bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression and localization of p53 and bcl‐2 in healing wounds in diabetic and nondiabetic mice
Authors: Kane Christine D , Greenhalgh David G
Published: March 2003

In a healing wound, inflammatory cells undergo apoptosis immediately beneath the leading edge of migrating epithelium. A potential mediator of this apoptosis pattern is p53, a protein with antiproliferative effects. Another protein, bcl‐2, is antagonistic to p53 and prevents apoptosis. The purpose of this study was to determine the expression and location of p53 and bcl‐2 mRNA and protein in healing wounds of normal and genetically diabetic mice. At various time points, full‐thickness skin wounds from nondiabetic and diabetic mice were evaluated for p53 and bcl‐2 by immunohistochemistry and in situ hybridization. Apoptosis patterns were also determined using the TUNEL method. Messenger RNA for p53 and bcl‐2 were quantitated by competitive reverse transcriptase‐polymerase chain reaction. Protein and mRNA for p53 were expressed in the leading edge of migrating epithelium, with apoptosis patterns closely following those of p53 production. p53 mRNA levels decreased soon after wounding, but after a few days, levels increased to greater than baseline. bcl‐2 was localized to the wound epithelium, but relative amounts tended to oppose levels of p53, i.e, when p53 increased, bcl‐2 decreased and vice versa. Wounds in diabetic animals showed a delayed onset of p53 mRNA expression but had persistently greater levels for longer periods of time. bcl‐2 mRNA expression was further delayed in diabetic mice and did not develop to levels as high as p53. Production of both proteins was delayed, consistent with the mRNA expression. Our data show that immediately after wounding, bcl‐2 increases and p53 decreases to allow for the cellular proliferation that is required for tissue repair. Over time, bcl‐2 levels decrease while p53 levels increase to shut down the inflammatory process and down‐regulate the proliferative response. Diabetic animals appear to lose the indirect relationship between p53 and bcl‐2. This loss may contribute to the altered apoptosis patterns observed in diabetic healing.
Randomized clinical trial of the effect of semi‐occlusive dressings on the microflora and clinical outcome of acute facial wounds
Authors: Thomas David W , Hill C. Michael , Lewis Michael A. O. , Stephens Phil , Walker Rita , Von Der Weth Andreas
Published: March 2003

This study investigated whether treatment with occlusive, hydroactive polyurethane dressings affects the microflora and clinical outcome of acute wounds. A randomized, controlled trial was performed on 60 patients with acute facial lacerations. Following primary closure, patients were provided with either a dry‐gauze dressing or a hydroactive polyurethane dressing (Cutinova® Thin). The wounds were assessed clinically and microbiologically prior to closure, then after 5, 28 and 56 days. The dressing, which was removed at day 5, was also sent for microbiological culture. Wounds treated with the polyurethane dressing showed improved comfort and contour (p < 0.04), less erythema (p < 0.03) and less potential for scarring (p < 0.01) at day 5. At day 28 and day 56, there were no significant differences in the clinical assessment between the test and control groups (p > 0.05). A total of 518 isolates were recovered from the patients during the study. Mean number of isolates and bacterial growth density were calculated in both groups. A similar range of microorganisms were obtained from both treatment groups with no clear difference in organism colonization. This study shows the potential usefulness of facial wounds as a human model for studying acute wound healing responses and anti‐scarring therapy. While short‐term, clinical benefits of occlusive dressings were evident in the management of acute wounds, these data clearly show that all studies of scarring following acute wounding should extend over at least 3 months post‐injury to allow for spontaneous improvement to occur.
Wound epithelialization deficits in the transforming growth factor‐α knockout mouse
Authors: Kim Injoong , Mogford Jon E , Chao Jerome D , Mustoe Thomas A
Published: March 2003

In vitro, transforming growth factor‐α is an important factor controlling epithelial cell proliferation and migration. However, the transforming growth factor‐α knockout mouse has shown no wound epithelialization defect in tail amputation and full‐thickness back wounds. To resolve this disparity, we combined a full‐thickness head wound and a partial‐thickness ear wound on the transforming growth factor‐α knockout mouse for analysis of wound epithelialization with or without granulation tissue formation. Three‐millimeter ear wounds were made on the transforming growth factor‐α knockout and heterozygous control mice. Full‐thickness head wounds were made using a 6‐mm trephine on the crown of the skull. In the ear model, transforming growth factor‐α knockout mice had significantly larger epithelial gaps versus control at post‐operative day 3 and 5. Epithelial thickness at the wound edge of transforming growth factor‐α deficient mice was also depressed at post‐operative day 3 and post‐operative day 5 compared to control mice. On post‐operative day 8, most wounds of both groups were epithelialized. In contrast, no difference in epithelial gap or new granulation tissue was found in the head model. The data support the concept that transforming growth factor‐α plays a significant early role in wound epithelialization in vivo but its deficit is compensated if accompanied by granulation tissue formation. The data further show the importance of appropriate wound models to address the role of vulnerary factors.
Perfusion of medium improves growth of human oral neomucosal tissue constructs
Authors: NAVARRO FERNANDO A. , MIZUNO SHUICHI , HUERTAS JUAN C. , GLOWACKI JULIE , ORGILL DENNIS P.
Published: March 2003

