bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharmacologic Treatments for Pain Associated With Diabetic Peripheral Neuropathies
Authors: Abrams Paris J.
Published: August 2007

Diabetic peripheral neuropathy (DPN) is a complication of diabetes mellitus that occurs in both type 1 and type 2 diabetics. This complication is estimated to be prevalent in approximately 50% of the diabetic population and is associated with significant morbidity and mortality. Painful DPNs affect a minority of patients with DPN but are often chronic, severe, and debilitating. Many pharmacologic agents—including but not limited to pregabalin, duloxetine, tricyclic antidepressants, abapentin, and carbamazepine—have been studied and proven effective for the treatment of pain associated with DPN. Data from these studies were extracted and evaluated to compile a list of agents that are effective in treating painful diabetic neuropathies.
New Options and Strategies for the Treatment of Urinary Incontinence
Authors: Treadway Angela K. , Canales Ann E.
Published: August 2007

Urinary incontinence is a prevalent, although often unreported, disease within the elderly population, with consequences spanning many aspects of the patient's life. Treatments differ for each subtype of urinary incontinence: urge incontinence, stress incontinence, and incontinence associated with bladder outlet obstruction and lower urinary tract symptoms in men. Limitations in current therapies have negatively affected care for each of these subtypes, particularly in the vulnerable elderly population. An emergence of new treatment options and strategies has created opportunities to optimize care for the general population. These include the use of trospium, darifenacin, solifenacin, and duloxetine as well as the strategic use of antimuscarinic agents in conjunction with alpha adrenergic blockade in men with bladder outlet obstruction. Yet, the literature regarding use of these agents and strategies in the elderly should be carefully evaluated to determine the benefits and the unique risks posed by their use in this vulnerable population.
Adoption and the Guatemalan Journey To American Parenthood
Authors: Noonan Emily J.
Published: August 2007

Examining the adoption of Guatemalan children by US citizens, this article argues that adoptive parents make meanings and form identities through their participation in the adoption process and in their production of both Internet-based and spoken narratives about adoption. Using theories of globalization and narrative theory, the article elucidates how adoptive parents imagine and articulate their gendered and national identities, primarily as `American mothers', in their production of narratives about travel and the adoption process.
Review: Gonadal functioning and preservation of reproductive fitness with juvenile systemic lupus erythematosus
Authors: Silva C.A.A. , Brunner H.I.
Published: August 2007

Increased survival of children with juvenile systemic lupus erythematosus (jSLE) and improved prognosis have led to a change in the long-term health issues arising for jSLE patients. Preservation of gonadal functioning and fertility are of increasing importance for young adults with jSLE. Events during childhood, such as exposure to alkylating agents, may compromise the reproductive potential. Even in the absence of gonadotoxic therapies, fertility may be decreased through organs specific involvement with jSLE. Strategies to preserve the reproductive potential of girl and boys with jSLE are discussed. Lupus (2007) 16, 593—599.
Review: Quality of life in children with systemic lupus erythematosus: a review
Authors: Moorthy LN , Peterson Mge , Harrison MJ , Onel KB , Lehman Tja
Published: August 2007

Systemic lupus erythematosus (SLE) in children is a chronic multisystem disease with wide ranging effects on their quality of life (QOL). While SLE's impact on different arenas of life and well-being has been extensively examined in the adult population, its effect on children has not received adequate attention. This review discusses the multidimensional aspect of QOL, the biopsychosocial implications of SLE, factors complicating QOL measurement in the affected population, and the different generic and disease-specific scales used for measuring QOL and related constructs. Until now, there have not been any pediatric SLE-specific health-related QOL (HRQOL) scales. A section is devoted to a novel instrument developed specifically for measuring QOL in pediatric lupus called the Simple Measure of the Impact of Lupus Erythematosus in Youngsters© (SMILEY©). SMILEY© is a brief, easily understood, valid, reliable and internally consistent pediatric SLE-specific QOL scale and will be a useful adjunct to clinical trials and outcomes research. Lupus (2007) 16, 663—669.
Selective IgA deficiency in children and adults with systemic lupus erythematosus
Authors: Cassidy J.T. , Kitson R.K. , Selby C.L.
Published: August 2007

