bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of plasma endothelin levels between osteoporotic, osteopenic and normal subjects
Authors: Muratli Hasan Hilmi , Çelebi Levent , Hapa Onur , Biçimoğlu Ali
Published: September 2005

Background

It has been demonstrated that endothelins (ET) have significant roles in bone remodeling, metabolism and physiopathology of several bone diseases. We aimed to investigate if there was any difference between the plasma ET levels of osteoporotic patients and normals.

Methods

86 patients (70 women and 16 men) with a mean age of 62.6 (ranges: 51–90) years were included in this study. Patients were divided into groups of osteoporosis, osteopenia and normal regarding reported T scores of DEXA evaluation according to the suggestions of World Health Organization. According to these criteria 19, 43 and 24 were normal, osteopenic and osteoporotic respectively. Then total plasma level of ET was measured in all patients with monoclonal antibody based sandwich immunoassay (EIA) method. One-way analysis of variance test was used to compare endothelin values between normals, osteopenics and osteoporotics.

Results

Endothelin total plasma level in patients was a mean of 98.36 ± 63.96, 100.92 ± 47.2 and 99.56 ± 56.6 pg/ml in osteoporotic, osteopenic and normal groups respectively. The difference between groups was not significant (p > 0.05).

Conclusion

No significant differences in plasma ET levels among three groups of study participants could be detected in this study.
Aerobic exercise and its impact on musculoskeletal pain in older adults: a 14 year prospective, longitudinal study
Authors: Bruce Bonnie , Fries James F , Lubeck Deborah P
Published: September 2005

We studied the long term impact of running and other aerobic exercise on musculoskeletal pain in a cohort of healthy aging male and female seniors who had been followed for 14 years. We conducted a prospective, longitudinal study in 866 Runners' Association members (n = 492) and community controls (n = 374). Subjects were also categorized as Ever-Runners (n = 565) and Never-Runners (n = 301) to include runners who had stopped running. Pain was the primary outcome measure and was assessed in annual surveys on a double-anchored visual analogue scale (0 to 100; 0 = no pain). Baseline differences between Runners' Association members and community controls and between Ever-Runners versus Never-Runners were compared using chi-square and t-tests. Statistical adjustments for age, body mass index (BMI), gender, health behaviors, history of arthritis and comorbid conditions were performed using generalized estimating equations. Runner's Association members were younger (62 versus 65 years, p < 0.05), had a lower BMI (22.9 versus 24.2, p < 0.05), and less arthritis (35% versus 41%, p > 0.05) than community controls. Runners' Association members averaged far more exercise minutes per week (314 versus 123, p < 0.05) and miles run per week (26 versus 2, p < 0.05) and tended to report more fractures (53% versus 47%, p > 0.05) than controls. Ever-Runners were younger (62 versus 66 years, p < 0.05), had lower BMI (23.0 versus 24.3, p < 0.05), and less arthritis (35% versus 43%, p < 0.05) than Never-Runners. Ever-Runners averaged more exercise minutes per week (291 versus 120, p < 0.05) and miles run per week (23 versus 1, p < 0.05) and reported a few more fractures (52% versus 48%, p > 0.05) than Never-Runners. Exercise was associated with significantly lower pain scores over time in the Runners' Association group after adjusting for gender, baseline BMI, and study attrition (p < 0.01). Similar differences were observed for Ever-Runners versus Never-Runners. Consistent exercise patterns over the long term in physically active seniors are associated with about 25% less musculoskeletal pain than reported by more sedentary controls, either by calendar year or by cumulative area-under-the-curve pain over average ages of 62 to 76 years.
Searching for differentially expressed gene combinations
Authors: Dettling Marcel , Gabrielson Edward , Parmigiani Giovanni
Published: September 2005

We propose 'CorScor', a novel approach for identifying gene pairs with joint differential expression. This is defined as a situation with good phenotype discrimination in the bivariate, but not in the two marginal distributions. CorScor can be used to detect phenotype-related dependencies and interactions among genes. Our easily interpretable approach is scalable to current microarray dimensions and yields promising results on several cancer-gene-expression datasets.
Design guidance for naturally ventilated theatres
Authors: Short CA , Cook MJ
Published: September 2005

This paper considers the reconstruction and redesign for natural ventilation of the UK’s stock of performing arts buildings from the 1960s and 1970s * / many of which are regarded as barely fit for service because of poorly maintained and noisy mechanical ventilation systems. The paper reviews interventions by the lead author into three such buildings, intended, in part, to reduce their dependence on mechanical systems and improve their thermal and aural comfort. It reports on the ventilation and control strategies devised, the difficulties encountered during design development and the performance achieved. Design issues deriving specifically from the application of natural ventilation principles to the three theatres are identified. The paper provides design guidance for intervention in this building type distilled from the authors’ practical experience.