Tissue engineering of the oral mucosa may be useful in congenital cleft palate repairs, defects following extirpative oncologic surgery, and periodontal disease. One of the limitations of in vitro growth of oral mucosal constructs is central necrosis of 3‐dimensional tissues. We tested the hypothesis that medium perfusion would enhance oral mucosal histogenesis in vitro. Normal human oral keratinocytes were obtained from young to middle‐aged adults. Porous 3‐dimensional matrices were prepared from collagen and chondroitin sulfate with some crosslinked with glutaraldehyde. Each device was seeded with 5.0 × 105 human oral keratinocytes. The seeded matrices were cultured with or without perfusion of medium at 1.3 ml/min. Histologic analysis of samples cultured for 3, 7, or 14 days showed superior viability and proliferation when perfused. At day 7, the average number of cell layers of the neoepithelium of sponges in the perfused culture system (9.4 ± 1.0) was 88% greater than for the nonperfused culture system (5.0 ± 0.9, p<0.005). Glutaraldehyde crosslinking did not influence cellular proliferation or the extent of matrix's shrinkage in either culture system. This study shows that medium perfusion enhanced cell viability and proliferation of human oral keratinocytes cultured in porous 3‐dimensional matrices.
Acceleration of wound contraction and healing with a photocrosslinkable chitosan hydrogel
Authors: ISHIHARA MASAYUKI , ONO KATSUAKI , SATO MASATO , NAKANISHI KUNIAKI , SAITO YOSHIO , YURA HIROFUMI , MATSUI TAKEMI , HATTORI HIDEMI , FUJITA MASANORI , KIKUCHI MAKOTO , KURITA AKIRA
Published: March 2003

Application of ultraviolet light irradiation to a photocrosslinkable chitosan aqueous solution resulted in an insoluble, flexible hydrogel like soft rubber within 60 seconds. In order to evaluate its accelerating effect on wound healing, full‐thickness skin incisions were made on the backs of mice and subsequently a photocrosslinkable chitosan aqueous solution was added into the wound and irradiated with UV light for 90 seconds. Application of the chitosan hydrogel significantly induced wound contraction and accelerated wound closure and healing compared with the untreated controls. Histological examination also showed an advanced contraction rate on the first 2 days and tissue fill rate on days 2 to 4 in the chitosan hydrogel‐treated wounds. Furthermore, in cell culture studies, chitosan hydrogel culture medium supplemented with 5% fetal–bovine serum was found to be chemoattractant for human dermal fibroblasts in an invasion chamber assay using filters coated with Matrigel and in a cell migration assay. Due to its ability to accelerate wound contraction and healing, chitosan hydrogel may become accepted as an occlusive dressing for wound management.
Neonatal rat cartilage has the capacity for tissue regeneration
Authors: WAGNER WOLFGANG , REICHL JOACHIM , WEHRMANN MANFRED , ZENNER HANS‐PETER
Published: March 2003

One of the most relevant issues in future medicine is tissue regeneration. Transplantation medicine alone cannot solve the problem of incurable conditions of vital organs. One approach to this might be the replication of the spontaneous regeneration that is found in embryonic/neonatal tissue. In this study, a tissue model for basic investigation of regeneration mechanisms in vivo was established. We demonstrated by histology and immunohistochemical staining for types I and II collagen that neonatal rat cartilage unlike adult cartilage has the capacity for rapid scarfree regeneration after full‐thickness incision. The underlying mechanism was identified in the preserved proliferative capacity of neonatal chondrocytes. This in vivo model should prove useful in further studies of the role of cellular (e.g., GA cell cycle regulators) and extracellular (e.g., cytokines) factors in tissue regeneration and wound healing.
P–T path of high‐pressure/low‐temperature rocks and tectonic implications in the western Tianshan Mountains, NW China
Authors: Gao  , Klemd  , Zhang  , Wang  , Xiao
Published: March 2003

The Chinese western Tianshan high‐pressure/low‐temperature (HP–LT) metamorphic belt, which extends for about 200 km along the South Central Tianshan suture zone, is composed of mainly metabasic blueschists, eclogites and greenschist facies rocks. The metabasic blueschists occur as small discrete blocks, lenses, bands, laminae or thick beds in meta‐sedimentary greenschist facies country rocks. Eclogites are intercalated within blueschist layers as lenses, laminae, thick beds or large massive blocks (up to 2 km2 in plan view). Metabasic blueschists consist of mainly garnet, sodic amphibole, phengite, paragonite, clinozoisite, epidote, chlorite, albite, accessory titanite and ilmenite. Eclogites are predominantly composed of garnet, omphacite, sodic–calcic amphibole, clinozoisite, phengite, paragonite, quartz with accessory minerals such as rutile, titanite, ilmenite, calcite and apatite. Garnet in eclogite has a composition of 53–79 mol% almandine, 8.5–30 mol% grossular, 5–24 mol% pyrope and 0.6–13 mol% spessartine. Garnet in blueschists shows similar composition. Sodic amphiboles include glaucophane, ferro‐glaucophane and crossite, whereas the sodic–calcic amphiboles mainly comprise barroisite and winchite. The jadeite content of omphacite varies from 35–54 mol%. Peak eclogite facies temperatures are estimated as 480–580 °C for a pressure range of 14–21 kbar. The conditions of pre‐peak, epidote–blueschist facies metamorphism are estimated to be 350–450 °C and 8–12 kbar. All rock types have experienced a clockwise P–T  path through pre‐peak lawsonite/epidote‐blueschist to eclogite facies conditions. The retrograde part of the P–T  path is represented by the transition of epidote‐blueschist to greenschist facies conditions. The P–T  path indicates that the high‐pressure rocks formed in a B‐type subduction zone along the northern margin of the Palaeozoic South Tianshan ocean between the Tarim and Yili‐central Tianshan plates.
Andalusite–sillimanite–quartz veins as indicators of low‐pressure–high‐temperature deformation during late‐stage unroofing of a metamorphic core complex, Turkey
Authors: Whitney  , Dilek
Published: March 2003

