bluuebunny/crossref_metadata_2025 huggingface dataset:
Prostate cancer survivors who would be eligible for active surveillance but were either treated with radiotherapy or managed expectantly: comparisons on long‐term quality of life and symptom burden
Authors: Thong Melissa S.Y. , Mols Floortje , Kil Paul J.M. , Korfage Ida J. , Van De Poll‐Franse Lonneke V.
Published: August 2009

Study Type – Therapy (outcomes research) Level of Evidence 2c

OBJECTIVE

To assess and identify factors associated with the long‐term health‐related quality of life (HRQL) of prostate cancer survivors managed expectantly, as patients with low‐risk prostate cancer can be managed with active surveillance (AS), but research on associated long‐term HRQL is scarce.

PATIENTS AND METHODS

From the population‐based Eindhoven Cancer Registry, 71 men managed with AS were matched with 71 survivors who had similar demographic and clinical characteristics but treated with external beam radiotherapy (RT). All were diagnosed between 1994 and 1998. HRQL data were collected 5–10 years after diagnosis. Patients completed generic‐ (Short Form‐36) and cancer‐specific (Quality of Life – Cancer Survivors) HRQL instruments, and symptom burden (Expanded Prostate Cancer Index, Sexual Activity) questionnaires.

RESULTS

Patients on AS were comparable to those treated with RT for most generic‐ and disease‐specific HRQL dimensions. Patients treated with RT had poorer mean (sd) bowel function scores, of 87.1 (13.1) vs 92.8 (10.7) (P < 0.001), more bother with bowel function, at 85.0 (16.4) vs 93.7 (10.1) (P < 0.001), and more problems with getting an erection (68% vs 47%, P = 0.005). Multivariate regression analyses (corrected for comorbidity and clinical disease progression) indicated that the management strategy independently predicted differences in physical functioning, bodily pain, spiritual and total well‐being, and bowel function and bowel bother.

CONCLUSIONS

Patients managed expectantly at initial diagnosis (AS) have comparable HRQL and a lower symptom burden than patients treated with RT up to 10 years after the diagnosis.
Morbidity of open retroperitoneal lymph node dissection for testicular cancer: contemporary perioperative data
Authors: Williams Stephen B. , McDermott David W. , Winston Dock , Bahnson Eamonn , Berry Alexander M. , Steele Graeme S. , Richie Jerome P.
Published: August 2009

Study Type – Therapy (prospective cohort) Level of Evidence 2b

OBJECTIVE

To review differences between primary retroperitoneal lymph node dissection (P‐RPLND) and RPLND after chemotherapy (PC‐RPLND) in a contemporary series of patients with testicular cancer, to validate the proposed low morbidity.

PATIENTS AND METHODS

Patients who had undergone RPLND at our institution in 2001–2008 were identified and their clinical charts reviewed; in all, 190 were identified and perioperative data obtained.

RESULTS

Of the 190 patients who had RPLND, 98 (52%) and 92 (48%) had P‐ and PC‐RPLND, respectively. Histology of the orchidectomy specimen consisted of embryonal carcinoma in 146 (76%) patients, also including lymphovascular invasion in 83 (44%). The mean (range) operative duration was 206 (110–475) min and the mean blood loss was 294 (50–7000) mL. The median hospital stay was 4 days. Mean blood loss, operative duration and hospital stay were significantly less for the P‐RPLND than for PC‐RPLND groups (P < 0.05). There were 18 (9%) perioperative complications in all. There were no deaths in either group.

CONCLUSIONS

The short‐term morbidity of open RPLND is acceptable, and open RPLND is safe and effective at select tertiary centres. When compared with historical data, the present contemporary series shows that the operative duration, blood loss and hospital stay have improved, with few complications. These contemporary data should be considered when comparing laparoscopic with open RPLND.
The (Cuban) Voice of the (Curaçaoan) People: The Making (And Taking) of a Collective Memory
Authors: DE JONG NANETTE
Published: August 2009

At the turn of the 20th century, Afro‐Curaçaoans developed an affinity for Cuban culture that influenced the manner to which they came to define their own collective memory. Cuba was raised to mythological status, appropriated and adapted to fit Curaçaoan daily life, enabling a new and inventive sense of belonging. This essay speaks to the intricacies involved in memory‐making, with the Cuban‐inspired memory of memories on Curaçao introduced as a relative category. It points to the variegated and tenuous nature of memory, showing how the past, when negotiated with the present, can shape group goals and demarcate membership.
Ritual Dynamics: Mayor Making in Early Modern Norwich
Authors: EZZY DOUGLAS , EASTHOPE GARY , MORGAN VICTOR
Published: August 2009

Through a detailed analysis of a Guild Day ceremony in early modern England we demonstrate that liminal points in this ritual are interrelated to form a “pattern” or “dance” of liminal pulsations. We argue it is the felt necessity, on the part of participants, to complete that pattern that provides a dynamic to any ritual event. It impels participants to continue the ritual to its conclusion and leads them to resist any interference with the “flow” of the ritual. “Flow”, we assert, is thusbothan interior state of participantsandan exterior social characteristic of a ritual. It is created by the structuring of liminal points in a ritual, the liminal pulsations, but it achieves its dynamic by affecting the interior states of participants so that they feel impelled to “close off” the ritual and complete it.
Trends in Monetary Policy Transparency*
Authors: Geraats Petra M.
Published: August 2009

