bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of gravel conditions on seedling emergence of the endangered monocarpic perennial Aster kantoensis (Compositae) on a floodplain
Authors: KAGAYA MITSUKO , TANI TAKASHI , KACHI NAOKI
Published: February 2008

The short‐lived monocarpic perennial Aster kantoensis Kitamura inhabits gravelly floodplains in the Kanto district of Honshu, Japan. Seedlings of this species are often found in unembedded‐gravel habitats where gravels shade the sand surface, and are rare in embedded‐gravel habitats where the sand surface is exposed to sunlight. To examine whether gravel conditions at the ground surface directly affect the seedling emergence of A. kantoensis, seeds were experimentally sown around unembedded gravels in the unembedded‐gravel habitat and around embedded and artificially unembedded gravels in the embedded‐gravel habitat on a floodplain of the Tama River. The cumulative numbers of seedlings that emerged around the unembedded and artificially unembedded gravels were approximately fourfold and sixfold of that around the embedded gravel. Results of this study indicate that gravel conditions at the ground surface directly affect the seedling emergence of A. kantoensis and that unembedded gravel conditions created by flooding provide microhabitats suitable for seedling emergence.
Management of localized prostate cancer in senior adults: the crucial role of comorbidity
Authors: Fitzpatrick John M.
Published: February 2008

Prostate cancer is predominantly a disease of senior adults, i.e. those aged >70 years. With the increasing life expectancy worldwide, the burden of prostate cancer in senior adults is expected to increase.

The management of senior adults with localized prostate cancer is not optimal. While most senior adults have indolent disease and will not die from it, some patients with aggressive tumours will rapidly progress to an advanced stage if not adequately treated. Treatment decisions need to balance life expectancy and the benefits of therapy vs treatment‐related adverse events. Comorbidity is a crucial predictor of nonprostate cancer mortality in senior adults. Moreover, complications of curative treatments appear to be related to comorbidity to a greater degree than to chronological age. Nevertheless, there is evidence that, in everyday clinical practice, treatment decisions are strongly influenced by patient age and that a minority of senior adults with prostate cancer will benefit from curative therapy, regardless of the comorbidity. Conversely, a large proportion of senior adults will receive hormone‐deprivation therapy, although it has no curative intent and is associated with an increased risk of metabolic syndrome, cardiovascular mortality and bone fractures.

In conclusion, every effort should be made to improve the standard of care of senior adults with localized prostate cancer. There is a need for specific treatment guidelines dedicated to this population.
The Reten‐World survey of the management of acute urinary retention: preliminary results
Authors: Emberton Mark , Fitzpatrick John M.
Published: February 2008

Acute urinary retention (AUR) is a urological emergency characterized by a sudden and painful inability to pass urine. It represents a significant worldwide public health issue, as mortality within the year following an AUR episode appears much higher than in the general population, especially in younger patients. Management of AUR involves immediate bladder catheterization usually followed, until recently, by prostatic surgery. The greater morbidity and mortality associated with emergency surgery (within a few days after AUR), and the potential morbidity associated with prolonged catheterization (bacteriuria, fever, urosepsis) has led to an increasing use of a trial without catheter (TWOC). TWOC involves catheter removal after 1–3 days, allowing 23–40% of patients to void successfully, so that surgery can be performed at a later stage, if needed. Use of an α1‐blocker before a TWOC may also be of help, as it has been demonstrated that it increases the chances of successful voiding after catheter removal. In the UK, this TWOC policy has resulted in a progressive decrease in the number of surgical procedures following a first episode of AUR, with the detriment of a slight increase in the AUR recurrence rate.

Currently, there is no consensus on the optimal management of AUR in terms of type of catheterization, duration of catheterization and management following catheterization. The Reten‐World survey is aimed at assessing current practice in the management of AUR in France, Asia, Latin America, North Africa and the Middle East. Interim results based on 3785 men with AUR associated with benign prostatic hyperplasia show that a urethral catheter is inserted in most cases (87%). Following this initial step, a TWOC after a median of 3 days’ catheterization has become standard practice worldwide, with only a minority of men (6%) undergoing immediate surgery. Treatment with an α1‐blocker before a TWOC improves the chances of success, regardless of the duration of catheterization. There is also evidence that prolonged catheterization (>3 days) is associated with a significantly higher rate of comorbidity and prolonged hospitalization due to adverse events. Every effort should thus be made to reduce the comorbidity and mortality associated with AUR.
Management of bacterial prostatitis: what’s new?
Authors: Naber Kurt G.
Published: February 2008

Prostatitis is a common healthcare issue affecting 10–14% of men of all ages and ethnicities. Acute bacterial prostatitis is associated with severe, mainly Gram‐negative infection; treatment consists of broad‐spectrum antibiotic therapy for 2–4 weeks, which can be tailored according to pathogen identification and susceptibility tests. Chronic bacterial prostatitis is more difficult to diagnose as the symptoms are shared by chronic pelvic pain syndrome; only 10% of patients with chronic prostatitis symptoms actually have bacterial infection. The pathogens associated with this condition are essentially common uropathogens, although there is debate around the role of Gram‐positive bacteria. Definitive diagnosis is obtained with the Meares–Stamey four‐glass test, or the two‐glass test in routine practice, which differentiates between chronic bacterial prostatitis and chronic pelvic pain syndrome. The fluoroquinolones are the first choice of therapy for chronic bacterial prostatitis, in particular levofloxacin which is as effective as ciprofloxacin but shows a better prostatic penetration and is given once daily.
Relationship between franking credits and the market risk premium: a comment
Authors: Lally Martin
Published: February 2008

