but evidence for adjustments is weak and feedback into population dynamics poorly understood. Here, we link sex ratio at fledging with sex‐specific subadult return and recruitment at the Banter See common tern Sterna hirundo colony. Using molecular sexing methods and a remote detection system, we permanently tracked individuals from four complete cohorts (n=1171 fledglings) across these life‐history stages at their natal colony site, which permitted a structured analysis of sex ratio across multiple seasons. Sex ratio shifted significantly from significant daughter dominance at fledging to higher proportions of natal males among recruits; return and recruitment rates of sons were significantly higher than daughters (p≤0.002). No significant between‐year differences were detected. 47.4% of natal male recruits were paired with a non‐natal female, but only 37.0% of natal female recruits had a non‐natal partner. Elasticity analysis suggested that natal males have a greater influence on natal population growth rate than natal females. Sex biased dispersal is the most probable reason for these results indicating higher emigration to and immigration from other colonies in females, the less territorial and less philopatric sex. This pattern may be related to different gender roles in parental duties and with respect to competition for local resources.
Acoustic analog to quantum mechanical level splitting
Authors: Hilbert Shawn A. , Batelaan Herman
Published: October 2007

A simple physical system is discussed that mirrors the quantum mechanical infinite square well with a central delta well potential. The physical realization consists of a continuous sound wave traveling in a pair of tubes separated by an adjustable diaphragm. The equivalence between the quantum system and the acoustic system is explored. The analytic solution to the quantum system exhibits level splitting as does the acoustic system.
Antibody Detection and Kinetics of Antibody Production during Early Stages of Immunization with Hepatitis B Virus Vaccine
Authors: Odinsen Odd , Owusu-Ofori Shirley , Dompreh Albert , Sarkodie Francis , Opare-Sem Ohene , Parker David , Allain Jean-Pierre
Published: October 2007

Antibodies to influenza virus and human immunodeficiency virus are detectable in B cells during the early stages of the immune response, prior to their occurrence in plasma. To investigate similar phenomena in a model of immunization against hepatitis B virus (HBV) infection, medical students in Ghana were screened for HBV markers, HBV surface (HBs) antigen (HBsAg), and HBV core antibodies (anti-HBc). Consenting volunteers, 24 of whom were seronegative (susceptible) and 2 of whom were positive for anti-HBc (prior infection), were vaccinated on day 0, day 40, and 6 months. Two sets of 10 blood samples, sequentially collected at intervals of 2 days following each immunization on days 0 and 40, were processed into B-cell lysates and plasma. Solid-phase HBsAg coated on microtiter plates for enzyme immunoassay or nitrocellulose membranes for dot blot assay was used to detect anti-HBs activity by an indirect antiglobulin assay. A commercially procured sandwich immunoassay was used, along with an enzyme-linked immunosorbent assay and a dot blot assay, for the detection of anti-HBs in B-cell lysates and plasma. Following the first injection of vaccine, a single sample of B-cell lysate collected between 5 and 21 days revealed anti-HBs in 18/21 subjects with no plasma antibodies detectable by sandwich immunoassay. After the booster dose was injected on day 40, a single sample of B-cell lysate collected between 44 and 49 days showed anti-HBs in 16/19 subjects, and this was accompanied by plasma antibodies in 8 subjects. In contrast, between 8 and 13 days, both subjects with prior HBV infection showed anti-HBs in B-cell lysates and plasma. Thus, primary immunization with the HBV vaccine appears to transiently elicit low-affinity anti-HBs in B-cell lysates into plasma.
Addition of Deoxynucleosides Enhances Human Immunodeficiency Virus Type 1 Integration and 2LTR Formation in Resting CD4+T Cells
Authors: Plesa Gabriela , Dai Jihong , Baytop Cliff , Riley James L. , June Carl H. , O'Doherty Una
Published: October 2007

