bluuebunny/crossref_metadata_2025 huggingface dataset:
PERIZONIUM AND INITIAL VALVE FORMATION IN THE DIATOM NAVICULA CUSPIDATA (BACILLARIOPHYCEAE)1
Authors: Cohn Stanley A. , Spurck Timothy P. , Pickett‐Heaps Jeremy D. , Edgar Lesley A.
Published: October 2004

This paper describes the perizonium and initial valve formation in Navicula cuspidata Kütz., based on light microscope (LM) and scanning electron microscope (SEM) observations. The perizonium consists of concentric over‐lapping bands, laid down sequentially at the tips of the expanding biconical auxospore during its elongation. The central perizonial band has fimbriate edges and is considerably more rigid than the more distal bands. During auxospore elongation and the band secretion, the chloroplasts continuously oscillate between the two ends of the cell; this oscillation ceases once the elongation is complete. The initial valves, formed within the perizonium, are molded into the basically biconical shape of the perizonium except for a central flattening of each valve face. In contrast to the raphes in gametangial and vegetative valves which are surrounded by a smooth axial area, the raphes in initial valves lie within a raised ridge running along the apical axis of the valve. The regular pattern of apically oriented ridges on the outer surface of vegetative valves is also lacking on initial valves. Comparison of pore–pore spacing within striae of gametangial valves, initial values and post‐initial valves (first division and vegetative cells) reveals that the pore–pore distance within striae is conserved at all sexual stages. However, the distance between striae is considerably larger in initial valves than in gametangial and post‐initial valves. Vegetative interstriae spacing as well as the planar morphology of the valve face is regained at the first division of the initial cell. This suggests that the spacing between striae is dependent on the sexual stage of the cell during valve formation (i.e. not directly dependent on the cell size) and can be altered independently of the pore–pore spacing.
COMPARATIVE ANALYSES OF THE DINOFLAGELLATE FLAGELLAR APPARATUS. I. WOLOSZYNSKIA SP.1
Authors: Roberts Keith R. , Timpano Peter
Published: October 2004

The three‐dimensional structure of the flagellar apparatus in Woloszynskia sp. was determined. This recently discovered dinoflagellate possesses two basal bodies that are offset from one another and lie at an angle of approximately 110°. The transverse basal body is associated with a striated fibrous root assemblage that consists of two differently staining fibrous portions with identical striation periodicity. Unlike the transverse striated fibrous roots reported in other dinoflagellates, this assemblage extends to the cell's right beyond the proximal end of the transverse basal body. The striated fibrous root complex is attached to the anterior end of the longitudinal microtubular root by a broad striated fibrous connective. The longitudinal basal body is also associated with the longitudinal microtubular root. The flagellar opening of each emerging axoneme is surrounded by a striated collar. The striated collars are linked to one another by a striated fibrous, striated collar connective. The variations and similarities of the flagellar apparatus and the ventral ridge/striated collar connective in Woloszynskia sp. are compared to similar components in other dinoflagellates.
EFFECTS OF TEMPERATURE, NITROGEN SUPPLY, AND TISSUE NITROGEN ON AMMONIUM UPTAKE RATES OF THE CHLOROPHYTE SEAWEEDS ULVA CURVATA AND CODIUM DECORTICATUM1
Authors: Duke Clifford S. , Litaker Wayne , Ramus J.
Published: October 2004

Nitrogen uptake rates of Ulva curvata (Kütz.) de Toni (Ulvales) and Codium decorticatum (Woodw.) Howe (Caulerpales) grown under several N addition regimes were determined by perturbation and continuous mode techniques, and as N demand, by the product of growth rate and tissue N. Uptake rates are reported as the slope of rate vs. concentration curves in each case. N uptake rates of U. curvata were inversely correlated with tissue N and affected only slightly by temperature. There was no correlation of N uptake rate with tissue N in C. decorticatum. N uptake rates of C. decorticatum were affected by temperature but to a lesser degree than were growth rates. Neither N addition per se nor light affected N uptake capacity of either species. The proximal mechanism for seaweeds accumulation of N at low light and temperatures may be that N uptake is less limited by light and temperature than is growth. This in turn may partially compensate for the effects of reduced light and temperature on growth by increasing pigment and enzyme levels. Perturbation uptake rates were higher than continuous mode or N demand rates in Ulva but not in Codium. N uptake rates of Ulva were higher than those of Codium, but N storage capacities were lower. These two observations suggest that Ulva experiences a fundamentally more variable N supply than does Codium. This is consistent with the clarification of Ulva as an ephemeral form and of Codium as persistent. A seaweed's functional form therefore appears to influence the spectrum of resource variability available to it as well as its ability to persist in the environment.
MANTONIELLAIN ANTARCTIC WATERS INCLUDING THE DESCRIPTION OFM. ANTARCTICASP. NOV. (PRASINOPHYCEAE)1
Authors: Marchant Harvey J. , Buck Kurt R. , Garrison David L. , Thomsen Helge A.
Published: October 2004

We report the finding of two species ofMantoniellafrom the Weddell Sen and Prydz Bay, Antarctica. As well asM. squamata,a cosmopolitan species, we describeM. antarcticasp. nov., the second species in this genus.M. antarcticais covered with two distinctive types of discoid scales. The flagella bear only the smaller of the scale types whereas the cell body has both types, the larger overlying the smaller.
THE WAVELENGTH DEPENDENCE OF MASSIVE CAROTENE SYNTHESIS IN DUNALIELLA BARDAWIL (CHLOROPHYCEAE)1
Authors: Ben‐Amotz Ami , Avron Mordhay
Published: October 2004