Ductilely deformed veins consisting of quartz+andalusite, in which the andalusite is partially replaced by fibrous sillimanite, locally occur in garnet–sillimanite schist near a margin of the Niğde metamorphic core complex in south‐central Turkey. Mineral assemblages, reaction textures and structural features of the veins record low‐pressure–high‐temperature deformation during exhumation of mid‐crustal rocks. The partial replacement of andalusite by sillimanite may indicate a late‐stage increase in temperature and/or fluid pressure, possibly related to Miocene magmatism, during extensional unroofing of the core complex. Aluminosilicate‐bearing veins are observed at the eastern margin of the massif where metapelitic rocks were deformed during unroofing of the core complex. Veins formed in aluminous rocks where deformation‐enhanced permeability allowed fluid flow during extensional shear. The cm‐scale veins are typically boudinaged and form asymmetric lenses concordant with the host rock foliation and are parallel to the down‐dip lineation defined by sillimanite and stretched biotite. Aluminosilicate‐bearing boudins record top‐to‐the‐east shear sense, which is compatible with the extensional shear sense displayed by structures in the host rock.
Metasomatism and self‐organization of dolerite dyke–marble contacts: Beinn an Dubhaich, Skye
Authors: Holness
Published: March 2003

Dolerite dykes which intrude dolomitic marble in the aureole of the Beinn an Dubhaich granite on the Isle of Skye have developed metasomatized margins close to the contact with the (younger) granite in the southern part of Torrin Quarry. These margins display well‐defined mineralogical zones which can be divided into two groups on the basis of composition. Chlorite‐bearing margins display the sequence dolerite | diopside+spinel | chlorite+calcite+magnetite | olivine+calcite+spinel | dolomite, whereas phlogopite‐bearing sequences have a phlogopite+calcite±fluorapatite layer in place of the chlorite‐bearing layer. No spatial pattern is seen in the distribution of the two margin types, but textural and compositional evidence points to an importance of metasomatism by localized infiltration of magmatic fluids in the development of the phlogopite‐bearing sequences. Extensive patterning of the phlogopite‐bearing margins by a process of self‐organization during grain growth has resulted in the formation of alternating silicate‐only/calcite‐only layers parallel to the dyke margin on a millimetre to centimetre scale. Early development of chlorite‐bearing sequences at the dolerite–dolomite contact during contact metamorphism was followed by metasomatism‐controlled growth of phlogopite and patterning at or after the peak of metamorphism associated with the expulsion of aqueous fluids from the crystallizing pluton.
Exhumation of the lower crust during crustal shortening: an Alice Springs (380 Ma) age for a prograde amphibolite facies shear zone in the Strangways Metamorphic Complex (central Australia)
Authors: Ballèvre M. , Möller A. , Hensen B. J.
Published: March 2003

Foliated garnet‐bearing amphibolites occur within the West Bore Shear Zone, cutting through granulite facies gneisses of the Strangways Metamorphic Complex. In the amphibolites, large euhedral garnet (up to 3 cm) occurs within fine‐grained recrystallized leucocratic diffusion haloes of plagioclase–quartz. The garnet and their haloes include a well‐developed vertical foliation, also present in the matrix. This foliation is the same as that cutting through the unconformably overlying Neoproterozoic Heavitree Quartzite. The textures indicate syn‐ to late kinematic growth of the amphibolite facies mineral assemblages.

All mineral assemblages record an arrested prograde reaction history. Noteworthy is the growth of garnet at the expense of hornblende and plagioclase, and the breakdown of staurolite–hornblende to give plagioclase–gedrite. These dehydration reactions indicate increasing P–T  conditions during metamorphism, and suggest heating towards the end of a period of intense deformation. Temperature estimates for the garnet–amphibolite and related staurolite–hornblende assemblages from the shear zone are about 600 °C. Pressure is estimated at about 5 kbar.