Resting CD4+T cells restrict human immunodeficiency virus (HIV) infection at a step prior to integration. Despite this restriction, we showed previously that HIV integration occurs in resting CD4+T cells in vitro, albeit at lower levels than in activated CD4+T cells. Here we show that addition of deoxynucleosides enhanced integration and 2LTR formation in resting CD4+T cells but that the kinetics were still significantly delayed compared to those of activated T cells. Thus, deoxynucleoside addition partially overcomes the restriction to HIV infection in resting CD4+T cells.
RIGIDITY OF THE IDENTITY
Authors: XAVIER FREDERICO
Published: October 2007

The structure of the group Aut (ℂn) of biholomorphisms of ℂnis largely unknown if n > 1. In stark contrast Aut (ℂ) is rather small, consisting of the non-constant affine linear maps. The description of Aut (ℂ) follows from the observation that an injective holomorphic function f : ℂ → ℂ satisfying f(0) = 0 and f′(0) = 1 must be the identity. These considerations suggest that similar characterizations of the identity might be useful in understanding the structure of Aut (ℂn). Using geometric methods we prove that an injective holomorphic map f : ℂn→ ℂnis the identity I if and only if the power series at 0 of f - I has no terms of order ≤ 2n + 1 and the function | det Df(z)| |z|2n|f(z)|-2nis subharmonic throughout ℂn.
Connexins 37 and 40 transduce purinergic signals mediating renal autoregulation
Authors: Takenaka Tsuneo , Inoue Tsutomu , Kanno Yoshihiko , Okada Hirokazu , Hill Caryl E. , Suzuki Hiromichi
Published: October 2007

Our previous data indicated that various subtypes of connexin (Cx) were expressed in the juxtaglomerular apparatus. Experiments were performed to characterize the effects on renal autoregulation of specific mimetic peptides that inhibit these Cx subtypes in Wistar-Kyoto rats. Intrarenal infusion ofCx37,43GAP27 increased autoregulatory index of renal plasma flow (0.06 ± 0.05 to 0.47 ± 0.06, n = 6, P < 0.05) and glomerular filtration rate (GFR; 0.01 ± 0.07 to 0.49 ± 0.07, P < 0.05). The additional administration of 8-cyclopentyl- 1,3-dipropylxanthine (CPX) produced a further elevation of autoregulatory index of RPF (0.86 ± 0.07, P < 0.05) and GFR (0.88 ± 0.09, P < 0.05), compared withCx37,43GAP27 alone. However, the addition of pyridoxal-phosphate-6-azophenyl-2,4-disulfonic acid (PPADS) toCx37,43GAP27 did not. Combined treatment with CPX and PPADS markedly worsened autoregulatory index of RPF (0.04 ± 0.10 to 0.81 ± 0.06, n = 6 P < 0.01) and GFR (0.05 ± 0.08 to 0.79 ± 0.05, P < 0.01).Cx40GAP27 induced similar changes toCx37,43GAP27. Renal autoregulation was preserved in the presence ofCx43GAP26. Our results indicate that the inhibition of gap junction impaired renal autoregulation. Furthermore, the present data provide evidence that both adenosine and purinergic receptors contribute to glomerular autoregulation. Finally, our findings suggest that gap junctions, at least in part, transduce purinergic signals mediating renal autoregulation.
Chronic continuous hypoxia decreases the expression of SLC4A7 (NBCn1) and SLC4A10 (NCBE) in mouse brain
Authors: Chen Li-Ming , Choi Inyeong , Haddad Gabriel G. , Boron Walter F.
Published: October 2007