Dunaliella bardawil Ben‐Amotz & Avron accumulates high concentrations of β‐carotene when grown under high light intensity. The β‐carotene is composed mainly of 9‐cis and all‐trans β‐carotene. Accumulation of β‐carotene and an increase in the ratio of the 9‐cis to the all‐trans isomer are strongly dependent on the light intensity under which the algae are cultivated but are independent of light quality within the photosynthetically active radiation range. Cells grown under continuous red (>645 nm) or white light of 500 W·m−2 reach a value of about 32 pg β‐carotene·cell−1 and a ratio of 9‐cis to all‐trans β‐carotene of around 2, whereas cells grown under low red or white light intensity of 25 W·m−2 contain about 3 pg·cell−1 and a ratio of isomers of around 0.3.
ULTRASTRUCTURAL OBSERVATIONS OF GYRODINIUM ESTUARIALE (DINOPHYCEAE)1
Authors: Gardiner William E. , Rushing Ann E. , Dawes Clinton J.
Published: October 2004

Gyrodinium estuariale Hulburt has ultrastructural features typical for a dinoflagellate including a particularly well developed pusule and numerous prominent trichocysts. The amphiesma is relatively simple with thecal vesicles containing thecal membranes. The epicone is embellished with two concentric raised ridges reminiscent of the form typical for more heavily thecate genera.
HYPNEA MUSCIFORMIS (RHODOPHYTA): ECOLOGICAL INFLUENCE ON GROWTH1
Authors: Rocilda P. F. Schenkman
Published: October 2004

Seasonal variations in growth, biomass, phenology, and phycocolloid content were studied in a population of Hypnea musciformis (Wulfen in Jacquin) Lamouroux on the coast of the state of São Paulo. H. musciformis grows epiphytically on Sargassaum cymosum C. Agardh in a zone ca. 0.5 m wide at the lower spring tide. It also epiphytizes, but to a lesser extent, Laurencia scoparia J. Agardh and occasionally Bryothamnion seaforthii (Turner) Kützing and Acanthophora spicifera (Vahl) Bargesen. Seawater temperatures vary from 19°C in winter to 29°C in summer.

Variations in H. musciformis biomass (32–190 g dry weight · m−2), were controlled by several factors, notably seawater temperature, diurnal lower spring tides on sunny days accompanied by calm seas soon followed by rough water, and by grazine, especially by Gammaridea (amphipods) and Aplysia (sea‐hares). Fertile tetrasporophytes were present all year, their frequency varying from 22–99%. Cystocarpic plants were rare; male thalli were not found. Carrageenan fields varied from 48–66% of dry weight. Lowest values of carrageenan occurred when sea‐water temperatures were high (26–29° C) and biomass was low or, when biomass was high but frequency of fertile tetrasporophytes was highest. Mean field growth in plastic containers initiated from branches of H. musciformis (ca. 0.1 g) over a 28‐day period was 0.48, 0.88, 1.30, and 1.53 g fresh weight, respectively, from summer to spring.
THE COMPOSITION AND PHYLOGENETIC SIGNIFICANCE OF THE MOUGEOTIA (CHAROPHYCEAE) CELL WALL1
Authors: Hotchkiss Arland T. , Gretz Michael R. , Hicks Kevin B. , Malcolm Brown R.
Published: October 2004

The two‐layered, fibrillar cell wall of Mougeotia C. Agardh sp. consisted of 63.6% non‐cellulosic carbohydrates and 13.4% cellulose. The orientation of cellulose microfibrils in the native cell wall agrees with the multinet growth hypothesis, which has been employed to explain the shift in microfibril orientation from transverse (inner wall) toward axial (outer wall). Monosaccharide analysis of isolated cell walls revealed the presence of ten sugars with glucose, xylose and galactose most abundant. Methylation analysis of the acid‐modified, 1 N NaOH insoluble residue fraction showed that it was composed almost exclusively of 4‐linked glucose, confirming the presence of cellulose. The major hemicellulosic carbohydrate was semi‐purified by DEAE Sephacel (Cl−) anion‐exchange chromatography of the hot 1 N NaOH soluble fraction. This hemicellulose was a xylan consisting of a 4‐xylosyl backbone and 2,4‐xylosyl branch points. The major hot water soluble neutral polysaccharide was identified as a 3‐linked galactan.

Mougeotia cell wall composition is similar to that of (Charophyceae) and has homologies with vascular plant cell walls. Our observations support transtructural evidence which suggests that members of the Charophyceae represent the phylogenetic line that gave rise to vascular plants. Therefore, the primary cell walls of vascular plants many have evolved directly from structures typical of the filamentous green algal cell walls found in the Charophyceae.
INORGANIC CARBON AND ACETATE ASSIMILATION IN BOTRYOCOCCUS BRAUNII(CHLOROPHYTA)1
Authors: Tenaud Mireille , Ohmori Masayuki , Miyachi Shigetoh
Published: October 2004

