bluuebunny/crossref_metadata_2025 huggingface dataset:
A Procedure for Making Optimal Selection of Input Variables for Multivariate Environmental Classifications
Authors: SNELDER TON H. , DEY KATIE L. , LEATHWICK JOHN R.
Published: February 2007

Abstract:  Multivariate classifications of environmental factors are used as frameworks for conservation management. Although classification performance is likely to be sensitive to choice of input variables, these choices have been subjective in most previous studies. We used the Mantel test on a limited set of sites for which biological data were available to iteratively seek a definition of environmental space (i.e., intersite distances calculated with a set of appropriately transformed and weighted environmental variables) that had maximal correlation with the same sites described in a biological space. The procedure was used to select input variables for a classification of New Zealand's rivers that discriminates variation in fish communities for biodiversity management. The classification performed (i.e., discriminated biological variation) better than classifications with subjectively chosen variables. The inherently linear measures of environmental distance that underlie multivariate environmental classifications mean that they will perform best if they are defined based on variables for which there is a linear variation in the biological community throughout the entire range of the variable. Classification performance will therefore be improved when variables that have nonlinear relationships with biological variation are transformed to make their relationship with biological turnover more linear and when the contributions of environmental factors that have particularly strong relationships with biological variation are increased by weighting. Our results indicate that attention to the manner in which environmental space is defined improves the efficacy of multivariate classification and other techniques in which the environment is used as a surrogate for biological variation.
Viability Analysis of Reef Fish Populations Based on Limited Demographic Information
Authors: WIELGUS JEFFREY , BALLANTYNE FORD , SALA ENRIC , GERBER LEAH R.
Published: February 2007

Abstract:  Marine protected areas (MPAs) that allow some degree of artisanal fishing have been proposed to control the overexploitation of marine resources while allowing extraction by local communities. Nevertheless, the management of MPAs is often impaired by the absence of data on the status of their resources. We devised a method to estimate population growth rates with the type of data that are usually available for reef fishes. We used 7 years of spatially explicit abundance data on the leopard grouper (Mycteroperca rosacea) in an MPA in the Gulf of California, Mexico, to construct a matrix population model that incorporated the effects of El Niño/La Niña Southern Oscillation on population dynamics. An environmental model that estimated different demographic estimates for El Niño and La Niña periods performed better than a single‐environment model, and a single‐habitat model performed better than a model that considered different depths as different habitats. Our results suggest that the population of the leopard grouper off the main island of the MPA is not viable under present conditions. Although the impact of fishing on leopard grouper populations in the MPA has not yet been established, fishing should be closed as a precautionary measure at this island if a priority of the MPA is to ensure the sustainability of its fish populations.
Susceptibility of Common and Rare Plant Species to the Genetic Consequences of Habitat Fragmentation
Authors: HONNAY OLIVIER , JACQUEMYN HANS
Published: February 2007

Abstract: Small plant populations are more prone to extinction due to the loss of genetic variation through random genetic drift, increased selfing, and mating among related individuals. To date, most researchers dealing with genetic erosion in fragmented plant populations have focused on threatened or rare species. We raise the question whether common plant species are as susceptible to habitat fragmentation as rare species. We conducted a formal meta‐analysis of habitat fragmentation studies that reported both population size and population genetic diversity. We estimated the overall weighted mean and variance of the correlation coefficients among four different measures of genetic diversity and plant population size. We then tested whether rarity, mating system, and plant longevity are potential moderators of the relationship between population size and genetic diversity. Mean gene diversity, percent polymorphic loci, and allelic richness across studies were positively and highly significantly correlated with population size, whereas no significant relationship was found between population size and the inbreeding coefficient. Genetic diversity of self‐compatible species was less affected by decreasing population size than that of obligate outcrossing and self‐compatible but mainly outcrossing species. Longevity did not affect the population genetic response to fragmentation. Our most important finding, however, was that common species were as, or more, susceptible to the population genetic consequences of habitat fragmentation than rare species, even when historically or naturally rare species were excluded from the analysis. These results are dramatic in that many more plant species than previously assumed may be vulnerable to genetic erosion and loss of genetic diversity as a result of ongoing fragmentation processes. This implies that many fragmented habitats have become unable to support plant populations that are large enough to maintain a mutation‐drift balance and that occupied habitat fragments have become too isolated to allow sufficient gene flow to enable replenishment of lost alleles.
Cesarean Delivery Among Nulliparous Women in Beirut: Assessing Predictors in Nine Hospitals
Authors: Tamim Hala , El‐Chemaly Souheil Y. , Nassar Anwar H. , Aaraj Alia M. , Campbell Oona M.R. , Kaddour Afamia A. , Yunis Khalid A. ,   National Collaborative Perinatal Neonatal Network
Published: February 2007

