bluuebunny/crossref_metadata_2025 huggingface dataset:
Aortic Stenosis in the Elderly
Authors: Saric Muhamed , Kronzon Itzhak
Published: June 2007

Since the incidence of aortic stenosis increases with age, physicians are likely to encounter this valvular disorder with greater frequency as populations continue to age. This paper provides a comprehensive overview of the etiology, natural history, pathophysiology, diagnosis, and management of aortic stenosis in the elderly. Echocardiography is the diagnostic modality of choice, suitable for the serial assessment of disease progression. Cardiac catheterization should be reserved mainly for the evaluation of possible concomitant coronary artery disease prior to cardiac surgery. Aortic valve replacement represents the only proven treatment modality for symptomatic, hemodynamically significant aortic stenosis. Advanced age is not a contraindication for surgery, and valve replacement can be performed in any patient with an acceptable surgical risk.
Ethical Issues in the Management of Geriatric Cardiac Patients
Authors: Basta Lofty , O'Neal Michael L.
Published: June 2007

Ethical Issue: A patient insists on having oral feeding against sure evidence of food aspiration.
Primary Diastolic Heart Failure
Authors: Chatterjee Kanu
Published: June 2007

Diastolic heart failure is defined clinically when signs and symptoms of heart failure are present in the presence of preserved left ventricular systolic function (ejection fraction >45%). The incidence and prevalence of primary diastolic heart failure increases with age and it may be as high as 50% in the elderly. Age, female gender, hypertension, coronary artery disease, diabetes and increased body mass index are risk factors for diastolic heart failure. Hemodynamic consequences such as increased pulmonary venous pressure, post‐capillary pulmonary hypertension, and secondary right heart failure as well as decreased cardiac output are similar to those of systolic left ventricular failure, although the nature of primary left ventricular dysfunction is different. Diagnosis of primary diastolic heart failure depends on the presence of preserved left ventricular ejection fraction. Assessment of diastolic dysfunction is preferable but not mandatory. It is to be noted that increased levels of B‐type natriuretic peptide does not distinguish between diastolic and systolic heart failure. Echocardiographic studies are recommended to exclude hypertrophic cardiomyopathy, infiltrative heart disease, primary valvular heart disease, and constrictive pericarditis. Myocardial stress imaging is frequently required to exclude ischemic heart disease. The prognosis of diastolic heart failure is variable; it is related to age, severity of heart failure, and associated comorbid diseases such as coronary artery disease. The prognosis of severe diastolic heart failure is similar to that of systolic heart failure. However, cautious use of diuretics and/or nitrates may cause hypotension and low output state. Heart rate control is essential to improving ventricular filling. Pharmacologic agents such as angiotensin receptor blockers, angiotensin‐converting enzyme inhibitors, and calcium channel blockers are used in selected patients to decrease left ventricular hypertrophy. To decrease myocardial fibrosis, aldosterone antagonists have a potential therapeutic role. However, prospective controlled studies will be required to establish their efficacy in primary diastolic heart failure.
Indications and Nonindications for Ablation of Atrioventricular Conduction in the Elderly: Is it Sensible to Destroy Normal Tissue?
Authors: Marshall Howard J. , Gammage Michael D.
Published: June 2007

Atrial fibrillation is common in later life. The goals of therapy are maintenance/restoration of sinus rhythm and control of ventricular rate when atrial fibrillation occurs. The only nonpharmacologic therapy of proven benefit is atrioventricular junction ablation and pacing, but this approach is irreversible and requires clear guidelines for patient selection. In paroxysmal atrial fibrillation, ablation and pacing carries a high risk of progression to permanent atrial fibrillation within 6 months but is indicated only when at least two appropriate drug strategies have failed. In persistent atrial fibrillation, ablation and pacing will inevitably result in permanent atrial fibrillation; this may influence the decision for pacemaker type and the timing of the procedure. In permanent atrial fibrillation, there is clear evidence for benefit, especially in those with reduced left ventricular function. In conclusion, ablation and pacing offers symptomatic and functional benefit to patients with drug‐refractory atrial fibrillation. Timing of the intervention relates to response to other pharmacologic therapy.
Atrial Pacing for the Prevention and Termination of Atrial Fibrillation
Authors: Savelieva Irina , Camm John A.
Published: June 2007

Atrial fibrillation (AF) affects about 2% of the general population and 8%–11% of those older than 65 years. The demand for effective therapeutic strategies for AF is anticipated to increase substantially as the proportion of the elderly population increases. Atrioventricular nodal ablation accompanied by permanent pacemaker implantation is an established option in elderly patients with intractable arrhythmia and poor ventricular rate control. However, it renders most patients pacemaker dependent and does not eliminate symptoms associated with loss of atrial transport or reduce the risk of stroke. The considerable limitations of rhythm or rate control strategies prompted interest in preventative atrial pacing, which may reduce the incidence of AF by either eliminating the triggers and/or by modifying the substrate of AF. Atrial or dual‐chamber pacing has been proven to prevent or delay progression to permanent AF in elderly patients with sinus node dysfunction as compared with ventricular pacing. Patients with advanced atrial conduction delay may benefit from ‘atrial resynchronization’ pacing. There may be additional benefits associated with the use of particular sites of pacing, specific pacing algorithms designed to target potential triggers of AF, and pace‐termination of atrial tachycardia. Preventive and antitachycardia pacing algorithms incorporated in implantable cardioverter‐defibrillators and pacemakers are currently under investigation and may offer a valuable alternative to antiarrhythmic drug therapy in elderly patients with left ventricular dysfunction at high risk of proarrhythmia or worsening heart failure. The evolution of ‘hybrid’ therapy, in which two or more different strategies are employed in the same patient, may be the most effective approach to management of AF.
Special Problems With Antiarrhythmic Drug in the Elderly: Safety, Tolerability, and Efficacy
Authors: Dayer Mark , Hardman Suzanna M.C.
Published: June 2007