Assimilation of 14CO2 or 14C‐acetate by the hydrocarbon producing alga Botryococcus braunii Kützing was investigated to determine the allocation of incorporated 14C among early metabolites of photosynthesis and secondary metabolites. When the cells were exposed to NaH14CO3 for 10 sec, over 90% of incorporated 14C was detected in phosphoglycerate, suggesting that this alga assimilates inorganic carbon by the C‐3 pathway. The distribution pattern of 14C in the number of metabolites revealed that organic acids, neutral sugars and amino acids were first labelled with 14C, and, after lag periods of a few minutes, lipids including hydrocarbon were increasingly labelled. Addition of 5 mM acetate to the culture medium did not affect the growth of this alga but enhanced cellular respiration. The incorporation of 14CO2 into the lipid fraction was stimulated, but net photosynthesis was inhibited by the addition of acetate. 14C‐acetate was incorporated into lipids at a very low rate in comparison with the rate of 14CO2 incorporation.
VARIATION IN DIATOM COMMUNITY STRUCTURE AMONG HABITATS IN SANDY STREAMS1
Authors: Stevenson R. Jan , Hashim Shaharum
Published: October 2004

Community structure of benthic diatoms in two sandy streams was studied for two summers to assess differences in abundances and species composition among habitats and between years and streams. The greatest differences in abundances (cells·cm−2) were lower abundances on rocks than on sand, whether the sand was clean or covered with flocculent organic material. Relatively little variation in abundances occurred between years and streams. Species composition of diatom communities varied more among habitats and between streams than from year to year. Species composition was most unique in floc‐covered sand when communities in clean and floc‐covered sand, rock, plant, and plankton were compared. Diatom species composition in these sandy streams was most similar on sand and rocks.
DIGESTION SURVIVAL OF ALGAE: SOME ECOLOGICAL COMPARISIONS BETWEEN FREE SPORES AND PROPAGULES IN FECAL PELLETS1
Authors: Santelices Bernabe , Paya Ignacio
Published: October 2004

Benthic algae survive passage through the digestive tract of different types of grazers, either regenerating new tissues or releasing protoplasts and swarmers which act as accessory means of reproduction to generate new individuals. The ecological importance of this phenomenon is evaluated here by studying spores and fecal pellets. Alga fragments egested alive inside fecal pellets have some ecological advantages over free propagules. In intertidal habitats, the sticky nature of the pellets permits attachment to the substratum while protecting the contained algae from desiccation. In subtidal habitats, the pellets sink 8–22 times faster than the fastest sinking algal propagule. Quantification of swarmers and protoplasts released from algal fragments in the fecal pellets indicates densities of about 217 germlings·cm−2 and values of 300–700 propagules per pellet. Extrapolation of these results to field conditions based on number of grazers and pellets suggest production figures varying from 0.5–3.5 × 105to 1.3–1.5 × 106 propagules·m−2·12 h−1. These values are within known density ranges of settling spores in the field. The ecological significance of the phenomenon may be especially important at seasons when the density of grazers increases and the normal reproductive activity of the algae being consumed decreases.
TAXONOMIC DISTRIBUTION OF COPPER‐ZINC SUPEROXIDE DISMUTASE IN GREEN ALGAE AND ITS PHYLOGENETIC IMPORTANCE1
Authors: de Jesus Marta D. , Tabatabai Farinaz , Chapman David J.
Published: October 2004

Twenty‐nine species of green algae (from four classes: Charophyceae, Chlorophyceae, Pleurastrophyceae, and Ulvophyceae, but not the Micromonadophyceae), five species of bryophytes, and four species of vascular plants were tested for the presence of iron, manganese, and copper‐zinc superoxide dismutase. Copper‐zinc superoxide dismutase was found in members of the Charophyceae, Bryophyta, and Tracheophyta. Manganese and/or iron superoxide dismutase were found in all classes of green algae and most land plants. The presence of the copper‐zinc form of superoxide dismutase only in the class of green algae hypothesized to be closest to the land plant progenitors strengthens the argument for that phylogenetic relationship. It also suggests that this form of superoxide dismutase was a vital attribute for the survival of the earliest land plants.
MULTILAYERED STRUCTURES (MLSs) IN TWO DINOFLAGELLATES, KATODINIUM CAMPYLOPS AND WOLOSZYNSKIA PASCHERI1
Authors: Wilcox Lee W.
Published: October 2004

The multilayered structure (MLS), best‐known from the flagellar apparatus of charophycean green algae and land plant motile cells, is reported for the first time in members of the Dinophyceae. The MLSs in two dinoflagellates, Katodinium campylops (Harris) Fott and Woloszynskia pascheri (Suchlandt) von Stosch, are similar to other MLSs in possessing the microtubular spline and lamellar strip. Also, as in the majority of MLS‐containing organisms, 1) the MLS of each dinoflagellate is closely associated with basal bodies; 2) the spline microtubules possess “keel‐like” extensions and 3) extend beyond the MLS, forming a microtubular rootlet that runs beneath the cell surface in a posterior direction; and 4) a mitochondrion is associated with the MLS (K. campylops only) The size, location, and general construction of the MLSs of K. campylops and W. pascheri suggest that they may be homologous to previously described MLSs.
Minifying Government: The Unintended Consequences of the Bergman Secondary Road Act of 1929*
Authors: Peter Beck J. , Rice Tom W.
Published: October 2004

Objective. In 1929, Iowa adopted the Bergman Secondary Road Act, which transferred control of the state's rural roads from the townships to the counties. This study examines the interesting and potentially important unintended consequences of the law.