ABSTRACT:  Background:
Obstetric practice has witnessed a worldwide trend of increasing cesarean section rates in recent years. Similar trends have been observed in Lebanon, according to 2 studies conducted in 1996 and 1999. The objective of the present study was to assess the differences in predictors of cesarean delivery among nulliparous women in a “control hospital” with a low cesarean delivery rate (12.5%) and the rest of the National Collaborative Perinatal Neonatal Network (NCPNN) “study hospitals” with a higher cesarean delivery rate (31.4%).
Methods:
Data were collected by the NCPNN database, which covers deliveries at 9 major hospitals located in the Greater Beirut area. Data analysis was performed on the 6,668 consecutive deliveries occurring between January 1, 2001, and December 31, 2002, at the NCPNN participating centers. The questionnaires included items that cover parental sociodemographic characteristics and maternal and newborn health characteristics. Sources of data included direct interviews with mothers after delivery and before hospital discharge and reviews of obstetric and nursery medical charts. Chi‐square tests and t tests were performed for categorical and continuous clinical predictors of cesarean section. Logistic regression was performed to determine the odds of having a cesarean section for the study hospitals when compared with the control hospital. Odds ratios and 95% confidence intervals are reported. Results: Variables in the study hospitals that correlated with a higher cesarean delivery rate were male obstetricians, day of the week, and mode of payment compared with the control hospital. Conclusions: In a country with a high cesarean section rate, 1 hospital met World Health Organization criteria for acceptable cesarean section rates, with no compromise in neonatal outcome. Further studies are needed to investigate potential policies to decrease the high cesarean section rate. (BIRTH 34:1 March 2007)
Continuity of Nursing Care and Its Link to Cesarean Birth Rate
Authors: Gagnon Anita J. , Meier Katharine M. , Waghorn Kathy
Published: February 2007

ABSTRACT:  Background:
High cesarean birth rates are an international concern. The role of patterns of nursing care responsibility in preventing or contributing to cesarean births has been understudied. Our study sought to identify and describe indicators of continuity of nursing care responsibility during labor and to explore whether any association between these indicators and risk of cesarean birth could be identified empirically using an existing data set.
Methods:
We obtained a representative sample of low‐risk women giving birth in an intrapartum unit at a university hospital in Quebec, Canada, with approximately 3,700 births per year. To be considered for inclusion, women needed to have been primiparous, carrying singletons in vertex position, and at 37 weeks’ gestation or more. All women giving birth over a 13‐month period were assessed for eligibility using the hospital’s birth log. Data were extracted from the medical records of every second eligible birth, including information related to patterns of nursing care responsibility, maternal and infant characteristics, obstetric procedures, non–health‐related risk factors, and type of birth.
Results:
Data on all variables of interest were available for 467 women. These women were cared for by 1–17 nurses, care responsibility changed hands for them from 1 to 28 times, and the mean length of labor for which the same nurse was responsible for a woman ranged from 10 to 1,045 minutes. After controlling for length of labor, maternal age, maternal height, infant weight, gestational age, induction, type of rupture, and epidural analgesia, the odds ratio for cesarean birth due to number of nurses was 1.17 (95% CI 1.04, 1.32); 1 or more nurses switch per 2 hours (i.e., number of times care responsibilities changed hands), 1.04 (95% CI 0.62, 1.74); and 33 percent or more of the labor attended by the same nurse, 0.74 (95% CI 0.42, 1.30).
Conclusions:
An association was observed between number of nurses caring for a laboring woman and risk of cesarean delivery. Estimates of the association of other patterns of nursing care responsibility on cesarean birth were not sufficiently precise to draw conclusions.
(BIRTH 34:1 March 2007)
Elective Cesarean Section and Decision Making: A Critical Review of the Literature
Authors: McCourt Chris , Weaver Jane , Statham Helen , Beake Sarah , Gamble Jenny , Creedy Debra K.
Published: February 2007

ABSTRACT:  Background:
The cesarean section rate continues to rise in many countries with routine access to medical services, yet this increase is not associated with improvement in perinatal mortality or morbidity. A large number of commentaries in the medical literature and media suggest that consumer demand contributes significantly to the continued rise of births by cesarean section internationally. The objective of this article was to critically review the research literature concerning women’s preference or request for elective cesarean section published since that critiqued by Gamble and Creedy in 2000.
Methods:
A search of key databases using a range of search terms produced over 200 articles, of which 80 were potentially relevant. Of these, 38 were research‐based articles and 40 were opinion‐based articles. A total of 17 articles fitted the criteria for review. A range of methodologies was used, with varying quality, making meta‐analysis of findings inappropriate, and simple summaries of results difficult to produce.
Results:
The range and quality of studies had increased since 2001, reflecting continuing concern. Women’s preference for cesarean section varied from 0.3 to 14 percent; however, only 3 studies looked directly at this preference in the absence of clinical indications. Women’s preference for a cesarean section related to psychological factors, perceptions of safety, or in some countries, was influenced by cultural or social factors.
Conclusions:
Research between 2000 and 2005 shows evidence of very small numbers of women requesting a cesarean section. A range of personal and societal reasons, including fear of birth and perceived inequality and inadequacy of care, underpinned these requests. (BIRTH 34:1 March 2007)
Unexpected Diagnosis of Fetal Abnormality: Women’s Encounters with Caregivers
Authors: Lalor Joan G. , Devane Declan , Begley Cecily M.
Published: February 2007

