bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and diffusion of helmet use at ski areas in Western North America in 2001–02
Authors: Andersen P A , Buller D B , Scott M D , Walkosz B J , Voeks J H , Cutter G R , Dignan M B
Published: December 2004

Objective:The purpose of this study was to examine diffusion of and predictors of helmet use among skiers and snowboarders in the Western United States and Canada.

Design:6400 skiers and snowboarders at 29 ski resorts in the Western United States and Canada were interviewed on chair lifts and observed for helmet use during two consecutive ski seasons (winters 2001 and 2002).

Setting:Skiers and snowboarders were observed and interviewed at 29 ski resorts in Alaska, California, Colorado, Idaho, Montana, New Mexico, Nevada, Oregon, Utah, and British Columbia as part of a sun protection project.

Subjects:Participants completing the survey consisted of 3525 adult skiers and snowboarders in the 2002 season and 2978 adult skiers and snowboarders in the 2001 season.

Main outcome measure:The outcome measure for all analyses was prevalence of helmet use by skiers and snowboarders.

Results:Helmet use by skiers and snowboarders is increasing and is most prevalent among snowboarders, experts, and more frequent skiers/snowboarders. No evidence was found for the hypothesis that helmet use is diffusing more rapidly among earlier adopters of helmets than later adopters.

Conclusions:Although controversy remains, helmets are rapidly diffusing as a safety device at western North American ski resorts. Expert and more frequent skiers and snowboarders are more likely to wear helmets, which may indicate that helmets are recognized as a safety device.
Oesophageal haematoma and associated Mallory-Weiss tear
Authors: Lim C H , Everett S M
Published: December 2004

Intramural oesophageal haematoma is a rare condition that may present as vomiting or haematemesis. Mallory-Weiss tear has been proposed as a possible aetiology but the evidence to support this is circumstantial. A case of oesophageal haematoma associated with evidence of Mallory-Weiss tear on endoscopy that helps to support this hypothesis is presented.
On the epsilon - 0 limit of the Lippmann-Schwinger-Low states
Authors: Menon V J , Dubey Ritesh Kumar
Published: December 2004

The LippmannSchwingerLow (LSL) quantum scattering states involve a resolvent operator depending on an infinitesimal adiabatic parameter ε. We reexamine the LSL formalism by taking the ε → + 0 limit at the end of the analysis (rather than at the outset). It is found that the LSL state vector |ψ kL > does not coincide with the Schrödinger eigen vector in Hilbert space as a whole, and the pair |ψ nL >, |ψ kL > is mutually nonorthogonal if the energy En = Ek, n ≠ k. For this purpose we carefully use a new type of projection operator ηk, a novel nonlinear relation among transition amplitudes, and a separable interaction as illustration. PACS Nos.: 0.3.65.Nk, 0.3.80.+r
LARGE-TIME BEHAVIOR OF SPHERICALLY SYMMETRIC SOLUTIONS TO AN ISENTROPIC MODEL OF COMPRESSIBLE VISCOUS FLUID IN A FIELD OF POTENTIAL FORCES
Authors: NAKAMURA TOHRU , NISHIBATA SHINYA , YANAGI SHIGENORI
Published: December 2004

We study the large-time behavior of a spherically symmetric motion of isentropic and compressible viscous gas in a field of potential force over an unbounded exterior domain in ℝn(n≥2). First, we show the unique existence of a stationary solution satisfying an adhesion boundary condition and a positive spatial asymptotic condition. Then, it is shown that the stationary solution becomes a time asymptotic state to the initial boundary value problem with the same boundary and spatial asymptotic conditions. Here, the initial data can be chosen arbitrarily large if it belongs to the suitable Sobolev space. Moreover, if the external force is attractive to the center of a sphere, it can also be taken arbitrarily large. The proof of the stability theorem is based on computations, executed by using the Lagrangian coordinate. In the proof, it is the essential step to obtain the pointwise estimate for the density. It is derived through employing a representation formula of the density with the aid of the standard energy method. The Hölder regularity of the initial data is also required for translating the results in the Lagrangian coordinate to those in the Eulerian coordinate.
ENTROPIES OF FUZZY INDISCERNIBILITY RELATION AND ITS OPERATIONS
Authors: HU QINGHUA , YU DAREN
Published: December 2004

Yager's entropy was proposed to compute the information of fuzzy indiscernibility relation. In this paper we present a novel interpretation of Yager's entropy in discernibility power of a relation point of view. Then some basic definitions in Shannon's information theory are generalized based on Yager's entropy. We introduce joint entropy, conditional entropy, mutual information and relative entropy to compute the information changes for fuzzy indiscerniblity relation operations. Conditional entropy and relative conditional entropy are proposed to measure the information increment, which is interpreted as the significance of an attribute in fuzzy rough set model. As an application, we redefine independency of an attribute set, reduct, relative reduct in fuzzy rough set model based on Yager's entropy. Some experimental results show the proposed approach is suitable for fuzzy and numeric data reduction.
PROBLEM SOLVING WITH INSUFFICIENT RESOURCES
Authors: WANG PEI
Published: December 2004

A new approach, "controlled concurrency," is introduced for inference control in an adaptive reasoning system working with insufficient knowledge and resources. With this method, a problem-solving process is constructed from atomic steps in run time, according to the system's past experience and the current context. The system carries out many such processes in parallel by distributing its resources among them, and dynamically adjusting the distribution according to feedback. A data structure, "bag," is designed to support this dynamic time-space allocation, and is a kind of probabilistic priority queue. This approach provides a flexible, efficient, and adaptive control mechanism for real-time systems working with uncertain knowledge. To analyze problem solving in such a system, the traditional computability theory and computational complexity theory become inappropriate, because the system no longer follows problem-specific algorithms in problem solving.
ESTIMATION OF WEIBULL PARAMETERS USING A FUZZY LEAST-SQUARES METHOD
Authors: HUNG WEN-LIANG , LIU YUAN-CHEN
Published: December 2004

