bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of style in reader-involvement: Deictic shifting in contemporary poems
Authors: Jeffries Lesley
Published: May 2008

This article investigates the language of two contrasting contemporary poems in English: “Mittens” by Peter Sansom and “Pain tells you what to wear” by Mebdh McGuckian. The different experiences of reading them are explored using concepts drawn from the narrative theories of Emmott (1997), deictic shift theory (see McIntyre 2006), and blending theory (see Dancygier 2005), with the aim of explaining some of the apparent differences of reader-involvement. Questions of identity and reference are raised in relation to the use of pronouns in such poems, the potential effects of blending of deictic centres is explored and the different literary effects of bringing the reader into the deictic centre or voiding the deictic centre are discussed.
A TWOOA construction for multi-receiver multi-message authentication codes
Authors: Fuji-Hara Ryoh , Li Xiyang , Miao Ying , Wu Dianhua
Published: May 2008

A (k, n; w) multi-receiver multi-message authentication code allows a transmitter to broadcast up to w − 1 distinct authenticated messages to n receivers in such a way that (1) not only an opponent but also any up to k − 1 receivers cannot cheat any other receivers, and (2) all the receivers can independently verify the authenticity of the messages. Obana and Kurosawa [Designs, Codes and Cryptography, 22 (2001), pp. 47–63] used a special pair of orthogonal arrays, called TWOOA, to construct a (k, n; 2) multi-receiver single-message authentication code. In this paper, we generalize the notion of a TWOOA, and then use this generalized TWOOA to construct a (k, n; w) multi-receiver multi-message authentication code, which exceeds that of Safavi-Naini and Wang [Proc. of Eurocrypt'98, LNCS 1403, Springer (1998), pp. 527–541] at least in the numbers of receivers and authenticated messages. The structures of TWOOAs are investigated. Two constructions for TWOOAs are also provided.
Preservation & Digital Imaging: How are We Doing?
Authors: Smith Steve
Published: May 2008

So far, the new millennium has been a challenging one for preservation librarians. After having been the darling of librarianship for much of the 1980s and 1990s, we have had our comeuppance. The publication last year of Nicholson Barker's assault on librarians,
Domesday Redux: The rescue of the BBC Domesday Project videodiscs
Authors: Darlington Jeffrey , Finney Andy , Pearce Adrian
Published: May 2008

William of Normandy, having conquered England, decided in 1086 to take account of his new territory. The result was the Domesday Book (actually more than one), which now resides in the National Archives. For the BBC, the 900
The Digital Book: A Medial Revolution without a New Medium
Authors: Titel Volker
Published: May 2008

Can a book that doesn't come from comprehensibly materialized textual means still be considered a book? What happens when, in the form of an electronic publication on the World Wide Web, a typical book-type volume is designed to be networked and includes multi-media? As the physical object itself disappears, one of the conditions required for the existence of book science faces extinction. Is the Internet – or rather the World Wide Web contained in it – a medium that opposes the book? In the context of discussions regarding media competition, this idea is becoming widespread. Infinitely more exciting, though, is that we are experiencing an information technology revolution and, in fact, a medial revolution without a new medium.
Stirring the Pot: Combining Traditional and Innovative Services at the University of Delaware
Authors: McCoy Shelly
Published: May 2008

The disco-like blue rings of ceiling lights and starburst pattern of colorful carpet radiating out from the semi-circle service desk beckon to the students – come here to do almost anything! Boasting 73 multimedia computers, four video editing studios, a sound studio, a transfer studio, and two classrooms, the Student Multimedia Design Center, which opened February 2007, in the University of Delaware Library offers a multitude of both traditional and innovative services to the students.
Zur Grammatikalisierung von geben im Deutschen und Lëtzebuergeschen
Authors: Lenz Alexandra
Published: May 2008

This contribution focusses on grammatical peculiarities of German and Luxembourgish connected with the verb geben ‘to give’. It addresses the grammaticalization processes which have been resulted in the existential construction es gibt ‘there is’, the geben-copula, and the passive and conditional auxiliary uses of geben. The paper sets out to collect and pull together scattered research findings which address individual aspects of the phenomena, and further, to document the large number of unresolved issues surrounding the grammatical affinity of geben. Selecting from the latter the question of the historical relationship between the grammaticalized geben-variants, this contribution first reviews the hypotheses extant in the research literature before testing these against the inter- and intrasystemic variation found in German regional varieties (dialects and regional varieties).
Das Zustandspassiv – Pragmatische Beschränkungen und Regelkonflikte
Authors: Welke Klaus
Published: May 2008

In constructions of copula + participle II, often called “Zustandspassiv”, we find many unclear restrictions. Maienborn (2007: 83-115) explains these by pragmatics in the following way: One invariant meaning is opposed to different pragmatic readings that are gaining their existence in the pragmatic level only. We explain these restrictions in semantics itself. Restrictions in forming copula + participle II-constructions are due to conflicts between the construction meaning of copula constructions and the construction meanings of participles II. Pragmatics is mediating between the conflicting construction meanings by means of pragmatic implicatures. Due to these accommodations nearly no copula + participle construction is grammatically wrong in a strict sense, but many constructions remain restricted in their acceptability. The construction meaning of Zustandspassiv is opposed to three meaning variants of participle II. The interplay between the construction meaning of copula constructions and the three meaning variants of participles II results in different accomodations between copula-constructions and participle meanings. In some cases participle meanings adapt to copula construction meanings, in other cases the opposite process is going on. On the one hand the construction meaning of copula construction is the predication of a property to the referent of the subject. On the other hand there are a post state (target state) meaning, a present state meaning and a past time meaning of particples II. The interplay with the construction meaning of the copula construction results in four meaning variants of Zustandspassiv: post state (target state) as a property, present state as a property, past time of an event as a property, and past time meaning only. The meaning ‘past time of an event as a property’ is grammaticalizing to a past sein-passive as opposed to past werden-passive with full grammaticality. At least there are constructions that are also not completely wrong, but the accommodation to the construction meaning of copula constructions failed in a way that the only possibility of interpretation is to understand these constructions of sein + participle II as elliptical werden-passives of past tense. In this case the past time meaning of the participle completely has gained superiority to the original copula construction.
Valenz-Tagung Universität Erlangen / Nürnberg vom 4.-7. April 2005
Authors: Czicza Dániel
Published: May 2008