Method. We gathered the minutes from 2,275 Iowa township meetings in 20 townships from 1917 to 1950 to investigate the effect of the Bergman Act.

Results. Multiple regression analysis shows that this apparently innocuous Act turned out to have dramatic and unintended consequences on Iowa's township governments. Without responsibility for the roads, township government activity plunged dramatically—the annual number of meetings and the length of those meetings fell by half from 1929 to 1930. The effect of the law on township activity remains substantial even after controlling for competing explanations, such as the onset of the Depression.

Conclusions. The Bergman Act unintentionally caused a sharp drop in township activity and it may have initiated the gradual marginalization of Iowa township governments that continues today. It is even possible that it had a depressing effect on voter turnout in rural Iowa.
Latent semantic analysis as a tool for learner positioning in learning networks for lifelong learning
Authors: Van Bruggen Jan , Sloep Peter , Van Rosmalen Peter , Brouns Francis , Vogten Hubert , Koper Rob , Tattersall Colin
Published: October 2004

As we move towards distributed, self‐organised learning networks for lifelong learning to which multiple providers contribute content, there is a need to develop new techniques to determine where learners can be positioned in these networks. Positioning requires us to map characteristics of the learner onto characteristics  of  learning  materials  and  curricula.  Considering  the  nature of the network envisaged, maintaining data on these characteristics and ensuring their integrity are difficult tasks. In this article we review the usability of Latent Semantic Analysis (LSA) to generate a common semantic framework for characteristics of the learner, learning materials and curricula. Although LSA is a promising technique we identify several research topics that must be addressed before it can be used for learner positioning.
‘Du hast jar keene Ahnung’: African American English dubbed into German
Authors: Queen Robin
Published: October 2004

This paper explores the translation of sociolinguistic variation by examining the ways that African American English (AAE) is dubbed into German. In discussing this ubiquitous yet poorly studied area of language use, I show that ideas about language as an index to social groupings are transferable to the degree that the ideas overlap in the cultures in question. In the case of German, if the character being dubbed is young, male and tied to the street cultures of the urban inner city, then AAE is dubbed using a form of German that has links to the urban youth cultures of north‐central Germany. The transferability of sociolinguistic variation is important to issues related to cross‐cultural communication and the ideologies that may play a role in the outcomes of that communication as well as to linguistic creativity and language style more generally.
ETHICS AND HEALTH SYSTEMS RESEARCH IN ‘POST’‐CONFLICT SITUATIONS
Authors: HILL PETER
Published: October 2004

Although considerable attention has been given to ethical issues related to clinical research in developing countries, in particular related to HIV therapy, there has been limited focus on health systems research, despite its increasing importance in the light of current trends in development assistance. This paper examines ethical issues related to health systems research in ‘post’‐conflict situations, addressing both generic issues for developing countries and those issues specific to ‘post’‐conflict societies, citing examples from the author’s Cambodian experience. It argues that the destruction of health infrastructure results in a loss of structures and processes that would otherwise protect prospective research subjects who are part of vulnerable populations. It identifies the growth of health systems research as part of a trend towards sectoral and programmatic development assistance, the emergence of ‘knowledge generation’ as a form of research linked to development, and the potential for conflict where multilateral and bilateral donors are both primary funders and users of health systems research. It also examines the position of the health system researcher in relation to the sponsors of this research, and the health system being analysed.
THE CURRENT SITUATION OF HEALTH RESEARCH AND ETHICS IN SUDAN
Authors: ELSAYED DYA ELDIN M.
Published: October 2004

At the beginning of the twentieth century, health research in the Sudan developed primarily as a function of the colonial British administration. Ethical issues in the medical profession in the Sudan are governed by the Sudan Medical Council. To address these issues, the Sudan Medical Council issued Medico‐legal and Ethical Guidelines in 1967. This important document has focused principally on ethical issues arising in clinical medicine. Throughout the history of health research in Sudan it is very difficult to find any reference to research ethics. Nevertheless, there have been a few attempts to articulate ethics in health research. In 1979, Sudan witnessed the establishment of the first ethical review committee, which was established by the initiative of a group of doctors and scientists from the national health research laboratory. This committee got neither political nor institutional recognition. Therefore, it was not developed and came to an end shortly after its inception. Yet, in 2000 the FMOH established an ethical review committee (ERC). The functions of this committee were to review proposals of health research to be carried out in the country for ethical issues irrespective to the funding agents. Unfortunately, the committee devoted all the jobs in reviewing only externally‐sponsored health research and research carried out by expatriate researchers or international organisations.
CURRENT TRENDS IN TEACHING ETHICS OF HEALTHCARE PRACTICES
Authors: HATTAB ABDULLA SAEED
Published: October 2004

The unprecedented progress in bio‐medical sciences and technology during the last few decades has resulted in great transformations in the concepts of health and disease, health systems and healthcare organisation and practices. Those changes have been accompanied by the emergence of a broad range of ethical dilemmas that confront health professionals more frequently. The classical Hippocratic ethical principles, though still retaining their relevance and validity, have become insufficiently adequate in an increasing range of problems and situations. Healthcare that has been practised for centuries on the basis of a direct doctor‐patient relationship has been increasingly transformed into a more complex process integrating the health‐team, the patient (healthcare seeker) and the community. Systematic review of the specialised literatures revealed that Healthcare Ethics education has become a basic requirement for any training programme for health professionals, and should cover the different stages of undergraduate, postgraduate and continuing education. Both theoretical foundations and practical skills are required for the appropriate ethical reasoning, ethical attitude and decision‐making abilities. There is growing evidence that physicians’ professional and moral development is not only determined by the formal curriculum of ethics; rather more, it is determined by the moral environment of the professional practice, the ‘hidden curriculum’ which deserves serious consideration by medical education.
Desk–edge syndrome: median nerve injury proximal to the carpal tunnel
Authors: WIGLEY Richard D.
Published: October 2004

Background:  Twelve women working full time as keyboard operators had median nerve entrapment attributable to pressure on the median nerve proximal to the tunnel from resting their wrists on a hard surface in full‐time keyboard work.