In the mammalian CNS, hypoxia causes a wide range of physiological effects, and these effects often depend on the stage of development. Among the effects are alterations in pH homeostasis. Na+-coupled HCO3−transporters can play critical roles in intracellular pH regulation and several, such as NCBE and NBCn1, are expressed abundantly in the central nervous system. In the present study, we examined the effect of chronic continuous hypoxia on the expression of two electroneutral Na-coupled HCO3−transporters, SLC4a7 (NBCn1) and SLC4a10 (NCBE), in mouse brain, the first such study on any acid-base transporter. We placed the mice in normobaric chambers and either maintained normoxia (21% inspired O2) or imposed continuous chronic hypoxia (11% O2) for a duration of either 14 days or 28 days, starting from ages of either postnatal age 2 days (P2) or P90. We assessed protein abundance by Western blot analysis, loading equal amounts of total protein for each condition. In most cases, hypoxia reduced NBCn1 levels by 20–50%, and NCBE levels by 15–40% in cerebral cortex, subcortex, cerebellum, and hippocampus, both after 14 and 28 days, and in both pups and adults. We hypothesize that these decreases, which are out of proportion to the expected overall decreases in brain protein levels, may especially be important for reducing energy consumption.
Rehabilitation in Endocrine Patients: A Novel Psychosomatic Approach
Authors: Sonino Nicoletta , Fava Giovanni A.
Published: October 2007

Long-standing endocrine disorders may imply a degree of irreversibility of the pathological process and induce highly individualized affective responses. The psychosocial impairment that is associated with incomplete remission from endocrine illness suggests the need for an innovative approach to treatment, introducing in clinical endocrinology the concept of rehabilitation, which in other fields of medicine is already established. This new proposal stems from a number of unresolved issues related to the high prevalence of psychosocial impairment in patients adequately treated for various endocrine conditions. Indeed, rehabilitation in endocrinology may be indicated in the following cases: (a) delayed recovery after appropriate treatment; (b) discrepancy between endocrine status and current functioning; (c) presence of a decline in physical and social functioning; (d) persistence of important comorbidity, with special reference to psychiatric disturbances; (e) assessment of abnormal illness behavior; (f) problems with lifestyle and risk behavior, and (g) potential role of stress in endocrine disturbances. The endocrine rehabilitation team should ideally include a trained clinical endocrinologist, a physical therapist and a psychologist, with opportunities for other specialist consultations. The goal of such service would be to ensure education, support and specific interventions, helping the patient and his/her family to achieve optimal coping with the difficulties of the recovery process. Due to its comprehensive psychosomatic characterization, this new approach would likely increase the chances of obtaining full recovery in a significant proportion of patients and has the potential of being cost-effective.
Promoting Mindfulness in Psychotherapists in Training Influences the Treatment Results of Their Patients: A Randomized, Double-Blind, Controlled Study
Authors: Grepmair Ludwig , Mitterlehner Ferdinand , Loew Thomas , Bachler Egon , Rother Wolfhardt , Nickel Marius
Published: October 2007

Background: All therapists direct their attention in some manner during psychotherapy. A special form of directing attention, ‘mindfulness’, is recommended. This study aimed to examine whether, and to what extent, promoting mindfulness in psychotherapists in training (PiT) influences the treatment results of their patients. Methods: The therapeutic course and treatment results of 124 inpatients, who were treated for 9 weeks by 18 PiTs, were compared. The PiTs were randomly assigned to 1 of 2 groups: (i) those practicing Zen meditation (MED; n = 9 or (ii) control group, which did not perform meditation (noMED; n = 9). The results of treatment (according to the intent-to-treat principle) were examined using the Session Questionnaire for General and Differen-tial Individual Psychotherapy (STEP), the Questionnaire of Changes in Experience and Behavior (VEV) and the Symptom Checklist (SCL-90-R). Results: Compared to the noMED group (n = 61), the patients of PiTs from the MED group (n = 63) had significantly higher evaluations (according to the intent-to-treat principle) for individual therapy on 2 STEP scales, clarification and problem-solving perspectives. Their evaluations were also significantly higher for the entire therapeutic result on the VEV. Furthermore, the MED group showed greater symptom reduction than the noMED group on the Global Severity Index and 8 SCL-90-R scales, including Somatization, Insecurity in Social Contact, Obsessiveness, Anxiety, Anger/Hostility, Phobic Anxiety, Paranoid Thinking and Psychoticism. Conclusions: This study indicates that promoting mindfulness in PiTs could positively influence the therapeutic course and treatment results in their patients.
Prediction of Medium-Term Outcome in Cluster B Personality Disorder following Residential and Outpatient Psychosocial Treatment
Authors: Chiesa Marco , Fonagy Peter
Published: October 2007