The purpose of this paper is to find a robust estimation method for a two-parameter Weibull distribution when outliers are present. This is a relevant problem because of the usefulness of the Weibull distribution in life testing and reliability theory. For that purpose, a cluster-wise fuzzy least-squares algorithm with a noise cluster is used. This is because a noise cluster can be used for compensating the effects of outliers. Numerical comparisons between this fuzzy least-squares algorithm and the existing methods are implemented. According to these comparisons, it is suggested that the proposed fuzzy least-squares algorithm is preferable when the sample size is large.
A SPECIAL ISSUE ON "COMPUTATIONAL FINANCE AND ECONOMICS" IMPACT OF IT ON SOME ECONOMICS PROBLEMS
Authors: DENG XIAOTIE , WANG SHOUYANG
Published: December 2004

We present a brief discussion on the impact of information technology on problems from finance and economics. Then, an overview is given upon the papers that are included in the special issue.
XML-BASED DECISION SUPPORT SYSTEMS: CASE STUDY FOR PORTFOLIO SELECTION
Authors: DONG JICHANG , DU HELEN S. , LAI K. K. , WANG SHOUYANG
Published: December 2004

The extensible, structural and validated nature of XML provides standard data representation for efficient data interchange among diverse information resources available on the Web. Therefore, it leads to its growing recognition in e-commerce and Internet-based information exchange. In this paper, we stress the adoption of XML technology in developing efficient and flexible Web-enabled decision support systems. Based on a case study for portfolio selection systems, we explore the design issues in applying XML to overcome the heterogeneity of data exchange and sharing of various portfolio optimization models.
Cardiovascular autonomic control in mice lacking angiotensin AT1a receptors
Authors: Chen Yanfang , Joaquim Luis F. , Farah Vera M. , Wichi Rogério B. , Fazan Rubens , Salgado Helio C. , Morris Mariana
Published: December 2004

Studies examined the role of angiotensin (ANG) AT1a receptors in cardiovascular autonomic control by measuring arterial pressure (AP) and heart rate (HR) variability and the effect of autonomic blockade in mice lacking AT1a receptors (AT1a −/−). Using radiotelemetry in conscious AT1a +/+ and AT1a −/− mice, we determined 1) AP and pulse interval (PI) variability in time and frequency (spectral analysis) domains, 2) AP response to α1-adrenergic and ganglionic blockade, and 3) intrinsic HR after ganglionic blockade. Pulsatile AP was recorded (5 kHz) for measurement of AP and PI and respective variability. Steady-state AP responses to prazosin (1 μg/g ip) and hexamethonium (30 μg/g ip) were also measured. AP was lower in AT1a −/− vs. AT1a +/+, whereas HR was not changed. Prazosin and hexamethonium produced greater decreases in mean AP in AT1a −/− than in AT1a +/+. The blood pressure difference was marked after ganglionic blockade (change in mean AP of −44 ± 10 vs. −18 ± 2 mmHg, AT1a −/− vs. AT1a +/+ mice). Intrinsic HR was also lower in AT1a −/− mice (431 ± 32 vs. 524 ± 22 beats/min, AT1a −/− vs. AT1a +/+). Beat-by-beat series of systolic AP and PI were submitted to autoregressive spectral estimation with variability quantified in low-frequency (LF: 0.1–1 Hz) and high-frequency (HF: 1–5 Hz) ranges. AT1a −/− mice showed a reduction in systolic AP LF variability (4.3 ± 0.8 vs. 9.8 ± 1.3 mmHg2), with no change in HF (2.7 ± 0.3 vs. 3.3 ± 0.6 mmHg2). There was a reduction in PI variability of AT1a −/− in both LF (18.7 ± 3.7 vs. 32.1 ± 4.2 ms2) and HF (17.7 ± 1.9 vs. 40.3 ± 7.3 ms2) ranges. The association of lower AP and PI variability in AT1a −/− mice with enhanced AP response to α1-adrenergic and ganglionic blockade suggests that removal of the ANG AT1a receptor produces autonomic imbalance. This is seen as enhanced sympathetic drive to compensate for the lack of ANG signaling.
Albumin is not an irreplaceable carrier for amphipathic mediators of thermoregulatory responses to LPS: compensatory role of α1-acid glycoprotein
Authors: Ivanov Andrei I. , Steiner Alexandre A. , Patel Shreya , Rudaya Alla Y. , Romanovsky Andrej A.
Published: December 2004

In view of the potential involvement of peripherally synthesized, circulating amphipathic mediators [such as platelet-activating factor (PAF) and prostaglandin E2] in the systemic inflammatory response to lipopolysaccharide (LPS), we hypothesized that transport of amphipaths by albumin is essential for conveying peripheral inflammatory signals to the brain. Our first specific aim was to test this hypothesis by studying LPS-induced fever and hypothermia in Nagase analbuminemic rats (NAR). NAR from two different colonies and normalbuminemic Sprague-Dawley rats were preimplanted with jugular catheters, and their febrile responses to a mild dose of LPS (10 μg/kg iv) at thermoneutrality and hypothermic responses to a high dose of LPS (500 μg/kg iv) in the cold were studied. NAR of both colonies developed normal febrile and hypothermic responses, thus suggesting that transport of amphipathic mediators by albumin is not indispensable for LPS signaling. Although alternative carrier proteins [such as α1-acid glycoprotein (AGP)] are known to assume transport functions of albumin in NAR, it is unknown whether inflammatory mediators are capable of inducing their actions when bound to alternative carriers. To test whether PAF, the most potent amphipathic pyrogen, causes fever when administered in an AGP-bound form was our second aim. Sprague-Dawley rats were preimplanted with jugular catheters, and their thermal responses to infusion of a 1:1 [PAF-AGP] complex (40 nmol/kg iv), AGP (40 nmol/kg iv), or various doses of free (aggregated) PAF were studied. The complex, but neither free PAF nor AGP, caused a high (∼1.5°C) fever with a short (<10 min) latency. This is the first demonstration of a pyrogenic activity of AGP-bound PAF. We conclude that, in the absence of albumin, AGP and possibly other carriers participate in immune-to-brain signaling by binding and transporting amphipathic inflammatory mediators.
Brown adipose tissue thermogenesis contributes to fentanyl-evoked hyperthermia
Authors: Cao Wei-Hua , Morrison Shaun F.
Published: December 2004