The objective of this study was to determine the frequency and clinical characteristics of selective IgA deficiency (SIgAD) in children and adults with systemic lupus erythematosus (SLE), and evaluate potential differences in presentation and course of the SLE. IgA deficiency was defined as a serum IgA concentration ≤0.01 mg/mL determined on two sera by radial diffusion. SLE was classified by the 1982 criteria of the American College of Rheumatology. Seventy-seven children with SLE followed prospectively for ≥20 years and 152 adults surveyed during a one-year period were assayed for serum IgA levels. Disease characteristics were compared among the deficient patients and the IgA-normal patients. Twelve patients with SIgAD were identified: 1) Juvenile(J)-SLE: four children with juvenile onset (≤18 years) and four others encountered as adults; and 2) Adult(A)-SLE: four patients with adult onset. No significant differences were found in clinical presentation or course except for a possible increase in recurrent infections and the observation that there were only two African-Americans. Five patients had received blood transfusions with no reactions; three of these patients had serum anti-IgA antibodies. One pediatric patient developed low levels of IgA (≤1 mg/mL) during a follow-up of three years. Two adult patients died (septicemia, carcinoma); one was on dialysis. SIgAD was identified in 5.2% of children and 2.6% of adults with SLE for an estimated 35-fold increase in frequency. This small number of patients did not appear to have an altered clinical presentation or course from that expected in patients with SLE who did not have SIgAD. Lupus (2007) 16, 647—650.
Review: Measuring permanent damage in pediatric systemic lupus erythematosus
Authors: Hiraki L.T. , Hamilton J. , Silverman E.D.
Published: August 2007

The survival rates in pediatric systemic lupus erythematosus (pSLE) have improved greatly over recent decades. Increased life expectancy has meant that more children are growing up with the consequences of chronic disease and prolonged therapy. Assessing complications of disease and its therapy becomes an important outcome measure by which to evaluate our therapeutic interventions and appraise quality of life.

In this paper we review the development of the Systemic Lupus International Collaborative Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI) and its application to the pSLE population. We examine the profile of damage in pSLE as identified by the SDI. However we also critically appraise its application and identify potential limitations in the SDI as a measure of permanent disease damage in children. In this paper we put forth suggestions for additional domains addressing pediatric specific issues such as decreased final height and delayed puberty. We also suggest modifications to domains of gonadal failure, diabetes mellitus, cognitive impairment and osteonecrosis in the SDI to make it more reflective of the damage phenomenon observed in pediatrics. Lupus (2007) 16: 657—662.
Review: Infant perinatal thrombosis and antiphospholipid antibodies: a review
Authors: Boffa M.-C. , Lachassinne E.
Published: August 2007

Perinatal thrombosis in infants born to mothers with antiphospholipid antibodies (aPL) is a rare event, but with risk of death or severe sequelae. We analysed 16 infants with such perinatal thrombosis reported in the literature in the last 20 years. Thromboses were arterial (13/16), mostly strokes (8/16). Hydrops fetalis with left renal vein thrombosis was associated to a lupus anticoagulant (LA) present only in the child. Risk factors additional to aPL: either prenatal (preeclampsia and/or intra-uterine growth retardation) or perinatal (asphyxia, sepsis, arterial or venous catheter and congenital thrombophilia) were present (one to four of them) in nine out of the 14 evaluable babies. aPL were the only risk factor found in five full term babies who suffered from stroke in four cases and from renal thrombosis in another. Eleven of these infants with aPL in their serum presented a neonatal APS with the same antibody (LA or aCL IgG) found in neonates and their mothers, while the other infants had thrombosis with aPL only in their mother's blood. aCL IgM was only found in one neonate who suffered from sepsis. Thrombosis treatments were diverse. This analysis suggests that women with aPL should be investigated for other thrombophilic risk factors and that aPL should be detected systematically at birth in the offspring of mothers with APS. Lupus (2007) 16 , 634—641.
Review: Congenital heart block: clinical features and therapeutic approaches
Authors: Gordon P.A.
Published: August 2007

Isolated congenital heart block is strongly associated with anti-Ro antibodies. It occurs in 2% of anti-Ro antibody positive pregnancies with a recurrence rate of 17—19%. Mortality is high in the first year of life (12—41%) and is predominantly due to dilated cardiomyopathy. A prolonged QTc occurs in 15—22% of cases and minor structural defects such as atrial septal defects and patent arterial ducts are well recognized. The `mechanical' PR interval can now be measured in utero allowing for the detection of first-degree heart block. Both first and second-degree heart block detected in utero respond to therapy with fluorinated steroids. Complete congenital heart block is not reversible. Progression from a normal PR interval to complete heart block can occur within a week. IVIG is under investigation for the prevention of recurrence of congenital heart block, while dexamethasone should not be used for this purpose due to unacceptable toxicity. Data on the use of fluorinated steroids for established complete heart block is conflicting, although their use in cases where there is evidence of hydrops, poor ventricular function or both is not controversial. Lupus (2007) 16, 642—646.
Review: Lupus in adolescence
Authors: Kone-Paut I. , Piram M. , Guillaume S. , Tran T.A.
Published: August 2007