Background: There is a paucity of research concerning the identification of individual characteristics predictive of outcome in the treatment of personality disorders (PDs). Methods: In this study, we carried out a predictor analysis of a sample of 73 hospitalized patients with a primary diagnosis of cluster B PD admitted to two different psychosocial programs for PD: (a) long-term inpatient treatment, and (b) a step-down program. Results: Younger age, higher Global Assessment Scale intake scores, longer length of treatment, absence of self-mutilation and avoidant PDs were a significant predictor of outcome at 24-month follow-up. Self-harming patients allocated to the step-down program had higher rates of improvement compared with patients allocated to the long-term inpatient model. Conclusions: The findings may carry potential clinical implications concerning patient selection and treatment delivery for inpatient and outpatient psychosocial programs for cluster B PD. Limitations include a relatively low sample size for a regression analysis, and a larger sample of cluster B patients may be needed to ensure greater reliability of results.
Increased 12-Month Prevalence Rates of Mental Disorders in Patients with Chronic Somatic Diseases
Authors: Härter Martin , Baumeister Harald , Reuter Katrin , Jacobi Frank , Höfler Michael , Bengel Jürgen , Wittchen Hans-Ulrich
Published: October 2007

Background: Although it is well established that chronic somatic diseases are significantly associated with a wide range of psychopathology, it remains unclear to what extent subjects with chronic somatic diseases are at increased risk of experiencing mental disorders. The present epidemiological study investigates age- and sex-adjusted 12-month prevalence rates of mental disorders in patients with cancer, and musculoskeletal, cardiovascular and respiratory tract diseases, based on comprehensive physicians’ diagnoses and compared with physically healthy probands. Methods: Prevalence rates were calculated from two large epidemiological surveys. These studies investigated inpatients and patients from the general population with cancer (n = 174) and musculoskeletal (n = 1,416), cardiovascular (n = 915) and respiratory tract diseases (n = 453) as well as healthy controls (n = 1,083). The prevalence rates were based on the Munich Composite International Diagnostic Interview, a standardized interview for the assessment of mental disorders. Results: Prevalence rates were very similar for inpatients (43.7%) and patients from the general population (42.2%). The adjusted odds ratios (OR) of patients with chronic somatic diseases were significantly elevated for mental disorders in comparison with healthy probands (OR: 2.2). Mood, anxiety and somatoform disorders were most frequent. The prevalence rates did not differ significantly between the somatic index diseases. The number of somatic diseases per patient had a higher association with mental disorders. Conclusions: There is a strong relationship between chronic somatic diseases and mental disorders. A future task is to improve the care of mental disorders in patients with chronic physical illness, specifically with multimorbid conditions.
Epidemiology of Life Events: Life Events and Psychiatric Disorders in the Sesto Fiorentino Study
Authors: Faravelli Carlo , Catena Mario , Scarpato Alessandra , Ricca Valdo
Published: October 2007