ABSTRACT: Background:It is acknowledged that health professionals have difficulty with breaking bad news. However, relatively little research has been conducted on the experiences of women who have had a fetal anomaly detected at the routine pregnancy ultrasound examination. The study objective was to explore women’s experiences of encounters with caregivers after the diagnosis of fetal anomaly at the routine second trimester ultrasound scan.Methods:The theoretical perspective of symbolic interactionism guided this study design. A purposive sample of 38 women, at low risk of fetal abnormality, who received a diagnosis of a fetal abnormality in a tertiary referral center in Ireland, were recruited to participate. An in‐depth interview was conducted within 4–6 weeks of the diagnosis. Data were collected between April 2004 and August 2005 and analyzed using the constant comparative method.Results:Six categories in relation to women’s encounters with caregivers emerged: information sharing, timing of referral, getting to see the expert, describing the anomaly, availability of written information, and continuity of caregiver. Once an anomaly was suspected, women wanted information quickly, including prompt referral to the fetal medicine specialist for confirmation of the diagnosis. Supplementary written information was seen as essential to enhance understanding and to assist women in informing significant others. Continuity of caregiver and empathy from staff were valued strongly.Conclusions:The way in which adverse diagnoses are communicated to parents leaves room for improvement. Health professionals should receive specific education on how to break bad news sensitively to a vulnerable population. A specialist midwifery or nursing role to provide support for parents after diagnosis is recommended. (BIRTH 34:1 March 2007)
Endocrine Effects of Valproate in Adolescent Girls with Epilepsy
Authors: De Vries Liat , Karasik Anna , Landau Zohar , Phillip Moshe , Kiviti Sara , Goldberg‐Stern Hadassa
Published: February 2007

Summary:  Purpose: To investigate the effect of epilepsy and/or valproate (VPA) monotherapy on physical growth, weight gain, pubertal development, and hormonal status in adolescent girls with epilepsy.

Methods: The study group included 88 consecutive female patients with epilepsy aged 6–20 years (28 premenarche, 60 postmenarche) attending an endocrinology institute of a major tertiary center. Forty‐five patients were under treatment with VPA, and 43 were before treatment initiation. The groups were compared for the relevant biochemical, anthropometric, ultrasonographic, and endocrine parameters.

Results: No statistically significant differences were found in any of the parameters studied between the groups, as a whole or by menarche status. The treated postmenarcheal subgroup had a higher mean testosterone level than the untreated postmenarcheal controls (1.83 ± 0.65 vs. 0.88 ± 0.24, p = 0.006). Body mass index–standard deviation score (BMI‐SDS) was 0.75 in the treated group and 0.63 in the untreated group; rates of obesity were 16.3% and 15.5%, respectively. No between‐group differences were found in menses irregularities, hirsutism, or acne. No correlation was found between duration or dosage of treatment and BMI‐SDS, height–SDS, or androgen level. The treated group had higher levels of thyroid‐stimulating hormone and lower levels of free thyroxine than did the untreated group, although still within normal range.

Conclusions: Long‐term treatment with VPA in girls with epilepsy is associated with increased testosterone levels after menarche, without clinical hyperandrogenism, polycystic ovary syndrome, or an increase in BMI‐SDS. VPA is a good treatment option in this age group but should be accompanied by careful endocrine observation.
Circadian Variation in Heart‐Rate Variability in Localization‐related Epilepsy
Authors: Persson Håkan , Kumlien Eva , Ericson Mats , Tomson Torbjörn
Published: February 2007

Summary:  Purpose: Case–control studies of sudden unexpected death in epilepsy (SUDEP) have reported that SUDEP is more likely to occur during sleep and thus presumably during night hours. The circadian variation of heart‐rate variability (HRV) might be of relevance to this risk. We examined night versus daytime HRV in patients with newly diagnosed and refractory localization‐related epilepsy, assessing the effects of drug treatment and epilepsy surgery on the night/daytime HRV ratio.

Methods: We used spectral analysis to assess HRV and calculated the night‐time (00.00–05.00)/daytime (07.30–21.30) ratio of HRV in 14 patients with newly diagnosed localization‐related epilepsy before and during carbamazepine (CBZ) treatment and in 21 patients with temporal lobe epilepsy before and after epilepsy surgery. Both groups were compared with age‐ and sex‐matched controls.

Results: No significant differences were found from controls in the night/daytime ratios of HRV whether compared before or after initiation of treatment with CBZ in newly diagnosed epilepsy patients. When patients were used as their own controls, night/daytime ratios of standard deviation of RR intervals (p = 0.04) and total power (p = 0.04) were significantly lower during treatment than before. Compared with those of controls, the night/daytime ratios were lower in epilepsy surgery patients before surgery [low‐frequency power (p = 0.04); high‐frequency power (p = 0.04)]. Night/daytime ratios did not change significantly after surgery.

Conclusions: The HRV of the patients was more affected during night‐time when the risk of SUDEP seems to be highest in such patients.
Lateralizing Significance of Quantitative Analysis of Head Movements before Secondary Generalization of Seizures of Patients with Temporal Lobe Epilepsy
Authors: O'Dwyer Rebecca , Silva Cunha Joao P. , Vollmar Christian , Mauerer Cordula , Feddersen Berend , Burgess Richard C. , Ebner Alois , Noachtar Soheyl
Published: February 2007

Summary:  Purpose: To quantitatively evaluate the lateralizing significance of ictal head movements of patients with temporal lobe epilepsy (TLE).

Methods: We investigated EEG‐video recorded seizures of patients with TLE, in which the camera position was perpendicular to the head facing the camera in an upright position and bilateral head movement was recorded. Thirty‐eight seizures (31 patients) with head movement in both directions were investigated. Ipsilateral and contralateral head movements were defined according to ictal EEG. Head movements were quantified by selecting the movement of the nose in relation to a defined point on the thorax (25/s) in a defined plane facing the camera. The duration of the head version was determined independently of the camera angle. The angle, duration, and angular speed of the head movements were computed and inter and intrasubject analyses were performed (Wilcoxon rank sum).