Practical application: This paper catalogues a series of naturally ventilated auditoria built by the lead author, records their key physical characteristics and gives an indication of their performance. Practitioners can use the guidance contained in this paper in the formulation of their own draft schemes. Natural ventilation is peculiarly suited to performing arts spaces due to its almost silent operation. Actors and artistic directors appear to prefer working in nonmechanically-conditioned environments. Furthermore, operating costs are particularly important to revenue-poor arts organizations.
A clinical, renal and immunological assessment of Surface Modifying Additive Treated (SMART™) cardiopulmonary bypass circuits
Authors: Allen Stephen , McBride William T , Young Ian S , MacGowan Simon W , McMurray Terence J , Prabhu Sachin , Penugonda S Prasad , Armstrong Marilyn A
Published: September 2005

Biocompatible cardiopulmonary bypass (CPB) circuits aim to reduce contact activation and its physiological consequences. We investigated the hypothesis that use of Surface Modifying Additive (SMA)-treated circuits (Sorin Group Ltd) compared with non-SMA circuits would be associated with preservation of blood pressure during CPB and modulation of perioperative subclinical renal function (urinary α-1-microglobulin (α-1-m)) and plasma and urinary cytokine changes. In a study of low-risk CABG patients ( n=40), randomized to SMA ( n=20) versus non-SMA circuits ( n=20), we found better preserved blood pressure at CPB initiation in SMA patients (p <0.05), particularly in ACE-inhibited SMA patients ( n=11) versus ACE-inhibited non-SMA patients ( n=10) (p <0.05). Plasma anti-inflammatory IL-10, as well as urinary α-1-m, were elevated 48 hours postoperatively (p <0.05). SMA patients also had lower blood loss (p <0.05). SMA circuits have some clinical benefit, especially in ACE-inhibited patients.
Inflammatory cytokines in pediatric cardiac surgery and variable effect of the hemofiltration process
Authors: Brancaccio Gianluca , Villa Emmanuel , Girolami Elia , Michielon Guido , Feltri Cristiana , Mazzera Ennio , Costa Dina , Isacchi Giancarlo , Iannace Enrico , Amodeo Antonio , Di Donato Roberto M
Published: September 2005

Cardiac surgery with cardiopulmonary bypass (CPB) elicits an inflammatory response and has a multitude of biological consequences, ranging from subclinical organ dysfunction to severe multiorgan failure. Pediatric patients are more prone to have a reaction that can jeopardize their outcome. Cytokines are supposed to be important mediators in this response: limiting their circulating levels is, therefore, appealing. We investigated the pattern of cytokine release during pediatric operation for congenital heart anomalies in 20 patients, and the effect of hemofiltration. Tumor necrosis factor a (TNF-α) was elevated after anesthesia induction and showed significant decrease during CPB. Hemofiltration reduced its concentration, but the effect disappeared on the following day. Interleukin-1 (IL-1) increased slowly at the end of CPB and hemofiltration had no effect. Interleukin-6 (IL-6) showed a tendency toward augmentation during rewarming and hemofiltration did not significantly affect the course. Soluble interleukin-6 receptor (sIL-6r) had a pattern similar to TNF-α, but hemofiltration had no effect. On the other hand, interleukin-8 (IL-8) behaved like IL-6. Our findings suggest that baseline clinical status, anesthetic drugs, and maneuvers before incision may elicit a cytokine response, whereas rewarming is a critical phase of CPB. Hemofiltration is effective in removal of TNF-α, but its role is debatable for the control of IL-1, IL-6, sIL-6r and IL-8 levels.
The more closed the bypass system the better: a pilot study on the effects of reduction of cardiotomy suction and passive venting on hemostatic activation during on-pump coronary artery bypass grafting
Authors: Koster Andreas , Böttcher Wolfgang , Merkel Frank , Hetzer Roland , Kuppe Hermann
Published: September 2005

Cardiac surgery with cardiopulmonary bypass (CPB) leads to a powerful activation of the hemostatic system. We assessed to what extent this activation can be attenuated by comparing three different perfusion regimens for on-pump coronary artery bypass grafting (CABG): 1) use of a closed CPB system with aspiration of blood from the operation field via the cardiotomy suction line and active venting of the heart via a roller pump; 2) use of a closed CPB system avoiding aspiration of blood from the operation field via the cardiotomy suction line, but with active venting of the heart; and 3) use of a closed system, avoidance of aspiration of blood from the operation field via the cardiotomy suction line and with passive venting of the heart into the collapsible venous reservoir. Our data show that avoidance of aspiration of blood via the cardiotomy suction line significantly reduces hemostatic activation during on-pump CABG. However, further attenuation of hemostatic activation can be achieved by further closing the system and minimizing the blood/air interface by passive venting of the heart.
Evaluation of coated oxygenators in cardiopulmonary bypass systems and their impact on neurocognitive function
Authors: Khosravi Amir , Skrabal Christian A , Westphal Bernd , Kundt Guenther , Greim Brigitte , Kunesch Erwin , Liebold Andreas , Steinhoff Gustav
Published: September 2005

Introduction: Coronary artery bypass graft surgery (CABG) using cardiopulmonary bypass (CPB) is assumed to be associated with a decline of neurocognitive functions. This study was designed to analyse the neurocognitive function of patients with coronary heart disease before and after CABG and to determine possible protective effects of oxygenator surface coating on neurological outcome.

Methods: Forty patients scheduled for selective CABG were prospectively randomized into two groups of 20 patients each according to the type of hollow-fibre membrane oxygenator used. Non-coated oxygenators (Group A) were compared to phosphorylcholine (PC)- coated oxygenators (Group B). A battery of six neurological tests was administered preoperatively, 7 - 10 days and 4 - 6 months after surgery.

Results: One patient of Group A suffered from a perioperative stroke and died on postoperative day 3, presumably because of sudden heart failure. Two patients of Group A (10%) developed a symptomatic transitory delirious psychotic syndrome (STPT) on postoperative days 3 and 5. None of the patients of Group B had perioperative complications. The test analysis revealed a trend of declined neurocognitive function early after CABG, but did not show any difference in neurocognitive outcome between the two groups.