With advancing age, atrial fibrillation is increasingly likely to indicate underlying cardiovascular disease and risk. An understanding of this is particularly important in the elderly patient, where likely triggers to atrial fibrillation and the influence of other pathologies on the safety and efficacy of proposed treatments will all contribute to optimal care of these patients. It is not yet clear whether rate control or cardioversion to sinus rhythm is the best strategy for the generality of patients with atrial fibrillation, and still less so for individuals. Age and comorbidity add complexities to this decision, which should inform the choice of drugs to be used. Further uncertainties arise from a literature that has often excluded elderly patients and derived its conclusions about mode of drug action from studies undertaken during sinus rhythm rather than atrial fibrillation. Despite these difficulties the careful evaluation of elderly patients with atrial fibrillation and their involvement in relevant choices should ensure optimum treatment for the individual.
Treatment of Hypertension in the Elderly
Authors: Elliott William J. , Black Henry R.
Published: June 2007

Hypertension is a common condition among older people in most developed countries, and is a very important, if not the most important, risk factor for all subtypes of vascular disease and death. Many clinical trials in older people have demonstrated significant reductions in myocardial infarctions and strokes when antihypertensive drugs are provided. Lifestyle modifications are still recommended because they can lower a surrogate end point—blood pressure—but there are no data showing they reduce event rates. It is not appropriate to limit the choice of initial drug for hypertensive older individuals to a single class of agents, since so many older people have other medical problems that affect this decision. Monotherapy with an α blocker, however, is no longer recommended, even for men with hypertension and benign prostatic hypertrophy, as doxazosin was associated with a higher rate of cardiovascular events in the Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial. The classic strategy of an initial diuretic (for at least 1 month) will likely be verified by the final results of ongoing randomized trials, expected in 2003. Until then, this strategy is effective, inexpensive, and unlikely to cause many adverse effects. Probably the most important exhortation, however, should be to achieve the blood pressure goal appropriate for the patient's risk status. Numerous clinical trials in older hypertensive patients have shown that more benefits accrue when the goal blood pressure is achieved than if a specific antihypertensive agent is chosen as initial therapy. Future cardiovascular risk may be related directly to the blood pressure attained, rather than to how it was attained.
Current Practice and Future Promise for Clinical Noninvasive Measurements of Subclinical Atherosclerotic Disease in the Elderly
Authors: Maroo Anjli , O'Donnell Christopher J.
Published: June 2007

The detection, treatment, and follow‐up of subclinical vascular disease are becoming clinically essential components of cardiovascular disease prevention in the elderly. Noninvasive measurements are available for different vascular beds, including carotid, coronary, aortic, and peripheral arterial circulation. Current interest in these measures is aimed at improving the accuracy of risk prediction for coronary heart disease and cardiovascular disease. Indirect physical examination and imaging evaluations detect significant obstruction of flow in the peripheral arteries. Doppler measures of ankle‐arm blood pressure index represent a simple, indirect test that has been shown to be predictive of incident cardiovascular disease independent of risk factors. Newer, high‐resolution tests allow direct detection and quantitation of the burden of atherosclerosis and vascular disease within the arterial wall, independent of flow obstruction. Carotid intimal‐medial thickness predicts incident coronary heart disease and stroke in the elderly, even after adjustment for traditional risk factors. Coronary calcium can be accurately detected by computed tomography and is a strong predictor of the incidence of coronary heart disease events. Evidence is accruing that coronary calcium screening will play a role in prevention in the elderly. Magnetic resonance imaging is currently under study as a promising modality for detection and quantification of aortic and carotid plaque. Ongoing studies will provide important information regarding the appropriate role of the many newer, high‐resolution tests of subclinical atherosclerosis in disease prediction, treatment, and tracking of disease progression in the elderly.
Predictors of Physical Activity in Older Adults in an Independent Living Retirement Community
Authors: Stuart Cheri L. , Marret James , Kelley George A. , Nelson Reid
Published: June 2007

This study was undertaken to examine potential predictors of physical activity in older adults in an independent living retirement community. Participants received a self‐developed questionnaire that included questions regarding age, gender, educational attainment, physical activity habits, and physicians' physical activity counseling habits. One hundred nine of 150 questionnaires (72.7%) were completed and returned. Multivariate regression analyses revealed that younger age (p=0.013), higher educational attainment (p=0.003), positive attitude toward physical activity (p=0.030), and receiving advice from a physician to be physically active (p=0.001) were all positive predictors of increased physical activity. The results demonstrate that younger age, higher educational attainment, a positive attitude toward physical activity, and receiving advice from a physician to be physically active result in increased physical activity levels of older adults in an independent living retirement community.
Angiotensin II (AT1) Redeptor Antagonists, Diabetes, and Nephropathy
Authors: Giles Thomas D. , Sander Gary E.
Published: June 2007