Results: Ipsilateral movement always preceded contralateral movement. The positive predictive value was 100% for movement in both directions. The duration of contralateral head version was significantly longer than ipsilateral head movement (6.4 ± 4.1 s vs. 3.9 ± 3.1 s, p < 0.001). The angular speed of both movements was similar (15.5 ± 12.1 deg/s vs. 17.3 ± 13.0 deg/s).

Conclusion: The quantitative analysis shows the importance of sequence in the seizure's evolution and duration, but not angular speed for correct lateralization of versive head movement. This quantitative method shows the high lateralizing value of ictal lateral head movements in TLE.
Increased von Willebrand Factor Over Decreased ADAMTS13 Activity May Contribute to the Development of Liver Disturbance and Multiorgan Failure in Patients With Alcoholic Hepatitis
Authors: Matsuyama Tomomi , Uemura Masahito , Ishikawa Masatoshi , Matsumoto Masanori , Ishizashi Hiromichi , Kato Seiji , Morioka Chie , Fujimoto Masao , Kojima Hideyuki , Yoshiji Hitoshi , Takimura Chikara , Fujimura Yoshihiro , Fukui Hiroshi
Published: February 2007

Background: Severe alcoholic hepatitis (SAH) in addition to alcoholic hepatitis (AH) is a life‐threatening complication of alcohol abuse, and its pathogenesis remains unclear. The deficiency of ADAMTS13 results in an increase of the plasma unusually large von Willebrand factor multimer (UL‐VWFM) and finally causes microcirculatory disturbance and multiorgan failure. We investigated the relationship of ADAMTS13 and von Willebrand factor antigen (VWF:Ag) with the clinical features of AH and SAH.

Methods: The plasma levels of ADAMTS13 activity, VWF:Ag, and UL‐VWFM were determined in 24 patients with AH, 5 with SAH, and 10 with alcoholic liver cirrhosis (LC).

Results: The ADAMTS13 activity was significantly lower in SAH (mean 24%), AH (62%), and LC (76%) than in the healthy subjects (102%, n=62). The VWF:Ag levels were higher in SAH (806%), AH (405%), and LC (514%) than in the healthy subjects (100%), resulting in a higher ratio of VWF:Ag to ADAMTS13 activity in SAH (102.2), AH (8.9), and LC (8.6) compared with the healthy subjects (1.0). In 3 nonsurvivors with SAH and multiorgan failure, the protease activity markedly decreased (from 4.5 to 16%), and VWF:Ag remarkably increased (from 560 to 1,202%), resulting in an extremely high ratio of VWF:Ag to the activity (from 35.0 to 240.4). At the recovery stage in the survivors with SAH and AH, the protease activity increased and the VWF:Ag decreased, whereas in a nonsurvivor with SAH, the activity remained extremely low and the VWF:Ag was still high. Unusually large von Willebrand factor multimer was detected in 80.0% of SAH and 55.6% of AH. Multivariate analysis showed that the serum albumin and platelet count independently correlated with VWF:Ag.

Conclusion: The enhanced production of UL‐VWFM over deficient activity of ADAMTS13 may, in part, contribute to not only the progression of liver injury but also the development of multiorgan failure through microcirculatory disturbance in SAH in addition to AH. The imbalance between the plasma ADAMTS13 activity and VWF:Ag could be a useful prognostic marker in AH.
Effect of the Inducer of Interleukin‐6 (ME3738) on Rat Liver Treated With Ethanol
Authors: Fukumura Atsushi , Tsutsumi Mikihiro , Tsuchishima Mutsumi , Hayashi Nobuhiko , Fukura Masayuki , Yano Hirokazu , Ozaki Kazuaki , Takase Shujiro
Published: February 2007

Background: Recently, ME3738, a derivative of soyasapogenol B, was developed as an inducer of interleukin (IL)‐6. It has been demonstrated that ME3738 is stimulate to produce IL‐6 and that it protects against concanavalin A‐induced liver failure. It has also been reported that IL‐6 prevents alcoholic fatty liver in mice. These results suggest that ME3738 may prevent alcoholic liver injury. In the present study, we investigated whether ME3738 prevents fatty liver in ethanol‐fed rats.

Methods: Twenty‐four male rats were fed with liquid diets containing ethanol or carbohydrates for 8 weeks. Liquid diets were prepared with or without ME3738 (0.8 mg/mL). Liver sections were stained for histology and IL‐6 expression. Fatty changes of liver were classified into 4 grades: 0, 1+, 2+, and 3+. Plasma levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ‐glutamyl transpeptidase (GGT), triglyceride, total cholesterol, and IL‐6 were measured, as was hepatic ATP content.

Results: The extent of fatty degeneration in ethanol‐fed rats was significantly greater (p=0.023) than that in controls. Fatty changes in rats fed ethanol containing ME3738 decreased, but were not significantly different from those in rats fed ethanol. Immunohistochemical staining of IL‐6 was observed in perivenular hepatocytes of all rats, with its intensity becoming stronger in the order of controls, controls containing ME3738, ethanol, and ethanol‐containing ME3738‐fed rats. Plasma levels of AST and ALT in rats fed ethanol were significantly higher than those in controls. In rats fed ethanol‐containing ME3738, these levels decreased to those of control‐fed rats, but were not significantly different from those in rats fed ethanol. Plasma IL‐6 was not detected in any rats. Hepatic ATP content in rats fed ethanol was significantly (p<0.05) lower than that in control‐fed rats; however, in rats fed ethanol‐containing ME3738, it increased to that in control‐fed rats.