An Sm–Nd isochron gives an age of 381±7 Ma for the peak metamorphism and associated deformation. This age determination confirms that amphibolite facies conditions prevailed during shear zone development within the Strangways Metamorphic Complex during the Alice Springs Orogeny. These temperature conditions are significantly higher than those expected at this depth assuming a normal geothermal gradient. The Alice Springs Orogeny was associated with significant crustal thickening, allowing exhumation of the granulite facies, Palaeoproterozoic, lower crust. Along‐strike variations of the tectonic style suggest a larger amount of crustal shortening in the eastern part of the Alice Springs Orogeny.
Mixing properties of phengitic micas and revised garnet‐phengite thermobarometers
Authors: Coggon R. , Holland T. J. B.
Published: March 2003

Mixing properties for muscovite–celadonite–ferroceladonite solid solutions are derived from combining available experimental phase equilibrium data with tabulated thermodynamic data for mineral end‐members. When a partially ordered solution model is assumed, the enthalpy of mixing among the end‐members muscovite–celadonite–ferroceladonite is nearly ideal, although the Gibbs energies of muscovite–celadonite and muscovite–ferroceladonite solutions are asymmetric due to an asymmetry in the entropy of mixing. Thermodynamic consistency is achieved for data on phengite compositions inassemblages with (a) pyrope+kyanite+quartz/coesite (b) almandine+kyanite+quartz/coesite (c)talc+kyanite+quartz/coesite and (d) garnet–phengite pairs equilibrated both experimentally at high temperatures and natural pairs from low‐grade schists. The muscovite–paragonite solvus has been reanalysed using the asymmetric van Laar model, and the effects of the phengite substitution into muscovite have been quantitatively addressed in order to complete the simple thermodynamic mixing model for the solid solution among the mica end‐members. Results are applied to a natural pyrope–coesite–phengite–talc rock from the Western Alps, and to investigate the conditions under which biotite‐bearing mica schists transform to whiteschist‐like biotite‐absent assemblages for average pelite bulk compositions.
Jadeite–chloritoid–glaucophane–lawsonite blueschists in north‐west Turkey: unusually high P/T ratios in continental crust
Authors: Okay A. I.
Published: March 2003

Sodic metapelites with jadeite, chloritoid, glaucophane and lawsonite form a coherent regional metamorphic sequence, several tens of square kilometres in size, and over a kilometre thick, in the Orhaneli region of northwest Turkey. The low‐variance mineral assemblage in the sodic metapelites is quartz + phengite + jadeite + glaucophane + chloritoid + lawsonite. The associated metabasites are characterized by sodic amphibole + lawsonite ± garnet paragenesis. The stable coexistence of jadeite + chloritoid + glaucophane + lawsonite, not reported before, indicates metamorphic pressures of 24 ± 3 kbar and temperatures of 430 ± 30  °C for the peak blueschist facies conditions. These P–T conditions correspond to a geotherm of 5  °C km−1, one of the lowest recorded in continental crustal rocks. The low geotherm, and the known rate of convergence during the Cretaceous subduction suggest low shear stresses at the top of the downgoing continental slab.
Geochemical and stable isotope resetting in shear zones from Täschalp: constraints on fluid flow during exhumation in the Western Alps
Authors: Cartwright I. , Barnicoat A. C.
Published: March 2003

Fluid flow at greenschist facies conditions during exhumation of the western Alps occurred in several penecontemporaneous systems, including shear zones at lithological contacts, deformed contacts between serpentinite bodies and metabasalts, albite veins within metabasalts, and calcite + quartz veins within calcareous schists. Fluid flow in shear zones that juxtapose metasediments and ophiolitic rocks within the Piemonte Unit reset O and H isotope ratios. δ18O values are buffered by the wall rocks; however, calculated fluid δ2H values are similar within all the shear zones suggesting that they formed an interconnected network. The similarity of δ2H values of the sheared rocks and those of unsheared calcareous schists suggests that the fluids were derived from, or had equilibrated with, the schists that envelop the ophiolite rocks. Time‐integrated fluid fluxes at the sheared contacts estimated from changes in Si in metabasalts were up to 105 m3 m−2, with the fluid flowing up temperature driven either by topography or seismic pumping. Individual shear zones were active for c. 2–3 Myr, implying average fluid fluxes of up to 10−9 m3 m−2 s−1. Rocks in shear zones within the ophiolite away from contacts with the metasediments show much less marked isotopic and geochemical changes, implying that fluid volumes decreased into the ophiolite unit, consistent with the source of fluids being the metasediments. Fluids were generated by dehydration reactions that were intersected during exhumation and, while many rocks show the affects of fluid–rock interaction, large‐scale fluid flow between major units was not common.
ACID‐BASE IN RENAL FAILURE: Influence of Diet on Acid‐Base Balance
Authors: Remer Thomas
Published: March 2003

It is well established that diet and certain food components have a clear impact on acid‐base balance. For adults, the following factors are involved: 1) the chemical composition of foods (i.e., their content of protein, chloride, phosphorus, sodium, potassium, calcium, and magnesium), 2) the different intestinal absorption rates of the relevant nutrients, 3) the metabolic generation of sulfate from sulfur‐containing amino acids, 4) the grade of dissociation of phosphorus at the physiologic pH of 7.4, and 5) the ionic valence of calcium and magnesium. All these factors allow us to estimate the potential renal acid load (PRAL) of any given food or diet. The PRAL (calculated for a 24‐hour period), together with a relatively constant daily amount of urinary excreted organic acids (in healthy subjects proportional to body surface area or body weight), yields the daily net acid excretion. This article provides an overview of the current concepts of diet influences on acid‐base balance and also focuses on the underlying physiologic and biochemical basis as well as on relevant clinical implications.
Dialysate Leaks in Peritoneal Dialysis
Authors: Leblanc Martine , Ouimet Denis , Pichette Vincent
Published: March 2003