Do Differences Between the Renal and Systemic Circulations Explain the Outcomes Observed With ARBs and ACE Inhibitors?
A novel approach to improving recombinant factor VIIa activity with a preserved platelet preparation
Authors: Campbell Robert A. , Fischer Thomas H. , Wolberg Alisa S.
Published: June 2007

Recombinant activated factor VII (NovoSeven, rFVIIa) is used to abrogate bleeding in haemophiliacs with inhibitors and is hypothesised to work by increasing activated factor X generation on the platelet surface. We hypothesised that rFVIIa activity could be increased by the co‐addition of platelet procoagulant surface. This study characterised the ability of a rehydrated, lyophilised (RL) platelet preparation to increase rFVIIa activity in haemophilic conditions. RL platelets supported thrombin generation in the presence of factors VIII and IX but, in the absence of factors VIII and IX, thrombin generation was significantly reduced. RL platelets supported rFVIIa‐mediated thrombin generation in a rFVIIa‐concentration dependent manner. In a cell‐based in vitro model of haemophilia, the presence of RL platelets increased the rFVIIa‐dependent thrombin generation rate 2.8‐fold compared with rFVIIa alone. Similarly, the addition of RL platelets plus rFVIIa to the in vitro model of haemophilia and to haemophilic platelet‐rich plasma shortened the onset of clot formation and increased clot stability in a fibrinolytic environment versus rFVIIa alone. These results suggest that RL platelets can support rFVIIa‐mediated thrombin generation, and that co‐administration of RL platelets with rFVIIa may increase the efficacy of rFVIIa in some patients.
Angioimmunoblastic T‐cell lymphoma: histological progression associates with EBV and HHV6B viral load
Authors: Zhou Yuanping , Attygalle Ayoma D. , Chuang Shih‐Sung , Diss Tim , Ye Hongtao , Liu Hongxiang , Hamoudi Rifat A. , Munson Philippa , Bacon Chris M. , Dogan Ahmet , Du Ming‐Qing
Published: June 2007

The clinical and histological presentations of angioimmunoblastic T‐cell lymphoma (AITL) often mimic an infectious process. Epstein–Barr virus (EBV) and human herpes virus (HHV6) are known to be associated with AITL, but whether these viral infections play a role in its pathogenesis is unclear. It also remains to be investigated whether there might be other viruses associated with AITL. We first screened 26 well‐characterised cases of AITL for herpesvirus by polymerase chain reaction (PCR) with universal primers and found evidence of only EBV and HHV6B infection. Subsequent PCR using virus‐specific primers demonstrated EBV and HHV6B infection in 40/49 biopsies (36/42 cases) and 21/49 biopsies (19/42 cases) of AITL respectively with both viral infections found in 17/49 specimens (15/42 cases). Importantly, simultaneous infection with both viruses was found only in specimens showing histological pattern II (n = 2) or III (n = 15). Interestingly, among specimens containing both viruses, there was a tendency towards an inverse correlation between the EBV and HHV6B viral load as shown by quantitative PCR. In specimens positive only for EBV, the viral load was significantly higher in specimens with histological pattern III than those with pattern II. High EBV load was also significantly associated with B‐cell monoclonality. Double EBV encoded small RNA (EBER) in situ hybridisation and immunohistochemistry indicated that EBV‐infected B cells had a late postgerminal centre immunophenotype. Our results demonstrate an association between EBV and HHV6B infection and the histological progression of AITL, suggesting that these viruses may play a role in the pathogenesis of this lymphoma.
Association of bone marrow natural killer cell dose with neutrophil recovery and chronic graft‐versus‐host disease after HLA identical sibling bone marrow transplants
Authors: Larghero Jerome , Rocha Vanderson , Porcher Raphael , Filion Alain , Ternaux Brigitte , Lacassagne Marie‐Noelle , Robin Marie , Peffault de Latour Regis , Devergie Agnes , Biscay Nicole , Ribaud Patricia , Benbunan Marc , Gluckman Eliane , Marolleau Jean Pierre , Socié Gerard
Published: June 2007

Allogeneic bone marrow (BM) transplant (BMT) outcomes have been correlated with the infused nucleated, CD34+, and T‐ cell dose. The potential impact of natural killer (NK) BM infused cell dose has however not been established. We analysed the outcomes of 78 patients receiving an HLA identical BMT. A higher NK cell dose was associated with the speed of neutrophil (P = 0·05) and platelet recovery (P = 0·04). Higher nucleated cells, CD34+, CD3+, CD3+/4+, CD3+/8+ and NK cell dose were associated with a lower incidence of chronic GvHD (cGvHD) in univariate analysis. In multivariate analysis, the risk of cGvHD was increased by a lower NK cell dose [hazard ratio (HR) = 2·3 (1·2–4·4) for cell dose <0·9 × 106/kg; P = 0·01] and an older age [HR = 1·4 /10 years (1·1–1·8); P = 0·002]. In addition, a higher CD3+/4+ and NK cell dose were associated with a decreased incidence of viral infections (P = 0·03 and P = 0·06 respectively). No specific cell subpopulation infused dose was associated with survival. In conclusion, a higher BM NK cell dose is associated with an increased speed of neutrophil recovery and a decreased incidence of cGvHD.
TLX1/HOX11 transcription factor inhibits differentiation and promotes a non‐haemopoietic phenotype in murine bone marrow cells
Authors: Dixon Darcelle N. , Izon David J. , Dagger Samantha , Callow Matthew J. , Taplin Ross H. , Kees Ursula R. , Greene Wayne K.
Published: June 2007