Transparency has become a prominent feature of monetary policy as central banks have greatly increased the amount of information they disclose about monetary policy‐making. This paper is the first to systematically analyse transparency trends throughout the world and across monetary policy frameworks. It shows that the most notable change in central bank communications has been the greater prevalence of the publication of macroeconomic forecasts and explanations of monetary policy decisions. The rise in transparency has not been confined to inflation targeters but extends to other monetary policy frameworks, although there are significant differences in information disclosure. Nevertheless, in some respects central banks remain quite opaque, in particular about policy deliberations and policy inclinations. This paper also establishes some stylized facts about the macroeconomic environment. In particular, countries with higher inflation and economic development have undergone larger increases in transparency. Moreover, countries with greater transparency have experienced lower subsequent inflation.
Reducing health inequalities in Scotland: the involvement of people with learning disabilities as national health service reviewers
Authors: Campbell Martin , Martin Mike
Published: August 2009

Accessible summary

 People with learning disabilities have more health needs than the general population, and those health needs are different and require more specialised services. There is evidence of poorer outcomes and less effective health interventions for people with learning disabilities in Scotland, and elsewhere.

 Reducing health inequalities is currently a key priority for the Scottish Government and National Health Service (NHS) policy has encouraged patient involvement in healthcare planning and delivery. This article reports on an NHS initiative to involve people with learning disabilities as ‘expert patient’ reviewers in national review teams, looking at the quality of inpatient and community services for people with learning disabilities. All 15 Health Boards in Scotland were reviewed, using a set of quality indicators. Details of the planning and support arrangements are reported. The success of the initiative was evaluated.

 This involvement of people with learning disabilities as reviewers of NHS services has tested traditional assumptions and challenged the power imbalance in patient‐provider relationships. Recommendations are made for the future success of similar schemes.

Reducing health inequalities is a key priority for the Scottish Government. Health authorities are expected to meet quality targets. The involvement of people with learning disabilities in health service review teams has been one of the initiatives used in by National Health Service Quality Improvement Scotland to empower patients and improve health services. This paper describes this initiative, how it was planned, and an evaluation by health staff, carers and people with learning disabilities. Recommendations are made to ensure the future success of this type of initiative in Scotland and elsewhere. This initiative was evaluated positively and tested traditional assumptions, challenging the power imbalance in patient‐provider relationships. The theory and the practice of including people with learning disabilities as ‘expert patient’ reviewers are discussed.
Disruption of nNOS‐PSD95 protein–protein interaction inhibits acute thermal hyperalgesia and chronic mechanical allodynia in rodents
Authors: Florio SK , Loh C , Huang SM , Iwamaye AE , Kitto KF , Fowler KW , Treiberg JA , Hayflick JS , Walker JM , Fairbanks CA , Lai Y
Published: August 2009

Background and purpose: Post‐synaptic density protein 95 (PSD95) contains three PSD95/Dosophilia disc large/ZO‐1 homology domains and links neuronal nitric oxide synthase (nNOS) with the N‐methyl‐D‐aspartic acid (NMDA) receptor. This report assesses the effects of disruption of the protein–protein interaction between nNOS and PSD95 on pain sensitivity in rodent models of hyperalgesia and neuropathic pain.

Experimental approach: We generated two molecules that interfered with the nNOS–PSD95 interaction: IC87201, a small molecule inhibitor; and tat‐nNOS (residues 1–299), a cell permeable fusion protein containing the PSD95 binding domain of nNOS. We then characterized these inhibitors usingin vitroandin vivomodels of acute hyperalgesia and chronic allodynia, both of which are thought to require nNOS activation.

Key results: IC87201 and tat‐nNOS (1–299) inhibited thein vitrobinding of nNOS with PSD95, without inhibiting nNOS catalytic activity. Both inhibitors also blocked NMDA‐induced 3′,5′‐cyclic guanosine monophosphate (cGMP) production in primary hippocampal cultures. Intrathecal administration of either inhibitor potently reversed NMDA‐induced thermal hyperalgesia in mice. At anti‐hyperalgesic doses, there was no effect on acute pain thresholds or motor coordination. Intrathecal administration of IC87201 and tat‐nNOS also reversed mechanical allodynia induced by chronic constriction of the sciatic nerve.

Conclusions and implications: nNOS–PSD95 interaction is important in maintaining hypersensitivity in acute and chronic pain. Disruption of the nNOS–PSD95 interaction provides a novel approach to obtain selective anti‐hyperalgesic compounds.
A prospective randomized trial of two popular mononuclear cell collection sets for autologous peripheral blood stem cell collection in multiple myeloma
Authors: Cooling Laura , Hoffmann Sandra , Herrst Michelle , Muck Charles , Armelagos Heidi , Davenport Robertson
Published: August 2009

BACKGROUND: The COBE Spectra AutoPBSC collection set (AUTO‐kit; CaridianBCT) is a popular dual‐stage collection set for peripheral blood progenitor (PBPC) collection. Although the AUTO‐kit is purportedly equivalent to the white blood cell (WBC) collection set (WBC‐kit) for PBPC collection, improved CD34 yields after switching from the AUTO‐kit to the WBC‐kit were anecdotally observed, particularly in patients with higher WBC counts. A prospective, randomized trial of the AUTO‐ and WBC‐kits for PBPC collection in multiple myeloma (MM) patients was therefore designed.