Dialysate leakage represents a major noninfectious complication of peritoneal dialysis (PD). An exit‐site leak refers to the appearance of any moisture around the PD catheter identified as dialysate; however, the spectrum of dialysate leaks also includes any dialysate loss from the peritoneal cavity other than via the lumen of the catheter. The incidence of dialysate leakage is somewhat more than 5% in continuous ambulatory peritoneal dialysis (CAPD) patients, but this percentage probably underestimates the number of early leaks. The incidence of hydrothorax or pleural leak as a complication of PD remains unclear. Factors identified as potentially related to dialysate leakage are those related to the technique of PD catheter insertion, the way PD is initiated, and weakness of the abdominal wall. The pediatric literature tends to favor Tenckhoff catheters over other catheters as being superior with respect to dialysate leakage, but no consensus on catheter choice exists for adults in this regard. An association has been found between early leaks (≤30 days) and immediate CAPD initiation and perhaps median catheter insertion. Risk factors contributing to abdominal weakness appear to predispose mostly to late leaks; one or more of them can generally be identified in the majority of patients. Early leakage most often manifests as a pericatheter leak. Late leaks may present more subtly with subcutaneous swelling and edema, weight gain, peripheral or genital edema, and apparent ultrafiltration failure. Dyspnea is the first clinical clue to the diagnosis of a pleural leak. Late leaks tend to develop during the first year of CAPD. The most widely used approach to determine the exact site of the leakage is with computed tomography after infusion of 2 L of dialysis fluid containing radiocontrast material. Treatments for dialysate leaks include surgical repair, temporary transfer to hemodialysis, lower dialysate volumes, and PD with a cycler. Recent recommendation propose a standard approach to the treatment of early and late dialysate leaks: 1–2 weeks of rest from CAPD, and surgery if recurrence. Surgical repair has been strongly suggested for leakage causing genital swelling. Delaying CAPD for 14 days after catheter insertion may prevent early leakage. Initiating CAPD with low dialysate volume has also been recommended as a good practice measure.

Although peritonitis and exit‐site infections are the most frequent causes of technical failure in peritoneal dialysis (PD), dialysate leaks represent one of the major noninfectious complications of PD. In some instances, dialysate leakage may lead to discontinuation of the technique (1). Despite its importance, the incidence, risk factors, management, and outcome of dialysate leakage are poorly characterized in the literature. We will review the limited available information on this topic in the next few sections.
Effect of Therapy Time and Frequency on Effective Solute Removal
Authors: Pierratos Andreas
Published: March 2003

Increasing dialysis frequency or time increases the removal of the molecules diffusing slowly across the intercompartmental barriers. By offering frequent dialysis the time on dialysis can be decreased, possibly without worsening the outcome. Increasing dialysis time increases large molecule removal. Increasing in both frequency and time on dialysis increases the removal of solutes of all molecular sizes. Increasing frequency and/or time of dialysis may have many other beneficial effects that are not traditionally quantitated and which can affect outcomes.
The Evolution and Function of Central Venous Catheters for Dialysis
Authors: Ash Stephen R.
Published: March 2003

The use of central venous catheters (CVC) for acute or chronic dialysis has been a relatively recent innovation in Nephrology. The first problem addressed has been how to allow removal and return of blood at high flow rates throughout a dialysis treatment. Four solutions have emerged: place the lumens within the right atrium; place the removal lumen on the insdie of the catheter; use a large catheter size; or provide independent limbs with multiple blood‐entry ports to draw and return blood in all directions. Many other requirements include resistance to infection, especially the passage of organisms around the catheter. A subcutaneous Dacron cuff within a tunnel has successfully accomplished this goal for most chronic CVC dialysis catheters, but other immobilizing devices such as plugs have also been successful. Materials for CVC dialysis catheters have improved, providing strength to allow the catheters to last for several years, with flexibility to avoid vein damage (in general). However, component and material failures still occur, and some materials are incompatible with medications placed at the exit site. CVC for dialysis will remain a necessary choice for many patients beginning and continuing dialysis therapy.
Calciphylaxis: Emerging Concepts in Prevention, Diagnosis, and Treatment
Authors: Wilmer William A , Magro Cynthia M
Published: March 2003