Methods:  As all were examined concerning legal dispute on attributability to work, there was extensive documentation dating back 1–15 years. Eleven were recalled for re‐examination.

Results:  Eleven of 12 had reduced sensation of median nerve distribution, including the thenar area supplied by the superficial cutaneous branch which passes over the tunnel. The sensory distribution of the superficial nerve was still affected in 10 of 11 re‐examined. Nerve conduction tests were abnormal in five of six tested. Surgery had not been successful in the eight cases operated on. Eight improved on using soft‐gel wrist‐rests and two on ceasing keyboard work.

Conclusion:  Median nerve injury proximal to the carpal tunnel can simulate CTS but does not respond to carpal release surgery. Involvement of the superficial branch of the nerve distinguishes this syndrome from the conventional CTS. Similar cases should be managed and/or prevented by providing suitable wrist‐rests or typing with the wrists raised.
Epidemiology of low back pain in the United Arab Emirates
Authors: BENER Abdulbari , EL‐RUFAIE Omer F. , SIYAM Abdulrahim , ABUZEID Mohammed S. O. , TOTH Ferenc , LOVASZ Gyorgy
Published: October 2004

Aims:  Low back pain (LBP), a common presenting problem in general practice in the United Arab Emirates (UAE), has received increasing attention in recent decades. We seek to investigate the prevalence of LBP and associated risk factors among people living in the typically hot, humid desert environment of the UAE.

Methods:  A cross‐sectional questionnaire survey was conducted. The setting was the Primary Health Care (PHC) Clinics in Al‐Ain, UAE. The subjects were a multistage stratified sample of 1304 UAE nationals, 15–70 years of age, who attended PHC clinics for any reason. All subjects were invited to participate. The questionnaire used in the survey is a modified version of the Roland‐Morris scale for evaluating low back pain. The questionnaires were administered during face‐to‐face interviews conducted in Arabic by qualified nurses.

Results:  Of the total 1304 subject, 1103 (84.5%) living in both urban and rural areas agreed to participate and responded to the study; 586 (53.1%) were men and 517 (46.9%) women. The mean ages and SD of the subjects were 34.9 ± 13.4 years for the men and 33.5 ± 11.8 years for the women. The prevalence of LBP in the present study was 64.6% (95% CI = 60.7–68.5). The results revealed that there were statistically significant differences between men and women with respect to LBP and body mass index (BMI) (P < 0.001), marital status (P < 0.001), occupational status (P < 0.001), housing condition (P < 0.001), and smoking habits (P < 0.001). Back pain had a greater influence on the lifestyle habits of the women than men. Stepwise multiple regression analysis showed that only BMI (OR = 2.54, 95% CI = 2.30–281; P < 0.001), prolonged standing (OR = 6.22, 95% CI = 4.01–9.67; P < 0.0001), weakness in leg (OR = 2.11, 95% CI = 1.16–3.85; P = 0.0142), lifting heavy weights (OR = 6.34, 95% CI = 4.09–9.84; P = 0.019) regular exercise (OR = 12.47, 95% CI = 7.50–20.71; P < 0.001) and smoking habits (OR = 1.61, 95% CI = 1.08–2.38; P < 0.05) had a significant effect on the presence of LBP in these patients.

Conclusions:  The study showed that the prevalence of back‐related disability was higher among women than men in the UAE. Also, low socio‐economic status and adverse lifestyle habits may constitute risk factors and predictors of LBP.
Multiorgan failure due to rapid occlusive vascular disease in antiphospholipid syndrome: the ‘catastrophic’ antiphospholipid syndrome
Authors: CERVERA Ricard , ASHERSON Ronald A.
Published: October 2004

The term ‘catastrophic’ antiphospholipid syndrome (CAPS) is defined as an accelerated form of antiphospholipid syndrome (APS) usually resulting in multiorgan failure. These patients have in common: (i) clinical evidence of multiple organ involvement developing in a very short time period; (ii) histopathological evidence of multiple small vessel occlusions (a minority also have large vessel thrombosis); and (iii) laboratory confirmation of the presence of antiphospholipid antibodies (aPL), usually in high titres. Although less than 1% of patients with the APS develop this complication, its potentially lethal outcome emphasizes its importance in clinical medicine.
Acupuncture therapy for rheumatoid arthritis
Authors: ZAN‐BAR Tal , ARON Anabel , SHOENFELD Yehuda
Published: October 2004

The current literature on the effects of acupuncture treatment on patients with rheumatoid arthritis (RA) is reviewed. The MEDLINE and Biological Abstracts databases were searched. Studies in which different substances were injected into acupuncture point location were excluded. Improvement of clinical symptoms has been observed in nine studies. In one study, no change was found. Immune responses (values of IL‐2, eythrocyte sedimentation rate, rheumatoid factor, immunoglobulins, leucocyte, natural killer cells, β‐endorphin, CD4, CD8, CD3, and phagocytosis) have been elevated in 14 studies.