Background: Although life events have been consistently reported as precipitating factors for most psychiatric disorders, there is no comprehensive investigation of the relationship between severe life events and psychiatric disorders in the general population. Methods: This is a community-based study of psychiatric disorders among a cohort representative of adults in an Italian town. A total of 2,363 subjects out of 2,500 selected to be representative of the population living in Sesto Fiorentino, central Italy, were interviewed by their own general practitioner using the Mini International Neuropsychiatric Interview. Of the 613 subjects, 609 who resulted positive for any psychiatric disorders and 123 out of a random sample of 130 negatives were re-interviewed by the psychiatrists using the Florence Psychiatric Interview. The Florence Psychiatric Interview was used to explore each distinct psychiatric episode. Life events were recorded in detail by a specific interview. Results: During the year prior to the onset of the first psychiatric disorder, 35.8% of cases suffered from at least a severe event, compared with 12.2% of non-cases during a comparable period (OR = 4.0, 95% CI = 2.3–7.1). The excess of life events occurred for almost all the diagnostic categories. The same results were reproduced even when only the ‘independent’ life events were considered. The distribution of the events through the 12 months taken into account showed an even distribution of events among non-cases, whereas there was a clear accumulation in the last 3 months prior to the onset of the pathology in the cases. Conclusions: Life stress is one of the main precipitating factors of psychopathology.
Genetic and Environmental Factors in Alexithymia: A Population-Based Study of 8,785 Danish Twin Pairs
Authors: Jørgensen Michael Martini , Zachariae Robert , Skytthe Axel , Kyvik Kirsten
Published: October 2007

Background: The role of genetic and environmental factors for developing alexithymia is still unclear, and the aim of this study was to examine these factors in a large population-based sample of twins. Methods: The Toronto Alexithymia Scale-20 (TAS-20) was included in a mail survey of 46,418 individuals born between 1931 and 1982 and registered with the Danish Twin Registry. The response rate was 75.3%. A total of 8,785 twin pairs, where both cotwins had completed all items of the TAS-20, were selected for this study. Analyses were conducted for total TAS-20 scores and the subscales of (1) difficulties in identifying feelings, (2) difficulties in describing feelings, and (3) externally oriented thinking. The phenotypes were analyzed both as categorical and continuous data. Results: All measures of similarity suggested that genetic factors added to all facets of alexithymia. Structural equation modeling of the noncategorical data, an ACE model including additive genetic, shared environmental and nonshared environmental effects, provided the best fit for all three facets of alexithymia as well as total alexithymia scores, with heritabilities of 30–33% and the remaining variance being explained by shared (12–20%) and nonshared environmental effects (50–56%). Conclusion: The results from this large population-based sample suggest that genetic factors have a noticeable and similar impact on all facets of alexithymia. While the results suggested a moderate influence of shared environmental factors, our results are in concordance with the general finding that environmental influences on most psychological traits are primarily of the nonshared rather than the shared type.
Chemotherapy-Induced Nausea, Vomiting, and Fatigue – the Role of Individual Differences Related to Sensory Perception and Autonomic Reactivity
Authors: Zachariae R. , Paulsen K. , Mehlsen M. , Jensen A.B. , Johansson A. , von der Maase H.
Published: October 2007

Background: In spite of antiemetics, postchemotherapy side effects continue to be common and may affect compliance to cancer treatment. Among the known factors associated with increased symptom severity are: younger age, treatment toxicity, expected severity, and distress, but little is still known about the role of other factors. The aim of our study was to investigate the role of individual differences related to sensory perception for posttreatment side effects. Methods: Hundred and twenty-five women receiving adjuvant chemotherapy for breast cancer completed measures of absorption, autonomic perception, somatosensory amplification, trait anxiety, and expected severity at baseline. Pretreatment distress and posttreatment nausea, vomiting, and fatigue were assessed at the 1st, 4th, 6th and last cycles of chemotherapy. Results: While univariate analyses showed several factors to be associated with side effects, only absorption and pretreatment distress remained independent predictors of nausea and fatigue when controlling for the remaining factors. Posttreatment vomiting was only predicted by expected severity of vomiting. Conclusion: Chemotherapy-induced side effects are related to increased autonomic nervous system activity, and absorption has been associated with increased autonomic nervous system reactivity to stress. The results suggest that individuals with high absorption may be at greater risk for developing side effects. Improved precision in identifying patients at risk of experiencing more severe side effects after cancer treatment will increase the ability to target treatments aimed at reducing these side effects.
The Startle Reflex in Alcohol-Dependent Patients: Changes after Cognitive-Behavioral Therapy and Predictive Validity for Drinking Behavior
Authors: Loeber Sabine , Croissant Bernhard , Nakovics Helmut , Zimmer Anke , Georgi Alexander , Klein Sabine , Diener Carsten , Heinz Andreas , Mann Karl , Flor Herta
Published: October 2007