Juvenile systemic lupus erythematosus (JSLE) represents 15—20% of all SLE cases. The leading presenting symptoms of JSLE are constitutional and not specific such as fatigue, headache, weight loss or mood swings. They are also encountered in healthy adolescents, which explains frequent diagnosis delay. The frequency of irreversible damage is high in JSLE and involves especially the renal, musculoskeletal and neuropsychiatric systems. Although the overall prognosis has markedly improved, thanks to earlier diagnosis and new therapeutic approaches, cardiovascular, hematological events and chronic renal failure remain severe, and constitute the main disease-related causes of death. Treatment is based on hydroxycloroquine and corticosteroids. Immunosuppressive agents must be discussed to decrease the duration of corticosteroids use. New drugs and monoclonal antibodies targeting B-cells and B-cell related cytokines are being evaluated with encouraging results. Management of JSLE has to challenge three objectives: controlling disease progression, obtaining patient's adherence to treatment, and preventing consequences of medication side effects on growth, puberty, development and fertility. Patients' quality of life and psychosocial development have also to be taken into account, as well as the organization of a successful transition from paediatric to adult care. Lupus (2007) 16, 606—612.
Review: Management of dyslipidemia in children and adolescents with systemic lupus erythematosus
Authors: Ardoin SP , Sandborg C. , Schanberg LE
Published: August 2007

Systemic lupus erythematosus (SLE) is an independent risk factor for atherosclerosis, placing children and adolescents with SLE at great risk for developing cardiovascular sequelae, including myocardial infarction, in adulthood. Dyslipidemia and other traditional cardiac risk factors occur frequently in pediatric SLE and are often under-recognized and under-treated. Two dyslipidemia patterns are evident in pediatric SLE. Active disease is characterized by elevated triglycerides (TG) and low high density lipoprotein (HDL). With SLE treatment HDL and TG often normalize, while total cholesterol and low density lipoprotein (LDL) rise. The complex pathophysiology of dyslipidemia in SLE involves cytokines, autoantibodies, disease activity, medications, diet, and physical activity level, as well as other factors. Routine screening for dyslipidemia with fasting lipid profiles is indicated for children and adolescents with SLE. If lipoprotein levels are abnormal, first line therapy involves diet and exercise interventions for a minimum of six months. For persistent dyslipidemia, several pharmacologic therapies are available. Hydroxychloroquine, a common treatment for SLE, can improve lipid profiles and should be considered for all patients with SLE. Statins and bile acid sequestrants are typically added first for dyslipidemia, while niacin and fibrates are reserved for refractory disease and optimally prescribed in a multidisciplinary lipid clinic. Future research is needed to further illuminate the mechanisms of dyslipidemia in pediatric SLE with well designed clinical trials to determine the safest and most effective interventions to correct lipid profiles and prevent atherosclerosis. Lupus (2007) 16, 618—626.
Review: Systemic lupus erythematosus in children: current and emerging therapies
Authors: MacDermott EJ , Adams A. , Lehman Tja
Published: August 2007

Treatment of children with systemic lupus erythematosus (SLE) is challenging. The therapeutic issues and risks and balances faced by adult patients are further complicated by an unpredictable disease course and long requirement for therapy in children with SLE. Further, non-compliance is a major obstacle to satisfactory outcome which must be recognized and dealt with in every adolescent in our efforts to attain optimal outcome. Treatment with combinations of cytotoxic agents and biologics which result in significant B-cell depletion often provide improved disease control. As our knowledge of the pathogenesis of SLE delineates more specific targets for immunotherapy the incidence of long-term remission rises. Our current emphasis is on therapeutic regimens which will induce remission followed by maintenance therapy in the oncologic model. SLE like neoplastic disease is no longer simply `treatable'. With appropriate therapy many children with SLE attain sustained remissions. In the foreseeable future childhood SLE may be curable. Lupus (2007) 16, 677—683.
Distinctive clinical features of pediatric systemic lupus erythematosus in three different age classes
Authors: Pluchinotta F.R. , Schiavo B. , Vittadello F. , Martini G. , Perilongo G. , Zulian F.
Published: August 2007

It is estimated that around 20% of patients with systemic lupus erythematosus (SLE) have their onset in childhood but there have been conflicting data about the prevalence and severity of the clinical features in different age classes. We conducted this study to analyse the clinical features of patients with pediatric SLE (pSLE) with onset in infancy, prepubertal and postpubertal age.The charts of patients followed at the Department of Pediatrics, University of Padua, who met the criteria for SLE diagnosis, were reviewed. Patients were divided into three groups based on age at disease onset: group A, patients ≤2 years old, group B patients aged between 2 and 10 years, group C patients between 11 and 16 years of age. The clinical and laboratory characteristics of each group were compared. Forty-two patients with pSLE entered the study: 2 were diagnosed before the age of 2 years, 11 between 2 and 10 years and 29 between 10 and 16 years. Eleven more patients with infantile (onset <2 years) SLE (iSLE) were found by a systematic literature search on PubMed and EmBASE and added for analysis to the group A. The female preponderance was significant only in postpubertal patients (F:M = 6.3: 1) whereas the other two groups presented a similar F:M ratio (1.2: 1). In comparison with the other two groups, iSLE showed a significantly higher prevalence of cardiovascular and pulmonary involvement, anemia and thrombocytopenia and a shorter disease duration at time of diagnosis. The postpubertal group showed a higher frequency of musculoskeletal involvement and leukopenia. In prepubertal patients there was no female preponderance and the frequency of clinical features was intermediate between infantile and postpubertal patients. Complement fractions level, antinuclear antibodies (ANA), anti-dsDNA, anti-cardiolipin antibodies and lupus anti-coagulant autoantibodies were not significantly different in the three groups. In general, the prevalence of internal organs involvement in pSLE seems to decrease with age. In infants, SLE is more severe than in the following ages. Postpubertal patients have a strong female preponderance and more specific signs of disease at onset. Prepubertal patients have an intermediate disease severity and no gender predilection. Lupus (2007) 16, 550—555.
Unusual neurologic manifestations (I): Parkinsonism in juvenile SLE
Authors: Khubchandani R.P. , Viswanathan V. , Desai J.
Published: August 2007

