bluuebunny/crossref_metadata_2025 huggingface dataset:
Right Ventricular Variants and Pulmonary Embolism—Association or Coincidence?
Authors: Ker James
Published: December 2010

It has been stated that the interior of the right ventricle is as unique to each individual as one's fingerprint. This statement is backed by numerous publications which demonstrates considerable variation in the number, shape and configuration of papillary muscles inside the normal right ventricle.

It has also been shown that these variants may be the cause of cardiac rhythm disorders.

In this case report another potential complication of such right ventricular papillary muscle variants is proposed—these muscles may be the source of pulmonary emboli.

The pathogenesis may be that of local stasis around these aberrant muscular structures and/or emboli may form inside the right ventricle as a result of cardiac rhythm disorders, induced by these muscles.

It is proposed that in future the role of the right ventricle as the source of pulmonary emboli will become more apparent and an important part of the diagnostic work up in cases of idiopathic pulmonary embolism.
Subaortic (Type 6) Muscular Band—Innocent Bystander or Pathologic Structure?
Authors: Ker J
Published: December 2010

Intraventricular tendons are structures that was identified more than a hundred years ago. It has been suggested that they represent intracavitary radiations of the bundle of His and that they may be an isolated finding or be associated with structural cardiac abnormalities.

Loukas et al divided these structures into five categories and recently a sixth type have been added.

Various physiological disturbances have been observed due to the sixth type of tendon, such as ST segment elevation and right bundle branch block. It has been noted that this peculiar structure appears too thick to be called a tendon, thus the term band.

This retrospective analysis analyzed the incidence of the thick, subaortic (type 6) muscular band in a cardiovascular clinic.
Expression of Toll-Like Receptor 4, Tumor Necrosis Factor-Alpha, Matrix Metalloproteinase-9 and Effects of Benazepril in Patients with Acute Coronary Syndromes
Authors: Xie Ping , Cao Yun-Shan , Su Peng , Li Yu-Hong , Gao Zhi-Ling , Borst Mathias M.
Published: December 2010

Objectives

The study aims to explore the relationship between expressions of toll-like receptor 4 (TLR4) on peripheral blood monocytes, serum tumor necrosis factor-alpha (TNF-α) and matrix metalloproteinase-9 (MMP-9) in patients with acute coronary syndromes(ACS), and to investigate the possible mechanisms of Benazepril stabilizing atherosclerosis plaques.

Methods

70 patients selected were randomly divided into Benazepril treatment group (35 patients) and regular treatment group (35 patients). Meanwhile, Stable angina pectoris (SAP) group of 32 patients and control group of 22 patients were also set up. With the help of flow-cytometry, expressions of TLR4 on peripheral blood monocytes of the four groups were analyzed and compared to show differences, correlations and changes of the above mentioned indicators. The concentration of TNF-α and MMP-9 in serum were measured by enzyme linked immunosorbent assay (ELISA).

Results

(1) Expressions of TLR4, levels of TNF-α and MMP-9 were increased and the rate was rising from the control group, to SAP group and then to ACS group. All these indicators in ACS group are significantly higher than those in other groups ( P < 0.05). (ACS versus SAP, control; all ( P < 0.05). (2) Multi-linear regression analysis indicates that there was a positive correlation between the expression level of TLR4 and serum levels of TNF-α and MMP-9 in patients with ACS ( P < 0.01). (3) There is no significant differences between the expression level of TLR4 and serum levels of TNF-α and MMP-9 in Benazepril treatment group and regular treatment group before treatment ( P > 0.05) while they all fell after treatment ( P < 0.05). In addition, all the indicators decreased more greatly than the regular treatment group.

Conclusions

TLR4 on peripheral blood monocytes and serum TNF-α and MMP-9 in patients with coronary arteriosclerosis disease may be effective markers of the vulnerable plaque. Benazepril can inhibit over-expression of TLR4 and reduce serum levels of TNF-α and MMP-9, thus stabilize the vulnerable plaques and improve the condition of the patients with ACS.
Post-Mortem Echocardiography as a Guide to Cardiac Autopsy—A Worthwhile Concept?
Authors: Ker J. , Du Toit-Prinsloo L. , Van Heerden WFP. , Saayman G
Published: December 2010

Sudden and unexpected death in the young is a common and worldwide problem. Sudden, unexpected death in infancy (SUDI), clinically unexpected death in an infant between one week and one year of age, affects around 1 in 1000 infants. Autopsy will reveal a specific cause of death in only one third of cases. This has led to various ancillary examinations in an effort to increase the diagnostic yield of the autopsy.

In this case report it is suggested that another diagnostic modality, that of the post-mortem echocardiogram might be a worthwhile concept to explore.
Usefulness of Cardiac Computed Tomography in the Diagnosis of Prosthetic Coronary Artery Graft with Interposition Procedure
Authors: Wake Ryotaro , Iwata Shinichi , Nakagawa Masashi , Doi Atsushi , Sugioka Kenichi , Otsuka Ryo , Hozumi Takeshi , Takemoto Yasuhiko , Ehara Shoichi , Hanatani Akihisa , Muro Takashi , Yoshiyama Minoru
Published: December 2010