μ-Opioid receptor activation increases body temperature and affects cardiovascular function. In the present study, fentanyl was administered intravenously [100 μg/kg (300 nmol/kg) iv] and intracerebroventricularly [3.4 μg (10 nmol) in 10 μl icv] in urethane-chloralose-anesthetized, artificially ventilated rats. Increases in brown adipose tissue (BAT) sympathetic nerve activity (SNA) (peak, +326% of control), BAT temperature (peak, +0.8°C), renal SNA (peak, +146% of control), and heart rate (HR; peak, +32 beats/min) produced by intravenous fentanyl were abolished by premamillary transection of the neuraxis but were mimicked by intracerebroventricular administration of fentanyl, which also increased arterial pressure (AP; peak, +12 mmHg). Pretreatment with the opioid antagonist naloxone (100 nmol in 10 μl icv) eliminated the intracerebroventricular fentanyl-evoked responses. Microinjection of glycine (0.5 M, 60 nl) to inhibit local neurons in the rostral raphe pallidus (RPa) selectively reversed the intracerebroventricular fentanyl-evoked increases in BAT SNA and HR, while the fentanyl-evoked excitation in RSNA, the pressor responses, and the tachycardic responses were reversed by inhibition of neurons in the rostral ventrolateral medulla (RVLM). Prior inhibition of neurons in the dorsomedial hypothalamus eliminated the intracerebroventricular fentanyl-evoked increases in BAT SNA, BAT temperature, and HR, but not those in RSNA or AP. These results indicate that activation of central μ-opioid receptors with fentanyl can elicit BAT thermogenesis and cardiovascular stimulation through excitation of the sympathetic outflows to BAT, kidney, and heart. Activation of neurons in the rostral RPa and RVLM are essential for the increases in BAT thermogenesis and renal sympathoexcitation, respectively, induced by activation of central μ-opioid receptors. BAT thermogenesis could contribute to fentanyl-evoked hyperthermia, particularly in infants where BAT plays a significant role in thermoregulation.
Mechanism of hypertensive nephropathy in the Dahl/Rapp rat: a primary disorder of vascular smooth muscle
Authors: Wang Pei-Xuan , Sanders Paul W.
Published: December 2004

The Dahl/Rapp salt-sensitive (S) rat is a model of salt-sensitive hypertension and hypertensive renal disease. This study explored the role of vascular remodeling in the development of renal failure in S rats. Groups of S and Sprague-Dawley rats were given 0.3 and 8.0% NaCl diets for up to 21 days and evidence of smooth muscle proliferation identified using immunohistochemistry that showed nuclear accumulation of proliferating cell nuclear antigen and 5-bromo-2′-deoxy-uridine. Compared with the other three groups, S rats on 8.0% NaCl diet showed increased nuclear labeling of cells of the aorta and arteries and arterioles of the kidney by the end of the first week of study. Progressive luminal narrowing of the interlobular arteries and preglomerular arterioles occurred in S rats over the 3 wk on the 8.0% NaCl diet. Accumulation of pimonidazole adducts and nuclear accumulation of hypoxia-inducible factor-1α (HIF-1α) were used as markers of tissue hypoxia. By the end of the second week of study, pimonidazole levels increased in S rats on 8.0% NaCl diet and deposition was apparent in tubular cells in the cortex and medulla. At the completion of the experiment, HIF-1α levels were increased in nuclear extracts from the cortex and medulla of S rats on this diet, compared with the other three groups of rats. The data demonstrated a disorder of the vascular remodeling process with proliferation of vascular smooth muscle cells temporally followed by development of tissue hypoxia in the hypertensive nephropathy of S rats on 8.0% NaCl diet.
Improvement of Visual Acuity in Eyes with Diabetic Macular Edema after Treatment with Pars plana Vitrectomy
Authors: Jahn Claus E. , Töpfner von Schütz Kerstin , Richter Joachim , Boller Jürgen , Kron Martina
Published: December 2004