This paper examines two arguments presented in Gray and Hall (2006). First, that the generally used estimate of 0.06 for the market risk premium within the Officer version of the capital asset pricing model (CAPM) and the generally used estimate of 0.50 for the parameter ‘gamma’ within the Officer framework are jointly inconsistent with evidence concerning the market risk premium in the standard version of the CAPM. Second, that the first two of these parameter estimates are also jointly inconsistent with the observed cash dividend yield on the Australian market. To resolve these problems, Gray and Hall recommend setting gamma to zero. The present paper shows that the first argument does not account for the fact that imputation induces a reduction in the market risk premium as defined in the standard version of the CAPM. The present paper also shows that both arguments identify a problem that characterizes only parts of the Officer framework, and these parts are not generally used in Australia. Therefore, rather than suggesting that gamma should be zero, Gray and Hall's analysis identifies parts of the Officer framework that should be avoided.
Relation between franking credits and the market risk premium: a comment
Authors: Truong Giang , Partington Graham
Published: February 2008

Based on the Officer (1994) model, Gray and Hall (2006) derive a relation between franking credits and the market risk premium. On the basis of this relation, the authors show that traditional estimates of the value of franking credits imply dividend yields that are inconsistent with historical equity market data. This inconsistency arises from assumptions about the franking credit payout ratio and the value of franking credits retained. With less than a 100 per cent payout ratio some franking credits are retained within the firm. Assuming that the retained franking credits have no value leads to the inconsistency in dividend yields. Current practice in the application of Officer's model makes this assumption and, therefore, leads to inconsistent results. Gray and Hall suggest resolving the inconsistency by setting the value of all franking credits to zero. An alternative solution is to recognize that retained franking credits might have a positive value.
Burden of Obesity – lessons learnt from Hong Kong Chinese
Authors: Ko G. T. C. , Chan J. C. N.
Published: February 2008

There is now a pandemic of chronic diseases in Asian countries, driven mainly by obesity, diabetes and cardio‐renal complications. In Hong Kong, the reported prevalence of obesity, defined as body mass index (BMI) ≥ 25 kg m−2, varied from one‐quarter to one‐third of the population. In a population‐based survey conducted in 1995, 16.7% of Hong Kong adults had the metabolic syndrome (MES) (National Cholesterol Education Programme criterion). Obesity is now a global concern not only in adults but also among children and adolescents. In 2003, a territory‐wide survey in Hong Kong reported the prevalence of central obesity and MES to be 9.0% and 2.4%, respectively, in Chinese adolescents. Overweight, positive family history of diabetes and studying at schools of lower academic grading were independent risk factors for the adolescent MES. Lifestyle modification with proper diet and exercise is essential for health protection. In accord with western data, a weight management programme in Hong Kong Chinese with a 4–6% reduction in body weight or waist circumference was associated with significant reductions in all cardiovascular risk factors. Psychosocial factors related to chronic diseases are also of growing concern. In Hong Kong Chinese, increasing BMI was associated with a lower number of sleeping hours and increasing working hours, suggesting an intimate relationship between physical health and psychosocial stress. Chronic non‐communicable diseases are therefore major health threats in Hong Kong, with obesity as one of the major risk factors. A multidimensional and multidisciplinary health promotion and disease management plan is urgently needed to control these epidemics.
International strategies to address obesity
Authors: Hill J. O. , Peters J. C. , Catenacci V. A. , Wyatt H. R.
Published: February 2008

Obesity rates are increasing in most countries throughout the world. The reasons for the increase are complex and involve biological, behavioural and environmental factors. We have unintentionally created environments that encourage over‐eating and discourage physical activity. Despite the recognition of the seriousness of obesity to public health, no interventions have been effective in reducing obesity rates on a population basis. Reversing obesity rates within populations will require addressing both individual behaviour and the obesogenic environment. Obesity rates could be reduced by treating affected individuals or by preventing the gradual increase in body weights of the population. Success in long‐term obesity treatment is poor and appears to require that large behaviour changes be made and sustained. An alternative approach is to promote small lifestyle changes to prevent the gradual increase in the body weight of populations. America On the Move is an initiative based on promoting small lifestyle changes to prevent weight gain in the US population. This is one strategy could be used in other countries to reduce obesity rates.
Nutrition transition and its relationship to the development of obesity and related chronic diseases
Authors: Astrup Arne , Dyerberg Jørn , Selleck Matthew , Stender Steen
Published: February 2008