STUDY DESIGN AND METHODS: Sixty‐eight MM patients were prospectively randomly assigned to either the WBC‐kit or the AUTO‐kit for PBPC collection. Primary study variables included the number of leukapheresis procedures per transplant, CD34/kg yield per procedure, and cumulative CD34/kg yield per mobilization cycle. Results were compared relative to collection kit and mobilization regimen. Statistics and graphics were performed with commercial software.

RESULTS: CD34/kg yields were higher with the WBC‐kit, with 94% of chemotherapy‐mobilized MM patients collecting 6 million CD34/kg in a single mobilization (p = 0.06). The WBC‐kit also had a faster CD34 collection rate relative to peripheral CD34 counts. The AUTO‐kit was significantly sensitive to high WBC counts, with a 50% decrease in CD34 collection efficiency and CD34 collection rate. This effect was specific to MM and not observed in lymphoma patients. Granulocyte–colony‐stimulating factor mobilization and the AUTO‐kit were associated with an increased incidence and severity of infusion reactions.

CONCLUSIONS: The WBC‐kit performed consistently better than the AUTO‐kit for PBPC collection in chemotherapy‐mobilized MM patients, with fewer procedures per mobilization, superior collection rates, and a decreased incidence of infusion reactions.
Role of neutralizing antibodies in controlling simian foamy virus transmission and infection
Authors: Williams Dhanya K. , Khan Arifa S.
Published: August 2009

BACKGROUND: Human infections with simian foamy viruses (SFVs) have been reported after occupational and nonoccupational exposure to infected animals and their tissues, blood, and body fluids, although there is no evidence for human‐to‐human transmission. We previously demonstrated SFV transmission in monkeys by blood transfusion with whole blood from one donor animal that had a low neutralizing antibody (NAb) endpoint titer, whereas blood transfusion from a second donor monkey that had a high NAb titer failed to transmit virus. These results suggested a role for NAbs in SFV transmission and establishment of infection.

STUDY DESIGN AND METHODS: Whole blood and antibody‐reduced blood were transfused into SFV‐negative rhesus macaques. SFV infection in recipient animals was monitored by detection of virus sequences using polymerase chain reaction assays with nucleotide sequence confirmation, by analysis for antibody development in Western blots, and by virus isolation in coculture assays. NAb titer was evaluated by endpoint dilution assays.

RESULTS: SFV transmission by whole blood transfusion from a donor monkey with high NAb endpoint titer failed to establish infection in SFV‐negative monkeys, whereas virus transmission was successful with transfer of antibody‐reduced blood cells.

CONCLUSIONS: Passive transfer of high‐titer NAbs blocked SFV cell–associated transmission, indicating that NAbs may play a role in virus transmission to individuals exposed to SFV‐infected blood and tissues.
Changes in Abdominal Aortic Diameter in Response to the Cold Pressor Test and Nitroglycerin: A New Noninvasive Model for the Assessment of Endothelial‐Dependent and Endothelial‐Independent Vascular Relaxation
Authors: Chandraratna Premindra Anthony N. , Wijegunaratne Kanishka , Farag Kameel F. , Nimalasuriya Anoshie R. , Mathews Sajen J.
Published: August 2009

Coronary vascular responses to the cold pressor test (CPT) have been shown to parallel changes caused by infusion of acetylcholine. Whereas the CPT is a method of assessing endothelial‐dependent vasodilation, nitroglycerin produces endothelial‐independent vasodilation. We performed histological studies on autopsy specimens of abdominal aorta and demonstrated that it is predominantly muscular artery. To test the hypothesis that vasodilatory responses of the abdominal aorta to interventions would parallel those of peripheral vessels, 33 normal males without hypertension, diabetes, or hyperlipidemia, and 10 younger male smokers had ultrasound imaging of the abdominal aorta conducted in the control state, 2 minutes after immersion of the hand in cold water and 10 minutes after rewarming the hand (i.e., cold pressor test). The internal diameter of the abdominal aorta at the onset of the QRS complex was determined for each intervention by averaging 4 beats. It was found that the cold pressor test and nitroglycerin resulted in similar degrees of dilation of the abdominal aorta in nonsmoking subjects, and that these responses were attenuated in smokers. Thus, both endothelial‐dependent and endothelial‐independent vascular relaxation were impaired in smokers. (ECHOCARDIOGRAPHY, Volume 26, November 2009)
Baseline Echocardiographic Predictors of Dynamic Intraventricular Obstruction of the Left Ventricle during Dobutamine Stress Echocardiogram
Authors: Câmara Edmundo Jose Nassri , Oliveira Maristela Magnavita , Ribeiro Fábio Maia
Published: August 2009