An der Friedrich-Alexander-Universität Erlangen-Nürnberg fand vom 4. April bis zum 7. April 2005 die Tagung Valency:Valenz. Theoretical, descriptive and cognitive issues statt. Für die Organisierung der Veranstaltung zeichneten Thomas Herbst und Katrin Götz vom Institut für Anglistik und Amerikanistik verantwortlich. Die beiden Organisatoren luden zu einer Tagung ein, die möglichst viele Aspekte des Themas Valenz umfassen sollte. So wurden u.a. lexikografische, kontrastive, kognitive und computerlinguistische Herangehensweisen angesprochen. Die Tagung war vorwiegend englischsprachig, was aber germanistisch orientierte Fragestellungen nicht ausschloss. Nach den Begrüβ ungsworten von Thomas Herbst begann Gert Rickheit die Vortragsreihe mit seinen Überlegungen zum Thema „Cognition and valency“. Zunächst ging er auf strukturelle, semantische und funktionale Aspekte von Valenz ein, wobei er die kognitive Relevanz dieser einzelnen Ebenen beleuchtete. Im zweiten Teil des Vortrags legte er den Schwerpunkt auf psycho- und neurolinguistische Aspekte der Valenztheorie und stellte Gedächtnisexperimente vor, die das Vorhandensein kognitiver Schemata und so genannter „default slots“ demonstrierten. Er kam dann zu dem Schluss, dass in einer adäquaten Valenztheorie weder strukturelle noch kognitive Gesichtspunkte zu kurz kommen dürften.
Development of an electrochemistry apparatus for the heaviest elements
Authors: Toyoshima A. , Kasamatsu Yoshitaka , Kitatsuji Y. , Tsukada K. , Haba H. , Shinohara Atsushi , Nagame Yuichi
Published: May 2008

We developed a new apparatus for the study of electrochemical properties of the heaviest elements. The apparatus is based on a flow electrolytic cell combined with column chromatography. Glassy-carbon fibers modified with Nafion perfluorinated cation-exchange resin are used as a working electrode as well as a cation-exchanger. The elution behavior of 139Ce with the number of 1010 atoms in 0.1 M ammonium α-hydroxyisobutyric acid solution from the column electrode was investigated at the applied potentials of 0.2–1.0 V versus the Ag/AgCl reference electrode in 1.0 M LiCl. It was found that 139Ce3+ is successfully oxidized to 139Ce4+ even with tracer concentration at around the redox potential determined by cyclic voltammetry for the macro amounts of Ce with 1017 atoms (10−3 M). The present oxidation reaction and separation of Ce4+ was accomplished within a few minutes.
Age determination of plutonium material by alpha spectrometry and thermal ionization mass spectrometry
Authors: Zhang Hai-Tao , Zhu F. R. , Xu J. , Dai Y. H. , Li D. M. , Yi X. W. , Zhang L. X. , Zhao Y. G.
Published: May 2008

Age is a key parameter to deduce the history of a plutonium material. An experimental method using both alpha spectrometry and thermal ionization mass spectrometry has been developed for the age determination of plutonium material. This method is based on the parent/daughter pair 241Pu/241Am ratio and has been validated using several plutonium source of known age. The results obtained are in good agreement with the last purification date of plutonium source.
Oxidation of ruthenium oxide deposits by ozone
Authors: Mun Christian , Cantrel L. , Madic Charles
Published: May 2008

During a hypothetical severe accident on a nuclear Pressurized Water Reactor (PWR), the formation of highly radiotoxic RuO4(g) may occur in the reactor containment building, resulting from the interactions of ruthenium oxide deposits with the oxidising medium induced by air radiolysis. Consequently, there is a risk that the gaseous ruthenium tetroxide could be dispersed into the environment through containment leakages; therefore data concerning the behaviour of ruthenium oxide deposits is of primary importance for safety studies. An experiment has been designed to study the interactions of ruthenium oxide deposits with ozone, formed by air radiolysis. Experimental results have shown that the oxidation reaction leading to the formation of RuO4(g) occurred to a large extent. An oxidation kinetic rate law has been determined, in dry and moist air, for ruthenium deposited onto painted substrates, representative of the inner surfaces of PWR's. This law, combined with tetroxide stability data [Mun, C., Cantrel, L., Madic, C.: Study of RuO4 decomposition in dry and moist air. Radiochim. Acta 95(11), 1 (2007)], will allow a first evaluation of ruthenium revolatilisation phenomenon, possibly occurring in the containment during a severe accident.
Oxidation–reduction reactions of simple hydroxamic acids and plutonium(IV) ions in nitric acid
Authors: Carrott M. J. , Fox O. D. , LeGurun G. , Jones C. J. , Mason C. , Taylor Robin J. , Andrieux F. P. L. , Boxall C.
Published: May 2008