Background: Diabetic macular edema (DME) is the leading cause of severe visual loss in patients with diabetic retinopathy. This is so despite the fact that argon laser photocoagulation of the macula (M-ALC) has been shown to be beneficial. Recently, it has been suggested that pars plana vitrectomy (PPV) can lead to the resolution of DME and stop the deterioration of central visual acuity. Purpose: To explore the potential benefit of PPV for the treatment of DME. Patients and Methods: PPV was carried out in 30 eyes of 21 consecutive patients (median age 71 years, range 61–88 years) with type II diabetes mellitus suffering from DME. 23 eyes had non-proliferative diabetic retinopathy (NPDR) and 7 eyes had proliferative diabetic retinopathy (PDR) in addition to DME. Posterior vitreous detachment had to be carried out in all cases. If epiretinal membranes were present (23 eyes), they were removed. In 13 eyes (initially 11 eyes) the internal limiting membrane (ILM) was also removed. Prior to PPV 8 eyes had received M-ALC. Three eyes had M-ALC after PPV. One eye developed a retinal detachment 6 weeks after PPV and was excluded form the analysis. After an initial treatment failure two eyes underwent repeat PPV with peeling of the ILM. Both eyes of another patient had 2 repeat PPVs because of recurrent vitreous hemorrhage. Median follow-up was 16 months (range 1–62 months). Results: Following PPV the macula flattened or became attached in 20/27 (74%) eyes. 15/18 (83%) eyes showed reduction or disapearance of leakage during fluorescein-angiography. Central visual acuity increased by two to six lines in 15/27 (56%) for the whole group at 6 months after PPV. For the subgroup (18 eyes) for which the evolution of visual acuity prior to PPV could be documented mean and median visual acuity had decreased markedly from 0.26 ± 0.19 resp. 0.2 (range 0.03–0.6) to 0.12 ± 0.09 resp. 0.1 (range 0.02–0.4) during the 12 months preceding PPV and increased to 0.28 ± 0.23 resp. 0.2 (range 0.03–0.8) during the 12 months following PPV. Conclusion: PPV almost always results in a reduction and often complete disappearance of DME as evidenced by ophthalmoscopy and fluorescein-angiography. Most importantly, central visual acuity often increases, sometimes to a very large extent with dramatic improvement in quality of life of the patients.
Cytotoxicity Evaluation of Soft Contact Lens Care Solutions on Human Conjunctival Fibroblasts
Authors: Horwath-Winter J. , Simon M. , Kölli H. , Trummer G. , Schmut O.
Published: December 2004

Purpose: To determine whether different contact lens care solutions for soft lenses cause damage to human conjunctival cells. Methods: Primary cultured human conjunctival fibroblasts were incubated with various concentrations of four different commercially available soft contact lens care solutions (OptiFree®, Renu®, SoloCare®, Titmus®) at concentrations of 5, 10 and 50 µl/ml medium. Toxicity was examined by determination of (1) the cell viability and mitochondrial activity with the colorimetric MTT test, and (2) the number of living cells with a cell analysis system (CASY 1) as compared with untreated cells. Results: For all four soft contact lens care solutions at a concentration of 5 µl/ml medium, no significant decrease in mitochondrial activity of the human conjunctival fibroblasts was found by the MTT test. At 10 µl/ml, only OptiFree and Titmus reduced mitochondrial viability significantly. The greatest reduction in mitochondrial activity occurred with all of the four soft contact lens care solutions at a concentration of 50 µl/ml. No significant decrease in the number of living conjunctival fibroblasts was observed by CASY 1 even at higher concentrations of the four solutions investigated. Conclusion: This in vitro study demonstrates that the examined soft contact lens care solutions induce changes in mitochondria of human conjunctival cells only at higher doses as observed by the MTT test. However, this damage to the mitochondria did not lead to cell death as shown by the cell analysis system.
Development of a Forced Choice Photographic Questionnaire for Photic Phenomena and Its Testing – Repeatability, Reliability and Validity
Authors: Aslam T.M. , Dhillon B. , Tallentire V.R. , Patton N. , Aspinal P.
Published: December 2004

Aim: To design, develop and test a system for analysis of photic phenomena. Method: Extensive background research, patient interviews and theoretical studies led to development of a set of photographic images resembling photic phenomena experienced by patients. These photographic images were processed and digitally altered to create scales of severity for each photic phenomenon in which patients indicated their severity of symptoms by choice of image. The system was tested for stability and validity. Results: The system showed excellent repeatability and reliability. Face, content, criterion and construct validity were all found to be acceptable. Conclusion: The photographic images of photic phenomena analyser is an acceptable, validated measure for the assessment of photic phenomena, in both pseudophakic patients and those with cataract.
Osteogenic Potential of Human Adipose Tissue-Derived Stromal Cells as an Alternative Stem Cell Source
Authors: Hattori Hidemi , Sato Masato , Masuoka Kazunori , Ishihara Miya , Kikuchi Toshiyuki , Matsui Takemi , Takase Bonpei , Ishizuka Toshiaki , Kikuchi Makoto , Fujikawa Kyosuke , Ishihara Masayuki
Published: December 2004

Adult bone marrow contains mesenchymal stem cells (bone marrow-derived mesenchymal stem cells; BMSCs) which contribute to the generation of mesenchymal tissue such as bone, cartilage, muscle and adipose. However, using bone marrow as a source of stem cells has the limitation of a low cell number. An alternate source of adult stem cells that could be obtained in large quantities, under local anesthesia, with minimal discomfort would be advantageous. Human adipose tissue obtained by liposuction was processed to obtain a fibroblast-like population of cells or adipose tissue-derived stromal cells (ATSCs). In this study, we compared the osteogenic differentiation of ATSCs with that of BMSCs. Both cell types were cultured in atelocollagen honeycomb-shaped scaffolds with a membrane seal (ACHMS scaffold) for three-dimensional culturing in a specific osteogenic induction medium. Optimal osteogenic differentiation in both cell types, as determined by alkaline phosphatase cytochemistry, secretion of osteocalcin, mineral (calcium phosphate) deposition and scanning electron microscopy, was obtained with the same three-dimensional culture. Furthermore, osteoblastic lining in vivowas examined using ATSC-seeded or BMSC-seeded scaffolds in nude mice. The present results show that ATSCs have a similar ability to differentiate into osteoblasts to that of BMSCs.
Morphological Features of Tail Bud Development in Truncate Mouse Mutants
Authors: Mitrečić Dinko , Kostović-Knežević Ljiljana , Gajović Srećko
Published: December 2004