An 80-year-old Japanese man was admitted with orthopnea and pitting edema of both lower legs. We diagnosed congestive heart failure (CHF) on the basis of a chest X-ray and an echocardiogram. An electrocardiogram showed a heart rate of 120 beats/min with atrial fibrillation rhythm (Af). The patient developed aortic valve failure and destruction of the base of right coronary artery (RCA) due to infectious endocarditis at 71 years of age. The patient underwent aortic valve replacement and coronary artery bypass grafting with an interposed graft with polyester vascular graft to RCA. The patient recovered from CHF after the 6 days of treatment with diuretics and verapamil. We confirmed the patency of coronary arteries and bypass grafts using a 64-slice cardiac computed tomography scan (CT) and diagnosed CHF due to Af. Here we describe the estimation of the prosthetic coronary artery graft patency with the interposition procedure using 64-slice cardiac CT.
The Double U Wave—Should the Electrocardiogram be Interpreted Echocardiographically?
Authors: Ker James
Published: December 2010

The U wave is still an electrocardiographic deflection of enigmatic origin. Numerous hypotheses on its origin have been formulated, but to date none has been conclusively proven. Recently, a report described the first case of bifid (or notched) U waves. Until then this phenomenon has only been described in the T wave. This is the first report of double U waves—two separate deflections, ascribed to an accessory papillary muscle.

Hypothesis

The presence of a double U wave will be associated with an accessory papillary muscle (s).

Materials and Methods

This is a retrospective analysis of 4729 patient files of patients who were evaluated at a cardiology practice. The 12-lead surface electrocardiogram was evaluated for the possible presence of a double U wave. In cases where a double U wave was found, the transthoracic echocardiogram was then scrutinized for the presence of an accessory papillary muscle.

Results

A total of 3 cases of a double U wave were found. In every case an accessory papillary muscle was clearly seen on the transthoracic echocardiogram.

Conclusion

A double U wave is a new variant of an old electrocardiographic deflection of enigmatic origin. This variant may be associated with an accessory papillary muscle.
Characteristics and Prognostic Importance of Myocardial Fibrosis in Patients with Dilated Cardiomyopathy Assessed by Contrast-Enhanced Cardiac Magnetic Resonance Imaging
Authors: Looi Jen-Li , Edwards Colin , Armstrong Guy P. , Scott Anthony , Patel Hitesh , Hart Hamish , Christiansen Jonathan P.
Published: December 2010

Introduction

Dilated cardiomyopathy (DCM) is associated with significant morbidity and mortality. Contrast-enhanced cardiac MRI (CE-CMR) can detect potentially prognostic myocardial fibrosis in DCM. We investigated the role of CE-CMR in New Zealand patients with DCM, both Maori and non-Maori, including the characteristics and prognostic importance of fibrosis.

Methods

One hundred and three patients (mean age 58 ± 13, 78 male) referred for CMR assessment of DCM were followed for 660 ± 346 days. Major adverse cardiac events (MACE) were defined as death, infarction, ventricular arrhythmias or rehospitalisation. CE-CMR used cines for functional analysis, and delayed enhancement to assess fibrosis.

Results

Myocardial fibrosis was present in 30% of patients, the majority of which was mid-myocardial (63%). Volumetric parameters were similar in patients with or without fibrosis. At 2 years patients with fibrosis had an increased rate of MACE (HR = 0.77, 95% CI 0.3-2.0). Patients with full thickness or subendocardial fibrosis had the highest MACE, even in the absence of CAD). More Maori had fibrosis on CE-CMR (40% vs. 28% for non-Maori), and the majority (75%) was mid-myocardial. Maori and non-Maori had similar outcomes (25% vs. 24% with events during follow-up).

Conclusions

DCM patients frequently have myocardial fibrosis detected on CE-CMR, the majority of which is mid-myocardial. Fibrosis is associated with worse outcome in the medium term. The information obtained using CE-CMR in DCM may be of incremental clinical benefit.
Sudden Infant Death Syndrome and Left Ventricular Hypertrabeculation-Hidden Arrhythmogenic Entity?
Authors: Ker J. , Du Toit-Prinsloo L. , Van Heerden W.F.P. , Saayman G.
Published: December 2010

Left ventricular noncompaction/hypertrabeculation is a condition which is characterized by a highly trabeculated, “spongy” myocardium.

It can present at any age with heart failure, arrhythmia and/or thromboembolic events.

A wide variety of mutations have been found to be a cause of hypertrabeculation and it is possible that there is a continuum of hypertrophic cardiomyopathy, dilated cardiomyopathy and hypertrabeculation/noncompaction.

We present a case of left ventricular hypertrabeculation which presented as sudden infant death syndrome and we propose that this entity may be a hidden cause of arrhythmic death in some infants presenting as sudden infant death syndrome.
Niacin or Ezetimibe for Patients with, or at Risk of Coronary Heart Disease
Authors: Guthrie Robert
Published: December 2010

Coronary heart disease treatment with HMG-CoA reductase inhibitors has been very successful. There is increasing interest in adding other lipid lowering therapy, primarily as additional therapy onto HMG-CoA reductase therapy. This paper will examine two of the more popular secondary agents, ezetimibe and niacin, and describe their research data and potential for usefulness in further reducing cardiovascular events.
A Pain-free Lancet with a Small Needle for Glucose Measurement
Authors: Kim Stanley
Published: December 2010