Calciphylaxis is a small vessel vasculopathy involving mural calcification with intimal proliferation, fibrosis, and thrombosis. This syndrome occurs predominantly in individuals with renal failure and results in ischemia and necrosis of skin, subcutaneous fat, visceral organs, and skeletal muscle. The syndrome causes significant morbidity in the form of infection, organ failure, and pain. Mortality rates are high. In individuals with renal failure, risk factors for the development of calciphylaxis include female sex, Caucasian race, obesity, and diabetes mellitus. Many cases occur within the first year of dialysis treatment. Several recent reports demonstrate that prolonged hyperphosphatemia and/or elevated calcium × phosphorus products are associated with the syndrome. Protein malnutrition increases the likelihood of calciphylaxis, as does warfarin use and hypercoagulable states, such as protein C and/or protein S deficiency. Recent advances in diagnostic tools and therapeutic strategies have helped in the management of patients with calciphylaxis.
Tuberculosis and Chronic Renal Disease
Authors: Hussein Magdi M. , Mooij Jaap M. , Roujouleh Haysam
Published: March 2003

There is an increased risk (6.9‐ to 52.5‐fold) of tuberculosis (TB) in patients with chronic renal failure and on dialysis as compared to the general population. The symptomatology in renal patients is often insidious and nonspecific, mimicking uremic symptoms, whereas the localization is often extrapulmonary (most frequently tuberculous lymphadenitis and peritonitis). Tuberculous peritonitis makes up a large part (37%) of the total number of TB cases in continuous ambulatory peritoneal dialysis (CAPD) patients. The prognosis is very much dependent on early diagnosis and treatment. Renal physicians should be aware of the unusual presentation and localization, and include TB in the differential diagnosis of any patient having nonspecific symptoms like anorexia, fever, and weight loss. All efforts should then be made (including invasive investigations) to reach an early diagnosis, a major determinant of the outcome. However, if this is not possible or the result is negative and the diagnosis remains strongly suspected, an empirical trial with anti‐TB medication is justified, especially in endemic areas. In view of the increased prevalence of the disease in the dialysis population, TB prophylaxis is recommended in those patients with a positive tuberculin (Mantoux) skin test and radiographs suggestive of old TB.
Bicalutamide and Flutamide, Each in Combination with Luteinizing Hormone‐Releasing Hormone Analogs, in Advanced Prostate Cancer: Exploratory Analysis of Impact of Extent of Disease by Bone Scan on Outcome
Authors: Soloway Mark S. , Schellhammer Paul F. , Sharifi Rooholloh , Block Norman L. , Venner Peter M. , Patterson A. Lynn , Sarosdy Michael F. , Vogelzang Nicholas J. , Schellenger Julie , Kolvenbag Geert J. C. M. ,   on Behalf of the CASODEX Combination Study Group
Published: March 2003

Objectives: We performed an exploratory analysis to determine whether there was a difference between two antiandrogen‐plus‐luteinizing hormone‐releasing hormone analogs (LHRHas) combinations in patients with minimal or extensive disease.

Materials and Methods: Data from a prospective, randomized, double‐blind study with a median follow‐up of 160 weeks were used to perform an exploratory analysis of outcome with 2 combined androgen blockade regimens in 813 advanced prostate cancer patients based on disease status at entry (minimal or extensive disease). A total of 404 patients received bicalutamide plus LHRHa, and 409 patients received flutamide plus LHRHa. Patients were grouped prospectively by “extent of disease” as determined by bone scan: minimal disease was defined as zero to five lesions, while extensive disease was defined as greater than or equal to six lesions. Patients with no lesions on bone scan (0 lesions) had to have at least one measurable nonskeletal metastasis.

Results: Patients with minimal disease receiving bicalutamide plus LHRHa demonstrated a trend to longer survival as reflected by a hazard ratio (HR) of 0.79 (95% confidence interval 0.59–1.07), but this was not statistically significant. In the extensive disease group, the effects of bicalutamide plus LHRHa and flutamide plus LHRHa on disease progression and survival were similar (HR 0.96 and 0.90, respectively).

Conclusions: Our results are consistent with previously published data demonstrating that patients with stage D2 prostate cancer and minimal disease have a better outcome than patients with extensive disease. In the patients with minimal disease per bone scan, there was a trend toward a benefit for bicalutamide plus LHRHa compared with flutamide plus LHRHa in terms of survival, but not in terms of disease progression.
Bringing the Population into Focus: A Natural Development in Community Health Nursing Practice. Part I.
Authors: Diekemper Margaret , SmithBattle Lee , Drake Mary Ann ,   Margaret Diekemper is an Assistant Professor of Nursing at the Maryville University Nursing Program, St. Louis, Missouri. Mary Ann Drake and Lee SmithBattle are Assistant Professors of Nursing at St. Louis University, St. Louis, Missouri.
Published: March 2003

An interpretive study conducted in a Midwestern metropolitan area was designed to examine expertise in everyday community health nursing (CHN) practice. Twenty‐five nurses from three practice areas (traditional, nontraditional, and program development) participated in group and individual interviews and field observations, sharing stories of their practice. Transcribed interviews and field observation notes were analyzed as a text. One of the major findings of the study focused on experiences of the nurses as they developed the population aspects of their everyday practice. Part I describes the natural development of a population focus of CHN generalists whose care most often targeted individuals and families. The stories of how their practices evolved and were supported by their institutions provided insights into how nurses develop a broad population‐focused practice perspective. Part II examines the practice of those CHN specialists who nurse their target populations from an intentional perspective. Their population‐focused practice, in which they repeatedly displayed what the research team terms multilingual and multiperspectival skills, was solidly based in their prior individual and family‐focused experience and expertise in program planning and evaluation.
The Public Health Nurse in Tornado Relief
Authors: MacMaster Jennie ,   Sarah E. Abrams is the Historical Editor for Public Health Nursing.
Published: March 2003