The prevalence of overweight and obesity has also increased substantially in the nutritional transition countries, and the health burden of obesity‐related complications is growing. The introduction of fast‐food chains and Westernized dietary habits providing meals with fast‐food characteristics seems to be a marker of the increasing prevalence of obesity. The mechanisms involved are probably that the supply of foods is characterized by large portion sizes with a high energy density, and sugar‐rich soft drinks. The high energy density of foods is partly brought about by a high dietary fat content, and it has been shown that even in a Chinese population the increase from about 15% to 20% in the proportion of calories from fat is sufficient to explain some weight gain in the population. In addition, fast food from major chains in most countries still contains unacceptably high levels of industrially produced trans fatty acids that have powerful biological effects, and contribute to type 2 diabetes and coronary artery disease. New evidence also suggests that a high intake of trans fat may produce abdominal obesity, an important factor in the metabolic syndrome, type 2 diabetes and cardiovascular disease. The optimal diet for the prevention of weight gain, obesity, metabolic syndrome and type 2 diabetes is fat‐reduced, without any industrially produced trans fatty acids, fibre‐rich, high in low energy density carbohydrates (fruit, vegetables and whole grain products) and with a restricted intake of energy‐containing drinks.
The role of dietary factors in chronic disease control in China
Authors: Chen C. M. , Zhao W. , Yang Z. , Zhai Y. , Wu Y. , Kong L.
Published: February 2008

Using the dietary intake and chronic disease condition data of 39 843 adults aged over 18 years old from the 2002 National Nutrition and Health Survey in China (2002 CNHS) logistic regression analysis was applied to calculate the odd ratios (ORs) of hypertension, diabetes and dyslipidaemia for the various dietary patterns of the subjects. The higher percentage of energy intake from cereals was significantly associated with lower body mass index (BMI), lower total serum cholesterol (TC) and lower low density lipoprotein cholesterol (LDL‐C), while it was significantly associated with lower risk of overweight/obesity, hypertension, high TC, high serum triglycerides (TG) and high LDL‐C, but the prevalence of underweight was significantly higher in the cluster of subjects with cereal energy share more than 75%. The higher percentage of energy intake of fat was related to higher BMI, higher TC and higher LDL‐C which were associated with a high risk of overweight/obesity, hypertension, TC and TG. The study confirmed the important role of dietary pattern in chronic disease control. In particular, an optimum energy contributed from cereals ranged from 55% to 65% of total dietary energy intake and dietary fat energy share no more than 30% which should be the focus of preventive measures.
Health implications of transition from a planned to a free‐market economy – an overview
Authors: Baillie K.
Published: February 2008

China and the Former Soviet Union have both undergone substantial political and economic change in recent years as they began the transition from planned to more liberal market economies. The approaches to market liberalization in Russia (privatization in the minimum time) and China (gradual liberalization of prices and slow withdrawal of agricultural subsidies) were quite different. This paper examines some of the health implications associated with these changes, particularly in relation to the increasing burden of diet‐related chronic diseases. The changing patterns of tobacco and alcohol use, increase in sedentary lifestyles and increased consumption of non‐traditional, energy‐dense processed foods, high in salt, fat and sugar are examined, as are the strategies used by foreign direct investors in these emerging markets to ensure market penetration, to gain a fuller understanding of how children and adults' choices of food are being influenced as a result of these socioeconomic changes. Some of the threats and opportunities facing Chinese and foreign food producers in these new conditions are assessed. It is suggested that to ensure successful prevention of future diet‐related chronic diseases in such rapidly changing conditions, there needs to be a move beyond reliance solely on health education programmes and individual or local community‐based interventions. A series of strategies involving multiple stakeholders should be considered as options for intervention.
Agro‐food industry growth and obesity in China: what role for regulating food advertising and promotion and nutrition labelling?
Authors: Hawkes C.
Published: February 2008

Taking a food supply chain approach, this paper examines the regulation of food marketing and nutrition labelling as strategies to help combat obesity in China in an era of rapid agro‐food industry growth. China is the largest food producer and consumer in the world. Since the early 1980s, the agro‐food industry has undergone phenomenal expansion throughout the food supply chain, from agricultural production to trade, agro‐food processing to food retailing, and from food service to advertising and promotion. This industry growth, alongside related socioeconomic changes and government policies, has encouraged a ‘nutrition transition’. China's population, especially in urban areas, is now consuming significantly more energy from dietary fat, which is leading to higher rates of obesity. Regulation of food advertising and promotion and nutrition labelling has the potential to help prevent the further growth of obesity in China and encourage the agro‐food industry to supplier healthier foods. Government legislation and guidance, as well as self‐regulation and voluntary initiatives, are needed to reduce children's exposure to food advertising and promotion, and increase the effectiveness of nutrition labelling. Policies on food marketing and nutrition labelling should be adapted to the China context, and accompanied by further action throughout the food supply chain. Given China's unique characteristics and position in the world today, there is an opportunity for the government and the agro‐food industry to lead the world by creating a balanced, health promoting model of complementary legislation and industry action.
The good, the bad and the wiki: Evaluating student‐generated content for collaborative learning
Authors: Wheeler Steve , Yeomans Peter , Wheeler Dawn
Published: February 2008