Discussion: PC coating of the oxygenators did not show any significant benefit on neurocognitive function after CABG using CPB.
Evaluation of a preprimed microporous hollow-fiber membrane for rapid response neonatal extracorporeal membrane oxygenation
Authors: Walczak Richard , Lawson D Scott , Kaemmer David , McRobb Craig , McDermott Patty , Smigla Greg , Shearer Ian , Lodge Andrew , Jaggers James
Published: September 2005

Delays in initiating extracorporeal membrane oxygenation (ECMO) in the critically ill pediatric patient may lead to adverse outcomes. Maintaining a primed ECMO circuit can considerably reduce the initiation time. The predominant concerns precluding this practice are a decrease in oxygenator efficiency due to the saturation of microporous hollow fibers and compromised sterility when the oxygenator has been primed for 30 days. For institutions using a hollow-fiber oxygenator for ECMO, there are no data reporting pre-primed hollow-fiber oxygenator viability. This study reports the efficiency of oxygen transfer and the sterility of the Carmeda Minimax Plus (Medtronic, Inc, Minneapolis, MN) oxygenator after being crystalloid primed for 30 days. A total of 10 Minimax Plus oxygenators were tested for oxygen transfer in a laboratory setting utilizing fresh whole bovine blood. The control group ( n=5) were tested immediately after priming. The test group ( n=5) were oxygenators primed for 30 days with crystalloid solution and left stagnant until tested. Prior to testing, all oxygenators were circulated for 5 min and samples drawn to test for circuit sterility. Venous inlet saturations were manipulated to achieve three levels of testing: venous saturation (SvO2) of 55% for an oxygen challenge, SvO2 of 65% to comply with AAMI standards, and SvO2 of 75% to assess oxygen transfer rates and peak PaO2 achievement. Blood flow for all tests was maintained at 2 L/min with 1:1 blood to gas flow ratio and 100% FiO2. Samples were drawn pre- and postoxygenator at 1- and 6-hour time intervals to compute actual oxygen transfer values. All cultures from the test group priming solution produced no microbial growth after 30 days of stagnant prime. Average oxygen transfer values (ml/O2/min) for the control group after 1 hour of continuous use were 130.1±15.5 (@55% SvO2), 113.7±10.4 (@65% SvO2),97.7±8.9 (@75% SvO2). After 6 hours, the average transfer values increased to 134.2±13.2 (@55% SvO2), 118.76±6.6 (@65% SvO2) and 98.9±8.3 (@75% SvO2). The average oxygen transfer values after 1 hour for oxygenators primed for 30 days were 114.9±10.0 (@55% SvO2), 112.4±8.2 (@65% SvO2) and 89.6±16.0 (@75% SvO2). After 6 hours of use, the average transfer values all decreased to 111.4±2.1 (@55% SvO2, p <0.05 versus control), 104.0±5.6 (@65% SvO2, p<0.05 versus control) and 88.4±3.2 (@75% SvO2, p<0.05 versus control). In conclusion, there was a decrease in the average oxygen transfer values for the test group after 6 hours versus the control. The modest loss of oxygen transfer ability observed can be considered acceptable due to the amount of surface area of the Minimax Plus oxygenator when used on a neonate, making it feasible to adopt the practice of prepriming the Minimax oxygenator for neonatal ECMO.
Extracorporeal membrane oxygenation to cardiopulmonary bypass with a single circuit exposure
Authors: Rogers Kellie , Owens Tami , Griffin Dee Ann , Frey Talya
Published: September 2005

Due to the short supply of donor organs available, many patients decompensate or die while waiting for transplantation. Options for mechanical support for infants and pediatrics with congenital heart disease are limited because of the patient’s size and device availability. Extracorporeal membrane oxygenation (ECMO) is the most common means of cardiac and respiratory support for these patients. One of the many indications for ECMO use in cardiac patients is as a bridge to transplantation, with patients being transported to the operating room (OR) on ECMO support. Converting the ECMO circuit to an open cardiopulmonary bypass system in the OR minimizes the patient’s exposure to new circuitry, decreases further donor exposures and provides continuous support for patients in cardiac and/or respiratory failure. In addition, the ability to use modified ultrafiltration post-bypass aids in reducing extracellular fluid, increasing the hematocrit and improving hemodynamic stability following an extended duration of ECMO and bypass support. The integrity of the ECMO circuit is maintained and can be converted back to ECMO for support postoperatively if needed.
Are we doing everything we can to conserve blood during bypass? A national survey
Authors: Belway D , Rubens F D , Wozny D , Henley B , Nathan H J
Published: September 2005

Introduction: Despite major advances in biomaterial research and blood conservation, bleeding is still a common complication after cardiopulmonary bypass and cardiac surgery remains a major consumer of blood products. Although the underlying mechanisms for these effects are not fully established, two proposed major etiologies are the hemodilution associated with the use of the heart-lung machine and the impact of reinfusion of shed cardiotomy blood. Therapeutic strategies that primarily encompass the use of devices or technologies to overcome these effects may result in improved clinical outcomes.

Objective: To determine the extent to which 1) lipid/leukocyte filtration and centrifugal processing of cardiotomy blood, and 2) modified ultrafiltration (MUF) are currently applied in adult cardiac surgery in Canada.