Simple hydroxamic acids such as formo- and aceto-hydroxamic acids have been proposed as suitable reagents for the separation of either Pu and/or Np from U in modified or single cycle Purex based solvent extraction processes designed to meet the emerging requirements of advanced fuel cycles. The stability of these hydroxamic acids is dominated by their decomposition through acid hydrolysis. Kinetic studies of the acid hydrolysis of formo- and aceto-hydroxamic acids are reported in the absence and the presence of Pu(IV) ions. The slow reduction of these plutonium(IV) hydroxamate complexes to Pu(III) aquo-ions has been characterised by spectrophotometry and cyclic voltammetry. The reductions of Pu(IV) in the presence of FHA and AHA are consistent with a mechanism in which free hydroxamic acid in solution is hydrolysed whilst Pu(IV) ions remain fully complexed to hydroxamate ligands; then at some point close to a 1 : 1 Pu(IV) : XHA ratio, some free Pu4+ is released from the complex and reduction is initiated. Electrochemical and kinetic data suggest that the reductant is the hydroxamic acid rather than the hydroxylamine.
Uptake of anionic radionuclides onto degraded cement pastes and competing effect of organic ligands
Authors: Pointeau I. , Coreau N. , Reiller Pascal E.
Published: May 2008

Hardened cement pastes (HCP) present a high affinity with a lot of radionuclides (RN) and can be used as waste confining materials in radioactive waste repository. Indeed, in cementitious media, RN can be removed from solution via (co)precipitation reactions or via sorption/diffusion mechanisms. In this study, the affinity of anionic RN (Cl−, I−, SeO3
2− and CO3
2− chemical forms) with a CEM-I HCP has been studied vs. the degradation of the HCP particles. These RN are considered as mobile in repository media and it is important to have a set of distribution ratio (R
d) in cement environment. The R
d values have been measured in batch experiments as a function of the pH, used as the degraded state parameter of the HCP suspensions. The R
d values increase in all cases, from the unaltered state (pH 13.3) to the altered state of HCP, i.e. until all portlandite is dissolved, corresponding to pH 12.6. Then, R
d values decrease until degraded states (pH 12.0), corresponding to the decalcification of the calcium silicate hydrate (C-S-H) phases. The behaviour of anionic RN seems to be correlated to the evolution of calcium concentration and is opposed to the evolution of sulphate concentration in solution which could have a competing effect. Comparison is done with the behaviour of caesium and uranium(VI), which is a cationic RN but has a major negative hydrolysed species at high pH. As awaited, the uranium(VI) behaviour is very different from purely anionic RN one in accord with spectroscopic analyses from literature works. The R
d values have also been measured for the organic ligands isosaccharinate (ISA) and EDTA. The uptake of ISA can be important and competing effect with the sorption of SeO3
2− has been evidenced in HCP suspensions as a function of the ISA concentration.
Local Understanding of Fish Consumption Advisory Risks in Michigan's Upper Peninsula: The Role of Structure, Culture, and Agency*
Authors: Habron Geoffrey , Barbier Melanie , Kinnunen Ronald
Published: May 2008

Abstract Fish consumption advisories fail to adequately help communities address the benefits and risks of eating potentially contaminated fish. We engaged community members and relevant institutions in identifying and implementing more effective risk communication in Michigan's rural Upper Peninsula. In 2004–2005, we collected data in four Michigan counties through focus groups, community dinners, public meetings and angler interviews. Residents express a strong affinity toward eating Great Lakes fish, though a minority of participants have read the official fish advisory. Participants lack an understanding of how bioaccumulation affects consumption risk depending on the type of contaminant. We attribute the situation to conditions of post‐normal risk that emerge through interaction of the structural dimensions of science and bureaucracy with a strong natural resource‐based culture that affects the agency of residents. The implications loom large as Michigan's Department of Community Health no longer distributes hard copies of the Michigan Fish Advisory.
Understanding the Nature and Extent of Farm and Ranch Diversification in North America*
Authors: Barbieri Carla , Mahoney Edward , Butler Larry
Published: May 2008

Abstract Pressure to adopt enhanced production technologies, changing government support policies, increasing and more diverse competition, and changing markets have posed economic challenges to North American farmers over the past two decades. As a response, farmers are adjusting their production model by incorporating agricultural related enterprises. Although there is evidence that farm diversification is occurring throughout North America, there is a dearth of scientific information regarding the types of enterprises being developed and used in this context. This study aims to fill this void by exploring the extent of farm diversification by identifying and describing eight types of enterprises that farmers and ranchers are using. It was found that levels of diversification are often dependent on operating and management attributes and owner characteristics, such as the number of family members working on the farm and the number of days that the farmer's spouse works off the farm.
Ideologically Structured Information Exchange among Environmental Groups*
Authors: Lhotka Laura , Bailey Conner , Dubois Mark
Published: May 2008

Abstract We use social network analysis to test the hypothesis that group ideology affects information exchange among environmental groups. The analysis is based on interviews with leaders of 136 environmental groups in Alabama. This paper adds to the literature on resource mobilization among social movement organizations by exploring information exchange among a wide range of environmental groups across an entire state, and by incorporating ideology into our analysis. A typology of environmental groups was developed based on willingness to engage or not engage in political and legal activism to pursue their goals. We found a level of information exchange between activist groups twice that among all other groups. We also found that differing ideological profiles did not limit the flow of information between groups, taken as a whole. We conclude that the relatively high level of connectivity is attributable in part to the presence of paid staff among several key activist groups, making these groups important resources for technical and non‐technical support for all groups across the state.
Political Socialization and Reactions to Immigration‐Related Diversity in Rural America*
Authors: Gimpel James G. , Lay J. Celeste
Published: May 2008