A new lancet with an extremely small needle (0.15 mm diameter and 0.75 mm length) mounted on a small pedestal was tested in diabetic patients for blood glucose measurement in a randomized clinical study. A total of 37 diabetic patients were enrolled for the study. A pain scale categorized from 0 to 3 was created to measure the intensity of puncture pain which was explained to patients before testing. The patients' fingers were punctured with their own old style lancets at least 1 hour before the punctures by the new lancets, and puncture pains recorded according to the pain scale. All patients tested with the new lancet reported no pain and recorded the puncture pain as scale 0. Among the total 37 patients tested with their old style lancets, 2 patients (5.40%) reported no pain and recorded the pain as scale 0, thirteen patients (35.14%) recorded as scale 1, 16 patients (43.24%) as scale 2, and 6 patients (16.22%) as scale 3. The average pain scale of the patients who used old style lancets was 1.702 with the standard error 0.133. The chi-square goodness-of-fit test shows that the proportion of the pain scales comes from the claimed distribution with unequal frequencies, and chi-square tests for independence indicate that neither sex nor age of the sample patients is related to the pain scales.

The paired t-test to test the existence of any difference in pain levels between the new lancet and the old style lancet showed; t = 1.702/0.133 = 12.796 with p-value ≤ 0.005 (df = 36). The average pain level from the old style lancet is significantly higher than from the new lancets. Pain-free needle puncture was achieved by limiting the puncture depth to less than 0.75 mm with a thin needle with a 0.15 mm diameter. By allowing patients to see the new lancets before testing, psychological pain anticipation was minimized as the very thin and short needle is visually less intimidating. With a pain free puncture, better compliance and improved subsequent glucose levels may be achieved.
Diurnal Variation in Peripheral (Hair) vs Central (Saliva) HPA Axis Cortisol Concentrations
Authors: Sharpley Christopher F. , Kauter Kathleen G. , Mcfarlane James R.
Published: December 2010

Cortisol concentrations in hair and saliva collected from male and female adults over a 15-hour period were compared for differences in overall level and cyclic pattern. Typical diurnal fluctuations were noted for both salivary and hair Cortisol, with some individual differences that are congruent with the previous literature. Issues of the link between central and peripheral HPA axes are raised for discussion and further investigation, and hypothetical explanations for the diurnal variability shown in these two sets of cortisol secretion patterns are discussed from an evolutionary advantage perspective.
Higher Dietary Protein Intake is Associated with Lower Body Fat in the Newfoundland Population
Authors: Green Kristian K. , Shea Jennifer L. , Vasdev Sudesh , Randell Edward , Gulliver Wayne , Sun Guang
Published: December 2010

Background

Increased protein proportions in the diet combined with energy restriction has been shown to enhance weight loss during dietary intervention. It is not known if the beneficial effect of dietary protein exists in the general population under normal living conditions without a negative energy balance.

Methods

A total of 1834 participants (n = 443 men, n = 1391 women) were recruited from the CODING study. Participants' dietary macronutrient compositions were determined through a Willett FFQ. Body composition variables including percent body fat (%BF), percent trunk fat (%TF), percent total lean mass (%LM), and percent trunk lean mass (%TLM) were determined using DXA. Major confounding factors including age, physical activity levels, total caloric intake, carbohydrate intake, menopausal status, smoking status and medication use were controlled for in all analyses.

Results

Significant inverse relationships were observed between dietary protein intake (g/kg body weight/day) and weight, waist circumference, waist-to-hip ratio, BMI, %BF, and %TF ( P ≤ 0.001). Significant positive relationships were observed with %LM and %TLM ( P ≤ 0.001). Additionally, significant differences in weight (12.7 kg in men, 11.4 kg in women), BMI (4.1 BMI units in men, 4.2 units in women), and %BF (7.6% in men, 6.0% in women) were observed between low and high dietary protein consuming groups ( P ≤ 0.001). Dietary protein explained 11% of the total variation in %BF in the NL population.

Conclusion

This study provides strong evidence that higher protein intake, even in the absence of energy restriction, is associated with a more favorable body composition in the general population.
Parathyroid Hormone's Acute Effect on Vasodilatory Function
Authors: Farahnak P. , Lind L. , Mattala K. , Nilsson I-L.
Published: December 2010

Parathyroid hormone (PTH) seems to affect the risk of cardiovascular disease. The aim of the present study was to investigate PTH's acute effect on endothelial vasodilatory function in forearm resistance vessels. Ten healthy subjects underwent forearm venous occlusion plethysmography. We measured forearm blood flow at baseline and at a stable, locally increased PTH level after intra-arterial infusion of metacholine and nitroprusside. The contralateral arm served as a control. Ionized calcium (Ca++) and PTH values were normal in all subjects at baseline (1.26 ± 0.02 mM/L, 3.6 ± 1.2 pM/L). After 30 minutes of PTH infusion, the PTH level increased in the active arm (13.8 ± 4.0 pM/L P < 0.01), while the Ca++ level was unchanged (1.25 ± 0.04; mM/L). Both the PTH and the Ca++ level in the contralateral arm remained unchanged, which indicates no systemic influence. The endothelial-dependent vasodilation was inversely correlated to the Ca++ level at baseline (r = −0.75, P < 0.05) and after PTH infusion (r = −0.68, P < 0.05). The vasodilatory function was not affected during PTH-infusion.
Pioglitazone in the Treatment of Type 2 Diabetes: Safety and Efficacy Review
Authors: Desouza Cyrus V. , Shivaswamy Vijay
Published: December 2010