Methods: A questionnaire was mailed to the chief perfusionist at all adult cardiac surgical centers in Canada, addressing details regarding the frequency of use of cardiotomy blood processing and MUF.

Results: All questionnaires (36, 100%) were completed and returned. With regards to cardiotomy blood management, in 21 centers (58%), no specific processing steps were utilized exclusive of the integrated cardiotomy reservoir filter. Of the remaining centers, two (6%) reported using lipid/leukocyte filtration and 15 (42%) reported washing their cardiotomy blood. Three centers (8%) reported using MUF at the end of CPB.

Conclusions: Despite growing concern about the potential detrimental effects of cardiotomy blood, few centers in Canada routinely manage this blood with additional filtration and/or centrifugal processing prior to reinfusion. Similarly, MUF, demonstrated to be effective in the pediatric population, has not seen popular application in adult cardiac surgical practice.
Resource management in cardiovascular engineering: is outsourcing the solution?
Authors: Feyrer Richard , Weyand Michael , Kunzmann Udo
Published: September 2005

In recent years, modern medicine has changed considerably. At maximum care centers, in particular, the use of state-of-the-art medical equipment has become an essential part of patient care. However, using such high-tech products also means a considerable burden on the financial resources available, because additional financing is rare. Consequently, there is a need for approaches that allow the use of state-of-the-art equipment without straining the budget unduly. The question now is whether economic strategies that have long since been established in other industries, e.g., the outsourcing of certain services, represent a potential solution for the economic problems of modern clinics. The fundamentals of outsourcing and its pros and cons are outlined and discussed, taking cardiovascular perfusion as an example, a cost-intensive field of heart surgery that is responsible for attending to heart / lung machines, artificial hearts and circulatory support systems.
Evidence for a significant myocardial contribution to total metabolic burden during hypothermic cardiopulmonary bypass: a study of continuously measured oxygen consumption and arterial lactate levels in pigs
Authors: Li Jia , Stokoe Jacqueline , Konstantinov Igor E , Kharbanda Rajesh K , Redington Andrew N
Published: September 2005

Objective: We assessed the causes of imbalance of oxygen transport by continuously measuring oxygen consumption (VO2) during hypothermic cardiopulmonary bypass (CPB) in pigs.

Methods: Six pigs (17.2±1.6 kg) underwent hypothermic (328C) CPB for 180 min with 120 min of aortic crossclamping (ACC). An AMIS 2000 mass spectrometer was adapted for the on-line measurement of VO2. Arterial lactate was measured at the beginning of CPB, the end of hypothermia, before and 10 min after ACC release, 20 min later, and at the end of CPB.

Results: Arterial lactate increased from 1.8±0.7 to 5.1±1.8 mmol/L during CPB. Hypothermia reduced VO2by 0.63±0.29 ml/min/kg per 8C, but lactate increased to 4.2±1.5 mmol/L ( p <0.05). The most rapid rise of VO2and lactate occurred during the first 10 min after ACC removal, accounting for 26% and 68%, respectively, of the total rise during rewarming.

Conclusions: Inadequate tissue oxygenation persists throughout hypothermic CPB. The rise in systemic VO2 and lactate immediately after ACC release may reflect inadequate oxygen transport within the myocardium during ischemia and manifest on reperfusion. This simple technique may be used to provide important information regarding the dynamic balance of systemic and myocardial oxygen transport during ischemia - reperfusion.
Atherogenesis and autoimmune disease: the model of lupus
Authors: Bruce I N
Published: September 2005

Accelerated atherosclerosis is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Certain ‘classic’ risk factors are associated with atherosclerosis risk in SLE. However, these factors alone do not fully explain the excess risk observed. Atherosclerosis is increasingly recognized as a chronic inflammatory condition and in SLE, complement activation and immune complex formation may promote atheroma development. Similarly, autoantibody production, especially those in the anticardiolipin (ACLA) family are gaining increasing attention. The role of steroids may not be completely straightforward, low doses may have a beneficial anti-inflammatory role whereas higher doses may exacerbate metabolic factors. In contrast, antimalarials have a beneficial effect on lipids as well as anti-inflammatory and anti-platelet effects. The aetiology of atherosclerosis in SLE is therefore multifactorial. A better understanding of the interface of autoimmunity and atherogenesis in the context of SLE will benefit lupus patients and will also help us better understand the pathogenesis of atherosclerosis in general.
Cardiac involvement in autoimmune myositis and mixed connective tissue disease
Authors: Lundberg I E
Published: September 2005

The clinical cardiac manifestations most frequently reported in idiopathic inflammatory myopathies, myositis, are congestive heart failure, conduction abnormalities, that may lead to complete heart block and coronary artery disease. Although clinically overt cardiac involvement is rarely reported in myositis patients, subclinical manifestations are frequently observed and are predominated by conduction abnormalities and arrhythmias detected by ECG. Furthermore, cardiovascular manifestations constitute a major cause of death in myositis, thus cardiac involvement maybe overlooked in these patients. Also children with juvenile dermatomyositis may develop cardiac involvement although the frequency seems to be low. The underlying pathophysiologic mechanisms that may cause cardiac manifestations could involve myocarditis and coronary artery disease as well as involvement of the small vessels of the myocardium. In patients with mixed connective tissue disease (MCTD) clinically significant cardiac involvement is also rare, the most frequently reported manifestations being pericarditis and pulmonary hypertension, the latter often attributable to small vessel disease, and often a prognostic unfavourable manifestation.
Cardiac involvement in small and medium-sized vessel vasculitides
Authors: Pagnoux C , Guillevin L
Published: September 2005