The TLX/HOX11 subfamily of divergent homeobox genes are involved in various aspects of embryogenesis and, in the case of TLX1/HOX11 and TLX3/HOX11L2, feature prominently as oncogenes in human T‐cell acute lymphoblastic leukaemia. TLX1 possesses immortalising activity in a wide variety of blood cell lineages, however, the effect of this oncogene on haemopoietic cell differentiation has not been fully investigated. We therefore constitutively expressed TLX1 in murine bone marrow or fetal liver cells using retroviral transfer followed by transplantation and/or in vitro culture. TLX1 was found to dramatically alter haemopoiesis, promoting the emergence of a non‐haemopoietic CD45− CD31+ cell population while markedly inhibiting erythroid and granulocytic cell differentiation. To identify genetic programs perturbed by TLX1, a comparison of transcript profiles from J2E erythroid cells with and without enforced TLX1 expression was undertaken. This revealed a pattern of gene expression indicative of enhanced proliferation coupled to differentiation arrest. Of the genes identified, two, KIT and VEGFC, were found to be potential TLX1 targets based on transcriptional assays. These results demonstrate that TLX1 can act broadly to impair haemopoiesis and divert differentiation to an alternative fate. This may account for its ability to promote the pre‐leukaemic state via perturbation of specific gene expression programs.
Distribution and growth of blue sucker in a Great Plains river, USA
Authors: EITZMANN J. L. , MAKINSTER A. S. , PAUKERT C. P.
Published: June 2007

Abstract  Blue sucker, Cycleptus elongatus (Le Sueur), was sampled in the Kansas River, Kansas, USA to determine how relative abundance varies spatially and growth compares to other populations. Electric fishing was conducted at 36 fixed sites during five time periods from March 2005 to January 2006 to determine seasonal distribution. An additional 302 sites were sampled in summer 2005 to determine distribution throughout the river. A total of 101 blue sucker was collected ranging from 242 to 782 mm total length and 1–16 years old. Higher catch rates were observed in upper river segments and below a low‐head dam in lower river segments, and catch rates were higher during November in the upriver sites. Kansas River blue sucker exhibited slower growth rates than other populations in the Great Plains including populations as far north as South Dakota.
Invaders or endemics? Molecular phylogenetics, biogeography and systematics of Dreissena in the Balkans
Authors: ALBRECHT CHRISTIAN , SCHULTHEIß ROLAND , KEVREKIDIS THEODOROS , STREIT BRUNO , WILKE THOMAS
Published: June 2007

1. Zebra mussels and their relatives (Dreissena spp.) have been well studied in eastern, central and western Europe as well as in North America, because of their invasiveness and economic importance. Much less is known about the biology and biogeography of indigenous (endemic) taxa of Dreissena, in the Balkans. A better knowledge of these taxa could help us (i) understand the factors triggering invasiveness in some taxa and (ii) identify other potentially invasive species.

2. Using a phylogenetic approach (2108 base pairs from three gene fragments), Dreissena spp. from natural lakes in the Balkans were studied to test whether invasive Dreissena populations occur in such lakes on the Balkan Peninsula, whether Dreissena stankovici really is endemic to the ancient Lakes Ohrid and Prespa, and to infer the phylogenetic and biogeographical relationships of Balkan dreissenids.

3. No invasive species of Dreissena, such as Dreissena polymorpha, were recorded. The supposedly ‘endemic’D. stankovici is not restricted to the ancient Lakes Ohrid and Prespa, but is the most widespread and dominant species in the west‐central Balkans. Its southern sister taxon, Dreissena blanci, occurs sympatrically with D. stankovici in Lakes Prespa, Mikri Prespa and Pamvotis. Both species are classified into the subgenus Dreissena (Carinodreissena) of which the subgenus Dreissena (Dreissena) (which includes the invasive D. polymorpha) is the sister taxon. Dreissena blanci and D. stankovici are considered to represent distinct species.

4. On a global scale, the two Balkan species have small ranges. An early Pliocene time frame for the divergence of the subgenera Carinodreissena and Dreissena is discussed, as well as potential colonization routes of the most recent common ancestor of Carinodreissena spp.

5. The ambiguous taxonomy of dreissenids in the Balkans is addressed. As nominal D. blanci presbensis from Lake Prespa has nomenclatural priority over D. stankovici, the correct name for the latter taxon should be Dreissena presbensis.
Morphological clines in dendritic landscapes
Authors: CHAPUT‐BARDY A. , PAYS O. , LODÉ T. , SECONDI J.
Published: June 2007

1. In complex landscapes such as river networks, organisms usually face spatio‐temporal heterogeneity and gradients in geomorphological, water, ecological or landscape characteristics are often observed at the catchment scale. These environmental variables determine developmental conditions for larval stages of freshwater insects and influence adult phenotypic characteristics. Environmental clines are therefore expected to generate morphological clines. Such a process has the potential to drive gradual geographical change in morphology‐dependent life history traits, such as dispersal.