Background: Intraventricular obstruction (IVO) during dobutamine stress echocardiogram (DSE) may be associated with or reproduce symptoms. Predictors of IVO are not well established. Methods: 149 patients were studied at rest and during DSE. The normal range of the left ventricular outflow tract (LVOT) velocities was investigated in 68 healthy patients. Results: 19 patients (13%) developed IVO (peak LVOT velocity > 271 cm/sec). A significant linear correlation was observed between peak LVOT velocity during DSE and the following rest parameters: LV end‐diastolic dimension (r =−0.20, P = 0.018), LV end‐systolic dimension (r =− 0.27, P = 0.001), relative wall thickness (r = 0.23, P = 0.006), shortening fraction (r = 0.24, P = 0.004), LVOT diameter (r =− 0.20, P = 0.023) and LVOT velocity (r = 0.29, P < 0.0001). Only relative wall thickness (P = 0.012) and LVOT diameter (P = 0.027) were independent predictors of IVO. As a dichotomous variable, a relative wall thickness ≥0.44 was the only independent predictor of IVO (OR 5.7, 95% CI 1.6–20, P = 0.006), with sensitivity, specificity, negative predictive value, and positive predictive value of 77%, 62%, 95%, and 21%, respectively, and global accuracy of 63% (area under the ROC curve = 0.7). IVO was significantly associated with general cardiovascular symptoms (P = 0.0006) and with chest pain (P = 0.008). Conclusions: Relative wall thickness and LVOT diameter were independent predictors of obstruction. As a dichotomous variable, a relative wall thickness ≤ 0.44 was the only independent predictor of dynamic IVO. (ECHOCARDIOGRAPHY, Volume 26, November 2009)
Hemochromatosis gene mutations and treatment of anemia in patients on hemodialysis
Authors: BROWN Michaela C. , GAFFNEY Dairena , GEMMELL Clare , OAKES Eleanor , MORRIS Scott , SPOONER Richard , JARDINE Alan G. , GEDDES Colin C.
Published: August 2009

Hemochromatosis causes iron overload by enhanced intestinal absorption. This study examined erythropoietin and intravenous (IV) iron requirements in hemodialysis (HD) patients with HFE mutations. Patients on HD for >90 days with no cause of anemia except chronic kidney disease were tested for HFE mutations (H63D and C282Y). Intravenous iron and erythropoietin doses were adjusted to achieve recommended targets. Monthly hemoglobin (Hb), ferritin, mean corpuscular volume, mean cell hemoglobin, erythropoietin, and IV iron doses for 3 consecutive months were averaged. Of 172 patients, 71 (41.3%) had ≥1 HFE mutation: 24 (14%) C282Y heterozygotes, 40 (23.3%) H63D heterozygotes, 5 compound heterozygotes, and 2 homozygotes. Comparing patients with ≥1 HFE mutation to those without mutations showed no significant difference in Hb or serum ferritin. There was a trend toward lower median weekly erythropoietin dose in patients with ≥1 HFE mutation (94.0 vs. 135.4 U/kg body weight; P=0.13). There was no difference in median weekly IV iron dose (1.0 vs. 0.9 mg/kg body weight; P=0.56). Comparing the 30 patients with a C282Y mutation to patients without HFE mutations produced similar results. Comparing the 47 patients with an H63D mutation, with those without HFE mutations, no discernable trend was observed. In this study, patients with HFE gene mutations on HD for established renal failure do not require less iron supplementation to achieve recommended Hb targets. We observed a trend toward lower erythropoietin requirement in patients possessing C282Y mutations. Larger studies may clarify the role of HFE mutations, regulators of iron metabolism and erythropoiesis in chronic kidney disease.
Assessment of adherence to cinacalcet by prescription refill rates in hemodialysis patients
Authors: GINCHERMAN Yekaterina , MOLONEY Kirsten , MCKEE Charles , COYNE Daniel W.
Published: August 2009

Secondary hyperparathyroidism is common among dialysis patients and leads to numerous complications including cardiovascular disease and renal osteodystrophy. Cinacalcet, an oral daily calcimimetic agent that sensitizes the calcium receptor to serum calcium, is approved for treatment of secondary hyperparathyroidism in dialysis patients. We identified 101 patients who received their first cinacalcet prescription between November 2004 and April 2005. All patients were participating in a Missouri state‐funded pharmacy program providing free or low cost medications. We tracked the cinacalcet refill rate and refills for another control medication prescribed to each patient. The average cinacalcet refill rate over the first 12 months was 56% vs. 64% for the control medication (P=0.02). Good adherence, defined as >80% medication possession ratio over the 12 months, was 29% for cinacalcet and 33% for the control medication (P=0.68). Additionally, the refill rate for cinacalcet fell significantly over five quarterly periods from 53% in the first quarter to 37% in the 5th quarter. We conclude that dialysis patients' adherence to medications, including cinacalcet, is poor even when medications are provided at a nominal cost. Poor cinacalcet adherence would be expected to impair long‐term control of SHPT. In a reimbursement system where injectable, but not oral medications, are bundled with dialysis payments there may be pressure to move patients to oral medications. The poor compliance found in this study highlights the potential adverse effects of movement toward self‐administered oral therapy.
Predictors of Decision Delay to Seeking Health Care Among Jordanians With Acute Myocardial Infarction
Authors: Khraim Fadi M. , Scherer Yvonne K. , Dorn Joan M. , Carey Mary G.
Published: August 2009

Purpose: To identify predictors of decision delay time for health care seeking among Jordanians with acute myocardial infarction (AMI).

Design: The study was a cross‐sectional descriptive survey. A convenience sample of Jordanians with AMI were interviewed at the coronary care units of two teaching hospitals in Jordan.

Methods: The Arabic version of the modified Response to Symptom Questionnaire was used to assess predictors of decision delay and patterns of health care–seeking behaviors. Decision delay was evaluated by assisting patients to triangulate time of symptom onset and time of decision to seek professional health care by placing both times in context of daily activities that participants could easily remember. Regression analysis was conducted to elicit predictors of decision delay.