The heart can be involved in vasculitides but the frequency of its involvement and the manifestations vary according to the vasculitis. Cardiovascular manifestations include cardiomyopathy (specific or resulting from myocardial infarctions), coronary arteritis (with risk of aneurysms, stenoses and thrombosis formation or rupture), pericarditis, valvulitis, conduction-tissue involvement (with heart blocks), arrhythmias (mainly supraventricular) and/or dissection of the aorta (and/or its proximal branches). As many of these manifestations are clinically silent, at least during their early stages, heart function should be systematically assessed in vasculitis patients, with at least ECG and echocardiography, and more invasive exploratory procedures when the former reveal abnormalities or symptoms become manifest. Specific cardiomyopathy has been identified as a factor of poor outcome in small and medium-sized vessel vasculitides (five-factor score). Therefore, in addition to symptomatic treatments, prescription of corticosteroids and immunosuppressants (mainly cyclophosphamide) is considered mandatory. This regimen has dramatically improved the overall prognosis of affected patients.
Statins and autoimmune diseases
Authors: Riboldi P , Gerosa M , Meroni P L
Published: September 2005

Besides the well-known lipid-lowering effect, statins display nonlipid-lowering pharmacological activities. In vitro and in vivo studies suggest that statins have direct anti-inflammatory, anti-thrombotic and plaque-stabilizing effects via a number of mechanisms. A direct immunomodulatory effect has been also demonstrated in in vitro and in vivo experimental models. In addition to traditional risk factors, systemic inflammation, immune-mediated responses and thrombophilia have been suggested to play a major role in sustaining the premature atherosclerosis in autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus. This review focuses on the anti-inflammatory and immunomodulating mechanisms of statins as demonstrated in in vitro and in vivo experimental models, providing new insights for the use of statins in treating systemic autoimmune diseases both for their anti-atherosclerotic activity and for their pleiotropic effects on inflammation, haemostasis and the immune responses.
Antineoplastic agent workplace contamination study: the Alberta Cancer Board Pharmacy perspective
Authors: Schulz Heidi , Bigelow Susan , Dobish Roxanne , Chambers Carole R
Published: September 2005

Study objective. To investigate the feasibility of routine monitoring for workplace antineoplastic agent contamination in the Alberta Cancer Board (ACB) pharmacy practice environment.

Setting. The ACB in the Canadian province of Alberta, which includes two public tertiary centres and 17 associated community satellite sites based around the province in existing hospitals. Methods. Obtained organizational support and input prior to launching the feasibility study (Phase I). Samples were analysed for a common cytotoxic agent - cyclophosphamide. Surfaces chosen were within the biological safety cabinets, workplace counter tops and on external surfaces of vials provided by manufacturers. Blank samples and known contaminated controls were included in Phase I to reconfirm the methodology in a previously published study.1 Feasibility aspects of logistics and financial expenses were examined. A second phase (Phase II) was completed to test other areas of the pharmacy and vials, with blank samples included to reconfirm previously mentioned methodology.

Results. The results determined that the samples tested were below acceptable detection limits with the exception of the known contaminated sample (Phase I) and exterior surfaces of vials (Phase II).

Conclusion. This project has increased staff awareness of the sources for antineoplastic agent workplace contamination. Some practice changes were instituted during the project itself. Logistics and expenses were realistic for routine monitoring to be adopted.
Strategies for management of the peritoneal surface component of cancer: cytoreductive surgery plus perioperative intraperitoneal chemotherapy
Authors: Sugarbaker Paul H , Stuart O. Anthony , Yoo Dal
Published: September 2005

Background. A prominent part of treatment failure of gastrointestinal and gynecologic malignancy is dissemination to peritoneal surfaces. This has been associated with a limited survival and no reliable treatment strategies.

Methods. A review of the natural history of carcinomatosis was performed and a rationale for intraperitoneal chemotherapy was sought. The pharmacology of chemotherapy administration into the peritoneal cavity was reviewed.

Results. The technology of perioperative intraperitoneal chemotherapy requires the administration of drugs along with moderate hyperthermia in the operating room as a planned part of the surgical procedure. The solution in which the chemotherapy is diluted has an effect upon the drug clearance from the peritoneal cavity. Also, the volume of the carrier solution affects the exposure of cancer nodules on peritoneal surfaces.

Conclusions. New combinations of intraperitoneal chemotherapy administration when combined with optimal surgical technology for maximal chemotherapy effects should result in benefit to patients with peritoneal surface dissemination of gastrointestinal and gynecologic malignancy.
Interstitial lung disease following erlotinib (Tarceva®) in a patient who previously tolerated gefitinib (Iressa®)
Authors: Tammaro Kelly A. , Baldwin Patricia D. , Lundberg Ante S.
Published: September 2005

Objective. To report a case of who a patient developed clinical and radiographical evidence of interstitial lung disease (ILD) on erlotinib after having tolerated gefitinib therapy.