Due to the small number of studies (seven studies of RA and acupuncture; six studies of acupuncture and side‐effects of RA treatments; eight studies of acupuncture effect on the immune system), it is recommended that further studies should be conducted, taking into consideration conventional criteria such as sample size and placebo‐controlled groups, as well as complementary criteria, such as Chinese differentiation diagnosis of patients and number of acupoints treated.
Mycophenolate mofetil as treatment for lupus nephritis
Authors: CHAN Tak Mao
Published: October 2004

Advances in immunosuppressive treatment and supportive care over the past few decades have led to improved clinical outcomes in patients with severe lupus nephritis. The management of severe proliferative lupus nephritis can be divided into an initial induction phase followed by a prolonged maintenance phase. Combined use of corticosteroid and cyclophosphamide has been the standard induction therapy, although a significant proportion of patients develop treatment‐related complications such as infection and gonadal failure. While there is general agreement on the immunosuppressive regimen for induction treatment, there is marked variation with regard to maintenance immunosuppressive regimens. The latter is consequent to a paucity of data, since a big sample size and prolonged follow‐up is required for clinical studies that investigate maintenance treatment, in view of the marked heterogeneity in patient characteristics and individual differences in the propensity for relapse. Nevertheless, there is accumulating evidence that a combination of corticosteroid and mycophenolate mofetil can be adopted as effective and well‐tolerated treatment both for induction and for long‐term maintenance in lupus nephritis. Favourable long‐term prognosis can be ensured provided that effective treatment can be instituted early, before irreversible renal parenchymal damage is established.
Double Filtration Plasmapheresis for the Treatment of a Rheumatoid Arthritis Patient with Extremely High Level of C‐reactive Protein
Authors: Matsuda Yukihiro , Tsuda Hiroshi , Takasaki Yoshinari , Hashimoto Hiroshi
Published: October 2004

Abstract:  A 68‐year‐old‐male who was diagnosed as having rheumatoid arthritis (RA) 7 years previously was admitted the Chiba Social Insurance Hospital due to general fatigue, spiking fever, and appetite loss. Blood tests showed extremely high levels of C‐reactive protein (CRP, 318.5 mg/dL), and hypergammapathy (IgG 3228 mg/dL, IgA 905 mg/dL, IgM 2537 mg/dL) and high titers of rheumatoid factor (RAPA 40960X). He was diagnosed as having RA with vasculitis, according to interstitial pneumonitis, cutaneous nodules and polyneuropathy. Prednisolone (30 mg/day) was prescribed, however, myeloperoxidase‐antineutrophil cytoplasmic antibody proved to be positive (86EU) and cyclophosphamide (50 mg/day) was added one week later. Additionally, IgM K‐chain M‐protein was revealed and the differentiation between auto‐immune and hematologic diseases was required for further drug prescriptions. Therefore, double filtration plasmapheresis (DFPP) was initiated weekly. Hematologic diseases were negated and the hypergammapathy was improved. C‐reactive protein and MPO‐ANCA decreased to the normal level after three sessions (IgG 1064 mg/dL, IgA 331 mg/dL, IgM 94 mg/dL, CRP 0.04 mg/dL) and the patients symptoms improved. Prednisolone was tapered and he was discharged. It was suggested that the case presented here was quite rare, having an extremely high level of CRP which was successfully managed   by   DFPP.
Continuous Hemodiafiltration in Pediatric Critical Care Patients
Authors: Shiga Hidetoshi , Hirasawa Hiroyuki , Oda Shigeto , Matsuda Kenichi , Ueno Hirokazu , Nakamura Masataka
Published: October 2004

Abstract:  Continuous hemodiafiltration (CHDF) is an essential procedure in critical care. However, application of this therapy to pediatric patients is associated with several problems derived from their smaller body size and weight compared with adults. We have successfully conducted CHDF in pediatric patients including newborns by taking such problems into consideration and carefully coping with them. The present study consisted of 60 pediatric patients treated with CHDF. Clinical efficacy and safety of CHDF in pediatric patients were assessed in these patients by reviewing patient clinical records. The 60 patients treated with CHDF included 27 males and 33 females. Their body weight ranged from 700 g to 53.0 kg. The mean CHDF duration was 6.80 ± 6.94 days. Blood access was provided in a veno‐venous mode in 42 patients, and an arterio‐venous mode in 18 patients. Of the 60 pediatric patients receiving CHDF, 31 patients survived without serious complications, achieving a survival rate of 51.7%. Successful CHDF in pediatric patients was achieved by careful and exact execution of the following countermeasures to overcome problems specific to application of this therapy to pediatric patients: minimization of the priming volume; use of colloid solutions or whole blood as priming solution; maintaining secure blood access; selection of an appropriate anticoagulant; temperature control of both the patient's body and components of the hemofiltration circuit. In pediatric critical care, CHDF is safely applicable to the critically ill and expected to produce a wide spectrum of clinical efficacy just as in adults.
Peripheral Digit Ischemic Syndrome Can Be a Manifestation of Postoperative Thrombotic Thrombocytopenic Purpura
Authors: Chang Jae C , Ikhlaque Nadeem
Published: October 2004