Editor's Note— The value of using public health nurses in disaster relief work was forcefully argued in an April 1929 article in The Public Health Nurse, written by Elizabeth G. Fox, then director of public health nursing services for the American Red Cross. Fox aimed directly at recruiting public health nurses for service by arguing that there were scarcely any disasters that did not also present “grave health hazards.” She identified two main types of service in which public health nurses might be engaged: care of the sick and injured, and care and protection of refugees in centers or shelters. Caring for the sick included provision of first aid, augmentation of local hospital staff, emergency hospital organization and operation, and home care. But true public health work would be accomplished in temporary shelters. Nurses would assist with inoculation and vaccination; segregate, care for, and supervise individuals with communicable diseases; perform sanitary inspections; refer the severely sick and badly injured to hospitals; and care for those who were ambulatory.

A young public health nurse vividly recounted her experience of those duties described by Elizabeth Fox. Jennie MacMaster cared for residents of the town of Benton, Illinois following a disastrous tornado storm that cut a wide path through the southern part of the state in 1925. Originally published in the July 1929 issue of The Public Health Nurse, the tone of this first of a three‐part series on nursing during times of natural disaster may mildly offend modern sensibilities. The enthusiasm with which MacMaster and her colleagues approached their nursing duties is unmistakable, however. MacMaster's description turned Fox's professional arguments into compelling images and the promise of adventure for the average reader of 1929.
Validating the Safety of Nurse‐Health Advocate Services
Authors: Nacion Karla Witt , Norr Kathleen Fordham , Burnett Glenda Morris , Boyd Cynthia Barnes
Published: March 2003

Prior to promoting the use of community health care advocates for home visits, it is necessary to evaluate their ability to safely screen for health problems. This study examined trained maternal‐child health advocates (MCHAs) who, supervised by professional nurses, conducted maternal‐child home visits consisting of health promotion and problem identification. Problems identified by MCHAs were compared to problems identified by professional, validating nurses, who were not part of the service project, on hypothetical home visit situations and during 213 duplicate home visits. There were no significant differences between MCHAs and professional nurses in their identifications of infant health problems, infant health care deficits, other family members' health problems, prenatal care deficits, emotional problems, and substance abuse on either the hypothetical home visits or the duplicate home visits. The validating nurses identified significantly more women's health problems (p= 0.01) and women's health care deficits (p= 0.02) than the MCHAs on the duplicate home visits. These findings validate the safety of using the model of trained community health advocates teamed with registered nurses to screen for infant health problems during home visits.
A Case Study in Translation Methodology Using the Health‐Promotion Lifestyle Profile II
Authors: Carlson Elizabeth D.
Published: March 2003

Although Hispanics constitute the most rapidly growing segment of the population in the United States, they have received relatively little attention regarding factors affecting their health behaviors and influences. One such factor is the scarcity of reliable and valid Spanish‐language instruments for research with this population. Researchers who attempt to translate an existing instrument into Spanish need to recognize the methodological issues involved in the translation process and psychometric testing. The purpose of this article is to describe the advantages and disadvantages of various translation methodologies, to identify statistical issues in cross‐cultural research, and to provide a case study of the translation process and statistical analysis of a translated instrument. Specifically, this study looks at the development and pilot testing of a Spanish‐language version of the Health‐Promoting Lifestyle Profile II using a randomized convenience sample of 60 bilingual Hispanic individuals.
Evaluation of Telenursing Outcomes: Satisfaction, Self‐Care Practices, and Cost Savings
Authors: Hagan Louise , Morin Diane , Lépine Rachel
Published: March 2003

Info‐Santé CLSC, the Québec telenursing service, is a telephone health line nursing service that was implemented in 1995 in every local community service center (CLSC; n= 141) of 15 regional health authorities in the Province of Québec, Canada. It is, at present, one of the most important first‐line health services and it operates in continuity with the other resources in the health and social service system. Info‐Santé CLSC operates 24 hours a day, 7 days a week, and received more than 2,260,000 calls in 1997. This article will report the findings from the first province‐wide survey of the service, based on a stratified random sample of 4,696 callers. The findings revealed that most respondents were highly satisfied with the service; they followed the nurses' advice and carried out self‐care measures as recommended. Nursing interventions helped respondents feel self‐reliant, like they could solve the same or similar problems should they occur in the future. The vast majority of respondents considered that the call they made to Info‐Santé CLSC was useful in finding a solution to their problems. The vast majority also claimed that they would certainly call Info‐Santé CLSC again should another problem occur. The majority reported they would have turned to another type of resource if Info‐Santé CLSC had not existed; half of the respondents stated that they would have used emergency departments and a third would have consulted a doctor in private practice.
The Effects of Community Health Nurse Monitoring on Hypertension Identification and Control
Authors: Clark Mary Jo , Curran Constance , Noji Ariko
Published: March 2003

Identification and control of hypertension are important public health concerns. Lack of regular health care makes diagnosis and control difficult in some populations. Community health nursing services in settings where clients regularly congregate promote identification and control of hypertension.