A key malformation in the homozygous truncate mouse mutants is a partial lack of the notochord in the embryo tail. In order to analyze if tail bud development was affected by the truncate (tc) mutation, serial semithin sections of tails of the homozygous mutant embryos were compared to the wild-type controls. In the wild-type embryos morphologically uniform mesenchyme of the tail bud was continuous via the medullary cord to the secondary neural tube, and via the tail cord to the notochord and the gut. In truncate embryos the tail cord was not continuous to the notochord, but to the additional lumen of the tail gut resulting in tail gut duplication. Toward the base of the tail two tail guts subsequently fused together or the additional one disappeared. If present in the tip of the tail, the notochord in truncate embryos ended near the ventral border of the secondary neural tube. The rest of the tail notochord was fragmented and the posterior ends of the fragments were frequently adjacent or even continuous to the neural tube. We suggest that the improper regionalization of the tail bud, where notochord is associated with the neural tube rather than with the tail gut, is related to the subsequent segmental lack of the notochord in truncate mutants.
Genotyping of Streptococcus pneumoniae and Haemophilus influenzae Isolated from Paired Middle Ear Fluid and Nasopharynx by Pulsed-Field Gel Electrophoresis
Authors: Hotomi Muneki , Yamanaka Noboru , Billal Dewan S. , Sakai Akihiro , Yamauchi Kazuma , Suzumoto Masaki , Takei Shin , Yasui Noriyo , Moriyama Sotomi , Kuki Kinoyori
Published: December 2004

Twenty-eight isolates of Streptococcus pneumoniae and 30 isolates of Haemophilus influenzae from paired nasopharynx and middle ear fluids of 21 children with acute otitis media (AOM) were evaluated to determine genotypes by polymerase chain reaction and pulsed-field gel electrophoresis (PFGE). Among the 28 isolates of S. pneumonaie, 21 isolates (75.0%) possessed mutations in the pbp1a,pbp2x, and pbp2b genes, and 7 isolates (25%) had mutations in the pbp2x gene. Nineteen isolates (67.9%) expressed the mefE gene, and 5 isolates (17.9%) possessed the ermB gene. Among the 30 isolates of H. influenzae, 5 isolates (16.7%) had mutations in pbp3 genes, 3 isolates (10.0%) produced β-lactamase, and 2 (6.7%) isolates possessed mutations both in the pbp3 gene and the β-lactamase gene. Ten out of the 14 pairs (71.4%) of the restriction fragment patterns of S. pneumoniae from paired nasopharynx and middle ear fluids were indistinguishable following PFGE analysis. The same patterns were identified among 5 children of unrelated families. The restriction fragment patterns of H. influenzae isolated by PFGE were also indistinguishable in 13 out of the 15 pairs (86.7%) of nasopharynx and middle ear fluids. The genetic similarity between nasopharyngeal and middle ear isolates suggests that the causative bacteria migrate from the nasopharynx into the middle ear cavity via the Eustachian tube. Some resistant strains might be prevalent. In children with AOM, the nasopharynx could have been colonized by a virulent strain of bacteria that replaced the benign, commensal bacteria and then progressed to the middle ear, where they caused AOM.
Mycobacterial Cervical Lymphadenitis
Authors: Bayazıt Yıldırım A. , Bayazıt Nurhayat , Namiduru Mustafa
Published: December 2004

Cervical lymphadenitis is the most common head and neck manifestation of mycobacterial infections. The incidence of mycobacterial cervical lymphadenitis has increased. It may be the manifestation of a systemic tuberculous disease or a unique clinical entity localized to neck. It remains a diagnostic and therapeutic challenge because it mimics other pathologic processes and yields inconsistent physical and laboratory findings. A high index of suspicion is needed for the diagnosis of mycobacterial cervical lymphadenitis. A unilateral single or multiple painless lump, mostly located in posterior cervical or supraclavicular region can occur. A thorough history and physical examination, tuberculin test, staining for acid-fast bacilli, radiologic examination, fine-needle aspiration and PCR will be instrumental in arriving at an early diagnosis early institution of treatment before a final diagnosis can be made by biopsy and culture. It is important to differentiate tuberculous from nontuberculous mycobacterial cervical lymphadenitis because their treatment protocols are different. Tuberculous adenitis is best treated as a systemic disease with antituberculosis medication. Atypical infections can be addressed as local infections and are amenable to surgical therapy.
Pathomechanisms of Cystoid Macular Edema
Authors: Bringmann Andreas , Reichenbach Andreas , Wiedemann Peter
Published: December 2004

Cystoid macular edema (CME) is a well-known endpoint of various ocular diseases, but the relative pathogenic impact of extra- and intracellular fluid accumulation within the retinal tissue still remains uncertain. While most authors favor an extracellular fluid accumulation as the main causative factor of cyst formation, there are indications that Müller cell swelling may also contribute to CME development (particularly in cases without significant angiographic vascular leakage). Vascular leakage occurs after a breakdown of the blood-retinal barrier during traumatic, vascular, and inflammatory ocular diseases, and allows the serum to get into the retinal interstitium. Since intraretinal fluid distribution is restricted by two diffusion barriers, the inner and outer plexiform layers, serum leakage from intraretinal vessels causes cysts mainly in the inner nuclear layer while leakage from choroid/pigment epithelium generates (in addition to subretinal fluid accumulation) cyst formation in the Henle fiber layer. In the normal healthy retina, the transretinal water fluxes are mediated by glial and pigment epithelial cells. These water fluxes are inevitably coupled to fluxes of osmolytes; in the case of glial (Müller) cells, to K+ clearance currents. For this purpose, the cells express a complex, microtopographically optimized pattern of transporters and channels for osmolytes and water in their plasma membrane. Ischemic/hypoxic alterations of the retinal microvasculature result in gliotic responses which involve down-regulation of K+ channels in the perivascular Müller cell end-feet. This means a closure of the main pathway which normally generates the osmotic drive for the redistribution of water from the inner retina into the blood. The result is an intracellular K+ accumulation which, then, osmotically drives water from the blood into the glial cells (i.e., in the opposite direction) and causes glial cell swelling, edema, and cyst formation. While the underlying mechanisms await further research, it is expected that their improved knowledge will stimulate the development of novel therapeutic approaches to resolve edema in retinal tissue.
Testicular Lymphoma: Organ-Specific Treatment Did Not Improve Outcome
Authors: Avilés Agustin , Neri Natividad , Huerta-Guzmán Judith , Pérez Felipe , Fernández Raúl
Published: December 2004