Abstract:  In addition to common dysfunction of the brain and kidney, thrombotic thrombocytopenic purpura (TTP) may present with atypical clinical features due to the involvement of other organs such as the lung, pancreas, heart, eye, and skin. We have also observed the unusual presentation of peripheral digit ischemic syndrome (PDIS) in some patients with postoperative TTP. To clarify this relationship between TTP and PDIS, the hematologic data from the medical records of patients with known diagnoses of thrombotic microangiopathy (TM) were examined in a single institution. A total of 94 patients were diagnosed with TM. Among these patients, PDIS developed in six patients and in all these patients PDIS occurred with postoperative TTP. Four patients also had acute respiratory distress syndrome (ARDS). Because of delayed diagnosis of TTP, only two patients survived and four died. One patient responded to plasma exchange and survived, and another patient recovered from postoperative TTP without plasma exchange. However, both patients required the amputation of multiple digits. In conclusion, PDIS is another atypical manifestation of TTP and has occurred exclusively in patients with postoperative TTP in this series. Once PDIS developed, the prognosis was poor and amputation of digits was needed in surviving patients. Early recognition of this atypical manifestation of TTP is essential for a favorable outcome.
How Welfare Policies Affect Adolescents' School Outcomes: A Synthesis of Evidence From Experimental Studies
Authors: Gennetian Lisa A. , Duncan Greg , Knox Virginia , Vargas Wanda , Clark‐Kauffman Elizabeth , London Andrew S.
Published: October 2004

Using data from 8 random assignment studies and employing meta‐analytic techniques, this article provides systematic evidence that welfare and work policies targeted at low‐income parents have small adverse effects on some school outcomes among adolescents ages 12 to 18 years at follow‐up. These adverse effects were observed mostly for school performance outcomes and occurred in programs that required mothers to work or participate in employment‐related activities and those that encouraged mothers to work voluntarily. The most pronounced negative effects on school outcomes occurred for the group of adolescents who had a younger sibling, possibly because of the increased home and sibling care responsibilities they assumed as their mothers increased their employment.
Family Relationships and Adolescent Psychosocial Outcomes: Converging Findings From Eastern and Western Cultures
Authors: Dmitrieva Julia , Chen Chuansheng , Greenberger Ellen , Gil‐Rivas Virginia
Published: October 2004

This study investigated the role of parent–adolescent relationships in mediating the association between family‐related negative life events and adolescent depressive symptoms and problem behaviors among 1,696 eleventh graders from the United States (n=201), China (n=502), Korea (n=497), and Czech Republic (n=496). Results indicated that perceived parental involvement and parent–adolescent conflict mediated the link between family‐related life events and adolescent depressed mood. The path from family‐related life events to adolescent problem behaviors was mediated by perceived parental involvement, parent–adolescent conflict, and perceived parental sanctions of adolescent misconduct. With the exception of minor cross‐cultural differences in the magnitude of associations among variables, this study revealed considerable similarity in the association of family factors with adolescent internalizing and externalizing symptomatology. The findings contribute to the growing literature on culture‐general developmental processes.
Can Chest Roentgenogram Predict the Posture Dependent Changes of Atrial Sensing Performance in Patients with a VDD Pacemaker?
Authors: CHOI KEE‐JOON , NAM GI‐BYOUNG , KIM JUN , RHEE KYOUNG‐SUK , KIM YOU‐HO
Published: October 2004

The VDD pacemaker is useful for sequential pacing with a single lead but carries a risk of sensing failure. This study was designed to evaluate the relationship between the relative position of atrial lead and atrial sensitivity in different postures in patients with VDD pacemakers. Atrial sensitivity determination and chest roentgenography was performed in the supine and standing position 3 months after implantation in 25 patients with VDD pacemakers. Measurements of cardiac longitudinal length (from the top of the aortic arch to the diaphragm) and distances from the floating electrode to the upper margin of the seventh thoracic vertebra (D‐T7), to the top of the aortic arch (D‐knob), to the lateral wall of right atrium (D‐wall), and the D‐knob/cardiac longitudinal length (D‐Ratio) were performed. Atrial signal amplitude decreased with the standing compared to the supine position in eight patients (group I) and increased or did not change in the other 17 patients (group II). In group I, the change of the D‐ratio was greater (0.073 vs 0.035, P < 0.01), and the change of the cardiac longitudinal length with standing position was greater (18.4 ± 7.3 vs 12.1 ± 8.8 mm, P < 0.05) than in group II. The change of atrial sensitivity was related to the change of the atrial electrode position with different postures. Decreased atrial‐sensed amplitude was observed in patients who had a greater change in the cardiac longitudinal length while standing. Thus, a decrease in atrial sensitivity with standing may be predicted by the positional changes of the cardiac silhouette on roentgenography before the procedure.
Atrial Signal Amplitude Measurements in VDD Systems According to Body Position
Authors: KUZNIEC JAIRO , GOLOVCHINER GREGORY , MAZUR ALEXANDER , BATTLER ALEXANDER , STRASBERG BORIS
Published: October 2004