This paper explores the potential for wiki‐type open architecture software to promote and support collaborative learning through the use of student‐created content. It delineates some of the affordances and constraints of wiki software as an open architecture that has the potential to facilitate collaborative learning through community‐focused enquiry. It seeks to promote debate in this key area of development, and highlights some recent key contributions to the developing discourse on social software in what has been termed ‘the architecture of participation’.
Decomposing manner how in colloquial Scandinavian*
Authors: Vangsnes Øystein Alexander
Published: February 2008

Abstract.  The shape of manner how varies to considerable extent across Scandinavian dialects, and many of them quite clearly have a complex internal structure. This paper investigates the internal structure of these many forms, and it will be argued that all forms of complex manner how can be derived from just two abstract templates. Furthermore, it will be shown that the complex forms of manner how unlike the simplex ones interact with other wh‐items morpologically speaking: the wh‐part will always be identical to the degree wh‐item in the various varieties, which in turn will be identical in form to either where or what. The few simplex forms that exist are identical to degree how, but do not share internal structure (apart from wh‐) with other wh‐items. Moreover, many of the complex forms of manner how are also used as determiners, and a comparison with complex wh‐determiners will reveal that at a certain level of abstraction such wh‐items share important parts of structure.
The predicate‐argument relation and the structure of discourse in spoken Frisian*
Authors: Hoekstra Eric
Published: February 2008

Abstract.  This article provides an analysis of some fragments of discourse taken from the Corpus Spoken Frisian. It is claimed that the predicate‐argument relation provides structure to such discourse fragments, provided that the argument position of the predicate can be occupied not just by a NP or CP but also by a list of clauses and phrases. The scope of the predicate‐argument relation is thus extended from intra‐sentential structure to discourse structure. In addition, attention is drawn to two syntactic phenomena which are present in lists of clauses and phrases of spoken Frisian, but absent from written Frisian: complementiser repetition around a phrase and the use of fan‘like’ to introduce direct speech.
Ethical dilemma associated with the off‐label use of antipsychotic drugs for the treatment of behavioral and psychological symptoms of dementia
Authors: IHARA Hiroshi , ARAI Heii
Published: February 2008

The term ‘off‐label use’ is generally taken to mean the prescription of a drug without approved official authorization. The present article deals with ethical problems associated with the off‐label use of antipsychotic drugs for the treatment of behavioral and psychological symptoms of dementia (BPSD) in Japan. Before the introduction of the Law of Protection of Private Information, the off‐label use of antipsychotics was an almost open secret in Japan. Indeed, users of mental health care make strong requests that they receive the best and newest treatment available. Here, a huge gap exists between what psychiatrists consider ‘best’ and what the health service authority approves. For the sake of patients' interest, psychiatrists cannot help prescribing a drug for an unapproved indication or in a dose outside the usual range, otherwise they are unable to effect a therapeutic outcome. Although thioridazine and vegetamin are officially approved for the treatment of geriatric psychosis in Japan, they are not used commonly compared with atypical neuroleptics. Clinicians' preference for atypical agents over conventional neuroleptics is based on ethical motivation regarding the safe use of the drug rather than profitability. The failure to follow the information on the drug label should not necessarily preclude a psychiatrist from making a good clinical judgment in the interest of the patient. Even so, the psychiatrist should be aware that the patient retains the right to redress for possible medical malpractice. Japanese psychiatrists should take into account the evidence concerning the effectiveness of the drug for any unlicensed indication when they prescribe it off‐label. They should also inform patients of the fact that the prescription is off‐label and of any risks and benefits involved in the prescription of that particular drug. Whenever there is evidence of benefit, a trial of the drug should always be performed under careful clinical monitoring.
The Effects of Mnemonic Interventions on Academic Outcomes for Youth with Disabilities: A Systematic Review
Authors: Wolgemuth Jennifer R. , Cobb R. Brian , Alwell Morgen
Published: February 2008

The relationship between mnemonic instruction and academic performance for secondary‐school‐age youth with disabilities was explored in this systematic review. A total of 20 studies intervening with 669 youth with learning disabilities, emotional and behavioral disorders, and mild developmental disabilities were reviewed. The findings of this review strongly support the efficacy of mnemonic interventions across study methods, educational settings, student ages, and disabilities in the improvement of academic performance, typically measured by recall of word meanings or factual information. A series of detailed implications for practice is discussed and reference is made to specific literature providing detailed descriptions of mnemonic interventions.
City Building and the Rhetoric of “Readability”: Architectural Debates in the New Berlin
Authors: Murray George J.A.
Published: February 2008

Berlin represents an unusual case vis–à–vis the international architectural debate about rebuilding cities. The debate generally takes place between neotraditionalists on the one hand and various avant–gardists on the other. But in Berlin, the main representatives of the first camp are not, for once, members of the New Urbanism movement, nor are they neotraditionalists tout court; they are, at least on their own self–understanding, pioneers of a kind of ‘Third Way’ between the two extremes of neotraditionalism and avant–gardism. Nevertheless, a closer look at their rhetoric reveals deeper–lying affinities with the cultural conservatism characteristic of New Urbanism: the image of the city that they favor for Berlin is one of clarity, order, permanence, weightiness, etc.—a surprising image, given the city's troubled past. I examine the Architektenstreit (“Architects’ Debate”) that arose among planners, architects, critics, and others concerning the rebuilding of the central city in Berlin after reunification, and I discuss, in particular, the doctrine of critical reconstruction that has come to dominate this debate. I locate the origins of critical reconstruction's peculiar rhetoric in a longing for stability amidst the perceived flux of modernity. More generally, I argue (contra many commentators on the Architektenstreit) that a debate on the representations and images of the city is not merely a distraction from, but rather an essential element in, the politics of the city.