Findings: Decision delay time among Jordanian men (n=110) and women (n=24) with AMI was alarmingly long (medians 3.5 and 3.6 hours, respectively). Variables that correspondingly predicted decision delay among men and women were age, waiting for symptoms to go away, anxiety due to symptom presentation, and others' responses to patients' symptoms. While 16 other variables (cognitive, emotional, and clinical) independently predicted delay among men, equivalent evidence was not established among women due to the relatively small sample size.

Conclusions: Similarities and differences existed between Jordanian men's and women's decision delay to seek health care for AMI. Decision delay time among Jordanians with AMI requires intervention that incorporates awareness of delay predictors. Future research needs to utilize adequate sample sizes of both sexes to obtain a better understanding of sex differences.

Clinical Relevance: To reduce decision delay among Jordanians, health educators should emphasize early symptom recognition and the value of prompt health care–seeking behaviors.
Professional Commitment, Patient Safety, and Patient‐Perceived Care Quality
Authors: Teng Ching‐I , Dai Yu‐Tzu , Lotus Shyu Yea‐Ing , Wong May‐Kuen , Chu Tsung‐Lan , Tsai Ying‐Huang
Published: August 2009

Purpose: To examine how professional commitment influences patient safety and patient‐perceived care quality.

Design: Investigators for this study used a cross‐sectional design with questionnaires. A total of 348 pairs of nurses and inpatients were contacted at two medical centers in Taiwan during the period from August 2007 to January 2008, yielding 284 pairs of completed questionnaires.

Methods: Frequencies of six adverse patient events were used to measure patient safety; and the Service Quality Scale was used to measure patient‐perceived care quality. Four items of the Professional Commitment Questionnaire were used to measure professional commitment. Regressions were used for the analyses.

Findings: Professional commitment positively influenced overall patient safety (ß=.19, p=.00) and overall patient‐perceived care quality (ß=.13, p=.03). Furthermore, professional commitment positively influenced all patient safety indicators (ß≥.12, p≤.04), except frequency of nosocomial infections, the coefficient of which reached borderline significance (ß=.11, p=.07). Professional commitment also positively influenced care quality in terms of responsiveness (ß=.16, p=.01) and empathy (ß=.14, p=.03).

Conclusions: Professional commitment may enhance patient safety and patient‐perceived care quality.

Clinical Relevance: This study indicates that nurse professional commitment can enhance patient safety and patient‐perceived care quality.
The Analysis of Black Powder Substitutes Containing Ascorbic Acid by Ion Chromatography/Mass Spectrometry*†
Authors: Lang Gui‐hua Lisa , Boyle Katherine M.
Published: August 2009

Abstract:  Black powder substitutes containing ascorbic acid are a group of low explosives that utilize ascorbic acid as the fuel. The analysis of these powders is complicated by the degradation of ascorbic acid which occurs rapidly in solution and may also occur as the powder ages. Aqueous extracts of both intact powders and postblast residues were analyzed by an existing ion chromatography/mass spectrometry (IC/MS) method used at the Bureau of Alcohol, Tobacco, Firearms and Explosives. Results have shown that while ascorbic acid itself is not detected in this method, its diagnostic degradation products (threonic acid, monohydrated diketogulonic acid, and oxalic acid) can be identified. In addition, anions from the inorganic oxidizers (perchlorate and nitrate) and combustion products such as chloride, chlorate, and nitrite, can be identified within the same experiment. While this IC/MS method shows promise, future modifications are necessary because of limitations in identifying threonate in postblast residues, as well as coeluting compounds observed in postblast residues.
A Method for Articulating and Displaying the Human Spine
Authors: Mann Robert W.
Published: August 2009

Abstract:  An inexpensive and effective method for articulating a dry human spine is described. By constructing a Styrofoam™ spine tray, analysts can now accurately position and align each vertebra in correct anatomical order, allow for gaps because of missing vertebrae, and lay out the spine for documentation and photography. The spine tray provides analysts with a quick, easy, and professional quality method for aligning and orienting the human spine in the field and laboratory.
Unexpected Death in Elephantiasis Due to an Abnormal Life‐Style
Authors: Sato Hiroaki , Tanaka Toshiko , Kasai Kentaro , Kita Toshiro , Tanaka Noriyuki
Published: August 2009

Abstract:  A 22‐year‐old man was found dead after he had continued to sit on a reclining chair for 2 years. He had consumed an unbalanced diet, kept wearing the same pair of socks and never washed himself for the term. His skin of bilateral crura developed into elephantiasis with severely festered ulcers on its surface. At autopsy, subcutaneous edema was significant in his lower limbs, and chronic circulatory disturbance of lymphoducts and veins was observed histologically. There were no crucial findings to account for chronic edema in the lower limbs. It has been reported that maintaining a seated posture obstructs both lymphoducts and veins because of bending the groin, decreases their return flow by inducing muscular atrophy, and causes subcutaneous edema in the lower limbs. Oligotrophia and dirt on his limbs might have exacerbated the chronic edema in elephantiasis. We concluded that a long‐term abnormal life‐style had caused fatal elephantiasis.
The Effects of Household Corrosive Chemicals on Human Dentition*
Authors: Cope Darcy J. , Dupras Tosha L.
Published: August 2009