A girl with neuropsychiatric lupus demonstrated Parkinsonian features soon after commencing risperidone. The single photon emission computed tomography scan showed hyperperfusion of the basal ganglia. Symptoms abated with the addition of dopaminergic agents to immunosuppressive therapy. The literature on juvenile Parkinsonism in lupus has been reviewed. Lupus (2007) 16, 572—575.
NANO SCENARIO: Role-playing to appreciate the societal effects of nanotechnology
Authors: Jarmon Leslie , Keating Elizabeth
Published: August 2007

This article describes a university-sponsored experiential-based simulation, the NANO SCENARIO, to increase the public's awareness and affect attitudes on the societal implications of nanoscience and nanotechnology by bringing together diverse stakeholders' perspectives in a participatory learning environment. Nanotechnology has the potential for massive societal effects across all sectors, globally. Thus, new forms of education are needed to prepare members of society for making complex decisions about policy, governance, and values. Here, the authors examine the theoretical and conceptual framework of the simulation, which uses improvised role-play and perspective-taking to engage the public in a transformative learning experience. As part of this examination, they describe the uses and constraints of simulations with open-ended goals and without competition and prescribed rules. They believe educational role-play scenarios with active participation of the public can serve as a dynamic method for civic engagement across a range of complex, interdisciplinary topics and new technological dilemmas.
Current Status of Mechanical Circulatory Assistance
Authors: Stone Marc E.
Published: August 2007

Mechanical circulatory support has become an increasingly used management strategy for patients with both acute and chronic ventricular failure. This article briefly reviews the current state of mechanical circulatory support with a focus on indications, contraindications, and complications of currently available devices. Perioperative considerations for ventricular assist device implantation are discussed, including the decision-making process underlying the use of univentricular versus biventricular support, specific anesthetic considerations, and the role of transesophageal echocardiography where ventricular assist devices are concerned. The anesthetic considerations for the patient already supported by a ventricular assist device presenting for noncardiac surgery are also reviewed. The work concludes with a discussion of the rationale behind the next generation of continuous flow devices currently in human clinical trials.
Anesthetic Consideration for Descending Thoracic Aortic Aneurysm Repair
Authors: Kahn Ronald A. , Stone Marc E. , Moskowitz David M.
Published: August 2007

Anesthesia for surgery of the aorta poses some of the most difficult challenges for anesthesiologists. Major hemodynamic and physiologic stresses and sophisticated techniques of extracorporeal support are superimposed on patients with complex medical disease states. In this review, etiologies, natural history, and surgical techniques of thoracic aortic aneurysm are presented. Anesthetic considerations are discussed in detail, including the management of distal perfusion using partial cardiopulmonary bypass. Considerations of spinal cord protection, including management of proximal hypertension, cerebral spinal fluid drainage, and pharmacological therapies, are presented.
Statins and the Perioperative Period
Authors: Bronheim David
Published: August 2007

Recent studies on the effects of statin use on perioperative morbidity and mortality suggest that statins may reduce risk during the perioperative period. However, studies published thus far either were retrospective nonrandomized studies or included small numbers of patients. Individually, none offered authoritative recommendations. However, in almost every study, preoperative statin use was associated with a substantial improvement in perioperative outcome. Thus, pending the publication of a large, prospective randomized trial, the preponderance of the evidence at this time suggests that perioperative statin usage may improve outcome in high-risk patients undergoing major surgery. Furthermore, even if statins are definitively found to be effective, additional studies will be necessary to establish the optimal timing of initiation, drug dosages, and length of therapy.
Perioperative Interventions to Modify Risk of Morbidity and Mortality
Authors: Reich David L. , Fischer Gregory W.
Published: August 2007