This study focused on the effects of community health nursing screening and monitoring services for hypertension provided to participants in a breadline, a senior nutrition program, an English as Second Language (ESL) class, and employees providing these services. Community health nurses (CHNs) provided 2,407 blood pressure‐related service encounters. Blood pressures were elevated in 19% of encounters, and 10% of clients had elevations that warranted referral for medical assistance. At the end of the 18‐month study period, 67% of all clients with elevations and 71% of those referred for medical assistance had achieved normal blood pressures. One‐way analysis of variance indicated a significant relationship between the number of encounters with the nurses and a positive outcome for all clients with elevations. This relationship was not supported for those clients referred to medical assistance.

The effectiveness of intervention appeared to vary somewhat among subgroups with some groups more likely than others to achieve a positive outcome. Group differences in outcome were not statistically significant.
Attitudes, Subjective Norm, Perceived Behavioral Control, and Intentions Related to Adult Smoking Cessation After Coronary Artery Bypass Graft Surgery
Authors: Bursey Mary , Craig Dorothy
Published: March 2003

The purpose of this study was to examine the relationships between intention, attitudes, subjective norm, and perceived behavioral control related to smoking cessation in adults after initial coronary artery bypass graft surgery (CABG). The theoretical framework for the study was derived from Ajzen's Theory of Planned Behavior. Intention, the global and belief‐based measures of attitude, subjective norm, and perceived behavioral control were measured with the Determinants of Adult Smoking Cessation (DOASC) Questionnaire developed by the investigator. Thirty‐two adult smokers completed the questionnaire 2 to 3 weeks following hospital discharge. Four weeks after the questionnaire completion, a follow‐up telephone call was used to determine the participants' current smoking status. The study results indicated that there was a statistically significant relationship between the intention to quit smoking after CABG and the global measure of attitude, and perceived behavioral control. This study highlights some of the beliefs about the outcomes of quitting smoking permanently after CABG which may underlie attitudes, subjective norm, and perceived behavioral control in this population. Implications for theory, practice, and research are discussed.
Continence Efficacy Intervention Program for Community Residing Women with Stress Urinary Incontinence in Japan
Authors: Kim Jeung‐Im
Published: March 2003

Many women in Japan have lived with urinary incontinence (UI). These women are not willing to visit the hospital with their problem of incontinence. Even if the women consent to a hospital visit, continence education is often very limited and patients may immediately stop looking for further treatment. Programs of effective education are needed. The Continence Efficacy Intervention Program (CEIP) was developed for patients and was designed to circumvent many of the obstacles common to stopping exercise.

In this study, a randomized trial was conducted to compare the effectiveness of this program to conventional intervention on exercise continuity. This report describes the study design, intervention program, and outcomes. Subjects were 48 women with stress urinary incontinence (SUI): the mean age was 53.5, the mean weight was 56.6 kg, and the average prevalent year was 6.5 years.

The CEIP phone interviews improved exercise continuity and urine loss symptom. Findings suggest that this intervention program is effective and readily available to the community‐residing women with SUI.
Prevention of Smoking Behaviors in Middle School Students: Student Nurse Interventions
Authors: Miller Marilyn P. , Gillespie Jackie , Billian Ann , Davel Susan
Published: March 2003

This article examines the use of the Tar Wars curriculum with the public health problem of preteen smoking and outlines interventions with a middle school population by community health student nurses from a state university. Smoking is the single most preventable cause of death and disability. Three million people die worldwide each year as a result of smoking. Cigarette smoking has now been labeled a pediatric disease. Estimates are that 3,000 children will begin a lifelong addiction to cigarettes every day. They will face a life of poor quality based on the medical consequences of smoking cigarettes. Mortality from tobacco use is annually greater than that from drug abuse, AIDS, suicide, homicide, and motor vehicle accidents combined. Preteen and teenage smoking is now a public health problem, therefore implications for service learning, nursing advocacy, and interventions with this health problem are discussed.
Factors Influencing Participation of African American Elders in Exercise Behavior
Authors: Walcott‐McQuigg Jacqueline A , Prohaska Thomas R
Published: March 2003

This study was designed to examine factors influencing exercise behavior of older African American adults. Using the Transtheoretical Stages of Change Model and focus group methodology, 103 participants were assigned to gender and stage specific groups of 5 to 12 each. The focus group discussion guide was developed to explore the meaning of health and exercise, and factors that influence exercise behavior for each stage of the model. Responses varied by stage and gender. Men and women alike described health as the ability to remain active and participate in desired activities. The meaning of exercise varied, by stage, from the ability to perform household chores to engaging in aerobic activities. Many factors such as health, social support, efficacy, and motivation influenced the desire and ability to exercise. Women were more likely than men to identify family responsibility as a barrier to participation in exercise activities. Participants identified strategies to recruit and retain African American elders in exercise programs. Findings of the study have implications for health professionals designing exercise health promotion programs for older African American adults in community settings.