Abstract We explore the roots of tolerance for immigration‐related diversity from a political socialization perspective. Among rural adolescent respondents, we find that attitudes toward immigrants are surprisingly variable along a number of important dimensions: anticipated socioeco‐nomic status, family longevity in the community, and employment in agriculture. The extent to which an adolescent's family is anchored in the community proves to be an important determinant of diversity attitudes. Tolerance for diversity is also contextually conditioned by the percentage of immigrants settled in a neighborhood, and the percentage of the local population employed in farming. Interestingly, lower income youth are more welcoming of immigration than the affluent, particularly when they live near them. Without quite labeling these rural adolescent populations racially “progressive,” the youth we encountered mostly expressed the norms of tolerance and civility essential for avoiding unpleasant intergroup conflict.
Regulation of spermatogenesis in McCune–Albright syndrome: lessons from a 15-year follow-up.
Authors: De Luca Filippo , Mitchell Valérie , Wasniewska Malgorzata , Arrigo Teresa , Messina Maria Francesca , Valenzise Mariella , de Sanctis Luisa , Lahlou Najiba
Published: May 2008

Context

McCune–Albright syndrome (MAS) is a disorder caused by a post-zygotic gain-of-function mutation in the gene encoding the Gs-α protein. Sexual precocity, common in girls, has been reported in only 15% of boys, and little is known on the long-term evolution of MAS in males.

Objective

In a boy with MAS, we studied spermatogenesis, testis histology, and immunohistochemistry with the aim to shed light on seminiferous tubule activity.

Design

A boy who presented at the age of 2.9 years with sexual precocity, monolateral macroorchidism, increased testosterone levels, and suppressed gonadotropins was followed up until the age of 18.

Results

Throughout follow-up testicular asymmetry persisted and gonadotropin and testosterone pattern did not change. At the age of 18, inhibin B was undetectable while α-immunoreactive inhibin was within normal range. Anti-Mullerian hormone level was slightly subnormal. Sperm cells were 3 900 000 per ejaculate. Histology of both testes showed spermatogonia, spermatocytes, and, in some tubes, matured spermatozoa. Sertoli cells were markedly stained with anti-inhibin α-subunit antibody in both the testes. There was no immunostaining of Sertoli, Leydig, or germ cells with anti-βA or anti-βB antibody. MAS R201H mutation was identified in both the testes.

Conclusion

The 15-year follow-up in this boy with MAS demonstrated that autonomous testicular activation and gonadotropin suppression persisted over time. This provides an interesting model of active spermatogenesis despite long-term FSH suppression. It also suggests that FSH is needed for the full expression of the inhibin βB-subunit gene, an expression previously reported in the germ and Leydig cells of normal adult subjects.
Analysis of mRNA expression for steroidogenic enzymes in the remaining adrenal cortices attached to adrenocortical adenomas.
Authors: Shigematsu Kazuto , Nakagaki Takehiro , Yamaguchi Naohiro , Kawai Kioko , Sakai Hideki , Takahara Osamu
Published: May 2008

Design and methods

We have recently demonstrated that the adrenal cortices attached to aldosterone-producing adenoma (APA) contained microscopic subcapsular micronodules suggestive of active aldosterone production. In this study, we usedin situhybridization to investigate the mRNA expression of steroidogenic enzymes in the adrenal cortices attached to cortisol-producing adenoma (CPA) and clinically silent adenoma (non-functioning adenoma; NFA), in addition to APA.

Results

Microscopic subcapsular micronodules, which were several hundreds of micrometers in size and spheroid in shape, were observed in the cortices attached to CPA and NFA, as well as APA, at high frequency. Most of the cortical nodules in zona fasciculata to zona reticularis showed a suppressed steroidogenesis in the cortices attached to adenoma, but some expressed intensely all necessary steroidogenic enzyme mRNAs for cortisol synthesis.

Conclusions

It is thus necessary to keep in mind, on the occasion of subtotal adrenalectomy, that lesions with the potential to later develop into functional adrenocortical nodules may be present in other parts of the ipsilateral or contralateral adrenal cortices.
Extremely long survival in six patients despite recurrent and metastatic adrenal carcinoma.
Authors: Hermsen I G C , Gelderblom H , Kievit J , Romijn J A , Haak H R
Published: May 2008

Objective

Adrenal cortical carcinoma (ACC) is an aggressive tumour with a high mortality. We describe six patients living 12–28 years despite recurrent and/or metastatic ACC.

Patients

The first patient presented in 1979 with an ACC of 8 cm. After resection, she developed seven recurrences for which she was treated with resection and/or mitotane (o,p′-DDD) treatment. The patient is still alive 28 years after diagnosis. The second patient presented with an ACC of 9 cm. After resection, the patient developed liver metastases, which were treated witho,p′-DDD. The patient is still alive 25 years after diagnosis. The third patient presented with an ACC of 12 cm. The tumour was resected followed byo,p′-DDD treatment. She had a local recurrence that was completely resected. She is still alive 18 years after diagnosis. The fourth patient presented with an ACC of 14 cm. After resection, adjuvanto,p′-DDD was started. Subsequently, the patient developed two recurrences, which were resected. He is still alive 17 years after the initial diagnosis. The fifth patient presented with an ACC of 10 cm. After diagnosis, she developed lung metastasis, which were treated witho,p′-DDD and chemotherapy. The patient is still alive with slowly progressive disease 12 years after diagnosis. The sixth patient presented with an ACC of 7 cm. After resection, she developed four recurrences, which were resected. The patient is still alive 28 years after diagnosis.