Conclusions: Oral administration of ME3738, inducer of IL‐6 may prevent the development of fatty liver caused by chronic ethanol consumption.
Maturation of Whisky Changes Ethanol Elimination Kinetics and Neural Effects by Increasing Nonvolatile Congeners
Authors: Haseba Takeshi , Mashimo Keiko , Sugimoto Junichi , Sato Shigeo , Ohno Youkichi
Published: February 2007

Background: The maturation of distilled spirits is known to change constituent congeners to improve the qualities of smell and taste. However, it has been largely unknown how maturation modifies the pharmacokinetics or neuropharmacological effects of ethanol. We used single malt whiskies to investigate the effects of spirit maturation on ethanol metabolism and drunkenness.

Methods: Mice were injected with 5‐year (5‐y) or 20‐year (20‐y) aged single malt whisky with a concentration of 20% (w/v) ethanol at a dose of 3 g/kg. The concentrations of ethanol and its metabolites in the blood and the duration of loss of righting reflex (LORR) were compared between the 2 whisky groups. In addition, the effects of nonvolatile congeners in whisky on the biomedical reactivities of ethanol were investigated by administering a nonvolatile fraction added to a 20% ethanol solution, whose fraction was prepared by evaporating 16‐y whisky. Liver alcohol dehydrogenase (ADH) activity was measured with whisky as the substrate or in the presence of nonvolatile congeners with ethanol as the substrate.

Results: The rate of ethanol elimination (mmol/kg/h) was smaller in the 20‐y whisky group than in the 5‐y group (p<0.01 by Fisher's protected least significant difference), which resulted in lower concentrations of blood acetaldehyde and acetate in the former group than in the latter group (p<0.01 by ANOVA). Nonvolatile congeners added to the ethanol solution also depressed the rate of ethanol elimination in mice. In vitro studies demonstrated that liver ADH activity measured with whisky as the substrate was decreased as a function of the age of the whisky, and that the activity measured with ethanol as the substrate was strongly inhibited by nonvolatile congeners. The duration of LORR was longer in the 20‐y group than in the 5‐y group (p<0.01). Nonvolatile congeners also prolonged the duration of ethanol‐induced LORR, when administered together with ethanol.

Conclusion: Maturation of whisky delayed ethanol metabolism to lower the level of blood acetaldehyde and acetate with increasing inhibition of liver ADH activity by nonvolatile congeners. It also prolonged drunkenness by enhancing the neurodepressive effects of ethanol, due to increases in the amount of nonvolatile congeners. These biomedical effects of whisky maturation may reduce aversive reactions and cytotoxicity due to acetaldehyde, and may also limit overdrinking with the larger neurodepression.
Serum Intercellular Adhesion Molecule‐1 in Patients With Nonalcoholic Steatohepatitis: Comparison With Alcoholic Hepatitis
Authors: Ito Shuji , Yukawa Toyokazu , Uetake Shinichiro , Yamauchi Masayoshi
Published: February 2007

Background:Nonalcoholic fatty liver disease (NAFLD) includes both nonalcoholic fatty liver (FL) and nonalcoholic steatohepatitis (NASH). It has previously been reported that alcoholic hepatitis, which shows morphological findings similar to that of NASH, leads to the onset of endotoxinemia and to an increase in the production of tumor necrosis factor‐α(TNF‐α) and/or interleukin‐1 (IL‐1) from macrophages. Tumor necrosis factor‐αand IL‐1 induce strong expression of intercellular adhesion molecule‐1 (ICAM‐1) of the cell membranes of hepatocytes and/or sinusoidal endothelial cells, resulting in increased serum ICAM‐1 levels in our previous study. In this study, we clarified the significance of serum ICAM‐1 levels in patients with NAFLD, and especially in NASH.

Methods:Thirty‐three obese patients of NAFLD (FL:n=14, NASH:n=19) with no habit of drinking, 20 cases of alcoholic liver diseases (alcoholic hepatitis; ASH:n=10, alcoholic hepatic fibrosis; HF:n=10), and 10 healthy individuals were studied. Serum ICAM‐1 concentrations were analyzed by enzyme‐linked immunoassay in patients with NAFLD and alcoholic liver diseases. Potential factors were assessed for increase in serum ICAM‐1 and a diagnostic tool for NASH including ICAM‐1 levels, C‐reactive protein (CRP), white blood cell count, aspartate aminotransferase, alanine aminotransferase,γ‐gluatmyl transferase, total cholesterol, triglyceride, type‐IV collagen, body mass index, homeostasis model assessment (HOMA‐IR), and existence of high blood pressure.

Results:The serum ICAM‐1 level was significantly higher in the patients with NASH than in the patients with FL, and in the normal subjects. The serum ICAM‐1 level was also significantly higher in the patients with ASH. The serum ICAM‐1 level in the patients with ASH was remarkably high compared with that of the patients with NASH. No significant difference in serum ICAM‐1 levels was found between the patients with NASH and those with HF. The serum ICAM‐1 level was significantly higher in patients with high blood pressure than in those without high blood pressure in NAFLD. A multivariate analysis using multiple logistic regression showed that high blood pressure and GGTP were the significant factors contributing to high serum ICAM‐1 levels, while highly sensitive CRP and ICAM‐1 were the significant factors for the diagnosis of NASH.