Case Summary. A 58-year-old man with stage IV non-small-cell lung cancer (NSCLC) failed first and second line chemotherapy. He then received gefitinib, a small molecule epidermal growth factor receptor (EGFR) inhibitor, a therapy which was well tolerated, but did cause a grade 1 rash. On gefitinib, the patient’s disease remained stable for seven months. Subsequent disease progression was treated with the newer EGFR inhibitor, erlotinib. After 5 days of erlotinib therapy, the patient presented with a sore throat and dyspnea, followed by a grade 2 rash and significant hemoptysis. Erlotinib was discontinued for three days, during which time his symptoms abated. Erlotinib was restarted and the patient again developed sore throat, dyspnea and severe hemotpysis, with progression of the rash to grade 3. Erlotinib therapy was discontinued and the patient recevied prednisone and supplemental oxygen. A CT scan of the chest demonstrated new areas of patchy ground glass opacity bilaterally and increased interstitial markings consistent with ILD.

Discussion. The case demonstrates that clinical ILD can occur following erlotinib therapy, even in patients who previously tolerated gefitinib. ILD has not been reported to occur more frequently with erlotinib than with gefitinib. However, the dose of erlotinib employed clinically is the maximum tolerated dose identified in phase 1 trials, and is associated with an increased incidence of grade 3-4rashand diarrhea, as compared to gefitinib. Thus, the observation of clinical ILD following erlotinib, but not gefitinib, may be the consequence of increased potency of erlotinib 150 mg/day compared to gefitinib 250 mg/day.

Conclusion. Clinical ILD can occur following erlotinib even in patients who previously tolerated gefitinib. IT is important to carefully monitor pulmonary symptoms in all patients who are receiving erlotinib, as early diagnosis and timely intervention are critical in managing drug-induced ILD.
Palifermin (Kepivance™) for the treatment of oral mucositis in patients with hematologic malignancies requiring hematopoietic stem cell support
Authors: Radtke Michelle L , Kolesar Jill M
Published: September 2005

Objective. To provide a comprehensive review of the clinical use of the recombinant biological agent, palifermin, with particular reference to its use in its approved indication, oral mucositis resulting from high dose chemotherapy and radiation in patients with hematologic malignancies requiring hematopoietic stem cell support.

Data Sources. A MEDLINE search was conducted using the terms ‘palifermin’ and ‘Kepivance.’ All data available from MEDLINE were reviewed. The reference lists from retrieved articles were reviewed and other relevant papers were identified.

Data Summary. Keratinocyte growth factor (KGF) is a growth factor that acts specifically on epithelial cells playing a role in proliferation, migration, and morphogenesis. Palifermin is a recombinant human form of KGF. Because of its ability to cause proliferation of the oral mucosa and to protect against mucosal injury, palifermin is a treatment option for patients who are at high risk for oral mucositis, specifically patients with hematological malignancies receiving stem cell transplantation (SCT). In a phase III study of these patients, the overall incidence of World Health Organization (WHO) grade 3 or 4 oral mucositis was significantly reduced in the palifermin group (palifermin=63% versus placebo=98%, P B0.001). Among the patients who experienced WHO grade 3 or 4 oral mucositis the average duration of this grade of mucositis in the palifermin group was six days compared with nine days in the placebo group (P B0.001). Common adverse effects of palifermin include pruritis, erythema, mouth and tongue disorders, and taste alterations.
Overview of drug therapy for multiple myeloma
Authors: Saunders Geoff
Published: September 2005

Background. Multiple myeloma accounts for 10% of all haematologic malignancies worldwide. In Europe, over 10 000 new cases and nearly 8000 deaths were attributed to multiple myeloma in 2000. Unlike other malignancies, in which surgery and radiation are important treatment modalities, myeloma is exclusively treated with stem cell transplantation and drug therapy, requiring pharmacists to stay abreast of new developments. The melphalan-prednisolone and vincristine-doxorubicin-dexamethasone (VAD) regimens, which have been standard treatments for multiple myeloma over the past few decades, have yielded responses without real survival benefits. Transplantation utilizing high-dose chemotherapy has produced the only meaningful survival benefits for patients with multiple myeloma, but many patients are not candidates for this aggressive treatment option. More effective therapies for multiple myeloma are needed.

Objective. To address the mechanisms of action, safety, and efficacy of novel approaches to the treatment of myeloma involving bortezomib, thalidomide and its analogues, lenalidomide and CC-4047 (ActimidTM), and arsenic trioxide as single agents or in combination regimens.

Data sources. Published preclinical and primary clinical trial results, as well as scientific or clinical meeting abstracts. The author determined the relevance and subsequent inclusion of the data.

Conclusions. Bortezomib is approved in the US and Europe as single-agent therapy for the treatment of relapsed or refractory multiple myeloma. Thalidomide, its analogues, and arsenic trioxide have demonstrated activity and are under investigation in this disease. Further clinical trials of the efficacy and toxicity of these novel agents are ongoing and will further define optimal combinations and sequencing with conventional therapies.
High Telomerase RNA Expression Level Is an Adverse Prognostic Factor for Favorable-Histology Wilms' Tumor
Authors: Dome Jeffrey S. , Bockhold Carol A. , Li Sierra M. , Baker Scott D. , Green Daniel M. , Perlman Elizabeth J. , Hill D. Ashley , Breslow Norman E.
Published: September 2005

Purpose

A primary objective of the fifth National Wilms Tumor Study (NWTS-5) was to identify prognostic indicators for patients with favorable-histology Wilms' tumor. The prognostic significance of telomerase expression level in primary tumor samples was assessed.