Conclusion

Some patients can have an extremely long survival of ACC, despite recurrent disease and metastases. The mainstay of therapy in our patients was repeated surgery ando,p′-DDD.
Lower sex hormone-binding globulin is more strongly associated with metabolic syndrome than lower total testosterone in older men: the Health in Men Study
Authors: Paul Chubb S A , Hyde Zoë , Almeida Osvaldo P , Flicker Leon , Norman Paul E , Jamrozik Konrad , Hankey Graeme J , Yeap Bu B
Published: May 2008

Background

Reduced circulating testosterone and sex hormone-binding globulin (SHBG) are implicated as risk factors for metabolic syndrome. As SHBG increases with age while testosterone declines, we examined the relative contributions of SHBG and testosterone to the risk of metabolic syndrome in older men.

Methods

We conducted a cross-sectional study of 2502 community-dwelling men aged ≥70 years without known diabetes. Metabolic syndrome was defined using the National Cholesterol Education Program-Third Adult Treatment Panel (NCEP-ATPIII) criteria. Early morning fasting sera were assayed for total testosterone, SHBG and LH. Free testosterone was calculated using mass action equations.

Results

There were 602 men with metabolic syndrome (24.1%). The risk of metabolic syndrome increased for total testosterone <20 nmol/l, SHBG <50 nmol/l and free testosterone <300 pmol/l. In univariate analyses SHBG was associated with all five components of metabolic syndrome, total testosterone was associated with all except hypertension, and free testosterone was associated only with waist circumference and triglycerides. In multivariate analysis, both total testosterone and especially SHBG remained associated with metabolic syndrome, with odds ratios of 1.34 (95% confidence interval (CI): 1.18–1.52) and 1.77 (95% CI: 1.53–2.06) respectively. Men with hypogonadotrophic hypogonadism (total testosterone <8 nmol/l, LH ≤12 IU/l) had the highest prevalence of metabolic syndrome (53%,P<0.001).

Conclusions

Lower SHBG is more strongly associated with metabolic syndrome than lower total testosterone in community-dwelling older men. SHBG may be the primary driver of these relationships, possibly reflecting its relationship with insulin sensitivity. Further studies should examine whether measures that raise SHBG protect against the development of metabolic syndrome in older men.
Differential expression of Fas system apoptotic molecules in peripheral lymphocytes from patients with Graves' disease and Hashimoto's thyroiditis.
Authors: Fountoulakis Stelios , Vartholomatos George , Kolaitis Nikolaos , Frillingos Stathis , Philippou George , Tsatsoulis Agathocles
Published: May 2008

Objective

To examine whether the Fas system apoptotic molecules are differentially expressed in Graves' disease (GD) and Hashimoto's thyroiditis (HT), the two opposite phenotypes of autoimmune thyroid disease (AITD).

Design

The expression of Fas and Fas ligand (FasL) on peripheral CD4 and CD8 lymphocytes, and non-lymphoid immune cells as well as their soluble forms in serum from untreated patients with GD and HT were evaluated.

Methods

Flow cytometry was performed for the study of peripheral immune cells from 70 newly diagnosed patients with AITD (55 with HT and 15 with GD) and 20 controls. ELISA was used for the measurement of soluble Fas (sFas) in serum samples from a subgroup of 35 AITD patients.

Results

An increase in the proportion of CD4 and CD8 cells expressing Fas was found in both GD and HT, albeit with some differences, when compared with controls. Importantly, in GD patients, the intensity of Fas expression on CD4 and CD8 lymphocytes was reduced and sFas levels in serum were simultaneously increased when compared with HT patients and controls.

Conclusions

The Fas system apoptotic molecules appear to be differentially expressed on peripheral lymphocytes in the two opposite phenotypes of AITD.
Egyszerű sebészi módszer a tricuspidalis annuloplasztika eredményének műtét alatti értékelésérer
Authors: Tamás Éva , Galajda Zoltán , Maros Tamás , Szentkirályi István , Palotás Lehel , Jagamos Endre , Péterffy Árpád
Published: May 2008

Absztrakt

A tricuspidalis annuloplasztika eredményének értékelése a műtét során transoesophagealis echocardiographiás vizsgálattal lehetséges. Ahhoz, hogy a vizsgálat megbízható eredményt nyújtson, fel kell függeszteni az extracorporalis keringést. A szerzők azt tapasztalták, hogy ha a megjavított tricuspidalis billentyű megfelelően működik, akkor verő szív mellett a pitvari varrat elkészítésekor nem észleltek visszaáramlást a billentyűn keresztül. Más szóval a sinus coronariuson visszatérő vért nem kell elszívni, ugyanis az a jobb kamrába befolyva, a jól záró billentyű meggátolja a vér visszaáramlását a pitvarba. Ez a jelenség jól egyezik a műtét alatt és után végzett echocardiographiás vizsgálattal. Ezt bizonyítja a 72 betegnél történt, nagyobbrészt tervezett (51 eset) vizsgálat. A műtétet túlélő és távozott 69 beteg (95,8%) közül csak egyetlen esetben (1,5%) volt jelentős eltérés az itt ismertetett észlelés és a műtét utáni echocardiás eredmény között. Összegezve: A funkcionális tricuspidalis elégtelenség (regurgitatio) megjelenése a bal szívfél betegsége esetén a szívizom-károsodás jele, és így a szívműtét elvégzésének sürgető javallata. A tricuspidalis plasztika elvégzendő mérsékelt-közepes billentyűelégtelenségnél is, mivel javítja a betegek rövid és hosszú távú életkilátásait. A leírt módszer alkalmas a beavatkozás sikerének műtét alatti megállapítására.
Hasfali sérv műtéte No-React® eljárással készült borjúpericardium-folt beültetésévelr
Authors: Szerafin Tamás , Leny Andrij , Palotás Lehel , Veres Lukács , Homolay Ágnes , Papp Csaba
Published: May 2008