The increase in obesity and the aging of the population has lead to an increase in the incidence of type 2 diabetes. This has led to the development of new drugs such as thiazolidinediones (TZDs) which are Peroxisome Proliferator-Activated Receptor (PPAR-gamma) agonists, to treat type 2 diabetes. TZDs have recently been at the center of a controversy with regards to their cardiovascular safety. Pioglitazone is a TZD which has been shown to be effective in glycemic control by lowering insulin resistance. Pioglitazone also has beneficial effects on lipid metabolism and cardiovascular risk. The safety and efficacy of pioglitazone including its pleotropic effects are discussed at length in this article.
Use of the Nd-YAG Laser for Inferior Turbinectomy: A comparative study
Authors: Abdullah Nazik E. , Al-Muslet Nafie A.
Published: December 2010

Nasal obstruction resulting from inferior turbinate hypertrophy was treated by Nd-YAG laser inferior turbinectomy (laser IT). The effectiveness of the procedure was assessed and compared with both functional endoscopic turbinoplasty (turbinoplasty) and conventional partial turbinectomy (conventional IT).

Materials and methods

A retrospective analytic study was carried out for 53 patients suffering from inferior turbinate hypertrophy. Twenty patients underwent Nd-YAG Laser IT (Group 1), 24 patients underwent turbinoplasy (Group 2) and 9 patients underwent conventional IT (Group 3). Improvement in nasal symptoms were assessed. Intra-operative bleeding, duration of hospital stay, and post-operative medications and instrumentation were compared between the three groups.

Results

The symptoms of sneezing, hyposmia and rhinorhoea were significantly reduced post-operatively among patients in the three groups and there were no differences statistically between them. The Nd-YAG laser turbinectomy group showed marked reduction in blood loss (average = 12 ml per patient) compared to the turbinoplasy group (average = 181 ml per patient) and conventional IT group (average 201 ml per patient). Hospital stay was much shorter in the laser IT group (average = 0.05 days) compared to Group 2 (1.2 days) and Group 3 (1.3 days). Only one patient in the laser IT group required nasal packing, whereas all patients in the other two groups required nasal packing routinely.

Conclusions

Nd-YAG laser IT was effective in reducing the symptoms of nasal obstruction, as well as other nasal symptoms without significant complications. The Nd-YAG laser is recommended as an alternative method, when applicable, in treating patients with nasal obstruction resulting from inferior turbinate hypertrophy.
A Phase II Study of S-1 Monotherapy as a First-line Combination Therapy of S-1 plus Cisplatin as a Second-line Therapy, and Weekly Paclitaxel Monotherapy as a Third-line Therapy in Patients with Advanced Gastric Carcinoma: A Second Report
Authors: Rino Yasushi , Yukawa Norio , Murakami Hitoshi , Wada Nobuyuki , Yamada Roppei , Hayashi Tsutomu , Sato Tsutomu , Ohshima Takashi , Masuda Munetaka , Imada Toshio
Published: December 2010

Background

We have previousy reported on a Phase II study of S-1 monotherapy as a first line, combination therapy of S-1 plus cisplatin as a second line, and weekly paclitaxel monotherapy as a third line therapy in patients with advanced gastric carcinomas. The median survival time (MST) of patients over the whole course of treatment was not previously calculated because 12 out of 19 patients had not yet succumbed. Since then, we have calculated the MST for this study and herein report our findings.

Patients and Methods

Between 2002 and 2005, 19 patients were enrolled in this study. Chemotherapy consisted of either 60 mg/m2 of S-1 for 4 weeks at 6-week intervals, a combination of 60 mg/m2 S-1 for 3 weeks and 60 mg/m2 cisplatin on day 8 at 5-week intervals, or 60 mg/m2 paclitaxel at days 1, 8, and 15, at 4-week intervals. The regimens were repeated until the occurrence of unacceptable toxicities, disease progression, or patient noncompliance. The primary end point was the overall survival.

Results

The median survival time was 774 days. The response rates were 33.3% (3/9), 12.5% (1/8), and 0% (0/4) after the first, second, and third line chemotherapies, respectively. The major adverse hematological toxicity was leukopenia, which reached grades 3–4 in all lines of chemotherapy investigated. In addition, the major adverse non-hematological toxicity was anorexia, which reached grade 3–4 in second line chemotherapy, and no deaths were attributable to the adverse effects of the drugs.

Conclusion

This sequential therapy was an effective treatment for advanced gastric cancer with acceptable toxic side-effects. We considered this therapy to be effective because of the smooth transition to the next regimen.
Pilot Study of a Clinical Pathway Implementation in Rectal Cancer
Authors: Uña Esther , López-Lara Francisco
Published: December 2010

Background

Rectal cancer is a highly prevalent disease which needs a multidisciplinary approach to be treated. The absence of specific protocols implies a significant and unjustifiable variability among the different professionals involved in this disease. The purpose is to develop a clinical pathway based on the analysis process and aims to reduce this variability and to reduce unnecessary costs.

Methods

We created a multidisciplinary team with contributors from every clinical area involved in the diagnosis and treatment in this disease. We held periodic meetings to agree on a protocol based on the best available clinical practice guidelines. Once we had agreed on the protocol, we implemented its use as a standard in our institution. Every patient older than 18 years who was diagnosed with rectal cancer was considered a candidate to be treated via the pathway.