Perioperative myocardial ischemia is the single most important, potentially reversible risk factor for mortality and cardiovascular complications during and after noncardiac surgery. The influence of anesthetic choices and techniques on cardiac risk in noncardiac surgery is difficult to ascertain because of the low incidence of morbid cardiac outcomes in the surgical population as a whole. This article summarizes several areas (eg, perioperative βblockade, glucose management, and perioperative hemodynamics) that have been addressed in well-designed clinical trials.
The Pulmonary Artery Catheter in Anesthesia Practice in 2007: An Historical Overview With Emphasis on the Past 6 Years
Authors: Leibowitz Andrew B. , Oropello John M.
Published: August 2007

The pulmonary artery catheter has been widely used in anesthesiology and critical care medicine. Until recently, only retrospective or relatively weak prospective studies examining its effect on outcome had been performed. Over the past 6 years, however, a number of well-designed prospective trials and statistically sound retrospective studies have been completed. All of these show no benefit and some even reveal a potential for increased morbidity. Reasons for this device's inability to improve outcome are numerous, including wrong patient selection and misinterpretation, but the most impressive and convincing evidence is that filling pressures measured from the catheter, particularly the pulmonary artery “wedge” pressure, have no physiologic value. The wedge pressure has been shown to not correlate with other accepted methods of determining left ventricular filling or volume or intravascular volume and also does not help to generate cardiac function curves. Therefore, knowledge of it may actually lead to incorrect management more frequently than not.
Using Content Analysis to Elaborate Adolescent Theories of Organization
Authors: Sonpar Karan , Golden-Biddle Karen
Published: August 2007

This article shows how content analysis of textual archival data facilitates elaboration of adolescent theories. Drawing on the framework of a well-developed theory offered by Bacharach, the authors explain how specific protocols in content analysis can facilitate elaboration of three theoretical elements underdeveloped in adolescent theories: scientific robustness, relationship identification, and boundary establishment. Using an empirical example from a health care study, they illustrate the use of content analysis protocols to elaborate some theoretical elements of the attention-based view of the firm. The article contributes to content analysis and more generally to research methodology by specifying closer linkages between theory elaboration and content analysis.
Mediation Testing in Management Research
Authors: Wood Robert E. , Goodman Jodi S. , Beckmann Nadin , Cook Alison
Published: August 2007

The authors review and critique the conduct and reporting of mediation analyses in 409 studies published in five leading organization studies journals over the past 25 years. The aim of the study is to learn from past practice and to use that knowledge to signal to researchers the importance of correctly applying mediation tests as well as to facilitate the valid testing of mediation models and the reporting of mediation results in future studies. The authors content code their sample for a wide range of characteristics and find that the majority of inferences of full and partial mediation are based on testing procedures that deviate significantly from procedures recommended by statisticians. In addition, the reporting of results is often incomplete and inefficient. The authors discuss and evaluate the findings of the study and make recommendations for future testing and reporting of results for mediation models.
Evaluation of accuracy of drug interaction alerts triggered by two electronic medical record systems in primary healthcare
Authors: Gaikwad Rekha , Sketris Ingrid , Shepherd Michael , Duffy Jack
Published: August 2007

This article presents a study to evaluate the accuracy of drug interaction (DI) alerts triggered by two electronic medical record (EMR) systems in primary healthcare. A scenario-based software architecture analysis methodology (SAAM) was used with drug—drug interaction (DDI) pairs in hypothetical patient scenarios. A literature search identified common drugs used in the management of conditions in the elderly population. Three reference programs determined the level of severity of drug interactions, and a common severity rating scale was adapted. The EMR systems showed a limited potential to identify `severe' clinically significant DDIs and considerable probability for triggering spurious alerts. This may explain the overriding of DI alerts and the interruption of the workflow of users of EMR systems. Reasons for EMR system deficiency included unavailable updates or programming, database functioning discrepancies, and controversies in the clinical evidence.
Mobile case-based decision support for intelligent patient knowledge management
Authors: O'Sullivan Dympna , McLoughlin Eoin , Bertolotto Michela , Wilson David C.
Published: August 2007

Hospitals everywhere are integrating health data using electronic health record (EHR) systems, and disparate and multimedia patient data can be input by different caregivers at different locations as encapsulated patient profiles. Healthcare institutions are also using the flexibility and speed of wireless computing to improve quality and reduce costs. We are developing a mobile application that allows doctors to efficiently record and access complete and accurate real-time patient information. The system integrates medical imagery with textual patient profiles as well as expert interactions by healthcare personnel using knowledge management and case-based reasoning techniques. The application can assist other caregivers in searching large repositories of previous patient cases. Patients' symptoms can be input to a portable device and the application can quickly retrieve similar profiles which can be used to support effective diagnoses and prognoses by comparing symptoms, treatments, diagnosis, test results and other patient information.
Supporting information technology across health boards in New Zealand: the role of learning in adapting to complex change
Authors: Day K.J. , Norris A.C.
Published: August 2007