Abstract:  There is a gap in the literature concerning the chemical effects that household products may produce on human remains. The present study examines the effects of household chemical products on teeth. A total of eight chemicals were utilized for this experiment. The corrosive chemical categories include: hydrochloric acid, sulfuric acid, phosphoric acid, and sodium hydroxide. Two products with each chemical were used, each representing varying concentrations of the corrosive product. Two human teeth were allocated for emergence in the chemical throughout a 24‐h period of exposure. Results demonstrate hydrochloric acid as the most detrimental chemical to the dental samples. Sulfuric acid enacted minimal alterations to the teeth, although some etching and discoloration were noticeable. Phosphoric acid resulted in variable changes of the organic and inorganic contents of teeth. Lastly, exposure of sodium hydroxide resulted in little to no change. As hypothesized, distinct effects are observable of each chemical.
Mammary Paget's disease and extra‐mammary Paget's disease: two morphologically similar but biologically different diseases
Authors: Liu Weiguo , Iqbal Jabad , Khoury Thaer
Published: August 2009

Background: The cells of origin of mammary Paget's disease (MPD) and extra‐mammary Paget's disease (EMPD) have been a controversial subject. The purpose of this study is to examine the expression of the human epidermal growth factor receptor 2 (HER2) pathway members in these two diseases.

Design: HER2, AKT, pAKT, PTEN, epidermal growth factor receptor (EGFR) and pEGFR were examined in 16 MPD and 14 EMPD cases. HER2 was graded on a scale from 0 to 3. A score of 3 was considered positive. For AKT, pAKT, PTEN, EGFR and pEGFR, a semi‐quantitative scoring system was used. A score >100 was considered positive. Fisher's exact test was used to analyze the data.

Results: HER2 was overexpressed in 87.5% MPD and 35.7% EMPD. While AKT was expressed in all cases, pAKT was expressed in 87.5% MPD and 92.9% EMPD. Both EGFR and pEGFR were negative in all cases. PTEN was positive in 62.5% MPD and 71.4% EMPD. For pAKT+ group, HER2–/PTEN+ was recorded in 0% MPD and 38.5% EMPD (P = .01).

Conclusions: In a subset of EMPD, AKT is not activated by HER2 overexpression or by loss of PTEN, which is not the case in MPD. These data suggest that these two diseases are biologically different.

Liu W, Iqbal J, Khoury T. Mammary Paget's disease and extramammary Paget's disease: two morphologically similar but biologically different diseases.
Expression of water and ion transporters in tracheal aspirates from neonates with respiratory distress
Authors: Li Yanhong , Marcoux Marie‐Odile , Gineste Martine , Vanpee Mireille , Zelenina Marina , Casper Charlotte
Published: August 2009

Aim:  The aim of the study was to determine whether neonatal respiratory distress is related to changes in water and ion transporter expression in lung epithelium.

Methods:  The study included 32 neonates on mechanical ventilation: 6 patients with normal lung X‐rays (control group), eight with respiratory distress syndrome (RDS), eight with transient tachypnea of the newborn (TTN), 10 with abnormal lung X‐rays (mixed group). The protein abundance of water channel AQP5, epithelial sodium channel (ENaC; α‐, β‐ and γ‐ENaC) and Na+, K+‐ATPase α1 were examined in tracheal aspirates using semiquantitative immunoblotting.

Results:  β‐ENaC level was significantly lower in RDS group compared with infants with TTN and infants in the control group. AQP5 expression was significantly higher in TTN compared with the infants with RDS and all other infants with abnormal lung X‐rays.

Conclusion:  Neonatal respiratory distress is associated with changes in β‐ENaC and AQP5 expression. The lower β‐ENaC expression may be one of the factors that predispose to the development of RDS. The higher AQP5 expression may provide the possibility for reabsorption of postnatal lung liquid, which contributes to quick recovery of infants with TTN.
ProtégéZiziphus mucronata (Rhamnaceae) show no negative effects of competition with the nurse tree Acacia (Leguminaceae), even as adults
Authors: Seymour Colleen L.
Published: August 2009

Question: A number of studies have demonstrated that the interaction between nurse plants and their protégés changes from one of facilitation to interference as life history stage progresses. Here, I aimed to assess relative fitness of the protégé plant Ziziphus mucronata (Rhamnaceae) under the subcanopy of Acacia erioloba (Leguminaceae), versus in the open, at various stages of the lifecycle.

Location: Southern Kalahari, southern Africa.

Methods: Germination was compared to assess the effects of shade, maternal origin (under A. erioloba or in the matrix) and soil. Seedlings were transplanted into the field under trees and in the open to ascertain establishment rates. Flower production, seed set and mistletoe infestation were compared between the two microhabitats.

Results: Seeds from maternal Z. mucronata plants growing beneath A. erioloba had higher germination rates than those from maternal plants growing in the open. Germination was higher in full sun and in matrix soil, although this result was found in experimental conditions mimicking good rainfall and may not hold under dry or medium rainfall conditions. Z. mucronata demography suggested that the A. erioloba subcanopy is important for establishment, but seedlings transplanted into the matrix had higher survival rates than those under trees. Causes of seedling mortality were different: desiccation in the matrix, but invertebrate herbivory and trampling beneath trees. Mistletoe infestation was higher for adult plants growing in the open. Seed set was not significantly different between subcanopy and matrix environments, but once mistletoe infestation rates and parent plant size were accounted for, seed set was lower for adult plants growing in the open than those growing beneath trees.

Conclusions: It appears that the nurse tree environment remains important for Z. mucronata throughout its lifecycle.
The invasive alien plant species Solidago gigantea alters ecosystem properties across habitats with differing fertility
Authors: Scharfy D. , Eggenschwiler H. , Olde Venterink H. , Edwards P.J. , Güsewell S.
Published: August 2009

Question: Invasive alien plants can affect biomass production and rates of biogeochemical cycling. Do the direction and intensity of such effects depend upon the functional traits of native and alien species and upon the properties of the invaded habitat, with the same alien species having differing impacts in different habitats?