In Berlin today the substitution of culture for politics is particularly manifest. One sometimes has the impression that architectural form is the most important form of political expression ( Lepenies, 2003 , p. 322). 1
Forward to the Past: Historical Preservation in Globalizing Shanghai
Authors: Ren Xuefei
Published: February 2008

This article examines the role of historical preservation in the spatial restructuring of postindustrial cities through a detailed case study of Xintiandi, a preservation–based redevelopment project in the inner city of Shanghai. At Xintiandi, two blocks of Shikumen houses, Shanghainese tenements built by Western landlords for Chinese tenants in the colonial period, were turned into a posh entertainment quarter by international developers and architects, with support from local governments. The history of Shikumen as dwellings of lower–middle–class tenants through the twentieth century is being carefully erased. The private–public coalition has repackaged Shikumen into a symbol of Shanghai's cosmopolitan colonial past by emphasizing its Western–influenced architecture. This article argues that historical preservation, far from hindering urban growth, serves the same development goal in globalizing Shanghai. Historical elements in the built environment are selectively recycled to produce a new transnational space.
Small Town Civic Structure and Interlocal Collaboration for Public Services
Authors: Morton Lois W. , Chen Yu–Che , Morse Ricardo S.
Published: February 2008

Local governments are responsible for financing and providing an array of public services ranging from police, fire, and emergency medical services to streets, parks, and water. Two mechanisms, civic structure and interlocal collaboration, have the potential to solve the problem of providing high–quality public services in the face of declining resources and increasing needs. We find that civic structure—citizen engagement in solving public problems—is positively and strongly associated with perceived quality of small town public services. Although many rural towns have entered into service agreements with other local governments, this approach is not significantly associated with citizen ratings of overall service quality. Citizens seem to prefer their local government directly providing police services rather than entering into interlocal agreements. This suggests that leaders and heads of departments providing public services need to carefully assess which services are most appropriately shared across governments to achieve cost savings and which support sense of community and would be better provided directly.
Between the Country and the Concrete: Rediscovering the Rural–Urban Fringe
Authors: Sharp Jeff S. , Clark Jill K.
Published: February 2008

Substantial U.S. population growth in relatively rural areas adjacent to large urban areas is sparking renewed interest in the rural–urban fringe. This research identifies some of the roots of the rural–urban fringe concept and reviews recent scholarly interest in the related exurban concept. Analysis of primary and secondary data is conducted to examine the fringe in relation to both urban/suburban areas and rural areas of Ohio, seeking to determine the extent to which the fringe is similar to or dissimilar from the suburbs or more rural areas. Comparisons are made across a number of ecological, occupational, and sociocultural attributes. Differences between incorporated (cities and villages) and unincorporated (township) areas are also considered. Findings support the notion of the fringe being distinct from the suburbs, with more modest differences compared to more rural places. Practical implications of this research are discussed as are future research needs for further understanding an increasingly important settlement area of the United States.
Integration of Three‐Dimensional Left Atrial Magnetic Resonance Images into a Real‐Time Electroanatomic Mapping System: Validation of a Registration Method
Authors: BERTAGLIA EMANUELE , BRANDOLINO GLAUCO , ZOPPO FRANCO , ZERBO FRANCESCA , PASCOTTO PIETRO
Published: February 2008

Background: The alignment of three‐dimensional (3D) left atrial images acquired by magnetic resonance (MR) with the anatomical information yielded by 3D mapping systems is one of the most critical issues in image integration techniques for catheter ablation of atrial fibrillation (AF). We assessed the accuracy of a simplified method of superimposing 3D MR left atrial images on real‐time left atrial electroanatomic maps (registration).

Methods: MR data on the left atrium in 40 patients with drug‐refractory AF were imported into the CartoMerge™ (Biosense Webster, Inc., Diamond Bar, CA, USA) electroanatomic mapping system. Registration was obtained by combining “visual alignment” of one endocardial point and “surface registration” of a limited number of points sampled on the posterior wall of the left atrium. The accuracy of the registration process was assessed through a statistical algorithm incorporated into the CartoMerge™ system, and through the percentage of pulmonary veins (PVs) in which electrical isolation was achieved after anatomical ablation.

Results: The mean registration surface‐to‐point distance and ablation surface‐to‐point distance were 1.33 ± 0.96 mm and 1.47 ± 1.15 mm, respectively. Upon completion of the circumferential anatomical ablation around the PVs, electrical PV isolation was confirmed by a multipolar circular mapping catheter in 129 of 146 PVs (89%).