This article describes a study of a major change management project involving the establishment of a shared services organization to align the information services functions for two district health boards in New Zealand. The research uncovered a capability crisis that many people experienced when they realized the magnitude of the task they were involved in. Not everyone experienced the crisis and it seems that learning, especially in a complex healthcare environment, plays an important role in reducing the negative impact of change.
Self-administered prescriptions of oral steroids and antibiotics in chronic obstructive pulmonary disease: are we doing more harm than good?
Authors: Beaulieu-Genest L. , Chrétien D. , Maltais F. , Pelletier K. , Parent J.-G. , Lacasse Y.
Published: August 2007

Patients with chronic obstructive pulmonary disease (COPD) are often given a prescription for a short course of oral steroids and antibiotics for self-administration during an acute exacerbation. The main objective of this study was to determine the impact of such prescriptions on medical care utilization, and steroids and antibiotics intake. This retrospective cohort study included patients with moderate to severe COPD participating in a self-management programme. We compared the number of unplanned medical visits (including hospitalizations) and the utilization of systemic steroids (number of short courses, number of days on treatment) and antibiotics (number of treatments) over a period of six months following registration to the programme in patients who received such a prescription and those who did not. Data were collected from hospital and community pharmacy files. A total of 89 patients were included; 46 received a self-administered prescription. During the study period, we found no difference between the two groups in the number of unplanned medical visits. However, we observed small but significant differences in the number of short courses of Prednisone ( P = 0.018) and antibiotics ( P = 0.006). This translated in an important difference in the number of days on steroids over the same period (`Prescription' group: 26; controls: 8; P = 0.005). Self-administered prescriptions may increase steroids and antibiotics utilization in patients with moderate to severe COPD, without reducing the number of unplanned medical visits. Chronic Respiratory Disease 2007; 4: 143—147
Review Article: Mechanical ventilation in Duchenne patients with chronic respiratory insufficiency: clinical implications of 20 years published experience
Authors: Toussaint M. , Chatwin M. , Soudon P.
Published: August 2007

Chronic respiratory insufficiency is inevitable in the course of disease progression in patients with Duchenne muscular dystrophy (DMD). Without mechanical ventilation (MV), morbidity and mortality are highly likely towards the end of the second decade of life. The present review reports evidence and clinical implications regarding DMD patients treated with MV. There is no doubt that nocturnal hypercapnia precedes daytime hypercapnia. Historical comparisons have provided evidence that non-invasive intermittent positive pressure ventilation (NIPPV) at night is effective and improves quality of life and survival by 5—10 years. By contrast, the optimal criteria and timing for initiation of NIPPV are inconsistent. A recent randomized study however demonstrated the benefits of commencing NIPPV as soon as nocturnal hypoventilation is detected (Ward S, et al., Randomised controlled trial of non-invasive ventilation (NIV) for nocturnal hypoventilation in neuromuscular and chest wall disease patients with daytime normocapnia. Thorax 2005; 60: 1019—24). The respective role of the three hypotheses of the indirect action of nocturnal NIPPV on daytime blood gases may be complimentary; the main improvement may be due to improved ventilatory response to CO2. The ultimate time to offer full time ventilation with the most advantageous interface is lacking in evidence. Full time NIV is possible with a combination of a nasal mask during the night and a mouthpiece during the day, however tracheostomy may be provided when mechanical techniques of cough-assistance are useless to treat chronic cough insufficiency. Chronic Respiratory Disease 2007; 4: 167—177
Depressed Mood in Informal Caregivers of Individuals With Mild Cognitive Impairment
Authors: Lu Yueh-Feng Yvonne , Austrom Mary Guerriero , Perkins Susan M. , Bakas Tamilyn , Farlow Martin R. , Feng He  , Shelia Jin  , Gamst Anthony
Published: August 2007

This study estimates the prevalence of depressed mood in caregivers of individuals with mild cognitive impairment (MCI) and assesses whether demographics, stressors, intrapsychic strain, and gain are associated with depressed mood. A secondary analysis of baseline data from the Alzheimer's Disease Cooperative Study MCI trial was conducted using a cross-sectional, correlational design. Descriptive statistics to estimate the prevalence of caregiver depressed mood and univariate and block-wise logistic regression analyses were used. The prevalence of depressed mood in 769 caregivers was 24.6% (95% confidence interval, 21.5-27.7). The odds of being depressed were significantly higher in younger, nonspousal caregivers with less education, who cared for MCI patients with lower activities of daily living functioning, and who perceived greater relational deprivation, higher levels of self-loss, and personal gain. Controlling for relevant variables, relational deprivation and caregiver education continued to be significantly associated with depressed mood. Relational deprivation may be important for future interventions.
Cognition and Amyotrophic Lateral Sclerosis (ALS)
Authors: Irwin D. , Lippa Carol F. , Swearer J.M.
Published: August 2007