Results

We evaluated 48 patients during the course of this study. Every parameter measured was improved after the implementation of the pathway, except the proportion of patients with 12 nodes or more analysed. The perception that our patients had about this project was very good.

Conclusions

Clinical pathways are needed to improve the quality of health care. This kind of project helps reduce hospital costs and optimizes the use of limited resources. On the other hand, unexplained variability is also reduced, with consequent benefits for the patients.
Classical and Novel Prognostic Markers for Breast Cancer and their Clinical Significance
Authors: Taneja Pankaj , Maglic Dejan , Kai Fumitake , Zhu Sinan , Kendig Robert D. , Elizabeth A. Fry , Inoue Kazushi
Published: December 2010

The use of biomarkers ensures breast cancer patients receive optimal treatment. Established biomarkers such as estrogen receptor (ER) and progesterone receptor (PR) have been playing significant roles in the selection and management of patients for endocrine therapy. HER2 is a strong predictor of response to trastuzumab. Recently, the roles of ER as a negative and HER2 as a positive indicator for chemotherapy have been established. Ki67 has traditionally been recognized as a poor prognostic factor, but recent studies suggest that measurement of Ki67-positive cells during treatment will more effectively predict treatment efficacy for both anti-hormonal and chemotherapy. p53 mutations are found in 20–35% of human breast cancers and are associated with aggressive disease with poor clinical outcome when the DNA-binding domain is mutated. The utility of cyclin D1 as a predictor of breast cancer prognosis is controversial, but cyclin D1b overexpression is associated with poor prognosis. Likewise, overexpression of the low molecular weight form of cyclin E1 protein predicts poor prognosis. Breast cancers from BRCA1/2 carriers often show high nuclear grades, negativity to ER/PR/HER2, and p53 mutations, and thus, are associated with poor prognosis. The prognostic values of other molecular markers, such as p14ARF, TBX2/3, VEGF in breast cancer are also discussed. Careful evaluation of these biomarkers with current treatment modality is required to determine whether their measurement or monitoring offer significant clinical benefits.
Trends in Cancer Immunotherapy
Authors: Murphy Joseph F.
Published: December 2010

Modulation of the immune system for therapeutic ends has a long history, stretching back to Edward Jenner's use of cowpox to induce immunity to smallpox in 1796. Since then, immunotherapy, in the form of prophylactic and therapeutic vaccines, has enabled doctors to treat and prevent a variety of infectious diseases, including cholera, poliomyelitis, diphtheria, measles and mumps. Immunotherapy is now increasingly being applied to oncology. Cancer immunotherapy attempts to harness the power and specificity of the immune system for the treatment of malignancy. Although cancer cells are less immunogenic than pathogens, the immune system is capable of recognizing and eliminating tumor cells. However, tumors frequently interfere with the development and function of immune responses. Thus, the challenge for cancer immunotherapy is to apply advances in cellular and molecular immunology and develop strategies that effectively and safely augment antitumor responses.
CD4 Count and anti Retroviral Therapy for HIV Positive Patients with Cancer in Nigeria -A Pilot Study
Authors: Ntekim Atara I. , Folasire Ayo M.
Published: December 2010

Background

Highly Active Anti Retroviral Treatment (HAART) improves the outcome of HIV positive patients treated for cancer. In our center HAART is only commenced in HIV positive patients with malignancy if the CD4 T lymphocyte count is less than 200 cells/ul. Presently, the outcome of treatment in these patients is poor.

Objective

To evaluate the influence of CD4 T- cell count and HAART on treatment outcome of HIV positive patients with cancer managed at the oncology service of The University College Hospital, Ibadan- South West Nigeria.

Patients and Methods

Twenty two adult HIV positive patients with malignancies who presented for treatment at our hospital from 2007 to 2009 were closely monitored by the investigators. Relevant clinical data collected included age, sex, HIV status, type of malignancy, CD4 counts, history of ART, ECOG performance status, prescribed oncology treatment with regularity of treatment and to follow up conditions.

Results

Twenty two patients aged between 26 and 67 years were evaluated. The performance status of all patients was at least ECOG 2. Three ART naive patients with initial CD4 counts 450 cells/ul and above were able to complete oncology treatment without HAART with good malignant disease control. Five other patients on HAART before the diagnosis of malignancy with CD4 counts 350 cells/ul and above were also able to complete their treatments on schedule with good outcome. Eight HAART naive patients with initial CD4 counts less than 370 cells/ul had inconsistent treatments with poor outcome.

Conclusion

Based on these observations, we propose that HAART should be commenced on all HIV positive patients diagnosed with malignancy with an initial CD4 count less than 450 cells/ul in our environment. Further studies in low resource settings with appropriate sample sizes are however needed to validate these findings.
The Challenge of Metastatic Colorectal Cancer
Authors: Cidón Esther Uña
Published: December 2010