Absztrakt

A hasfali sérvek sebészi kezelése az elmúlt évtizedekben jelentősen fejlődött. A hasfal hiányának feszülésmentes zárása a sikeres műtét alapja, mely sokszor csak sérvhálóval/folttal biztosítható. Az erre a célra széles körben elterjedt szintetikus anyagú hálók jelentősen csökkentették a sérvek kiújulását, azonban ezek beültetése fertőzések és egyéb súlyos szövődmények forrása lehet. A szerzők két esetben – a fertőzéses szövődmény elkerülésére – egy különleges eljárással, borjúszívburokból készült sérvfolt segítségével zárták az epigastrialis hegsérvet. Mindkét beteg szövődménymentesen gyógyult. A 7, illetve 15 hónappal a műtét után végzett ellenőrző vizsgálat során sem a sérv kiújulását, sem egyéb szövődményt nem észleltek. A közlemény ismerteti az alkalmazott műtéti eljárást, a beültetett sérvfolt kedvező tulajdonságait, és áttekinti a szakirodalmat. Következtetés: Kezdeti tapasztalatok és irodalmi adatok alapján a Shelhigh No-React® borjúszívburok-sérvfolt biztonságosan és eredményesen használható a direkt varrattal nem helyreállítható hasfali sérvek kezelésében. A módszer alkalmasságának igazolására további vizsgálatok szükségesek.
Terhesség és nyitott szívműtétr
Authors: Aranyosi János , Aranyosi János , Péterffy Árpád
Published: May 2008

Absztrakt

Az anya és a magzat egészségét és életét jelentősen veszélyezteti a szívműtétet igénylő várandós szívelégtelenségének kezelése. A szívbetegség a legtöbb esetben régóta ismert, de a terhesek általában nem rendelkeznek kellő ismeretekkel szívbetegségük súlyosságáról és a terhesség során kialakuló szövődményekről. A termékeny korú szívbeteg nőknek a családtervezés során való rendszeres kardiológiai és nőgyógyászati gondozása a terhesség vállalásával járó veszélyek részletes feltérképezését valósítaná meg, és így a szükségessé váló szívműtét a terhesség előtt elvégezhető lenne. A nyitott szívműtét kizárólag olyan terheseknél indokolt, akiknél a kardiológiai kezelés elégtelen – beleértve az invazív katéteres eljárásokat –, és a műtét halasztása a szívteljesítmény jelentős romlásához, szívelégtelenséghez és halálhoz vezetne. A szívműtét a terhesség idején az érintett szakemberek együttműködését igényli. A pontos kórisme, a javallat körültekintő meghatározása, a megfelelő időzítés, valamint az anaesthesia, a művi keringés és a műtét részleteinek megtervezése és sikeres megvalósítása a magzat folyamatos cardiotocographiás észlelésével együtt a beavatkozást biztonságossá teszi. A magzat folyamatos észlelése oxigénhiányos veszélyállapotának felismerése és gyors elhárítása érdekében elengedhetetlen. A szívműtét magzati kockázatának csökkentését a rövid műtéti és művi keringési idő, a normotermia, valamint a szokásosnál magasabb perctérfogat és artériás középnyomás szolgálja. Napjainkban a terhesség alatti szívműtét az anya számára elegendően biztonságos eljárás, de a magzati veszteség még mindig nem fogadható el.
A vákuumtámogatott sebkezelés eredményei szívműtétet követő sternotomiás sebfertőzésekbenr
Authors: Debreceni Tamás , Szerafin Tamás , Galajda Zoltán , Miskolczi Szabolcs , Péterffy Árpád
Published: May 2008

Absztrakt

Bevezetés: A sternotomia utáni sebfertőzések kezelésére az elmúlt évtizedben egy új módszer – a vákuumtámogatott sebkezelési eljárás (VAC – Vacuum-Assisted Closure) – került bevezetésre, amelyet a szívsebészetben hazánkban elsőként a Debreceni Egyetem Orvos- és Egészségtudományi Centrum Szívsebészeti Központjában alkalmaztak. Anyag és módszerek: Az eljárást 2002. szeptember és 2005. december között 62 betegnél használták a szívműtéteket követő sterno-mediastinitisek kezelésében. A dolgozat célja ezen új kezelési eljárás és módszer eredményeinek középtávú vizsgálata. Eredmények: A tanulmányba bevont 42 férfi és 20 nő átlagéletkora 63,1 ± 6,8 (42–75) év volt, akiknél mesterséges keringés segítségével végzett szívműtétet követően alakult ki a sternotomiás seb felszínes vagy mély fertőzése. A vákuumtámogatott sebkezelés a fertőzött sternotomiás seb feltárását és kitakarítását követően került alkalmazásra a seb feltisztulásáig, amely minden esetben sikerült. Ezt követően a mellkasi seb helyreállítására került sor. Ez 34 betegnél a nagy mellizomból képzett izomlebeny(ek) és/vagy a nagycseplesz-, illetve szívburokzsírszövet felhasználásával, 13 esetben a sternum újrarögzítésével, 11 betegnél a seb másodlagos varratával, 1 esetben pedig Ley-protézis (a sternum stabilizálására alkalmazott fémprotézis) beültetésével történt. Három beteg a kezelés során elhalálozott, ezért nem kerülhetett sor helyreállító műtétre. A fertőzés első tüneteitől átlagosan 42,2 ± 18,5 (5–185) nap, az első seb helyreállításától 19 ± 9,6 (1–63) nap telt el a beteg elbocsátásáig. A vákuumtámogatott sebkezelés átlagos időtartama 7,9 ± 3,4 (1–21) nap volt. A kórházi halálozás 11,3% volt (7/62). Az utánvizsgálatok során két beteg esetében (3,6%) észleltük a fertőzés kiújulását. Következtetések: Az elért eredmények alapján megállapítható, hogy a vákuumasszisztált sebkezelés a szívműtéteket követő sternotomiás sebfertőzések kezelésének hatékony és biztonságos módszere, melynek alkalmazása a sebek gyors feltisztulását eredményezi, továbbá jelentősen csökkenti a kiújulás veszélyét.
Evaluation of a Single Fixed Dose of Rasburicase 7.5 mg for the Treatment of Hyperuricemia in Adults with Cancer
Authors: Reeves David J. , Bestul Daniel J.
Published: May 2008