Amyotrophic lateral sclerosis (ALS) is classically described as a pure motor disease; however, there is growing evidence of a range of cognitive impairment. Cognitive abnormalities include deficiencies in frontal executive skills, varying from mild deficits to meeting criteria for diagnosis of frontotemporal dementia (FTD). Cognitive impairment occurs in sporadic and familial forms of ALS. Patients may present with cognitive deficits before, after, or at the onset of motor neuron disease. Structural and functional imaging studies have shown extramotor cortical degeneration corresponding to levels of frontal executive impairment on neuropsychologic testing. In addition, ALS and a subset of FTD patients display common pathological findings on immunohistochemistry staining. It is believed that these disorders represent a continuum between motor and nonmotor cortical degeneration. The purpose of this article is to review the literature on cognitive deficits in ALS. Identifying changes in cognition is critical for physicians and caregivers of ALS patients, as cognitive decline may interfere with patient compliance. Diagnosis and treatment of cognitive symptoms in ALS patients may improve quality of life.
Impact of a Multimodal Rehabilitative Intervention on Demented Patients and Their Caregivers
Authors: Onor Maria Luisa , Trevisiol Marianna , Negro Cecilia , Alessandra Signorini , Saina Marisa , Aguglia Eugenio
Published: August 2007

Alzheimer's disease is becoming a social, political, and economic issue as a result of both the growing number of people affected and the enormous economic, social, and emotional costs involved in caring for Alzheimer's patients. The aim of this study is to evaluate the effects of a multimodal intervention program for patients with Alzheimer's disease and their caregivers. The study was conducted on a sample of 32 subjects: 16 Alzheimer's patients and their caregivers. The results obtained after the multimodal rehabilitation program showed that the Alzheimer's patients had a more stable cognitive status and improved mood. Regarding the psychoeducational program, the results demonstrate the efficacy of such interventions in terms of increasing and preserving the caregivers' coping skills and enhancing their perception of the value of support groups.
The role of FDG-PET scans in patients with lymphoma
Authors: Seam Pamela , Juweid Malik E. , Cheson Bruce D.
Published: August 2007

18-Fluoro-deoxyglucose positron emission tomography (FDG-PET) is a noninvasive, 3-dimensional imaging modality that has become widely used in the management of patients with malignant lymphomas. This technology has been demonstrated to be more sensitive and specific than either 67gallium scintigraphy or computerized tomography, providing a more accurate distinction between scar or fibrosis and active tumor. PET scans have been evaluated in pretreatment staging, restaging, monitoring during therapy, posttherapy surveillance, assessment of transformation, and, more recently, as a surrogate marker in new drug development. Data to support these various roles require prospective validation. Moreover, caution must be exercised in the interpretation of PET scans because of technical limitations, variability of FDG avidity among the different lymphoma histologic subtypes, and in the large number of etiologies of false-negative and false-positive results. Recent attempts to standardize PET in clinical trials and incorporation of this technology into uniformly adopted response criteria will hopefully lead to improved outcome for patients with lymphoma.
Prediction of the burial status of transmembrane residues of helical membrane proteins
Authors: Park Yungki , Hayat Sikander , Helms Volkhard
Published: August 2007

Background

Helical membrane proteins (HMPs) play a crucial role in diverse cellular processes, yet it still remains extremely difficult to determine their structures by experimental techniques. Given this situation, it is highly desirable to develop sequence-based computational methods for predicting structural characteristics of HMPs.

Results

We have developed TMX (TransMembrane eXposure), a novel method for predicting the burial status (i.e. buried in the protein structure vs. exposed to the membrane) of transmembrane (TM) residues of HMPs. TMX derives positional scores of TM residues based on their profiles and conservation indices. Then, a support vector classifier is used for predicting their burial status. Its prediction accuracy is 78.71% on a benchmark data set, representing considerable improvements over 68.67% and 71.06% of previously proposed methods. Importantly, unlike the previous methods, TMX automatically yields confidence scores for the predictions made. In addition, a feature selection incorporated in TMX reveals interesting insights into the structural organization of HMPs.

Conclusion

A novel computational method, TMX, has been developed for predicting the burial status of TM residues of HMPs. Its prediction accuracy is much higher than that of previously proposed methods. It will be useful in elucidating structural characteristics of HMPs as an inexpensive, auxiliary tool. A web server for TMX is established at http://service.bioinformatik.uni-saarland.de/tmx and freely available to academic users, along with the data set used.
Extensive horizontal transfer of core genome genes between two Lactobacillus species found in the gastrointestinal tract
Authors: Nicolas Pierre , Bessières Philippe , Ehrlich S Dusko , Maguin Emmanuelle , van de Guchte Maarten
Published: August 2007

Background

While genes that are conserved between related bacterial species are usually thought to have evolved along with the species, phylogenetic trees reconstructed for individual genes may contradict this picture and indicate horizontal gene transfer. Individual trees are often not resolved with high confidence, however, and in that case alternative trees are generally not considered as contradicting the species tree, although not confirming it either. Here we conduct an in-depth analysis of 401 protein phylogenetic trees inferred with varying levels of confidence for three lactobacilli from the acidophilus complex. At present the relationship between these bacteria, isolated from environments as diverse as the gastrointestinal tract (Lactobacillus acidophilus and Lactobacillus johnsonii) and yogurt (Lactobacillus delbrueckii ssp. bulgaricus), is ambiguous due to contradictory phenotypical and 16S rRNA based classifications.