Conclusions:The serum ICAM‐1 concentration is increased in patients with NASH. The serum level of ICAM‐1 in patients with NAFLD may be a useful marker for the diagnosis of NASH.
Effects of Gangliosides on Ethanol‐Induced Neurodegeneration in the Developing Mouse Brain
Authors: Saito Mariko , Mao Rui‐Fen , Wang Ray , Vadasz Csaba , Saito Mitsuo
Published: February 2007

Background: Ethanol exposure induces apoptotic neurodegeneration in the developing rodent brain during synaptogenesis. This process has been studied as a model for fetal alcohol syndrome. Previously, we have shown that gangliosides and LIGA20 (a semisynthetic derivative of GM1 ganglioside) attenuate ethanol‐induced apoptosis in cultured neurons. In the present study, the effects of GM1 and LIGA20 on ethanol‐induced apoptotic neurodegeneration were examined using an in vivo neonatal mouse model.

Methods: Seven‐day‐old C57BL/6By (B6By) mice were pretreated twice with intraperitoneal administration of GM1 (30 mg/kg), LIGA20 (2.5 mg/kg), or saline, followed by subcutaneous injection of either saline or ethanol (2.5 g/kg) twice with a 2 hours interval. Then the brains were: (1) perfusion‐fixed 24 hours after the first ethanol injection, and the extent of neurodegeneration was assessed by cupric silver staining of the brain sections, or (2) perfusion‐fixed 8 hours after the first ethanol injection, and the sections were immunostained with anti‐cleaved (activated) caspase‐3 antibody to evaluate caspase‐3 activation.

Results: The comparison of cupric silver stained coronal sections indicates that ethanol‐induced widespread neurodegeneration in the forebrains of B6By mice was reduced overall by GM1 and LIGA20 pretreatments. The extent of neurodegeneration detected by silver impregnation and activated caspase‐3 immunostaining was quantified in the cingulate and retrosplenial cortices, which were the regions most severely affected by ethanol. The results indicate that GM1 and LIGA20 pretreatments induced statistically significant reductions—approximately 50% of the ethanol‐treated samples—in silver impregnation and activated caspase‐3 immunostaining. No significant differences were observed between saline controls and samples treated with GM1 or LIGA20 alone.

Conclusions: These results indicate that GM1 and LIGA20, which have been shown to be neuroprotective against insults caused by various agents, partially attenuate ethanol‐induced apoptotic neurodegeneration in the developing mouse brain.
Direct Evidence for Imidazoline (I1) Receptor Modulation of Ethanol Action on Norepinephrine‐Containing Neurons in the Rostral Ventrolateral Medulla in Conscious Spontaneously Hypertensive Rats
Authors: Li Guichu , Abdel‐Rahman Abdel A.
Published: February 2007

Background: Enhancement of the rostral ventrolateral medulla (RVLM) presympathetic (norepinephrine, NE) neuronal activity represents a neurochemical mechanism for the pressor effect of ethanol. In this study, we tested the hypothesis that ethanol action on RVLM presympathetic neurons is selectively influenced by the signaling of the local imidazoline (I1) receptor. To support a neuroanatomical and an I1‐signaling selectivity of ethanol, and to circumvent the confounding effects of anesthesia, the dose‐related neurochemical and blood pressure effects of ethanol were investigated in the presence of selective pharmacological interventions that cause reduction in the activity of RVLM or nucleus tractus solitarius (NTS) NE neurons via local activation of the I1 or the α2‐adrenergic receptor in conscious spontaneously hypertensive rats.

Results: Local activation of the I1 receptor by rilmenidine (40 nmol) or by the I1/α2 receptor mixed agonist clonidine (1 nmol), and local activation of the α2‐adrenergic receptor (α2AR) by the pure α2AR agonist α‐methylnorepinephrine (α‐MNE, 10 nmol) caused reductions in RVLM NE, and blood pressure. Intra‐RVLM ethanol (1, 5, or 10 μg), microinjected at the nadir of the neurochemical and hypotensive responses, elicited dose‐dependent increments in RVLM NE and blood pressure in the presence of local I1—but not α2‐receptor activation. Only intra‐NTS α‐MNE, but not rilmenidine or clonidine, elicited reductions in local NE and blood pressure; ethanol failed to elicit any neurochemical or blood pressure responses in the presence of local activation of the α2AR within the NTS.

Conclusion: The findings support the neuroanatomical selectivity of ethanol, and support the hypothesis that the neurochemical (RVLM NE), and the subsequent cardiovascular, effects of ethanol are selectively modulated by I1 receptor signaling in the RVLM.
Alcohol Binge Before Trauma/Hemorrhage Impairs Integrity of Host Defense Mechanisms During Recovery
Authors: Greiffenstein Patrick , Mathis Keisa W. , Stouwe Curtis Vande , Molina Patricia E.
Published: February 2007

Background: Alcohol abuse, both chronic and acute, is a known modulator of immune function and is associated with increased incidence of traumatic injury. Previously, we demonstrated that acute alcohol intoxication before hemorrhagic shock impairs hemodynamic and neuroendocrine counterregulation, suppresses early lung proinflammatory cytokine expression, and increases mortality from infection during recovery. In the present study, we examined the impact of a 3‐day alcohol binge on host responses during trauma/hemorrhage (T × Hem) and following overnight recovery.

Methods: Chronically catheterized, adult male Sprague–Dawley rats were administered an intragastric bolus of alcohol (5 g/kg; 30% w/v) or isocaloric dextrose solution for 3 consecutive days, followed by a 2.5 g/kg dose on day 4 before undergoing full‐thickness muscle‐crush and fixed pressure (∼40 mmHg) hemorrhage and fluid resuscitation (2.4 × total blood volume removed).