Conclusions: Our registration method, which is mainly based on the surface registration of the posterior wall of the left atrium, enables almost 90% of PVs to be isolated by means of an anatomically based catheter ablation approach.
Use of Three‐Dimensional Catheter Guidance and Trans‐Esophageal Echocardiography to Eliminate Fluoroscopy in Catheter Ablation of Left‐Sided Accessory Pathways
Authors: CLARK JOHN , BOCKOVEN J.R. , LANE JOHN , PATEL C.R. , SMITH GRACE
Published: February 2008

Background: Newer technologies such as three‐dimensional mapping and echocardiography can decrease x‐ray exposure during catheter ablation. Many right‐sided tachycardias can now be ablated without fluoroscopy. Left‐sided tachycardias, however, have not yet been ablated using a zero fluoroscopy approach.

Objective: This study sought to examine the utility of trans‐esophageal echocardiography (TEE) in providing adequate imaging as an alternative to fluoroscopy for transseptal puncture. When combined with NavX guidance (St. Jude Medical, St. Paul, MN, USA), fluoroscopy may not be necessary.

Methods: Ten pediatric patients with supraventricular tachycardia (SVT) had accessory pathways mapped to the left side. Right atrial and coronary sinus geometries were created using NavX. Once a left‐sided pathway was confirmed, a transseptal puncture was performed. A guide wire was placed in the SVC and confirmed by TEE. A transseptal sheath and dilator were advanced over the wire and positioned with TEE guidance so that the tip of the dilator was tenting the fossa ovalis. A transseptal needle was advanced across the fossa. Left atrial location of the needle tip was confirmed on TEE by saline contrast injection. The sheath and dilator were advanced over the needle with continuous pressure monitoring and TEE. Once the sheath was appropriately positioned, the ablation was completed using NavX guidance.

Results: All patients had acutely successful ablations and none required the use of fluoroscopy. Number of cryo lesions ranged from five to 19, with a mean of 9. Mean procedure time was 4.4 hours, with a range of 3.2 hours to 7.2 hours. There were no complications. One patient had recurrence.

Conclusions: Three‐dimensional mapping combined with TEE shows potential for eliminating fluoroscopy use during catheter ablation.
Contrasting Effects of Convective Flow on Catheter Ablation Lesion Size: Cryo Versus Radiofrequency Energy
Authors: PILCHER THOMAS A. , SAUL J. PHILIP , HLAVACEK ANTHONY M. , HAEMMERICH DIETER
Published: February 2008

Background: Cryoablation has now become an alternative to treat many cardiac arrhythmias, and may be the treatment of choice in some patient populations. We compared the effects of convective flow on large‐tip cryo and radiofrequency (RF) lesions dimensions.

Methods: Cryoablation and RF ablation were performed on porcine heart sections in a saline bath with varying directed flow rates. Cryoablation was performed for 4 minutes on 50 tissue pieces with tip temperature controlled at −80°C. RF ablation was performed on 50 tissue pieces for 60 seconds at 60°C tip temperature. The pieces were placed in culture media for 24 hours, and then sectioned, stained, and measured.

Results: Cryoablation and RF lesion sizes varied significantly with flow such that higher flow rates produced smaller cryoablation lesions and larger RF lesions (mean cryoablation volumes: 854 ± 402, 808 ± 217, 781 ± 217, 359 ± 114, and 292 ± 117 mm3, and mean RF volumes: 211 ± 35, 304 ± 79, 439 ± 125, 525 ± 187, and 597 ± 126 mm3 for 0, 1, 2, 3, and 5L/min flow rates, respectively, P < 0.0005). Trabeculated pieces had larger cryoablation lesions and smaller RF lesions than nontrabeculated ones at higher flow rate (P < 0.005). Cryoablation lesion volume increased as the time to reach −80°C decreased (r2= 0.72).

Conclusion: In contrast to RF ablation, cryoablation lesion size is smaller at high flow rates, and larger at low flow rates due to the warming effects of local convective flow. The effects of high flow are reduced in areas of trabeculation, and the time to reach −80°C predicts cryoablation lesion size.
Paroxysmal AV Block in Children with Normal Cardiac Anatomy as a Cause of Syncope
Authors: SILVER ERIC S. , PASS ROBERT H. , HORDOF ALLAN J. , LIBERMAN LEONARDO
Published: February 2008

Background: Syncope due to episodes of paroxysmal atrioventricular (AV) block, defined as transient advanced second or third‐degree block, is rarely reported in pediatric patients without congenital heart disease.

Methods: We reviewed our institutional arrhythmia database from January 1988 to January 2007 to identify all patients less than 18 years of age with normal cardiac anatomy and episodes of syncope associated with paroxysmal AV block. Demographic and clinical information was collected.

Results: Six patients were identified (

Table I

). Five of the six patients were female, with an average age of 9.3 ± 4.4 years. Patients had episodes of syncope for an average of 5.6 ± 3.3 years prior to diagnosis. All patients had normal physical examinations, electrocardiograms, and echocardiograms. None were on medications known to interfere with AV nodal function, and laboratory evaluation including Lyme titers were negative. Five of the six patients' episodes were atypical for vasovagal syncope (except patient 6). All patients had documented paroxysmal AV block on either inpatient cardiac monitor, Holter monitor, or event recorder at the time of syncope. There was maintenance or acceleration of the sinus rate during episodes of syncope in all patients (mean atrial rate 107 ± 37 bpm). All six patients had permanent transvenous pacemakers implanted with resolution of symptoms over a mean follow‐up of 5.2 ± 6.3 years.