Location: Lowlands of Switzerland.

Methods: Fourteen grassland and wetland sites invaded by Solidago gigantea and widely differing in biomass production and soil P availability were surveyed. To determine whether the impact of the species was related to site fertility, we compared the invaded and native vegetation in terms of biomass, species composition, plant traits and soil properties.

Results: S. gigantea generally increased the above‐ground biomass production of the vegetation and soil C content, while reducing nutrient concentrations in biomass and N availability in the soil. However, it had no significant effect on plant species richness, soil respiration, soil pH and P availability. Leaves of S. gigantea had a greater C content than those of native species; other leaf traits and root phosphatase activity did not differ significantly.

Conclusions: Our results suggest that a conservative nutrient‐use strategy allows S. gigantea to invade a broad range of habitats. The observed effects of invasion did not vary according to biomass production of the invaded sites, but some effects did depend on soil P availability, being more pronounced at more P‐rich sites. Thus, the full range of invaded habitats should be considered in studying the potential impact of plant invasions on ecosystem processes.
Integration of STI and HIV Prevention, Care, and Treatment into Family Planning Services: A Review of the Literature
Authors: Church Kathryn , Mayhew Susannah H.
Published: August 2009

The last comprehensive literature review to examine the effectiveness of family planning (FP) services in delivering STI and HIV prevention and care was published in 2000. This review updates that report by examining evidence of the impact of integrating any component of STI or HIV prevention, care, and treatment into a family planning setting in developing countries. Forty‐four reports were identified from a comprehensive search of published databases and “grey literature.” The weight of evidence demonstrates that integrated services can have a positive impact on client satisfaction, improve access to component services, and reduce clinic‐based HIV‐related stigma, and that they are cost‐effective. Evidence of FP services reaching men and adolescents and of their impact on health outcomes is inconclusive. Several studies found that providers frequently miss opportunities to integrate care and that the capacity to maintain the quality of care is also influenced by many programmatic challenges. The range of experiences indicates that managers need to determine appropriate health‐care service‐delivery models based on a consideration of epidemiological, structural, and health‐systems factors.
Behavioral Mechanisms in HIV Epidemiology and Prevention: Past, Present, and Future Roles
Authors: Bingenheimer Jeffrey B. , Geronimus Arline T.
Published: August 2009

In the 1980s, behavioral variations across geographically and socially defined populations were the central focus of AIDS research, and behavior change was seen as the primary means of controlling HIV epidemics. Today, biological mechanisms—especially other sexually transmitted infections, antiretroviral therapy, and male circumcision—predominate in HIV epidemiology and prevention. We describe several reasons for this shift in emphasis. Although the shift is understandable, we argue for a sustained focus on behavioral mechanisms in HIV research in order to realize the theoretical promise of interventions targeting the biological aspects of HIV risk. We also provide evidence to suggest that large reductions in HIV prevalence may be accomplished by small changes in behavior. Moreover, we contend that behavioral mechanisms will find their proper place in HIV epidemiology and prevention only when investigators adopt a conceptual model that treats prevalence as a determinant as well as an outcome of behavior and that explicitly recognizes the dynamic interdependence between behavior and other epidemiological and demographic parameters.
Toward Replacement Fertility in Egypt and Tunisia
Authors: Eltigani Eltigani E.
Published: August 2009

Egypt and Tunisia began their fertility transition at almost identical fertility levels and at roughly the same time period, yet the difference in the pace of decline has been such that the total fertility rate (TFR) in Tunisia reached replacement level by the year 2001, whereas the TFR in Egypt remains above three live births per woman. This article draws on the secondary literature and on several nationally representative surveys from the two countries between 1978 and 2005 to provide empirical evidence of the difference in the pace of fertility decline and to analyze the determinants of the differential. Findings include (a) variation across the two countries in the consistency of fertility decline among the segments of the population leading the transition; (b) that the success of each country's family planning program was influenced by the role of political leaders and the extent of the program's integration within socioeconomic development objectives; (c) that the impact of contraception on TFR decline became an important factor in the mid‐1980s; and (d) that the greatest determinant of the discrepancy in the pace of fertility decline is the disparity in age at marriage, which rose more significantly in Tunisia than in Egypt. The latter finding indicates that reaching replacement fertility in Egypt hinges primarily on further declines in marital fertility, resulting from reduction of wanted fertility and from an expansion of family planning program coverage and improved efficiency of service delivery and use.
Penile Sonographic and Clinical Characteristics in Men with Peyronie’s Disease
Authors: Smith James F. , Brant William O. , Fradet Vincent , Shindel Alan W. , Vittinghoff Eric , Chi Thomas , Huang Yun-Ching , Davis Cole B. , Conti Simon , Lue Tom F.
Published: August 2009

Introduction

Ultrasonography of the penis is readily available to the urologist and gives good anatomic detail of soft tissue structures. It has not been widely utilized in the assessment of Peyronie’s disease (PD).

Aims

To describe the sonographic characteristics of the penis in PD and the relationship between clinical and sonographic features.

Methods

This cross-sectional study enrolled patients from a single clinical practice. A PD-specific questionnaire was administered and sonographic evaluations were performed.

Main Outcome Measures

Sonographic characteristics of men with PD.