Background: Previous studies demonstrated an attenuation of the affect-modulated startle reflex when alcohol-dependent patients were viewing alcohol-associated pictures. This indicates an appetitive valence of these stimuli. We used the affect-modulated startle reflex to assess the effects of behavioral treatment on the emotional processing of alcohol-associated stimuli. Further, we examined whether the affect-modulated startle reflex is a predictor of treatment success. Methods: Forty-three alcohol-dependent patients (21 females, mean age 45.67 years, SD 9.45) were recruited consecutively from an inpatient alcohol detoxification facility where patients attended a 3-week detoxification program including cognitive-behavioral treatment to successfully handle high-risk situations. The eye blink component of the affect-modulated startle response, self-reported cue-induced craving and skin conductance responses to alcohol-associated and control slides were assessed before and after treatment. Changes were analyzed using repeated measures analysis of variance. Drinking behavior was assessed in the 6 months following treatment, and a regression analysis was performed to evaluate the predictive validity of the affect-modulated startle response for drinking behavior. Results: Drinking behavior as well as craving and skin conductance responses decreased significantly over time. The pattern of the affective modulation of the startle reflex was not altered over time. However, startle modulation and relapse were related, and within the group of relapsers, startle modulation was a significant predictor of drinking behavior. Conclusions: Our results suggest that the modulation of the startle reflex may reflect more enduring and permanent processes of emotional responding to alcohol-related cues than autonomic arousal and self-reported craving, and that startle modulation by alcohol-associated cues may be a better predictor of drinking behavior for relapsers than other measures. Further studies including a control condition are necessary to validate these findings.
Psychosocial Factors Associated with Preterm Uterine Contractions
Authors: Facchinetti Fabio , Ottolini Fedra , Fazzio Marta , Rigatelli Marco , Volpe Annibale
Published: October 2007

Background: The aim of our study was to evaluate how sociodemographic factors, psychosocial adaptation to pregnancy and well-being levels are associated with the onset of preterm uterine contractions allowing symptomatic preterm labor. Methods: In a prospective case-control design, 51 consecutive women admitted for threatened preterm labor were enrolled. The patients received standard care. The day before discharge, once contractions had been stopped, the patients were administered 2 questionnaires: the Prenatal Self-Evaluation Questionnaire of Lederman and the Psychological Well-Being Scales. Controls were enrolled among asymptomatic, healthy women attending routine prenatal care. They were matched for parity and gestational age. Results: Gestational age at inclusion ranged from 25 to 34 weeks. Fourteen cases and 4 controls delivered preterm. Cases were less educated than controls, showed a lower acceptance of pregnancy and worse relationship with others, namely with the husband, compared to controls. They also displayed a reduced environmental mastery. Conclusion: Having a low education, poor relationship with others, including the husband, and impaired coping skills appeared to be independent risk factors for the development of symptomatic preterm labor in urbanized women.
Evaluation and Treatment of Sleep Complaints: Patients’ Subjective Responses
Authors: Hossain Naheed K. , Irvine Jane , Ritvo Paul , Driver Helen S. , Shapiro Colin M.
Published: October 2007