Colorectal cancer (CRC) is a very common disease with a high rate of mortality around the world, representing the second most frequent cause of cancer-related death. As the majority of patients are diagnosed with advanced cancer with a subsequent low five-year survival rate (10%), it is imperative to develop new strategies to treat this challenging patient population. Traditionally, patients received successive lines of chemotherapy and discontinued the treatment or switched to a different one in the event of disease progression. But despite the therapeutic advances achieved with combination chemotherapy regimens, particularly FOLFOX and FOLFIRI, considerable research has been necessary to further optimize chemotherapy for patients with metastatic colorectal cancer (mCRC). However, progress has been achieved over recent years. The most relevant relates to the approval of several new effective therapeutic drugs, such as monoclonal antibodies, which have greatly improved the outcomes for metastatic disease. The last agent approved has been panitumumab, which has been designed to target the epidermal growth factor receptor molecular pathway involved in the appearance and spread of cancer.
Early Diagnosis of Invasive Aspergillosis in Neutropenic Patients. Comparison between Serum Galactomannan and Polymerase chain Reaction
Authors: Da Silva Rodrigo Lopes , Ribeiro Patrícia , Abreu Natacha , Ferreira Teresa , Fernandes Teresa , Monteiro Alexandra , Costa Fátima , Caldas Joana , Silva Madalena , Carande Luísa , Ferreira Gilda , Conduto António , Cruz Ernesto , Sousa Maria Henrique , Rodrigues António Silva , Costa Isabel , Veiga Joana , De Sousa Aida Botelho
Published: December 2010

Background

Invasive aspergillosis (IA) is a major cause of morbidity and mortality in profoundly neutropenic patients, so early diagnosis is mandatory.

Aim

Consecutive patients with hematological malignancies undergoing intensive chemotherapy were screened for IA with two different methods which were compared.

Methods

From October 2000 to August 2003 we tested 1311 serum samples from 172 consecutive patients with a polymerase chain reaction assay and between April 2005 and April 2008 we tested 806 serum samples from 169 consecutive patients with a Galactomannan (GM) test. Bronchoalveolar (BAL) samples were obtained whenever the patient's condition allowed and tested with either method.

Results:

The serum PCR assay had a sensitivity of 75.0% and a specificity of 91.9% and the serum GM assay had a sensitivity of 87.5% and a specificity of 93.1%, ( P > 0.05). The presence of two or more consecutive positive serum samples was predictive of IA for both assays. BAL GM/PCR was positive in some patients without serum positivity and in patients with 2 or more positive serum GM/PCR.

Conclusions:

No significant differences between the 2 serum tests were found. The GM assay has the advantage of being standardized among several laboratories and is incorporated in the criteria established by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycosis Study Group (EORTC/MSG), however is much more expensive. BAL GM and PCR sampling aids in IA diagnosis but needs further validation studies to differentiate between colonization and true infection in cases where serum GM or PCR are negative.
High Dose Rate Brachytherapy in the Treatment of Cervical Cancer: Preliminary Experience with Cobalt 60 Radionuclide Source—A Prospective Study
Authors: Ntekim Atara , Adenipekun Adeniyi , Akinlade Bidemi , Campbell Oladapo
Published: December 2010

Iridium-192 is widely used for high-dose rate brachytherapy. Co-60 source with similar geometric and dosimetric properties are now available. It has a longer half life but higher energy than Iridium-192. If Co-60 source can produce similar results, it will be more economical for low resource settings.

Objective

To evaluate the acute gastrointestinal and genitourinary toxicity associated with Co-60 source in the brachytherapy of cervical cancer.

Methods

Seventy patients with cervical cancer received 45 Gy in 22 fractions of pelvic external beam radiotherapy and 19.5 Gy in 3 fractions of HDR with Co-60 source using tandem and ring applicators with 6 courses of cisplatin 50 mg/m2 and 5 fluorouracil 1000 mg/m2 every 3 weeks Toxicity was scored using NCI-CTC version 4.0.

Results

The median total BED (Gy10) for tumor was 86.2 (84.4–88.8) while that for rectum (BED Gy3) was 124.4 (120–133). Two patients (3%) had grade 3 gastrointestinal toxicity while all others had ≤grade 2 toxicity and this is comparable with previous results.

Conclusion

Co-60 as HDR brachytherapy source is tolerable and is economical for low resource settings.
Puberty Onset among Boys in Riyadh, Saudi Arabia
Authors: Alwan Ibrahim Al , Felimban Naila , Altwaijri Yasmin , Tamim Hani , Mutair Angham Al , Shoukh Mohamed , Tamimi Waleed
Published: December 2010

Background

The ages of onset of pubertal characteristics are influenced by genetic, geographic, dietary and socioeconomic factors; however, due to lack of country-specific norms, clinicians in Saudi Arabia use Western estimates as standards of reference for local children.

Aims

The aim of the Riyadh Puberty Study was to provide data on pubertal development to determine the average age of onset of pubertal characteristics among Saudi boys.

Methods

Cross-sectional study among male school children in Riyadh, Saudi Arabia, in 2006, 542 schoolboys, aged 6 to 16 years old, from diverse socioeconomic levels were selected into the sample using a cluster sample design. Tanner stages were ascertained during physical examination by pediatric endocrine consultants, and also trained pediatric residents and fellows.

Results

The mean age (standard deviation) at Tanner Stages 2, 3, 4, and 5 for pubic hair development of Saudi boys was 11.4 (1.6), 13.3 (1.3), 14.4 (1.0) and 15.1 (0.8) years old, respectively. For gonadal development, the mean age (standard deviation) at stages 2, 3, 4, and 5 were 11.4 (1.5), 13.3 (1.2), 14.3 (1.1) and 15.0 (0.9) years old, respectively.