Results

Tunical thickening, calcifications, septal fibrosis, and intracavernosal fibrosis, were observed at initial clinical evaluation in 50%, 31%, 20%, and 15% of men, respectively. Men aged 40–49 (OR 2.4, P = 0.02) and men aged 50–59 (OR 2.4, P = 0.004) were more likely to have sub-tunical calcifications relative to men under age 40. Men with septal fibrosis had fewer chronic medical conditions such as diabetes (OR 0.3, P = 0.04), hypertension (OR 0.5, P = 0.03), and coronary artery disease (OR 0.2, P = 0.05), and presented within 1 year of disease onset (OR 2.1, P = 0.001). Men with septal fibrosis were less likely to have lost penile length (OR 0.5, P = 0.04) and more likely to be able to have intercourse (OR 1.9, P = 0.05). Men with intracavernosal fibrosis were less likely to have penile pain (OR 0.5, P = 0.05), but more likely to have penetration difficulty during intercourse (OR 1.9, P = 0.008), an additional penile deformity (OR 1.8, P = 0.02), or rapid onset of disease (OR 1.7, P = 0.04). Tunical thickening was associated with a decreased ability to have intercourse (OR 2.3, P < 0.001).

Conclusion

PD is a clinically and sonographically heterogeneous condition. Sonography is a safe, low-cost, and rapid means of objectively characterizing lesions in this condition. This may help track the evolution of the condition in individual patients and in the future may be useful for tailoring treatment strategies.
Original Research—Basic Science: I. Slow Oscillations in Vaginal Blood Flow: Alterations during Sexual Arousal in Rodents and Humans
Authors: Allers Kelly A. , Richards Natalie , Sultana Stefan , Sudworth Maria , Dawkins Toni , Hawcock Anthony B. , Buchanon Tim , Casey James H. , Wayman Chris
Published: August 2009

Purpose

This study investigated slow oscillatory rhythms in vaginal blood flow as a physiological marker of female sexual arousal in rodents, human healthy volunteers, and women with female sexual arousal disorder (FSAD).

Materials and Methods

Vaginal blood flow was measured in urethane-anesthetized rodents using laser Doppler flowmetry, while in humans, vaginal photoplethysmography was used. Acquired data were filtered for frequency analysis in the range of 0.013–2.5 Hz in rodents and 0.01–0.5 Hz in humans. Rodents were assessed for changes in a high frequency range (HF=0.6–2.5 Hz), and a low frequency range (LF=0.013–0.6 Hz). Human data were assessed for total spectral power in the entire frequency range.

Results

During naturally induced arousal (exposure to male), oscillatory rhythms in vaginal blood flow from rodents demonstrated an increase in the ratio of LF oscillations to HF oscillations (LF/HF ratio). Drugs known to induce sexual arousal (apomorphine and melanotan II) were tested in anesthetized rodents. Both compounds induced an increase in the LF/HF ratio. In humans, visual sexual stimulation induced an increase in the total power of slow oscillatory activity in vaginal blood flow in healthy human volunteers. No such increase was observed in women with FSAD.

Conclusions

This study demonstrated that slow oscillations in vaginal blood flow are correlated with subjective physiological arousal and display diminished responsiveness in women with FSAD. Slow oscillations in vaginal blood flow are entirely independent of vaginal vasocongestion as women with FSAD demonstrated a normal vasocongestion response to visual sexual stimulation. In conditions where rodents would be expected to be sexually aroused, slow oscillations in vaginal blood flow showed a shift from HFs to LFs. This technique will greatly enhance the investigation of female sexual function both clinically and preclinically.
Variation of B Chromosome Associated with Tissue Culture in Wheat‐rye Cross
Authors: Tian Bohong , Li Hongjie
Published: August 2009

In vitro variation of B chromosomes was studied by examining the callus cells derived from the immature embryos from a cross of Chinese Spring wheat (Triticum aestivum L.) and Fin 7416 rye (Secale cereale L.) carrying two B chromosomes. In 40‐d‐old callus cells, the numbers of B chromosomes ranged from one to four in 65.6% of the cells observed. The distribution of B chromosome numbers was associated with the ploidy levels of the normal chromosomes (A chromosomes). The frequency of the cells with high numbers of B chromosomes (i.e., three or four B chromosomes) in the amphiploid cells with 56 A chromosomes was greater than those in the haploid cells with 28 A chromosomes. Although structural changes in the rye A chromosomes were observed, cytological observation and genomic in situ hybridization demonstrated that the rye B chromosomes were conserved in morphological appearance following tissue culture.
Better Regulation of Industry-Sponsored Clinical Trials is Long Overdue
Authors: Wynia Matthew , Boren David
Published: August 2009

There is an old saw in health policy that everyone wants health care that is good, fast, and cheap — but it’s impossible to have more than two of these at one time.

A similar bit of folk wisdom seems intuitively true for the development and testing of new pharmaceutical products. The public is in a bind. We want breakthrough drugs, and fast. But we also want these drugs to be affordable, thoroughly tested, safe, and effective. It seems we can’t have it all.

In this paper, we will not claim that one can have it all — but that we can do far better than we are at present. First, we review extensive data on contemporary problems in the design, conduct, and analysis of industry-sponsored clinical trials. Finding major issues that have been solidly documented over more than a decade, we provide many examples of the multifarious ways in which industry-funded trials have been manipulated to raise the likelihood of producing industry-friendly results.