Objectives: To assess whether the use of an organ-specific treatment could improve event-free survival (EFS) and overall survival as endpoints in testicular lymphoma in the early stage: IE and IIE. Methods: Thirty-four patients were selected to be treated with orchiectomy following six cycles of anthracycline-based combined chemotherapy and radiotherapy (scrotum and contralateral testis in stage IE, contralateral testis and lymph nodes in stage IIE). Prophylaxis to the central nervous system was administered with four monthly cycles of a high dose of methotrexate: 6 g/m2. Results: Complete response was achieved in 33 cases (97%). However, relapses continue to be the rule; at a median follow-up of 74 months (range 61–120), 21 patients relapsed. Thus, actuarial curves at 5 years were 32% for EFS and 30% for overall survival, because all patients with failure and relapse died of tumor progression. Relapses were observed in uncommon sites: lung, bone marrow and as disseminate disease; no relapses were observed in irradiated sites of the central nervous system. Conclusions: Testicular lymphomas remain a problem as regards defining the optimal treatment. The use of a specific treatment based on organ-involved sites did not show any improvement in outcome. It is evident that more specific therapies need to be explored.
5-Fluorouracil Leucovorin and Oxaliplatin (FOLFOX) in the Treatment of Metastatic Colon Cancer with Severe Liver Dysfunction
Authors: Fakih Marwan G.
Published: December 2004

Colon cancer patients with severe hepatic dysfunction secondary to liver metastases have limited treatment options. 5-Fluorouracil (5-FU) infusional therapy has been attempted, but data suggesting significant clinical benefit are lacking. Although both 5-FU and oxaliplatin have been well tolerated as single agents in patients with severe hepatic dysfunction, the combination of these drugs in this setting has not been investigated. We report on three patients with severe liver dysfunction secondary to metastatic colon cancer treated with a combination of 5-FU, oxaliplatin, and leucovorin (FOLFOX). All three patients tolerated chemotherapy well without any significant toxicity. Liver function tests improved within 2 weeks from the start of treatment. Clinical outcomes consisted of two partial responses and one disease stabilization. Two patients progressed after 4 and 7 months from FOLFOX initiation while treatment is ongoing in the third patient. FOLFOX chemotherapy is feasible and can be associated with positive outcomes in patients with metastatic colon cancer and severe hepatic dysfunction. This regimen should be investigated further in similar clinical settings.
Weekly Combination of Docetaxel and Vinorelbine in Metastatic Breast Cancer: A Phase I/II Study
Authors: Cals L. , Nouyrigat P. , Valenza B. , Pedinelli F.J. , Juin P.
Published: December 2004

Objective: A phase I/II study was carried out to determine the recommended dose (RD) and to assess the efficacy and safety of a weekly docetaxel-vinorelbine combination in advanced breast cancer (ABC) patients. Methods: Twenty-four female patients with histologically proven ABC received intravenous vinorelbine (20 min) followed by intravenous docetaxel (1 h) on days 1, 8 and 15 of a 4-week cycle. Starting doses were 20 mg/m2 docetaxel and 15 mg/m2 vinorelbine. Results: Patients had a median age of 62 years (range 38–74 years), and 92% had performance status 0–1. The most common sites of metastases were the lungs (32%), liver (29%) and bone (14%). Seventy-one percent of patients had received prior chemotherapy. The RDs of docetaxel and vinorelbine were 20 and 15 mg/m2, respectively. Dose-limiting toxicities were neutropenia-induced dose delay and febrile neutropenia. The response rate at the RD was 43%. All responses were seen in non-pretreated patients. Grade 3–4 neutropenia occurred in 80% of patients, 3 of whom experienced febrile neutropenia and died as a possible consequence of neutropenia. Conclusion: This docetaxel-vinorelbine combination as first-line therapy yields a response rate similar to that of single-agent docetaxel as second-line therapy. However, given the high rate of myelotoxicity, higher doses are not feasible.
Hepatocellular Carcinoma with Intra-Atrial Tumor Thrombi
Authors: Chang Jang-Yang , Ka Wann-Shen , Chao Tsu-Yi , Liu Tsang-Wu , Chuang Tsai-Rong , Chen Li-Tzong
Published: December 2004

Background: In patients with advanced hepatocellular carcinoma (HCC), inferior vena cava/intra-right atrial (IVC/RA) tumor thrombi are not uncommon findings and are usually associated with extremely poor outcome. Surgical interventions as well as nonsurgical approaches, such as transcatheter arterial chemoembolization and radiotherapy, have been used in the treatment of patients with symptomatic IVC/RA tumor thrombi. However, such therapeutic modalities are usually not feasible when a patient shows poor general performance, the presence of metastatic disease, and underlying hepatic dysfunction. Such patients show limited survival. Material and Methods: Herein we describe 3 patients with advanced-stage HCC whose IVC/RA tumor thrombi and primary tumors regressed remarkably after low-dose thalidomide (200–400 mg/day) therapy. An Entrez PUBMED search of English Literature articles was performed to identify other cases of RA tumor thrombi in HCC who had received various treatments. Results: Two of our patients survived for more than 15 months after the diagnosis of IVC/RA tumor thrombi, while the other had effective symptomatic palliation associated with a drastic fall of AFP serum levels and significant tumor regression within 4 weeks of thalidomide therapy. A literature review suggested that the survival of our patients is comparable with that of occasional patients who had received aggressive surgical intervention. Conclusions: Our results suggest that, despite the low tumor response rate in earlier studies, thalidomide therapy may sometimes provide effective palliation for patients with far advanced HCC with symptomatic IVC/RA tumor thrombi and who are not candidates for alternative treatment options.
Role of the Receptor-Mediated Apoptosis in Helicobacter pylori in Gastric Epithelial Cells
Authors: Ledig S. , Wagner S. , Manns M.P. , Beil W. , Athmann C.
Published: December 2004