Conclusion

The ages of onset of pubertal characteristics, based on gonadal development, among Saudi boys are comparable to those reported in Western populations.
Anti-annexin V Antibodies in Women with Recurrent Miscarriage
Authors: EL-Gharib M.N. , Elhawary T.M. , Elshourbagy S.H. , Morad M.A.
Published: December 2010

Objective

To determine the role of anti-annexin V antibodies (a-A5) as an etiologic factor in recurrent pregnancy failure.

Study design

Prospective observational study.

Material and methods

The study included ninety first trimester pregnant women who had a history of unexplained recurrent miscarriage (group I) with ninety well-matched pregnant women with a history of normal reproductive outcome allocated as control group (GII) and another ninety nonpregnant women (GIII). Sera from all women controls were analyzed for anti-annexin antibody measured by Elisa.

Results

The mean value of a-A5 was 11.37 ± 6.78, 7.7 ± 1.40 and 6.20 ± 0.95 ng/ml in groups I, II and III respectively. There was a significant increase in the mean value a-A5 among women with a history of recurrent miscarriage, compared with controls. The mean value was 13.92 ± 2.42 ng/ml among patients with unfavourable outcome, compared with a corresponding value of 6.95 V 0.58 ng/ml among women with favourable outcome. The receiver operator characteristic curve revealed that the cutoff value of a-A5 was 8.61 ng/ml.

Conclusion

This study emphasizes the relationship between anti-annexin V antibodies and recurrent miscarriage.
Bilateral Basal Cell Adenocarcinoma of the Parotid Gland: In a Recipient of Kidney Transplant
Authors: Markkanen-Leppänen Mari , Mäkitie Antti A. , Passador-Santos Fabricio , Leivo Ilmo , Hagström Jaana
Published: December 2010

We report a rare case of bilateral basal cell adenocarcinoma (BcAC) of the parotid gland in a male patient 30 years after kidney transplantation and continuous administration of immunosuppressive therapy. BcAC is a salivary gland malignancy first recognized as a distinct neoplastic entity in WHO classification of salivary gland tumours in 1991. Over 90% of BcACs are detected in the parotid gland. The most important differential diagnosis is basal cell adenoma. Infiltrative growth is the distinguishing feature of BcAC. Administration of immunosuppressive medication to this patient for three decades may have contributed to development of this rare neoplasia. To our knowledge, similar cases of BcAC have not been reported previously.
Presentations of finite simple groups: a computational approach
Authors: Guralnick Robert M. , Kantor William M. , Kassabov Martin , Lubotzky Alexander
Published: December 2010

All finite simple groups of Lie type of rank
n
over a field of size
q
, with the possible exception of the Ree groups 2_G_2(
q
), have presentations with at most 49 relations and bit-length
O
(log
n
+ log
q
). Moreover,
An
and
Sn
have presentations with 3 generators; 7 relations and bit-length
O
(log
n
), while SL(
n
,
q
) has a presentation with 6 generators, 25 relations and bit-length
O
(log
n
+ log
q
).
Euler characteristics of moduli spaces of curves
Authors: Bini Gilberto , Harer John
Published: December 2010

Let

\mathcal M^n_g

be the moduli space of

n

-pointed Riemann surfaces of genus

g

. Denote by

\overline {\mathcal M}^n_g

the Deligne-Mumford compactification of

\mathcal M^n_g

. In the present paper, we calculate the orbifold and the ordinary Euler characteristic of

\overline {\mathcal M}^n_g

for any

g

and

n

such that

n> 2-2g

.
Statistical Discrimination in Labor Markets: An Experimental Analysis
Authors: Dickinson David L. , Oaxaca Ronald L.
Published: December 2010

This article reports results from controlled laboratory experiments designed to study second‐moment (that is, risk‐based) statistical discrimination in a labor market setting. Since decision makers may not view risk in the same way as economists or statisticians (that is, risk 5 variance of distribution), we also examine alternative measures of risk: the support of the distribution and the probability of earning less than the expected (maximum) profits for the employer. Our results indicate that employers made statistically discriminatory wage offers consistent with loss aversion in our full sample (though the result is driven by the male employer subsample). If one can transfer these results outside of the laboratory, they indicate that discrimination estimates based only on first‐moment (mean‐based) discrimination are biased. The public policy implication is that efforts and legislation aimed at reducing discrimination of various sorts face an additional challenge in trying to identify and limit relatively hidden, but significant, forms of statistical discrimination.
Estimating Local Welfare Generated by an NFL Team under Credible Threat of Relocation
Authors: Fenn Aju J. , Crooker John R.
Published: December 2010

This study offers the opportunity to examine the welfare contribution of the Minnesota Vikings to Minnesota households in the context of a credible threat of team relocation. We find the credibility of the threat of relocation is essential to providing unbiased estimates of welfare. This study utilizes contingent valuation methodology (CVM) and a random utility model (RUM) to analyze Minnesotans' decision‐making mechanisms for supporting a new stadium initiative. While previous studies have attempted to measure the welfare associated with a sports franchise, we develop and discuss bias that may be imparted to estimates when the researcher fails to calculate a “choke price.” Further, we develop an unbiased approach to identify welfare when respondents perceive a risk of losing the franchise. The range of welfare contribution by the Vikings to households in Minnesota is $;445.3 million to $;1,571.3 million according to a 95% confidence interval based on our study.
The Finance–Growth Link in Latin America
Authors: Blanco Luisa
Published: December 2010