Patients and Methods

A case-cohort study was conducted involving 291 NWTS-5 registrants. Telomerase activity was measured using the telomeric repeat amplification protocol (TRAP). Expression levels of TERT mRNA (encoding the telomerase catalytic component) and TERC/hTR (the telomerase RNA template) were measured using quantitative real-time polymerase chain reaction.

Results

After excluding samples because of lack of viable tumor, RNA degradation, or insufficient clinical information, 244 patients remained for the final analysis (96 with relapse and 148 without relapse). Univariate analysis revealed a positive correlation between relative risk (RR) of relapse and levels of TERT mRNA and TERC expression. For each doubling in TERT mRNA and TERC level, the RR increased by a factor of 1.16 (95% CI, 1.04 to 1.29; P = .01) and 1.35 (95% CI, 1.11 to 1.64; P = .003), respectively. The one third of patients whose tumors had the highest TERC expression level had an RR of 2.06 (95% CI, 1.14 to 3.70; P = .02) compared with patients with the lowest level. TERC expression level remained a significant prognostic indicator in a multivariate analysis adjusting for TERT mRNA, tumor stage, and patient age. TRAP level did not correlate with RR of relapse. Telomerase expression levels were not predictive of overall survival.

Conclusion

Telomerase RNA expression level may provide a clinically useful adjunct to the current risk classification schema for favorable-histology Wilms' tumor.
Parent and Physician Perspectives on Quality of Care at the End of Life in Children With Cancer
Authors: Mack Jennifer W. , Hilden Joanne M. , Watterson Jan , Moore Caron , Turner Brian , Grier Holcombe E. , Weeks Jane C. , Wolfe Joanne
Published: September 2005

Purpose

To ascertain parents' and physicians' assessments of quality of end-of-life care for children with cancer and to determine factors associated with high-quality care as perceived by parents and physicians.

Methods

A survey was conducted between 1997 and 2001 of 144 parents of children who received treatment at the Dana-Farber Cancer Institute and Children's Hospital (Boston, MA) or Children's Hospitals and Clinics of St Paul and Minneapolis, MN, between 1990 and 1999 (65% of those located and eligible) and 52 pediatric oncologists.

Results

In multivariable models, higher parent ratings of physician care were associated with physicians giving clear information about what to expect in the end-of-life period (odds ratio [OR] = 19.90, P = .02), communicating with care and sensitivity (OR = 7.67, P < .01), communicating directly with the child when appropriate (OR = 11.18, P < .01), and preparing the parent for circumstances surrounding the child's death (OR = 4.84, P = .03). Parent reports of the child's pain and suffering were not significant correlates of parental ratings of care (P = .93 and .35, respectively). Oncologists' ratings of care were inversely associated with the parent's report of the child's experience of pain (OR = 0.15, P = .01) and more than 10 hospital days in the last month of life (OR = 0.24, P < .01). Parent-rated communication factors were not correlates of oncologist-rated care. No association was found between parent and physician care ratings (P = .88).

Conclusion

For parents of children who die of cancer, doctor-patient communication is the principal determinant of high-quality physician care. In contrast, physicians' care ratings depend on biomedical rather than relational aspects of care.
Care-Related Distress: A Nationwide Study of Parents Who Lost Their Child to Cancer
Authors: Kreicbergs Ulrika , Valdimarsdóttir Unnur , Onelöv Erik , Björk Olle , Steineck Gunnar , Henter Jan-Inge
Published: September 2005

Purpose

Palliative care is an important part of cancer treatment. However, little is known about how care-related factors affect bereaved intimates in a long-term perspective. We conducted a population-based, nationwide study addressing this issue, focusing on potential care-related stressors in parents losing a child to cancer.

Methods

In 2001, we attempted to contact all parents in Sweden who had lost a child to cancer in 1992 to 1997. The parents were asked, through an anonymous postal questionnaire, about their experience of the care given and to what extent these experiences still affect them today.

Results

Information was supplied by 449 (80%) of 561 eligible parents. Among 196 parents of children whose pain could not be relieved, 111 (57%) were still affected by it 4 to 9 years after bereavement. Among 138 parents reporting that the child had a difficult moment of death, 78 (57%) were still affected by it at follow-up. The probability of parents reporting that their child had a difficult moment of death was increased (relative risk = 1.4; 95% CI, 1.0 to 1.8) if staff were not present at the moment of death. Ten percent of the parents (25 of 251 parents) were not satisfied with the care given during the last month at a pediatric hematology/oncology center; the corresponding figure for care at other hospitals was 20% (33 of 168 parents; P = .0163).

Conclusion

Physical pain and the moment of death are two important issues to address in end-of-life care of children with cancer in trying to reduce long-term distress in bereaved parents.
An Experimental Study of the Emergence of Human Communication Systems
Authors: Galantucci Bruno
Published: September 2005

The emergence of human communication systems is typically investigated via 2 approaches with complementary strengths and weaknesses: naturalistic studies and computer simulations. This study was conducted with a method that combines these approaches. Pairs of participants played video games requiring communication. Members of a pair were physically separated but exchanged graphic signals through a medium that prevented the use of standard symbols (e.g., letters). Communication systems emerged and developed rapidly during the games, integrating the use of explicit signs with information implicitly available to players and silent behavior‐coordinating procedures. The systems that emerged suggest 3 conclusions: (a) signs originate from different mappings; (b) sign systems develop parsimoniously; (c) sign forms are perceptually distinct, easy to produce, and tolerant to variations.
Â«Pour devenir homme, tu transgresseras...Â» Quelques enjeux de la socialisation masculine dans les colleges classiques quebecois (1880-1939)
Authors: Bienvenue Louise , Hudon Christine
Published: September 2005