Single lead VDD pacing is an established therapy in patients with AV block. Body position may influence the amplitude of the atrial signal recorded through the floating atrial electrode. This study analyzed the degree of posture related variation in the signal amplitude of floating atrial electrodes in 63 patients (mean age 72 ± 21 years) implanted with a VDD system. The average atrial amplitude in the supine position was 1.59 ± 1.15 mV and decreased significantly in the sitting position (1.37 ± 1.08, P < 0.014), right decubitus (1.33 ± 0.83, P < 0.007), and the abdominal position (1.24 ± 0.86, P < 0.001). The left side decubitus showed a nonsignificant increase in atrial amplitude (1.66 ± 1.02, P < 0.64). Body position significantly affects P wave amplitude and may be the cause of intermittent atrial undersensing. P wave amplitude measurement in different body postures should be performed in cases where suspected atrial undersensing occurs.
Relation Between the AH Interval and the Ablation Site in Patients with Atrioventricular Nodal Reentrant Tachycardia
Authors: CHRISTOPH GELLER J. , BIBLO LEE A. , CARLSON MARK D.
Published: October 2004

The determinants of slow pathway conduction in patients with AV nodal reentrant tachycardia (AVNRT) are still unknown, and great differences in the AH interval during slow pathway conduction are observed between patients. In 35 patients with typical AVNRT who underwent successful slow pathway ablation (defined as complete elimination of dual pathway physiology), the A2H2 interval at the “jump” during programmed atrial stimulation and the AH interval during AVNRT (as a reflection of slow pathway conduction time) and the fluoroscopic distance between the successful ablation site and the His‐bundle recording site and between the coronary sinus ostium (CSO) and the His‐bundle recording site were determined. The mean (± SEM) AH interval during slow pathway conduction was 323 ± 12 ms with programmed stimulation and 310 ± 10 ms during AVNRT. The mean number of energy applications was 8 ± 1 (range 1–21). The mean distances between (1) the successful ablation site and the His bundle recording site and (2) between the CSO and the His‐bundle recording site were 24 ± 1 and 28 ± 1 mm in the RAO and 23 ± 1 and 28 ± 1 mm in the LAO projections, respectively. The AH interval during slow pathway conduction correlated significantly with the distance between the successful ablation site and the His‐bundle (P < 0.001) but not with the distance between CSO and His‐bundle recording site. There is a significant correlation between the AH interval during slow pathway conduction and the distance of the successful ablation site from the His bundle. This relationship (1) suggests that, in addition to functional factors, anatomic factors influence slow pathway conduction and (2) may be helpful in determining the initial energy application site during slow pathway ablation.
Pulmonary Vein Stenosis and Remodeling After Electrical Isolation for Treatment of Atrial Fibrillation:
Authors: JIN YUANZHE , ROSS DAVID L. , THOMAS STUART P.
Published: October 2004

Asymptomatic pulmonary vein (PV) stenosis after PV electrical isolation for atrial fibrillation has been reported in several studies and may be due to dynamic factors. The purpose of this study was to determine if PV stenosis progresses after the initial procedure. Consecutive patients (n = 26) requiring repeat procedures for atrial fibrillation recurrence were studied (mean age 55 ± 12 years). Segmental PV potential‐guided ostial ablation was performed with transvenous catheters. Biplane angiographic images were obtained before and after each procedure (52 procedures). Stenoses were found in 14 (16%) of 87 targeted veins immediately after the initial procedures. After 129 ± 94 days no new stenoses were found at the second procedure. PV stenoses were unchanged in 8 previously stenosed veins, slightly deteriorated in 1 vein, improved in 2 veins, and fully resolved in 3 veins. No patients had symptoms attributable to PV stenosis. PV stenosis occurred in 6 (9%) of 68 additional veins at the second procedure. No baseline or procedural characteristics predicted stenosis. Progression of PV stenosis is uncommon in the medium term. Complete or partial resolution of PV stenosis occurs in approximately one third of cases. Absence of PV stenosis after an initial procedure does not ensure PV stenosis will not occur with further ablation in the same vein.
Autonomic Nervous System Changes in Vasovagal Syncope:
Authors: KOCHIADAKIS GEORGE E. , PAPADIMITRIOU EVANGELOS A. , MARKETOU MARY E. , CHRYSOSTOMAKIS STAVROS I. , SIMANTIRAKIS EMMANUEL N. , VARDAS PANOS E.
Published: October 2004

Spectral analysis of heart rate variability was used to compare the changes in autonomic function during tilting in young and older patients with vasovagal syncope. Twenty‐four young (age 28 ± 8 years) and 31 older (56 ± 5 years) patients with unexplained syncope and a positive tilt test and 25 controls (age 48 ± 12 years) were included in the study. Frequency‐domain measurements of the low (LF) (0.06–0.15 Hz) and high (HF) (0.15–0.40 Hz) frequency bands and the ratio of LF to HF were computed from Holter recordings for 4‐minute intervals before and immediately after tilting and just before the end in all groups. Syncopal patients showed a different pattern of response to tilting from controls in all spectral indexes. Young and older patients showed the same pattern of changes in all measurements, even though certain differences were observed. The LF after tilting reduced more in the older (‐20 ± 7% vs ‐14 ± 5%, P < 0.001), while HF reduced more in young patients (‐17 ± 8% vs ‐8 ± 3%, P < 0.001). Young patients showed mainly a cardioinhibitory type (71%) of response whereas a vasodepressor type response predominated (68%) in the older patients. The autonomic nervous system appears to play an important role in the pathophysiological mechanism of vasovagal syncope. This role is similar in young and in older patients and this should be taken into account in the therapeutic approach to the condition. Specific differences between age groups may be related to the type of vasovagal syncope.