Results: Alcohol‐binge produced a 16% decrease in basal mean arterial blood pressure (MABP), reduced the total blood loss required to reach and to sustain MABP of 40 mmHg, markedly blunted the increase in circulating epinephrine and norepinephrine (20‐fold and 3‐fold, respectively) levels, and increased immediate mortality from T × Hem. Consistent with our previous reports, significant up‐regulation in lung and spleen tumor necrosis factor (TNF)‐α and interleukin (IL)‐1α expression was observed immediately following T × Hem and fluid resuscitation. Only the T × Hem‐induced increase in lung TNF‐α was prevented by binge alcohol administration. Following overnight recovery, significant lipopolysaccharide (LPS)‐stimulated release of TNF‐α, IL‐1α, IL‐6, and IL‐10 was observed in cells isolated from blood and the alveolar and pleural compartments from all experimental groups. While T × Hem did not prevent LPS‐induced release of TNF‐α, IL‐1α, IL‐6, or IL‐10 at 6 or 24 hours, alcohol binge suppressed TNF‐α, IL‐1 and IL‐6 release, without altering IL‐10 response in cells isolated from blood and pleural compartment. No significant modulation of alveolar macrophage response was observed following alcohol binge and T × Hem.

Conclusions: These results indicate that a 3‐day alcohol binge results in hemodynamic instability associated with attenuated neuroendocrine activation and increased mortality during T × Hem as well as sustained suppression of the proinflammatory cytokine response of blood and pleural‐derived cells to a “second‐hit” inflammatory challenge. As a result, we speculate that the net shift toward an anti‐inflammatory state may contribute to enhanced susceptibility to infection during the recovery period.
The Consequences of Falls in Acute and Subacute Hospitals in Australia That Cause Proximal Femoral Fractures
Authors: Murray Geoffrey R. , Cameron Ian D. , Cumming Robert G.
Published: February 2007

OBJECTIVES:To compare consequences for patients with proximal femoral fractures (PFFs) sustained in the hospital with patients who sustained PFFs in the community.

DESIGN:Data were collected from inpatient notes and incident reports of patients admitted to hospitals over a 6‐year period. All patients aged 75 and older sustaining a PFF in the hospital were identified and matched according to sex, age, and fracture date with patients who sustained a PFF in the community.

SETTING:Illawarra region hospitals, New South Wales, Australia.

PARTICIPANTS:Forty‐three patients with a hospital‐acquired PFF and 43 patients with a community‐acquired PFF; mean age was 84.0 (range 75–92), and 67% were women.

MEASUREMENTS:Outcomes at hospital discharge and circumstances of hospital‐acquired PFF.

RESULTS:Comparing outcomes of subjects with hospital versus community‐acquired PFF revealed that 12 versus four died in the hospital (P=.03), 14 versus five were discharged to long‐term nursing care facilities (P=.02), six versus 18 returned to preadmission ambulation (P=.004), and four versus 24 returned to preadmission activity of daily living status (P<.001). The median postfracture length of stay was 46 days for subjects with hospital‐acquired PFF versus 32 days for those sustaining a PFF in the community (P<.01). Review of circumstances of the 43 hospital‐acquired fractures revealed that 26 occurred in subacute wards, 25 occurred in bedrooms, 25 occurred at night, and 38 occurred while unsupervised.

CONCLUSION:Patients with hospital‐acquired PFF have poor outcomes. Adequate supervision, provision of hip protectors in the hospital, and strategies that address fracture circumstances may hold the keys to prevention.
Validity of the Patient Health Questionnaire 2 (PHQ‐2) in Identifying Major Depression in Older People
Authors: Li Chunyu , Friedman Bruce , Conwell Yeates , Fiscella Kevin
Published: February 2007

OBJECTIVES: To determine the performance of the Patient Health Questionnaire 2 (PHQ‐2) against the criterion standard for diagnosing major depression, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV), and to examine its performance across age, sex, and racial/ethnic groups.

DESIGN: Cross‐sectional observational study.

SETTING: The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) (2001/02), a nationally representative survey of the noninstitutionalized U.S. household population.

PARTICIPANTS: The 8,205 adults aged 65 and older who participated in NESARC.

MEASUREMENTS: The PHQ‐2's criterion validity (sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) against the DSM‐IV) and construct validity (Spearman correlations between the PHQ‐2 and the six scales of the Medical Outcomes Study 12‐item Short Form Questionnaire (SF‐12)) were calculated.

RESULTS: The PHQ‐2's criterion validity for major depression was good (sensitivity=100%, specificity=77%, AUC=0.88). Its sensitivity was 100% for each subgroup. Specificity increased with age, was higher for men than for women, and differed across racial and ethnic groups. For the total sample and each sex, all six SF‐12 scales were significantly lower in people who tested positive using the PHQ‐2. For each age and racial or ethnic group, most of the six scales differed significantly between those who tested positive and tested negative.

CONCLUSION: The PHQ‐2 is a valid screening tool for major depression in older people but should be followed by a more‐comprehensive diagnostic process. Although its specificity differs by age, sex, and racial and ethnic groups, these differences appear to be of little clinical significance.
The Benefits of Biventricular Pacing in Heart Failure Patients with Narrow QRS, NYHA Class II and Right Ventricular Pacing
Authors: NG KENNETH , KEDIA NAVIN , MARTIN DAVID , TCHOU PATRICK , NATALE ANDREA , WILKOFF BRUCE , STARLING RANDALL , GRIMM RICHARD A.
Published: March 2007

Objective: To identify subgroups of heart failure patients who might benefit from biventricular pacing.