Dans l'univers normatif des collèges classiques et des petits séminaires pour garçons de la fin du XIXe siècle et du premier tiers du XXe siècle, « devenir homme » présentait des défis particuliers. Pour quiconque ne se destinait pas à la vie religieuse, le modèle masculin véhiculé par ces institutions pouvait apparaître, dans son exaltation de vertus tel la chasteté, l'ascétisme et la soumission, déficitaire sur le plan viril au point de motiver des résistances plus ou moins grandes. À partir d'un corpus composé des fonds d'archives de trois collèges classiques régionaux ainsi que d'une soixantaine d'ouvrages (mémoires et autobiographies) rédigés par d'anciens collégiens, cet article cherche à approfondir le lien entre l'acte transgressif et la construction de l'identité sexuée. Saisissant l'acte délictueux au-delà de son sens premier, celui de l'affirmation de l'autonomie individuelle face au groupe et à l'autorité, il l'appréhende dans sa fonction d'expression et de restauration d'une masculinité ponctuellement menacée par la pédagogie collégienne. In the prescriptive world of classical colleges and junior seminaries for boys at the end of the nineteenth century and during the first third of the twentieth century, 'becoming a man' presented specific challenges. The male model promoted by these institutions, with its emphasis on virtues such as chastity, asceticism, and obedience, could appear lacking in virility for anyone not destined for religious life, to the point of engen dering varying degrees of resistance. Based on a corpus that comprised the archival holdings of three regional classical colleges, as well as approximately sixty works (memoirs and autobiographies) written by former collegians, this article seeks to investigate the connection between the transgressive act and the construction of sexual identity. Understanding the criminal act beyond its primary meaning – that of asserting individual autonomy in the face of authority and the group – it conceives of it in terms of its function of expressing and restoring a masculinity threatened from time to time by college education.
'The line over which he must not pass': Defining the Office of Governor General, 1878
Authors: Messamore Barbara Jane
Published: September 2005

Confederation in 1867 did not mark any dramatic shift in the functioning of the office of governor general. The watershed of colonial self-government in 1848 was the real point of change. But neither of these constitutional milestones led to any redrafting of the instruments defining the viceregal role. The governor general's commission – or letters patent, and instructions – remained out of step with actual constitutional practice, and the British Colonial Office was content to let the anomaly stand. Lord Dufferin, Canada's governor general between 1872 and 1878, had an activist approach to the role, and his frequent clashes with Alexander Mackenzie's Liberal administration, most notably over the commitment to build a railway to British Columbia, sharpened Justice Minister Edward Blake's resolve to see new permanent documents drafted to define the limits of viceregal power.

La confédération, en 1967, n'a pas engendré de changement marquant dans le fonctionnement du rôle de gouverneur général. L'élément décisif qu'a été l'autonomie gouvernementale coloniale, en 1848, constituait le véritable changement. Cependant, aucun de ces jalons constitutionnels n'a mené à une refonte des instruments définissant le rôle vice-royal. Le pouvoir délégué au gouverneur général, c'est-à-dire ses lettres patentes, ainsi que ses instructions sont restées déconnectées des pratiques constitutionnelles réelles, et le British Colonial Office souhaitait laisser cette anomalie perdurer. Lord Dufferin, Gouverneur général du Canada entre 1872 et 1878, a adopté une approche activiste à l'égard de son rôle, et ses disputes fréquentes avec l'administration libérale d'Alexander Mackenzie, surtout au sujet de l'engagement de celle-ci à construire un chemin de fer jusqu'en Colombie-Britannique, a renforcé la détermination d'Edward Blake, Ministre de la Justice, à faire en sorte que de nouveaux documents permanents soient rédigés afin de définir les limites du pouvoir vice-royal.
Totem Poles, Teepees, and Token Traditions: 'Playing Indian' at Ontario Summer Camps, 1920-1955
Authors: Wall Sharon
Published: September 2005

In a broad sense, summer camp was hailed as a recreation of 'the Indian way of life,' a place where (mainly) white children learned 'to live like Indians' during the summer months. This article explores this curious cultural phenomenon and concludes that the camp's Indian programming had little to do with honouring or even understanding Aboriginal peoples and more to do with seeking a balm for the non-Native experience of modernity. Drawing on recent scholarship on antimodernism, 'playing Indian,' and child-rearing, it suggests that a racialized form of antimodernism expressed itself at camp, as did modern infatuation with questions of childhood, identity, and race.
Dans un sens large, le camp d'été était acclamé comme un retour au mode de vie des Indiens, un lieu où des enfants blancs (pour la plupart) apprenaient à vivre comme des Indiens pendant les mois d'été. Cet article explore ce curieux phénomène culturel et conclut que la thématique indienne des camps d'été n'avait pas grand chose à voir avec la commémoration ni même la compréhension des peuples autochtones, mais qu'il s'agissait plutôt de la recherche d'un remède à l'expérience vécue par les non-autochtones à l'égard de la modernité. À la lumière d'études récentes sur l'antimodernisme, la tendance à « jouer aux indiens » et l'éducation des enfants, cet article révèle qu'une forme d'antimodernisme axée sur la race s'est exprimée à travers les camps d'été, parallèlement à l'engouement moderne pour des questions comme l'enfance, l'identité et la race.