Background and Aims: Two major pathways leading to apoptosis have been described. It has been shown that Helicobacter pylori-mediated apoptosis is mainly effected through the mitochondrial pathway (type II). The role of the type I pathway, including the death receptors, has been discussed controversially. Therefore, we investigated the role of Fas ligand (FasL) and TRAIL in H. pylori-mediated apoptosis by overexpressing antiapoptotic proteins in the human gastric epithelial cell line AGS. Methods: AGS cells overexpressing the antiapoptotic proteins dnFADD, CrmA and Bcl-2 were generated. Apoptosis induced by Fas and H. pylori was monitored by histone ELISA. To investigate the role of TRAIL-mediated apoptosis, AGS cells were transduced with antisense constructs against the proapoptotic TRAIL receptors DR4 and DR5. Protein expression of Fas, TRAIL, DR4, and DR5 was analyzed by Western blot. Results: Fas and H. pylori-mediated apoptosis was significantly inhibited in all generated cell lines, mainly in cells overexpressing CrmA and Bcl-2 with equal effectiveness. In the presence of H. pylori, TRAIL ligand and DR5 receptor were continuously expressed whereas DR4 expression was increasing time dependently. TRAILDR5 antisense significantly reduced H. pylori-mediated apoptosis. Conclusions:H. pylori-mediated apoptosis is characterized by activation of either type I or type II pathway. Caspase-8 plays an important role since it triggers the Type II pathway. Fas and TRAIL play an important role in the H. pylori-mediated apoptosis.
Evolution of Renal Interstitial Inflammation and NF-κB Activation in Spontaneously Hypertensive Rats
Authors: Rodríguez-Iturbe Bernardo , Quiroz Yasmir , Ferrebuz Atilio , Parra Gustavo , Vaziri Nosratola D.
Published: December 2004

Lymphocytes and macrophages infiltrate the kidney of spontaneously hypertensive rats (SHR) and interventions leading to their reduction are associated with improvement of the hypertension. The present studies examined the evolution of the interstitial inflammation in the natural course of the SHR to gain insight on the potential role of interstitial immune cell accumulation in the development of hypertension. We studied SHR and control WKY rats at 3 weeks (SHR-3wk group, n = 11 and WKY-3wk group, n = 10), 11 weeks (SHR-11wk group, n = 5 and WKY-11wk group, n = 5) and 24 weeks (SHR-24wk group, n = 10 and WKY-24wk group, n = 10). The SHR-3wk group was normotensive and older SHR developed hypertension that was severe in the SHR-24wk group. Tubulointerstitial accumulation of lymphocytes, macrophages, angiotensin II-positive cells, cells expressing the p65 DNA-binding subunit of NF-ĸB and activation of NF-ĸB in the kidney were all significantly increased (p < 0.01) in the prehypertensive SHR-3wk group and augmented progressively, with the highest values in the SHR-24wk group. The SHR-24wk group showed increased (p < 0.001) helper (CD4) T cell infiltration and a high CD4/CD8 ratio. These findings are consistent with the possibility that activation of NF-ĸB and renal interstitial infiltration of immune cells may be part of the pathophysiologic process that drives hypertension in the SHR.
Allergy to Pigeon Tick (Argas reflexus): Demonstration of Specific IgE-Binding Components
Authors: Rolla Giovanni , Nebiolo Franco , Marsico Pietro , Guida Giuseppe , Bigo Patrizia , Riva Graziella , Zanotta Stefania
Published: December 2004

Background: The European tick, Argas reflexus, is an urban pest parasitizing urban pigeons and may cause a wide range of allergic reactions. Methods: Specific IgE to A. reflexus, SDS-PAGE and IgE immunoblotting, performed with tick extract, were carried out in the sera of 6 patients who reported allergic reactions after tick bite. Results: Specific IgE to A. reflexus (RAST class ranging from 1 to 3) were detected in the sera of 6 patients who reported allergic reactions (urticaria and angioedema in 2 and anaphylaxis in the other 4 patients) after tick bite. IgE reactivity to two bands of 22 and 40 kDa were identified in the patient sera. Conclusions: Allergy to A. reflexus has to be considered in allergic patients living in buildings where pigeons have their nests. The powerful sensitizing property of tick allergen is underlined by the observation that none of our patients was atopic.
Executive Function Impairment in Community Elderly Subjects with Questionable Dementia
Authors: Lam Linda C.W. , Lui Victor W.C. , Chiu Helen F.K. , Chan Sandra S.M. , Tam Cindy W.C.
Published: December 2004