2. We studied the influence of aquatic and terrestrial environmental factors on morphological variations in Calopteryx splendens across the Loire drainage. To investigate these effects we took explicitly into account the hierarchical structure of the river network.

3. We analysed eight morphological traits. Results showed significant body size variation between tributaries and the presence of a morphological cline at the drainage scale. We observed an effect of pH and water temperature on body size. Individuals in downstream sites were larger than individuals in upstream sites, and adults whose larval stages were exposed to alkaline pH and high temperatures during summer were larger.

4. Body size affects flight abilities in insects. Thus, our results suggest that morphological clines may generate an asymmetric dispersal pattern along the downstream–upstream axis, downstream populations dispersing farther than upstream ones. Such a process is expected to influence population genetic structure at the drainage scale if larval drift and floods do not balance an asymmetrical dispersal pattern of adults along the downstream–upstream gradient. To assess the influence of environmental gradients on the variation of life history traits it is important to understand the population biology of freshwater insects, and more generally of riverine organisms. It is also essential to integrate such data in conservation or restoration programmes.
Bayesian inference of the Cole–Cole parameters from time‐ and frequency‐domain induced polarization
Authors: Ghorbani A. , Camerlynck C. , Florsch N. , Cosenza P. , Revil A.
Published: June 2007

The inversion of induced‐polarization parameters is important in the characterization of the frequency electrical response of porous rocks. A Bayesian approach is developed to invert these parameters assuming the electrical response is described by a Cole–Cole model in the time or frequency domain. We show that the Bayesian approach provides a better analysis of the uncertainty associated with the parameters of the Cole–Cole model compared with more conventional methods based on the minimization of a cost function using the least‐squares criterion. This is due to the strong non‐linearity of the inverse problem and non‐uniqueness of the solution in the time domain. The Bayesian approach consists of propagating the information provided by the measurements through the model and combining this information with a priori knowledge of the data. Our analysis demonstrates that the uncertainty in estimating the Cole–Cole model parameters from induced‐polarization data is much higher for measurements performed in the time domain than in the frequency domain. Our conclusion is that it is very difficult, if not impossible, to retrieve the correct value of the Cole–Cole parameters from time‐domain induced‐polarization data using standard least‐squares methods. In contrast, the Cole–Cole parameters can be more correctly inverted in the frequency domain. These results are also valid for other models describing the induced‐polarization spectral response, such as the Cole–Davidson or power law models.
Reconstituting factor concentrates: Defining Evidence of Coaching Non‐Experts (DEVICE) in haemophilia – a prospective randomized feasibility study
Authors: BIDLINGMAIER C. , KURNIK K. , HÖLSCHER G. , KAPPLER M.
Published: June 2007

Summary.  The introduction of new needleless devices as demanded by the US Department of Labor Occupational Safety and Health Administration (OSHA) has caused problems with the reconstitution of antihaemophilic factor in emergency situations. Our aim therefore was to evaluate the feasibility of a needleless device for reconstitution of antihaemophilic factor for non‐haemophilia experts and to define evidence of the need for coaching these physicians via providing two additional photographs illustrating the two key points of the factor reconstitution process. Twenty‐eight physicians of a tertiary care university children's hospital were randomized into two groups, either with no further explanation of the reconstitution device or with two additional photographs, showing the two key steps of the procedure. Reconstitution of dummy‐factor concentrate was video‐taped and evaluated by a blinded helper. Main outcome measure was the successful reconstitution of dummy‐factor concentrate and procedure failure respectively. Of the group without explanation of the reconstitution device, only two of 14 physicians were able to reconstitute the dummy‐factor concentrate. Of the group receiving two photographs, nine of 14 completed the task successfully (P = 0.0068). The needleless device is not self explaining to non‐haemophilia physicians involved in emergency services. Coaching via short to the point instructions as provided by simple visual educational material therefore is crucial to enable these physicians to resolve the expensive emergency drug quickly and correctly. Companies concerned with the production of any devices to dissolve drugs, especially for treatment of rare diseases as haemophilia, therefore should take measures to simplify therapy.
Attitudes towards and beliefs about genetic testing in the haemophilia community: a qualitative study
Authors: THOMAS S. , HERBERT D. , STREET A. , BARNES C. , BOAL J. , KOMESAROFF P.
Published: June 2007

Summary.  Widespread genetic testing for haemophilia has recently been introduced in Victoria, Australia. While attitudes towards predictive testing have been studied in other conditions, such as cancer, there is limited knowledge about the attitudes of members of the haemophilia community towards predictive testing. This study aimed at exploring attitudes towards, and beliefs about, genetic testing amongst members of the haemophilia community in Victoria prior to the widespread introduction of testing. The study was qualitative and descriptive. In‐depth face to face interviews were held with a sample of 39 individuals, including men with haemophilia, female carriers and family members. Data were analysed thematically using cross‐case analysis techniques. There was considerable knowledge about the proposed introduction of widespread genetic testing. However, not everyone thought that testing was accessible or user friendly, and there was confusion about who needed to be tested. Most thought that testing was necessary for adolescent girls to determine carrier status to help prepare families for a child with haemophilia, rather than leading them to choose to terminate a pregnancy or not to have children. A minority of women stated that if there was a history of inhibitors in a family then a termination might be considered. The study revealed strong religious beliefs among those studied, which may have influenced attitudes and approaches towards testing. Further investigation is needed into how people with a possible haemophilia genotype negotiate decisions about their further identification, and how this knowledge is placed within cultural, religious and family contexts.
Persistent problems and practices in information systems development
Authors: Kautz Karlheinz , Madsen Sabine , Nørbjerg Jacob
Published: June 2007