Background: This study set out to evaluate whether patients’ expectations affected their responses to treatment of a sleep disorder. Methods: Fifty consecutive patients attending a sleep clinic for the first time and who had different diagnoses of sleep disorders were included in this study. The patients completed a set of 6 questionnaires on 7 occasions as they progressed through the process of a sleep clinic referral, assessment and treatment. Self-report questionnaires were used to assess their sleepiness, fatigue and alertness. Predictor measures included mental health and individual items assessing expectation regarding the seriousness of the sleep problem. A battery of questions dealt with mental health issues, patients’ expectation and their commitment to the sleep investigation and treatment process. Each patient’s responses were examined over a period of 6 months. Results: Immediately following their interview with the sleep consultant, the patients’ concern regarding their sleep problem was higher than the first measures obtained at baseline. Compared to prior to their first consultation with a sleep specialist, while on treatment they directed more attention to their sleep problem when problems associated with fatigue were reduced. Although there was a lessening in fatigue with treatment, subjectively rated sleepiness (Epworth Sleepiness Scale) did not vary over the study. Contact with a sleep center and the diagnosis and treatment of individual sleep problems also resulted in improved satisfaction with life. Conclusions: Contact with and treatment at a sleep clinic was found to be beneficial. The fatigue levels were reduced and the patients had greater life satisfaction regardless of the diagnosis and treatment of their sleep disorder, although subjective sleepiness did not change. Patient expectations were not critical in determining the outcome of the sleep clinic assessment.
VIH et allaitement maternel
Authors: Downs Jane Helen , Cooper Peter A.
Published: October 2007

Il est bien établi que plus de 90% des enfants infectés par le VIH ont contracté ce virus par transmission mère-enfant (TME). Selon des estimations, 750 000 enfants sont infectés par le VIH chaque année au plan mondial et la plupart d’entre eux vivent en Afrique sub-saharienne. La TME se fait au cours de la grossesse par voie transplacentaire, lors de l’accouchement et par l’intermédiaire du lait et de saignements mamelonnaires au cours de l’allaitement. Le risque de TME exprimé en pourcentage varie selon chacune de ces voies. En l’absence d’intervention spécifique, le taux de TME est d’environ 15–20%, et double à 35–40% quand l’allaitement maternel est prolongé (>6 mois). L’utilisation de substituts du lait maternel (SLM) peut sembler être le choix évident afin de réduire le risque de TME par l’intermédiaire du lait maternel et des saignements mamelonnaires, mais cette option peut s’avérer nocive pour les nourrissons nés de mères vivant dans des contextes où les ressources sont limitées. Dans ces contextes, le risque élevé de mortalité infantile est dû à des diarrhées sévères et à une malnutrition liée à une alimentation peu sûre par SLM et à un allaitement maternel non optimal (allaitement non exclusif pendant les 6 premiers mois de la vie). Selon des estimations présentées dans un rapport récent de l’OMS (2006), 1,45 million de vies d’enfants de moins de 2 ans sont globalement perdues chaque année dans les pays en développement en raison d’un allaitement maternel non optimal, comparativement à 242 000 décès de nourrissons liés à la TME. Les recommandations de l’OMS concernant l’alimentation des nourrissons dans le contexte de l’infection à VIH sont un ensemble important de principes fondamentaux que les gouvernements, les décisionnaires politiques et les professionnels de santé doivent prendre en compte pour la conception de politiques et de protocoles de prévention de la TME. Dans les pays tant industrialisés qu’en développement, des communautés ont ou non accès à de l’eau non contaminée et à l’électricité. De ce fait, les politiques doivent répondre aux besoins de communautés différentes. Comme l’indiquent les recommandations de l’OMS: «quand une alimentation de remplacement est acceptable, faisable, financièrement abordable, durable et sûre, l’évitement de tout allaitement par les mères infectées par le VIH est acceptable». Les infections à VIH transmises de façon verticale ont été quasiment éliminées dans les pays industrialisés par l’utilisation appropriée du traitement antirétroviral, la pratique et la programmation d’une césarienne élective et un soutien pour l’évitement de l’allaitement, résultant en une réduction du taux de TME à moins de 1–2%.