 Characteristics of Six Patients with Paroxysmal AV Block

Patient
Age (years)
Sex
Medical History
Preceding Symptoms
Length of Symptoms (years)
Method of Diagnosis
Atrial Rate with AV Block (bpm)
Longest Pause (sec)
Pacing Mode
Follow‐up (years)

1
2.5
F
None
Crying out, headache
5
Event recorder
150
17
VVI
0.5

2
 8
F
ADHD, asthma
Nausea, syncope while lying flat
6
Cardiac monitor
115
22
VVI
 1.75

3
 8
F
None
Nausea, syncope while lying flat
4
Cardiac monitor
 75
11
VVI
16

4
 9
F
None
Crying out, abdominal pain
7
Cardiac monitor
150
14
DDD
10

5
13
M
ADHD
Blurry vision and room spinning while eating
1
Event recorder
 75
 7
DDD
1.6

6
15
F
None
Strong emotion, sight of blood
11 
Holter monitor
 75
16
DDD
1.5

ADHD = Attention Deficit Hyperactivity Disorder.

Conclusion: Paroxysmal AV nodal block is a rare finding in pediatric patients, but should be considered as a possible etiology in patients presenting with episodes atypical for vasovagal syncope. Pacemaker therapy prevented future episodes in all six of our patients.
Feasibility of Magnetic Resonance Imaging in Patients with an Implantable Loop Recorder
Authors: WONG JORGE A. , YEE RAYMOND , GULA LORNE J. , SKANES ALLAN C. , ROSS IAN G. , WHITE JAMES B. , KLEIN GEORGE J. , KRAHN ANDREW D.
Published: February 2008

Background: The implantable loop recorder (ILR) is a useful tool in the diagnosis of syncope. Our understanding of their functional and safety profile in interfering environments such as magnetic resonance imaging (MRI) becomes increasingly important as they become more prevalent.

Methods: We report four patients with an ILR who underwent MRI. The ILR memory was cleared before MRI and no changes were made to programmed settings. Device interrogation took place immediately after the scan. Patients were surveyed for device movement and heating, in addition to cardiopulmonary symptoms after their MRI.

Results: Following MRI scanning, all patients were asymptomatic and no device movement or heating was observed. In addition, the functionality of the device remained unaffected. Artifacts mimicking arrhythmias were seen in all ILR patients regardless of the type of MRI scan.

Conclusions: MRI scanning of ILR patients can be performed without harm to patient or device, but artifacts that could be mistaken for a tachyarrhythmia are seen frequently.
Transcatheter Closure of Patent Foramen Ovale in Patients with Paradoxical Embolism. Procedural and Follow‐up Results after Implantation of the Starflex® Occluder Device with Conjunctive Intensified Anticoagulation Regimen
Authors: FISCHER DIETER , FUCHS MARTIN , SCHAEFER ARND , SCHIEFFER BERNHARD , JATEGAONKAR SMITA , HORNIG BURKHARD , DREXLER HELMUT , MEYER GERD P.
Published: February 2008

Background:

Prevalence of patent foramen ovale (PFO) is higher in patients with paradoxical embolism and associated with increased risk for recurrent thromboembolic events. By percutaneous closure of PFO, surgical closure or permanent oral anticoagulation can be avoided. So far, published series included different occluder systems and various indications and regimens of postprocedural anticoagulation. The aim of the present study was to evaluate the short‐ and long‐term results after implantation of the Starflex® occluder in patients with PFO using an intensified anticoagulation regimen.

Methods and Results:

154 patients with PFO (94 men; age: 44 ± 13 years) and >1 thromboembolic event were included. Other causes for embolism were excluded. PFO closure was successful in 147 patients (95.5%). All patients were treated with phenprocoumon (INR 2.5) and aspirin (100 mg/die) for 6 months. Transesophageal echocardiography (TEE) was repeated at 6 months. Mean clinical follow‐up period was 26 ± 18 months.

After 6 months, five patients had a significant residual shunt, and five patients had suspected thrombus formation on the occluder. In three of these five patients, the occluder was surgically removed and foreign body reaction was noted. During follow‐up, nine patients suffered from neurological events (two strokes, seven transient ischemic attacks [TIA]), though complete closure of the PFO was documented by TEE. Two patients died during follow‐up; three patients had bleeding complications.