Study Objective. To determine the efficacy of a single 7.5‐mg dose of rasburicase compared with single doses of 0.15 mg/kg for the prevention or treatment of hyperuricemia associated with tumor lysis syndrome.

Design. Prospective, open‐label study using a historical control group.

Setting. Large, nonprofit community teaching hospital.

Patients. Seventeen hospitalized patients with cancer and hyperuricemia or a risk for hyperuricemia in the prospective group, and 23 control subjects with cancer who received a weight‐based dose of rasburicase.

Intervention. Patients in the prospective group received a single 7.5‐mg dose of rasburicase and were followed for a minimum of 96 hours. Control subjects received a single 0.15‐mg/kg dose of rasburicase.

Measurements and Main Results. Uric acid levels were measured in all patients at baseline, at 12 and 24 hours after dosing, and then daily. In all patients receiving 7.5 mg, uric acid levels returned to normal at 12 and 24 hours. Mean uric acid levels were similar between the 7.5‐mg and 0.15‐mg/kg groups at 12 hours (1.9 vs 0.99 mg/dl, p=0.12) and at 24 hours (1.34 vs 1.69 mg/dl, p=0.64). Mean reductions in uric acid levels in the 7.5‐mg and 0.15‐mg/kg groups were, respectively, 82% and 91% at 12 hours (p=0.04) and 87% and 79% at 24 hours (p=0.35). If 26 doses of rasburicase were administered every year, a 7.5‐mg dose would save $41,000/year compared with a 0.15‐mg/kg dose ($15,750/10 patients treated).

Conclusions. A single 7.5‐mg intravenous dose of rasburicase appeared to have effects similar to those of a single 0.15‐mg/kg intravenous dose for the treatment or prevention of hyperuricemia associated with tumor lysis syndrome. This low fixed dose also has the potential to reduce costs.
Steady‐State Pharmacokinetics and Pharmacodynamics of Meropenem in Hospitalized Patients
Authors: Cheatham S. Christian , Kays Michael B. , Smith David W. , Wack Matthew F. , Sowinski Kevin M.
Published: May 2008

Study Objective. To evaluate the steady‐state pharmacokinetics and pharmacodynamics of meropenem 500 mg every 6, 8, and 12 hours, based on renal function, in hospitalized patients.

Design. Prospective, open‐label, steady‐state pharmacokinetic study.

Setting. One tertiary care medical center and one community hospital.

Patients. Twenty adult patients (12 men, 8 women) with suspected or documented bacterial infections requiring antimicrobial therapy.

Intervention. Patients received 30‐minute infusions of meropenem 500 mg every 6 hours (group 1), every 8 hours (group 2), or every 12 hours (group 3) based on estimated creatinine clearances greater than 60, 40–60, or 10–39 ml/minute, respectively.

Measurements and Main Results. Serial blood samples were collected after 2 or more days of therapy. Meropenem concentrations were determined by high‐performance liquid chromatography, and pharmacokinetic data were analyzed by noncompartmental methods. Monte Carlo simulations (10,000 patients) were performed to calculate the cumulative fraction of response (CFR) for a percentage of the dosing interval that free drug concentrations remain above the minimum inhibitory concentration (fT>MIC) of 40% by using pharmacokinetic data for each group and MIC data for seven gram‐negative pathogens from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC, 2004–2005) database. Maximum and minimum serum concentrations (mean ± SD) were 29.2 ± 9.8 and 2.4 ±1.1 μg/ml, 33.2 ± 8.5 and 3.8 ± 2.7 μg/ml, and 33.5 ± 4.7 and 4.9 ± 1.6 μg/ml for groups 1, 2, and 3, respectively. The half‐life values were 2.5 ± 0.9, 3.4 ± 1.3, and 6.1 ± 1.4 hours, and the values for volume of distribution at steady state were 29.3 ± 8.7, 23.8 ± 8.1, and 28.7 ± 8.6 L for groups 1, 2, and 3, respectively. For all three groups, the CFR was greater than 90% for the enteric pathogens and Pseudomonas aeruginosa and 82.4–85.2% for Acinetobacter species.

Conclusion. Pharmacodynamic analyses suggest that regimens of meropenem 500 mg every 6, 8, or 12 hours, adjusted for renal function, are acceptable for treatment of infections caused by enteric gram‐negative pathogens and P. aeruginosa. However, more aggressive dosing or alternative dosing strategies may be necessary for Acinetobacter species.
Pharmacodynamics of Uniform versus Nonuniform Warfarin Dosages
Authors: Hameed Mohamed S. , Nafziger Anne N. , Gartung Anne M. , Bertino Joseph S.
Published: May 2008

Study Objective. To compare the pharmacodynamics of uniform versus nonuniform warfarin dosages.