Results

Among the 401 phylogenetic trees, those that could be reconstructed with high confidence support the 16S-rRNA tree or one alternative topology in an astonishing 3:2 ratio, while the third possible topology is practically absent. Lowering the confidence threshold for trees to be taken into consideration does not significantly affect this ratio, and therefore suggests that gene transfer may have affected as much as 40% of the core genome genes. Gene function bias suggests that the 16S rRNA phylogeny of the acidophilus complex, which indicates that L. acidophilus and L. delbrueckii ssp. bulgaricus are the closest related of these three species, is correct. A novel approach of comparison of interspecies protein divergence data employed in this study allowed to determine that gene transfer most likely took place between the lineages of the two species found in the gastrointestinal tract.

Conclusion

This case-study reports an unprecedented level of phylogenetic incongruence, presumably resulting from extensive horizontal gene transfer. The data give a first indication of the large extent of gene transfer that may take place in the gastrointestinal tract and its accumulated effect. For future studies, our results should encourage a careful weighing of data on phylogenetic tree topology, confidence and distribution to conclude on the absence or presence and extent of horizontal gene transfer.
A detailed transcript-level probe annotation reveals alternative splicing based microarray platform differences
Authors: Lee Joseph C , Stiles David , Lu Jun , Cam Margaret C
Published: August 2007

Background

Microarrays are a popular tool used in experiments to measure gene expression levels. Improving the reproducibility of microarray results produced by different chips from various manufacturers is important to create comparable and combinable experimental results. Alternative splicing has been cited as a possible cause of differences in expression measurements across platforms, though no study to this point has been conducted to show its influence in cross-platform differences.

Results

Using probe sequence data, a new microarray probe/transcript annotation was created based on the AceView Aug05 release that allowed for the categorization of genes based on their expression measurements' susceptibility to alternative splicing differences across microarray platforms. Examining gene expression data from multiple platforms in light of the new categorization, genes unsusceptible to alternative splicing differences showed higher signal agreement than those genes most susceptible to alternative splicing differences. The analysis gave rise to a different probe-level visualization method that can highlight probe differences according to transcript specificity.

Conclusion

The results highlight the need for detailed probe annotation at the transcriptome level. The presence of alternative splicing within a given sample can affect gene expression measurements and is a contributing factor to overall technical differences across platforms.
Classification of a moderately oxygen-tolerant isolate from baby faeces as Bifidobacterium thermophilum
Authors: von Ah Ueli , Mozzetti Valeria , Lacroix Christophe , Kheadr Ehab E , Fliss Ismaïl , Meile Leo
Published: August 2007

Background

Bifidobacteria are found at varying prevalence in human microbiota and seem to play an important role in the human gastrointestinal tract (GIT). Bifidobacteria are highly adapted to the human GIT which is reflected in the genome sequence of aBifidobacterim longumisolate. The competitiveness against other bacteria is not fully understood yet but may be related to the production of antimicrobial compounds such as bacteriocins. In a previous study, 34Bifidobacteriumisolates have been isolated from baby faeces among which six showed proteinaceous antilisterial activity againstListeria monocytogenes. In this study, one of these isolates, RBL67, was further identified and characterized.

Results

Bifidobacteriumisolate RBL67 was classified and characterized using a polyphasic approach. RBL67 was classified asBifidobacterium thermophilumbased on phenotypic and DNA-DNA hybridization characteristics, although 16S rDNA analyses and partialgroEL sequences showed higher homology withB. thermacidophilumsubsp.porcinumandB. thermacidophilumsubsp.thermacidophilum, respectively. RBL67 was moderately oxygen-tolerant and was able to grow at pH 4 and at a temperature of 47°C.

Conclusion

In order to assign RBL67 to a species, a polyphasic approach was used. This resulted in the classification of RBL67 as aBifidobacterium thermophilumstrain. To our knowledge, this is the first report aboutB. thermophilumisolated from baby faeces since theB. thermophilumstrains were related to ruminants and swine faeces before.B. thermophilumwas previously only isolated from animal sources and was therefore suggested to be used as differential species between animal and human contamination. Our findings may disapprove this suggestion and further studies are now conducted to determine whetherB. thermophilumis distributed broader in human faeces. Furthermore, the postulated differentiation between human and animal strains by growth above 45°C is no longer valid sinceB. thermophilumis able to grow at 47°C. In our study, 16S rDNA and partialgroEL sequence analysis were not able to clearly assign RBL67 to a species and were contradictory. Our study suggests that partialgroEL sequences may not be reliable as a single tool for species differentiation.