Abstract.  This paper identifies and discusses the persistent problems and development practices of information systems development (ISD). A critical examination and comparison of past times’‘traditional’ and present‐day ‘web‐based’ development shows that contemporary ISD can be seen as an accentuated evolution – rather than a revolution – of well‐known challenges and solutions. On this basis, (1) diversity; (2) knowledge; and (3) structure are identified as inherent and interrelated problems, while the practices for coping with these three challenges are (a) organization and specialization; (b) constant verbal communication and negotiation; and (c) pragmatic application of certain development methods and methodical concepts. We conclude that more research on the occurrence and interaction of problems and practices at, and between, different contextual levels (e.g. the business environment, company, project, team and individual levels) is needed to understand and assess (the gap between) ‘observed practice’ and ‘good practice’ across the many types of Web and non‐Web ISD projects conducted today. We outline a possible research agenda to investigate these issues.
How did common ragweed (Ambrosia artemisiifolia L.) spread in Québec? A historical analysis using herbarium records
Authors: Lavoie Claude , Jodoin Yvon , De Merlis Albane Goursaud
Published: June 2007

Aim  To reconstruct the spread of common ragweed (Ambrosia artemisiifolia L.; Asteraceae) using herbarium specimens to document whether the habitat preferences of this plant have shifted through time.

Location  Southern Québec.

Methods  Herbarium specimens stored in the main herbaria of southern Québec were used to reconstruct the spread of common ragweed. All data (sampling location, year of sampling, habitat characteristics, etc.) were incorporated into a geographical information system. Maps indicating the spatial distribution of common ragweed were produced for four time periods. The cumulative number of locations was plotted against time to construct invasion curves. The sequence of habitats where herbarium specimens were collected was also reconstructed.

Results  A data base incorporating 707 common ragweed herbarium specimens was constructed for this study. The spread of common ragweed in most regions of southern Québec was initiated at the beginning of the 20th century. Herbarium specimens suggest that common ragweed first spread along river corridors. Specimens of common ragweed were not collected in agricultural fields before the mid‐1920s, nor along roads and railways before the mid‐1930s. The colonization of a large number of agricultural fields by common ragweed probably began with seed‐contaminated crops, but was certainly accelerated by the dispersal of seeds from populations growing along nearby roads.

Main conclusions  Herbarium specimens suggest that common ragweed has been present in southern Québec for at least 200 years, but the species was probably restricted to the Montréal area during the 19th century. It is likely that the development of the road network in Québec since the mid‐1930s significantly contributed to the spread of common ragweed. Controlling common ragweed solely in agricultural fields would not prevent the re‐infestation of crops, because roadsides would act as refuges for the weed.
Mucosal immune responses in the genital tract of HIV‐1‐exposed uninfected women
Authors: Hirbod T. , Broliden K.
Published: June 2007

The development of HIV‐1 vaccines and microbicides remains hindered by our limited understanding of correlates of immune protection to infection. Evidence indicating that resistance to HIV‐1 infection is indeed possible comes from HIV‐1‐exposed yet uninfected individuals, including cohorts of commercial sex workers and discordant couples. Despite their uninfected status some of these individuals have mucosal and systemic HIV‐1‐specific humoral and cellular immune responses in addition to their innate immune response. The combined contribution of innate and adaptive immunity as well as genetic factors is most likely of great importance for this protection against infection. Here we review data on the antibody responses and secreted immune molecules of the innate immune system in the female genital tract with emphasis on individuals who seem to resist HIV‐1‐infection despite repeated exposure to the virus.
Osseointegration of anodized titanium implants under different current voltages: a rabbit study
Authors: PARK K. H. , HEO S. J. , KOAK J. Y. , KIM S. K. , LEE J. B. , KIM S. H. , LIM Y. J.
Published: June 2007

summary  The oxide layer that covers a titanium surface is extremely stable and appears to have excellent biocompatibility, which can result in successful osseointegration. The aim of this study was to analyse the characteristics of an oxide layer formed by anodic oxidation (anodization), and to evaluate the extent of bone healing around the anodized implant. The screw‐type implants were made of commercially pure titanium (Grade 2). The Group 1 samples had a turned surface, and three other types of experimental specimens were anodized under constant voltages of 190 V (Group 2), 230 V (Group 3) and 270 V (Group 4). The surface characteristics of each sample type were inspected. Removal torque was measured after a 4‐week healing period and the histomorphometric analysis was performed 6 weeks after implantation in rabbit tibiae. There was an increase in both the size and number of pores as the anodizing voltage increased. The Ra value of the Group 4 samples was higher than those in the Group 1 and 2 samples (P < 0·05). Group 3 showed a difference compared with Group 1 (P < 0·05). A thicker oxide layer, which contained crystalline (anatase) TiO2 with the inclusion of some electrolytes (Ca, P), was formed at the higher anodizing voltage. Group 4 had higher removal torque values and percentages of bone‐to‐implant contact than the other groups (P < 0·05). The anodized titanium implants showed more intimate and stronger connections with peri‐implant bone during early osseointegration than the turned titanium implants in this experimental model.
Molecular differentiation of three closely related members of the mosquito species complex, Anopheles moucheti, by mitochondrial and ribosomal DNA polymorphism
Authors: KENGNE P. , ANTONIO‐NKONDJIO C. , AWONO‐AMBENE H. P. , SIMARD F. , AWOLOLA T. S. , FONTENILLE D.
Published: June 2007