Background: Cardiac resynchronization therapy (CRT) improves the quality of life, New York Heart Association (NYHA) functional class, and exercise capacity and decreases hospitalizations for heart failure for patients who have severe heart failure and a wide QRS. It is unclear if other populations of heart failure patients would benefit from CRT.

Methods: One hundred forty‐four consecutive heart failure patients who underwent CRT and completed 3 months of follow‐up were reviewed. Demographic, echocardiographic, electrocardiographic, and clinical outcome data were analyzed to assess the relationship of functional class and QRS duration before device implantation to postimplant outcomes.

Results: There were 20, 88, and 36 patients in NYHA functional class II, III, and IV, respectively. Thirty‐four patients had right ventricular pacing and another 29 patients had a QRS duration ≤150 ms. Patients who were in NYHA functional class II at baseline had significant improvement in left ventricular ejection fraction and indices of left ventricular remodeling after CRT. Similar significant findings were seen in the subgroup with right ventricular pacing at baseline after CRT. However, in the subgroup with a narrow QRS duration, there were no significant changes in the indices of left ventricular remodeling or in the NYHA functional class and there was a significant increase in the QRS duration. For the study cohort as a whole, an improvement in NYHA functional class after CRT correlated with a significant decrease in adverse clinical outcomes.

Conclusions: Heart failure patients who were in NYHA functional class II and those with right ventricular pacing appeared to benefit from CRT.
Laser Lead Extraction: Predictors of Success and Complications
Authors: ROUX JEAN‐FRANÇOIS , PAGÉ PIERRE , DUBUC MARC , THIBAULT BERNARD , GUERRA PETER G. , MACLE LAURENT , ROY DENIS , TALAJIC MARIO , KHAIRY PAUL
Published: March 2007

Background: Paralleling the rise in pacemaker and defibrillator implantations, lead extraction procedures are increasingly required. Concerns regarding failure and complications remain.

Methods and Results: A total of 200 lead extraction procudures were performed at the Montreal Heart Institute between September 2000 and August 2005. In 23 patients, all leads were removed by traction with a locking stylet. A total of 270 leads were extracted using a laser sheath system (Spectranectics, Colorado Springs, CO, USA) in 177 procedures involving 175 patients (74% male), age 62±16 years. Procedural indications were: infection 88 (50%), dysfunction 54 (30%), upgrade 21 (12%), and other 14 (8%). Overall, 241 leads (89%) were successfully extracted, 7 (3%) were partially extracted (≤4 cm retained), and 22 (8%) were non‐extractable. In multivariate analyses, predictors of failed extraction were longer time from implant (OR 1.16 per year, P=0.0001) and history of hypertension (OR 5.2, P=0.0023). Acute complications occurred in 14 of 177 procedures (7.9%): 8 (4.5%) minor and 6 (3.4%) major, with one death. In multivariate analyses, the only predictor of acute complications was laser lead extraction from both right and left sides during the same procedure (OR 9.4, P = 0.0119). In addition, 3 of 10 patients with failed or partially extracted infected systems eventually required open chest explantation because of endocarditis.

Conclusion: Most leads not amenable to manual traction may be successfully extracted by a percutaneous laser sheath system. While most complications are minor, major complications including death may occur. Older leads are at higher risk for failed extraction. Endocarditis may ensue if infected leads are incompletely removed.
Extraction of the Inner Coil of a Pacemaker Lead Slid into the Pulmonary Artery
Authors: GOLZIO PIER GIORGIO , BONGIORNI MARIA GRAZIA , CHIRIBIRI AMEDEO , FRANCO ERICA
Published: March 2007

A patient required lead extraction for chronic draining sinus, due to abandoned leads. Preoperatively, the chest film showed a filament in the right pulmonary artery: it was the inner coil of an old atrial lead that, while remaining anchored to the auricle, slid outside the outer coil. By right subclavian approach, the old ventricular lead and the outer coil of the atrial lead were removed. Then, by right jugular approach, the freely floating end of the
inner atrial coil was grasped by a pig‐tail catheter, drawn back into the superior vena cava, exteriorized by a Lasso catheter, and finally extracted.
Reduction of Pacemaker Pressure Symptoms Using Nonantigenic Preserved Human Dermis Grafts
Authors: RUDOLPH ROSS , SMITH MICHAEL , CURTIS GUY
Published: March 2007

Skin pressure symptoms can occur in thin patients with pacemakers, with erosion through the skin surface a possibility. To correct this problem without device removal, two patients had nonantigenic preserved human dermis grafts placed over their pacemakers. This acellular nonantigenic human dermal substitute provided significant thickness over the devices and improvement in pressure symptoms.
A New Analytical Model for Estimation of Scratch‐Induced Damage in Brittle Solids
Authors: Jing Xiaoning , Maiti Spandan , Subhash Ghatu
Published: February 2007

Scratch tests are of fundamental interest both for understanding machining‐induced damage and for evaluating the scratch resistance of brittle materials. An improved blister field model for the scratch process is proposed where the blister field strength is explicitly determined in terms of the material properties, loading conditions, and geometry of the scratch tool. Additionally, one new expanding cylindrical cavity model is implemented to estimate the plastic zone size surrounding the scratch groove. A quantitative evaluation of the damage zone size is conducted by combining the above two models. The predicted damage zone sizes are in good agreement with the results available elsewhere in literature.