Conclusion:

Percutaneous closure of PFO in symptomatic patients by Starflex® occluder represents an effective therapy with a low incidence of periinterventional complications and recurrent thromboembolism. However, thrombus formation at the occluder system may occur in some patients despite an aggressive anticoagulation regimen.
Investigation of micronized titanium dioxide penetration in human skin xenografts and its effect on cellular functions of human skin‐derived cells
Authors: Kiss Borbála , Bíró Tamás , Czifra Gabriella , Tóth Balázs I. , Kertész Zsófia , Szikszai Zita , Kiss Árpád Zoltán , Juhász István , Zouboulis Christos C. , Hunyadi János
Published: February 2008

Abstract:  Titanium dioxide (TiO2) nanoparticles are ubiquitously used materials in everyday life (e.g. paints, household products and plastic goods). However, despite the wide array of common applications, their pathogenetic role was also suggested under certain conditions (e.g. pulmonary neoplasias and lung fibrosis). From a dermatological point of view, it is also of great importance that TiO2 also serves as a physical photoprotective agent in sunscreens and is widely used in various cosmetic products. However, the effect of TiO2 on human cutaneous functions is still unknown. Therefore, in the current study, we investigated the in vivo penetration of TiO2 via human skin transplanted to immunodeficient mice and, furthermore, we measured the in vitro effects of nanoparticles on various functional properties of numerous epidermal and dermal cells in culture. Hereby, using various nuclear microscopy methods, we provide the first evidence that TiO2 nanoparticles in vivo do not penetrate through the intact epidermal barrier. However, we also report that TiO2, when exposed directly to cell cultures in vitro, exerts significant and cell‐type dependent effects on such cellular functions as viability, proliferation, apoptosis and differentiation. Therefore, our novel findings will hopefully inspire one to systemically explore in future, clinically oriented trials whether there is indeed a risk from micronized TiO2‐containing products on skin with an impaired stratum corneum barrier function.
Congenital malaria in neonates: two case reports and review of the literature
Authors: Vottier Gaelle , Arsac Marie , Farnoux Caroline , Mariani‐Kurkdjian Patricia , Baud Olivier , Aujard Yannick
Published: February 2008

Congenital malaria is uncommon in nonendemic countries. We describe two cases involving neonates hospitalized with fever, anaemia and thrombocytopaenia. Thick and thin blood smears were positive for Plasmodium vivax (P. vivax) and P. ovale, respectively. These two cases were discussed regarding the literature and potential implications of HIV coinfection in the mother.

Conclusion: Consistent data in the literature suggest that peripheral blood films should be performed in HIV‐positive women who travelled to an endemic area or with a history of malaria prior to gestation. With today's travelling patterns, congenital malaria should be considered as an important differential diagnosis of neonatal sepsis.
Excessive Copper Induces the Production of Reactive Oxygen Species, which is Mediated by Phospholipase D, Nicotinamide Adenine Dinucleotide Phosphate Oxidase and Antioxidant Systems
Authors: Yu Zhong‐Lian , Zhang Jin‐Guang , Wang Xue‐Chen , Chen Jia
Published: February 2008

Tobacco BY‐2 suspension cells were used to study the chemical damage and its associated mechanisms caused by Cu2+. Treatment with 100 μmol/L Cu2+ generated a large amount of H2O2 and thiobarbituric acid‐reactive substances (TBARS) in cells. Using phospholipase D (PLD) specific inhibitor (1‐butanol) or phosphatidic acid (PA), we demonstrated that PLD plays an important role in the generation of H2O2 and TBARS. Semi‐quantitative reverse‐transcriptase polymerase chain reaction and enzyme activity assays with wild type and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase‐overexpressing BY‐2 cells revealed that PLD and PA are the key factors leading to NADPH oxidase activation, which is responsible for H2O2 and TBARS production induced by Cu2+. Moreover, the content of ascorbic acid (AsA), an effective antioxidant, was sharply reduced in BY‐2 cells exposed to excessive Cu2+. Furthermore, a significant downregulation of the enzymes of AsA biosynthesis and the antioxidant system was found. This evidence suggests that excessive Cu2+‐elevated reactive oxygen species (ROS) production is caused by upregulated PLD that elevates the activity of NADPH oxidase and its collapsed antioxidant systems that scavenges ROS.
ADDITION OF SULFAMETHOXAZOLE TO SELECTIVE MEDIA AIDS IN THE RECOVERY OF CAMPYLOBACTER SPP. FROM BROILER RINSES
Authors: LINE J.E. , BAILEY J.S. , BERRANG M.E.
Published: February 2008

The association of Campylobacter spp. with raw poultry products has been well established. Campy‐Line agar (CLA) is a recently developed selective culture medium that allows very few non‐Campylobacter colonies to grow. The few contaminants able to grow on CLA from typical broiler chicken carcass rinses were identified and found to be sensitive to the antimicrobial agent sulfamethoxazole (SMX). The purpose of our experiment was to determine the influence of SMX on recovery of C. jejuni from broiler carcass rinse samples when added to Campy‐Cefex agar or CLA. Cefex and CLA were prepared with and without the addition of 25 mg SMX/L media. Broiler carcass rinse samples (post‐pick, n = 80 and post‐chill, n = 80) were obtained from eight different commercial processors across the United States and were surface plated on the selective agars. Both Cefex and CLA with and without SMX recovered similar populations of Campylobacter; however, significantly fewer contaminants were observed on the Cefex with added SMX and the CLA with or without SMX compared to normal Cefex. The more selective CLA with SMX had no contaminants present from this sample type, which simplified enumeration. Addition of SMX should be considered for increasing selectivity of Campylobacter‐specific media.

PRACTICAL APPLICATIONS

The addition of sulfamethoxazole to Campylobacter‐selective agar can reduce the number of contaminants on the agar and facilitate enumeration of Campylobacter colonies.