Abstract Distinction between members of the equatorial Africa malaria vector Anopheles moucheti (Evans) s.l. (Diptera: Culicidae) has been based mainly on doubtful morphological features. To determine the level of genetic differentiation between the three morphological forms of this complex, we investigated molecular polymorphism in the gene encoding for mitochondrial cytochrome oxidase b (CytB) and in the ribosomal internal transcribed spacers (ITS1 and ITS2). The three genomic regions revealed sequence differences between the three morphological forms similar in degree to the differences shown previously for members of other anopheline species groups or complexes (genetic distance d = 0.047–0.05 for CytB, 0.084–0.166 for ITS1 and 0.03–0.05 for ITS2). Using sequence variation in the ITS1 region, we set up a diagnostic polymerase chain reaction (PCR) for rapid and reliable identification of each subspecies within the An. moucheti complex. Specimens of An. moucheti s.l. collected in Cameroon, the Democratic Republic of Congo (DRC), Uganda and Nigeria were successfully identified, demonstrating the general applicability of this technique.
Detection of Salmonella sp. in Dermanyssus gallinae using an FTA® filter‐based polymerase chain reaction
Authors: VALIENTE MORO C. , DESLOIRE S. , CHAUVE C. , ZENNER L.
Published: June 2007

Abstract Salmonella spp. bacteria are responsible for some of the most important zoonoses worldwide. Because Dermanyssus gallinae (DeGeer) (Acari: Dermanyssidae) has been recently reported to be an experimental vector of Salmonella Enteritidis, it would be of benefit to evaluate the presence of this bacterium in mites. A molecular detection tool associating a simple filter‐based DNA preparation with a specific 16S rDNA Salmonella sp. polymerase chain reaction (PCR) amplification was described. The limit of detection with this method was 2 × 104 bacteria per mite. To adapt this technique for large‐scale studies, two sizes of mite pools were tested and a preliminary investigation was carried out on mites from 16 currently or previously contaminated farms. Mites sampled from one farm of each type were positive for Salmonella, suggesting that Dermanyssus could act as a reservoir between flocks. In further investigations, it will be necessary to carry out a large‐scale study to assess the role of D. gallinae in the epidemiology of avian salmonellosis.
Identification of a transcriptional regulator that controls intracellular gene expression in Salmonella Typhi
Authors: Haghjoo Erik , Galán Jorge E.
Published: June 2007

Salmonella enterica serovar Typhi (S. Typhi), the aetiological agent of typhoid fever, is an exclusively human pathogen. Little is known about specific factors that may confer to this bacterium its unique pathogenic features. One of these determinants is CdtB, a homologue of the active subunit of the cytolethal distending toxin, which causes DNA damage leading to cell cycle arrest and distension of intoxicated cells. A unique property of S. Typhi CdtB is that it is only synthesized when this bacterium is within an intracellular compartment. Through a genetic screen, we have identified a transcriptional regulatory protein that controls the intracellular expression of cdtB. This regulator, which we have named IgeR, is a member of the DeoR family of transcriptional regulatory proteins and is highly conserved in all S. enterica serovars. IgeR directly binds the cdtB promoter and represses its expression in the extracellular environment. Microarray analysis identified additional IgeR‐regulated genes that are involved in virulence. Constitutive expression of igeR resulted in the reduction of intracellular expression of cdtB by S. Typhi and in significant impairment of the virulence of Salmonella enterica serovar Typhimurium (S. Typhimurium) in mice. We propose that IgeR may co‐ordinate gene expression during Salmonella's transition from an extracellular to an intracellular environment.
Unexpected effect of a Bacteroides conjugative transposon, CTnDOT, on chromosomal gene expression in its bacterial host
Authors: Moon Kyung , Sonnenburg Justin , Salyers Abigail A.
Published: June 2007

Foreign DNA elements such as plasmids and conjugative transposons are constantly entering new bacterial hosts. A possible outcome of such events that has not been considered previously is that regulatory genes carried on some of them might affect the expression of chromosomal genes of the new host. To assess this possibility, we investigated the effect of the Bacteroides conjugative transposon CTnDOT on expression of chromosomal genes in Bacteroides thetaiotaomicron 5482 (BT4001). Most of the upregulated genes were genes of unknown function, but a number of them were associated with a region of the chromosome that contained a putative conjugative transposon, which had been tentatively designated as CTn4‐bt. Upregulation of CTn4‐bt genes and other chromosomal genes affected by CTnDOT was controlled by two regulatory genes on CTnDOT, rteA and rteB, which encode a two‐component regulatory system. Transfer of CTn4‐bt was also mediated by rteA and rteB. Three other putative CTns, CTn1‐bt, CTn2‐bt and CTn3‐bt, were mobilized by CTnERL, a CTn closely related to CTnDOT, but genes from CTnERL other than rteA and rteB were also required. Unexpectedly, homologous recombination was required for CTn1‐bt, CTn2‐bt, CTn3‐bt and CTn4‐bt to integrate in the recipient. Our results show that regulatory genes on an incoming mobile element can have multiple effects on its new host, including the activation of previously non‐transmissible elements.
Why do host‐deprived seed beetles ‘dump’ their eggs?
Authors: MESSINA FRANK J. , MORREY JENNIFER L. , MENDENHALL MICHELLE
Published: June 2007