This paper analyzes the relationship between financial development and economic growth in Latin America with a Granger causality test and impulse response functions in a panel vector autoregression (VAR) model. With annual observations from a sample of 18 countries from 1962 to 2005, it is shown that while economic growth causes financial development, financial development does not cause economic growth. This finding is robust to different model specifications and different financial indicators. Interestingly, when the sample is divided according to different income levels and institutional quality, there is two‐way causality between financial development and economic growth only for the middle income group and for countries with stronger rule of law and creditor rights. The impulse response functions show that a shock to financial development has a positive impact on economic growth only for these subsamples, but the net effect of financial development on growth is relatively small.
A Meta‐Analysis of the Investment‐Uncertainty Relationship
Authors: Koetse Mark J. , de Groot Henri L.F. , Florax Raymond J.G.M.
Published: December 2010

In this article we use meta‐analysis to investigate the investment‐uncertainty relationship. We focus on the direction and statistical significance of empirical estimates. Specifically, we estimate an ordered probit model and transform the estimated coefficients into marginal effects to reflect the changes in the probability of finding a significantly negative estimate, an insignificant estimate, or a significantly positive estimate. Exploratory data analysis shows that there is little empirical evidence for a positive relationship. The regression results suggest that the source of uncertainty, the level of data aggregation, the underlying model specification, and differences between short‐ and long‐run effects are important sources of variation in study outcomes. These findings are, by and large, robust to the introduction of a trend variable to capture publication trends in the literature. The probability of finding a significantly negative relationship is higher in more recently published studies.
Pharmaceutical Patents: Incentives for Research and Development or Marketing?
Authors: Brekke Kurt R. , Straume Odd Rune
Published: December 2010

We analyze how a patent‐holding pharmaceutical firm may strategically use advertising of existing drugs to affect research and development (R&D) investments in new (differentiated) drugs, and thereby affect the probability distribution of future market structures in the industry. Within a fairly general model framework, we derive exact conditions for advertising and R&D being substitute strategies for the incumbent firm and show that it may overinvest in advertising to reduce the incentive for an entrant to invest in R&D, thereby reducing the probability of a new product on the market. In a more specific setting of informative advertising, we show that such overinvestment incentives are always present and that more generous patent protection implies that a larger share of the patent rent is spent on marketing, relative to R&D.
Trade Barriers, Openness, and Economic Growth
Authors: Madsen Jakob B.
Published: December 2010

Using a long data set on openness and productivity, this article tests the influence of openness on total factor productivity (TFP) growth and per capita growth since 1870 for 16 industrialized countries. It is shown, in simple regressions, that growth is, by and large, independent of openness. However, once the interaction between openness and foreign knowledge is allowed for, productivity is positively affected by openness.
The New Keynesian Phillips Curve and Lagged Inflation: A Case of Spurious Correlation?
Authors: Hall Stephen G. , Hondroyiannis George , Swamy P. A. V. B. , Tavlas G. S.
Published: December 2010

The New Keynesian Phillips Curve (NKPC) specifies a relationship between inflation and a forcing variable and the current period's expectation of future inflation. Most empirical estimates of the NKPC, typically based on generalized method of moments (GMM) estimation, have found a significant role for lagged inflation, producing a “hybrid” NKPC. Using U.S. quarterly data, this article examines whether the role of lagged inflation in the NKPC might be due to the spurious outcome of specification biases. Like previous investigators, we employ GMM estimation and, like those investigators, we find a significant effect for lagged inflation. We also use time varying coefficient (TVC) estimation, a procedure that produces consistency under a variety of sources of misspecification. Using two separate measures of expected inflation, we find strong support for the view that, under TVC estimation, the coefficient on expected inflation is near unity and that the role of lagged inflation in the NKPC is spurious.
Optimal Two‐Part Pricing in a Carbon Offset Market: A Comparison of Organizational Types
Authors: Fulton Murray , Vercammen James
Published: December 2010

This article examines the optimal two‐part pricing by an intermediary in a carbon offset market. In addition to creating a framework for analyzing carbon offset pricing, this article makes two contributions to the theoretical literature. First, we provide an in‐depth examination of the roles played by the upstream inframarginal supply and participation elasticities and the downstream demand elasticity in determining the optimal two‐part pricing strategy. Second, we compare the pricing decisions of three different organizational types: a for‐profit firm, a public agency, and a producer association. The producer association problem, which has received little attention in the literature, yields counterintuitive results because a producer association must simultaneously reduce output and distribute all profits back to its members.
Do Market Pressures Induce Economic Efficiency? The Case of Slovenian Manufacturing, 1994–2001
Authors: Orazem Peter F. , Vodopivec Milan
Published: December 2010

Using a unique longitudinal data set on all manufacturing firms in Slovenia from 1994 to 2001, this article analyzes how firm efficiency changed in response to changing competitive pressures associated with the transition to market. Results show that the period was one of atypically rapid growth of total factor productivity (TFP). The rise in firm efficiency occurs across almost all industries and firm types: large or small, state or private, domestic or foreign owned. Changes in firm ownership type have no direct impact on firm efficiency. However, increased market competition related to rising market share of private firms, new market entrants, foreign‐owned firms, and international trade raises TFP across all firms in an industry, whether private or state owned. In addition, competitive pressures that sort out inefficient firms of all types and retain the most efficient, coupled with the entry of new private firms that are at least as efficient as surviving firms, prove to be the major source of TFP gains. Results strongly confirm that market competition fosters efficiency.