Design. Prospective, randomized, crossover study.

Setting. Anticoagulation clinic.

Subjects. Twenty healthy subjects who had the extensive metabolizer cytochrome P450 (CYP) genotype of 2C9*1/*1 or CYP2C9*1/*3.

Intervention. Subjects received either warfarin 5.75 mg once/day (two 1‐mg tablets plus one and a half 2.5‐mg tablets) as part of the uniform dosage group or warfarin 7.5 mg/day on Mondays and Fridays and 5 mg/day on each of the remaining days of the week as part of the nonuniform dosage group. Subjects received the first regimen for 17 days, had a 2‐week washout period, and then were switched to the other regimen for another 17 days.

Measurements and Main Results. During both treatment periods, international normalized ratios (INRs) were checked daily using a fingerstick method. Any changes in concomitant drug therapy, including over‐the‐counter and supplement products, as well as health status were recorded. The Scheffe post hoc test revealed no significant differences in mean INR values obtained during receipt of the two dosage regimens. In both dosage groups, variation in the INR became more pronounced as INR values increased. No adverse events (i.e., major or minor bleeding) or changes in drug therapy were reported during the study.

Conclusion. Our findings suggest that it is safe to use a nonuniform dosage regimen of warfarin to reach a target INR range. With both uniform and nonuniform regimens, close monitoring remains important to ensure that patients remain within the desired INR range.
Absorption, Bioavailability, and Partner Transfer of Estradiol from a Topical Emulsion
Authors: Taylor Maida B. , Gutierrez Maria J.
Published: May 2008

Study Objective. To investigate the systemic absorption of estradiol in partners of postmenopausal women after making skin‐to‐skin contact with the application sites of estradiol topical emulsion.

Design. Open‐label, nonrandomized clinical study.

Setting. Clinical study unit.

Subjects. Fourteen postmenopausal women and their male partners (mean ± SD age 57.6 ± 8.7 and 49.1 ± 13.3 yrs, respectively).

Intervention. Women applied 1.74 g/day of estradiol topical emulsion (containing 2.5 mg estradiol/g) to each leg on 2 consecutive days. Their male partners were exposed to the application sites by mean of vigorous skin‐to‐skin contact at 2 and 8 hours after application.

Measurements and Main Results. Serum concentrations of estradiol, estrone, and estrone sulfate were measured in the female subjects and their male partners. The mean ± SD estradiol level in the women at baseline was 2.9 ± 1.5 pg/ml. Their average concentration (Caverage) increased from 15.3 ± 14.8 pg/ml on the first day of treatment to 27.6 ± 22.7 pg/ml on the second day. Among male partners, Caverage for serum estradiol increased from 17.0 ± 4.3 pg/ml at baseline to 21.0 ± 4.4 pg/ml on the second exposure day. Their geometric mean fold ratio for the area under the serum concentration‐time curve from 0–24 hours was 1.25 (baseline vs after second exposure, p<0.0001).

Conclusions. Estradiol was transferred to male partners by means of vigorous skin‐to‐skin contact at application sites. Although the increase in postexposure levels of estradiol was statistically significant, all levels were still below the upper limit of the normal range for men (45 pg/ml).

Conclusion
Concurrent Administration of Sirolimus and Voriconazole: A Pilot Study Assessing Safety and Approaches to Appropriate Management
Authors: Surowiec Dorothy , DePestel Daryl D. , Carver Peggy L.
Published: May 2008

Study Objectives. To assess the use and safety of concurrent administration of voriconazole and sirolimus—which is contraindicated—and to determine approaches for appropriately managing patients who receive both drugs.

Design. Retrospective medical record review.

Setting. University‐affiliated medical center.

Patients. Thirty‐one cases in 23 inpatients who received at least one dose of voriconazole and sirolimus concomitantly within a 24‐hour period.

Measurements and Main Results. Data on sirolimus and voriconazole indications, doses, routes, frequencies, and administration times; number of days of coadministration; and sirolimus dosage adjustments were collected. In addition, data on laboratory values, adverse events, sirolimus concentrations, and concomitant drugs, including cytochrome P450 (CYP) 3A isoenzyme and P‐glycoprotein inhibitors and inducers, were collected for 7 days before, during, and for 14 days after coadministration. No cases of elevated sirolimus concentrations (> 20 mg/ml) occurred in patients stabilized with voriconazole before starting low‐dose sirolimus 0.5‐1 mg/day, or in those stabilized with sirolimus 0.5‐2 mg/day who had baseline sirolimus concentrations of 12 ng/ml or lower and whose sirolimus dose was decreased by 50% before the addition of voriconazole. In contrast, elevated sirolimus concentrations were experienced in patients receiving sirolimus doses of 4 mg/day or higher who had sirolimus concentrations of 12 ng/ml or higher and whose sirolimus dose was not decreased before addition of voriconazole. In a patient who received sirolimus with itraconazole, a strong CYP3A isoenzyme inhibitor, one case of only a minimal increase in the sirolimus concentration occurred after the addition of voriconazole.

Conclusions. Sirolimus and voriconazole can be safely coadministered as long as consideration is given to which agent the patient receives first, the sirolimus dosage, sirolimus concentrations, and concurrent disease states and CYP3A isoenzyme inhibitors. Sirolimus concentrations should be closely and routinely monitored before, during, and after coadministration of voriconazole and other CYP3A isoenzyme inhibitors. Based on the results of this pilot study, a protocol on the management of this drug combination will be implemented and prospectively evaluated for efficacy and safety.