Abstract If host seeds are absent, females of the seed beetle Callosobruchus maculatus sometimes ‘dump’ eggs on unsuitable substrates, which causes complete larval mortality and decreases female lifespan. To understand the possible function of this behaviour, the present study examines genetic variation in dumping behaviour between and within populations. When deprived of hosts, females from an African population are much more prone to dump eggs than Asian females, most of which dump no eggs over their lifetimes. Egg dumping therefore cannot be explained as a simple, species‐wide constraint imposed by the accumulation of mature oocytes. A transfer experiment tested the hypothesis that dumping eggs improves a female’s ability to exploit the subsequent availability of seeds, perhaps by preventing a disruption of oocyte maturation. Contrary to prediction, the number of eggs laid after females are transferred to seeds is inversely related to the number dumped during deprivation. Two bidirectional selection experiments revealed heritable variation in egg‐dumping behaviour within the African population. Deprived females from the dumper line dump more than twice as many eggs as do females from the nondumper line. Pre‐adult development time is significantly longer in the nondumper line, which suggests that trade‐offs with other fitness components could maintain variation in egg‐laying behaviour within populations. The divergent responses to host availability by African and Asian females may represent a pleiotropic effect of similarly divergent responses to host quality.
Clinical patterns of sexually transmitted diseases, associated sociodemographic characteristics, and sexual practices in the Farwaniya region of Kuwait
Authors: Al‐Mutairi Nawaf , Joshi Arun , Nour‐Eldin Osama , Sharma Ashok K. , El‐Adawy Ibtesam , Rijhwani Manish
Published: June 2007

Background  Sexually transmitted diseases (STDs) are common worldwide, but there are few studies available on STDs from the Gulf countries, including Kuwait. Our goal was to determine the clinical patterns, sociodemographic factors, and sexual practices of patients with STDs who attended a government hospital in the Farwaniya region of Kuwait.

Methods  All patients seen over a 1‐year period (July 2003 to June 2004), who presented with signs and symptoms suggestive of STDs, were included. Sociodemographic details and clinical findings were recorded. The diagnosis of each STD was based mainly on standard World Health Organization (WHO) criteria and available data. Serologic tests for syphilis and human immunodeficiency virus (HIV) were offered to all patients.

Results  One thousand and ninety‐six patients (1068 male, 28 female) with STDs constituted 2.84% of all new dermatology patients seen; most (866) were in the 21–40‐year age group. The STDs were acquired from commercial sex workers in 844 patients (77%). Heterosexual encounter (99.3%) was the most common mode of acquiring STDs. Urethral discharge was noted in 54.1% of patients, followed by genital ulcers (17.8%), papules/growths (16.4%), and urethral/pubic pain without associated discharge/ulcers (5.9%); these were the four most common presenting complaints. Evaluation revealed gonorrhea in 31.5% of patients, nongonococcal urethritis in 23.6%, chlamydia in 4.1%, nonspecific urethritis in 19.5%, concomitant gonorrhea and chlamydia urethritis in 2.7%, genital warts in 13.7%, chancroid in 13.0%, genital herpes in 4.8%, molluscum contagiosum in 2.7%, and lymphogranuloma venereum in 1.4%.

Conclusions  Urethral discharge, gonorrhea, and nonspecific urethritis (presenting with urethral discharge), followed by genital warts, chancroid, and genital herpes (ulcers), were the most common STDs among male patients in the Farwaniya region of Kuwait. Although no case of HIV or syphilis was detected, health authorities and physicians need to remain vigilant.
Chagas’ disease reactivation with skin symptoms in a patient with kidney transplant
Authors: Gallerano Verónica , Consigli Javier , Pereyra Susana , Gómez Zanni Susana , Danielo Cristian , Gallerano Rafael H. , Guidi Andrés
Published: June 2007

Immunodepressed patients in the intermediate phase of Chagas’ disease may undergo reactivation of the disease together with atypical symptoms. The case of an immunodepressed kidney transplant patient with reactivation of Chagas’ disease with skin symptoms is reported.

A 65‐year‐old man presented with infiltrated erythematous lesions on the anterior aspect of the right thigh of 2 weeks’ duration. The lesions later extended to the abdomen, thorax, and lower limbs. In the histologic skin examination, amastigotes and Trypanosoma cruzi trypoamastigotes were observed. A fresh smear showed positive parasitemia. Using the Strout hemoconcentration method, multiple Trypanosoma cruzi trypoamastigotes with motility could be seen. Polymerase chain reaction was positive for Trypanosoma cruzi. An immunofluorescence test was positive (1 : 64) and there was hemoagglutination (1 : 32).

Treatment was started with benznidazole, 7 mg/kg/day. The patient did not evolve favorably and died 20 days after hospitalization.

Skin lesions may be a manifestation of the reactivation of Chagas’ disease in immunosuppressed patients. All patients with positive Chagas’ serology who require immunosuppressant drugs should receive specific treatment for Chagas’ disease.