Background: The neurocognitive profile of community-dwelling Chinese subjects with ‘questionable’ dementia was studied. Methods: One hundred and fifty-four ambulatory Chinese subjects were recruited from local social centers for the elderly. Each subject was examined using the Clinical Dementia Rating (CDR), the Cantonese version of the Mini-Mental State Examination (CMMSE), the Chinese version of the Alzheimer’s Disease Assessment Scale – Cognitive Subscale (ADAS-Cog), the Category Verbal Fluency Test (CVFT), digit and visual span tests, and the Cambridge Neurological Inventory. The neurocognitive profile of nondemented subjects (CDR 0) was compared with that of subjects with ‘questionable’ dementia (CDR 0.5). Results: Subjects with ‘questionable’ dementia were older, and had lower educational levels and global cognitive assessment scores than the controls (CMMSE and ADAS-Cog; t tests, p < 0.001). In addition, they also had significantly lower scores in delayed recall, reverse span, verbal fluency tests and worse performance in complex motor tasks related to executive function (Mann-Whitney tests, p < 0.001). Logistic regression analysis revealed that ADAS-Cog, CVFT, and reverse visual span were significant predictors for the CDR of ‘questionable’ dementia. Conclusion: Aside from memory impairment, executive function deficits were also present in subjects with ‘questionable’ dementia. To identify groups cognitively at risk for dementia, concomitant assessments of memory and executive function are suggested.
Insulin-Like Growth Factor I (IGF-I) and IGF-Binding Protein 3 as Diagnostic Markers of Growth Hormone Deficiency in Infancy
Authors: Jensen Rikke Beck , Jeppesen Katrine Arp , Vielwerth Signe , Michaelsen Kim Fleischer , Main Katharina M. , Skakkebaek Niels E. , Juul Anders
Published: December 2004

Background: The diagnosis of growth hormone deficiency (GHD) in infancy is difficult, and no specific cutoff value during GH provocative testing is recommended in early life. Methods: Serum insulin-like growth factor I (IGF-I) and serum IGF-binding protein 3 (IGFBP-3) levels were evaluated as diagnostic markers of GHD. Measurements of IGF-I and IGFBP-3 during the 1st year of life were analyzed in 11 patients clinically suspected of having GHD (neonatal hypoglycemia, micropenis, or evidence of other pituitary hormone deficiencies), in whom the diagnosis was later verified. A prospective cohort of 51 healthy infants served as controls. Results: The sensitivity of IGF-I as a diagnostic marker of GHD was 90% (10 out of 11 patients) with a cutoff value of –2 standard deviations (SD), and the sensitivity of IGFBP-3 measurements was 81% (9 out of 11 patients) with a cutoff value below –2 SD. One patient had serial measurements before initiation of GH treatment where the IGF-I was fluctuating (3 of 6 slightly above –2 SD), whereas all IGFBP-3 measurements were below –2 SD. Conclusions: The IGF-I had a high sensitivity in detecting infants with GHD. The combination of IGF-I and IGFBP-3 increased the diagnostic sensitivity. We speculate that assessment of IGF-I and IGFBP-3 may add diagnostic value in infants suspected of having GHD and furthermore that values below –2 SD are highly suggestive of GHD.
Vegetable, Fruit, and Cereal Intake and Risk of Idiopathic Pulmonary Fibrosis in Japan
Authors: Miyake Yoshihiro , Sasaki Satoshi , Yokoyama Tetsuji , Chida Kingo , Azuma Arata , Suda Takafumi , Kudoh Shoji , Sakamoto Naomasa , Okamoto Kazushi , Kobashi Gen , Washio Masakazu , Inaba Yutaka , Tanaka Heizo
Published: December 2004

Aims: There has been little interest in the role of nutrition in prevention of idiopathic pulmonary fibrosis (IPF). We investigated the relationship between dietary intake of vegetables, fruit, cereals, antioxidants, and fiber and the risk of IPF in Japan. Methods: Included were 104 cases aged 40 years or over who were within 2 years of the diagnosis in accordance with the most recent criteria. Controls aged 40 years or over comprised 56 hospitalized patients diagnosed as having acute bacterial pneumonia and 4 outpatients with common cold. Information on dietary factors was collected using a validated self-administered diet history questionnaire. Adjustment was made for age, sex, region, pack-years of smoking, employment status, occupational exposure, saturated fatty acid intake, and body mass index. Results: Consumption of fruit in the second and third quartiles was associated with a statistically significant reduced risk of IPF. Although not statistically significant, a beneficial association between soluble fiber intake and IPF was found. No statistically significant dose-response relationship was observed between intake of green and yellow vegetables, other vegetables, cereals, β-carotene, vitamins C and E, or insoluble fiber and the risk of IPF. Conclusion: Our findings suggest that fruit intake may confer protection against the development of IPF.
Stability of the ECG Features of Complete Right Bundle Branch Block over Time: A Methodological Study for Implementation in Research and Clinical Practice
Authors: Madias John E. , Ashtiani Ramin , Agarwal Himanshu , Narayan Virenjan K. , Win Moethu , Sinha Anjan
Published: December 2004

Since research is concentrated to a large extent on patients with left bundle branch block, we aimed at evaluating the hypothesis that measurements of certain intervals and other characteristics of the ECG may change over time in patients with right bundle branch block (RBBB), and to design a model, which could be implemented in research and clinical practice, irrespective of the specific ECG features present. The duration of the QRS complex, QT, QTc, and PR intervals, the frontal QRS axis, the heart rate and the presence of hemiblocks, atrioventricular blocks, and atrial fibrillation were compared in the 1st and last of all available ECGs for each patient. Also, a subgroup of patients who had a ventricular aneurysm (VA) was compared with the remaining patients, with respect to the above variables. This longitudinal analysis included all of the patients with RBBB followed in our Cardiology Clinic. There were no significant changes in the ECG variables from the two ECGs recorded 487.6 ± 410.1 (range 0–1,476) days apart, in the two comparisons carried out in 151 patients with RBBB. Comparison of the above-described ECG intervals and characteristics of patients with RBBB were found to be stable over the time course of the investigation. This methodological study is presented as a model to be used serially and prospectively in research and clinical practice for the follow-up of patients with bundle branch block, VA, dilated cardiomyopathy, congestive heart failure, or those considered for cardiac resynchronization therapy.