bluuebunny/crossref_metadata_2025 huggingface dataset:
Rate of Neural Recovery in Implanted Children with Auditory Neuropathy Spectrum Disorder
Authors: Fulmer Susan L. , Runge Christina L. , Jensen Jamie W. , Friedland David R.
Published: December 2010

Objectives

The study objectives were to compare the rate of neural recovery and speech perception performance in children with auditory neuropathy spectrum disorder (ANSD) and children with sensorineural hearing loss (SNHL) from other etiologies.

Study Design

Cohort study.

Setting

Academic hospital and cochlear implant center.

Subjects and Methods

Ten children with ANSD were matched based on type of implant and age at implantation with peers diagnosed with SNHL. Electrically evoked compound action potential (ECAP) recovery functions were obtained to measure neural refractory behaviors in response to stimulation from the cochlear implant. Speech perception performance was measured using speech recognition thresholds (SRTs) for monosyllable and spondee word stimuli. These outcome measures were compared between groups.

Results

There was no difference in average recovery function exponent in children with ANSD compared to children with SNHL. Similarly, there were no differences in average SRTs in quiet and in noise in children with ANSD compared to children with SNHL. Relationships between SRT and recovery rate were not present within groups or for all subjects for SRT in quiet, but a significant relationship was found for all subjects for SRT in noise (P =. 04).

Conclusions

Dyssynchronous neural activity in ANSD may affect temporal encoding of electrical stimulation from a cochlear implant. As a group, children with ANSD did not demonstrate slower neural recovery compared to those with SNHL, but there was slower neural recovery observed for some subjects. The utility of ECAP recovery functions on optimizing the stimulation rate for individual patients with ANSD requires further investigation.
Outcomes of Hyoid Myotomy and Suspension Using a Mandibular Screw Suspension System
Authors: Gillespie M. Boyd , Ayers Christopher M. , Nguyen Shaun A. , Abidin Michael R.
Published: December 2010

Objective

To review the outcomes of hyoid myotomy and suspension with a mandibular screw anchoring device.

Study Design

Case series with chart review.

Setting

Academic and private sleep surgery clinics.

Methods

The study is a consecutive case series of patients undergoing hyoid myotomy and suspension using a mandibular screw suspension device as part of multilevel treatment of obstructive sleep apnea (OSA). Outcomes of interest included complication rates, change in daytime sleepiness scores, and change in apnea‐hypopnea index (AHI).

Results

Ten women and 23 men with a mean age of 54 years (range, 33‐73 years) underwent hyoid myotomy and suspension using a mandibular screw suspension device. Four (12%) patients experienced minor complications, including neck seroma (3 patients) and tongue edema (1 patient). Epworth Sleepiness Scale scores fell from a preoperative median of 12 to a postoperative median of 6 (P =. 002). Ten patients (30%) refused the postoperative sleep study. In the 23 patients who underwent postoperative sleep studies, AHI scores decreased from a preoperative mean ± SD of 40.9 ± 25.1 to 18.6 ± 21.2 postoperatively (P =. 001). Ten patients (30%) achieved a postoperative AHI below 10. The Repose system was initially applied using a standard hyoid dissection but was later modified using a minimally invasive small incision (<2 cm) approach that demonstrated significantly fewer complications (P =. 04).

Conclusion

Hyoid myotomy and suspension with a mandibular screw anchor is an effective method with which to address hypopharyngeal collapse in multilevel surgery for OSA. The procedure can be performed with a small‐incision, minimally invasive approach with minimal complications and patient morbidity.
Retracted: Antiemetic Efficacy of Low‐Dose Midazolam in Patients Undergoing Thyroidectomy
Authors: Fujii Yoshitaka , Itakura Michiyo
Published: December 2010

The article has been retracted as a result of notice received from the author, Yoshitaka Fujii, M.D., that the study described in the article was undertaken without the approval of an institutional ethics committee. The Editor‐in‐Chief and Publisher have therefore determined that the article failed to meet the ethical standards required by the Journal. Additionally, Toho University Faculty of Medicine, where Dr. Fujii was employed until February 29, 2012, issued a statement in March 2012 regarding its investigation of Dr. Fujii, finding that the study referenced in the article, as well as other studies reference by Dr. Fujii in his published articles, were conducted without the approval of any ethics committee, and therefore “did not conform to the global standard of ethics for clinical studies.”

Additionally, the Publisher has been informed by Dr. Michiyo Itakura and Dr. Ken Takasaki, President of Ushiku Aiwa General Hospital, that Dr. Itakura did not participate in the authorship of the article. The Publisher has also been informed by Ushiku Aiwa General Hospital that Yoshitaka Fujii is not affiliated with the hospital. At the time of the article's publication, Dr. Fujii was affiliated with the Toho University School of Medicine.
Correlates of Precoital Behaviors, Intentions, and Sexual Initiation Among Thai Adolescents
Authors: Atwood Katharine A. , Zimmerman Rick , Cupp Pamela K. , Fongkaew Warunee , Miller Brenda A. , Byrnes Hilary F. , Chamratrithirong Aphichat , Rhucharoenpornpanich Orratai , Chaiphet Nonthathorn , Rosati Michael J. , Chookhare Warunee
Published: December 2010

This paper examines the risk and protective factors associated with sexual behaviors among Thai youth ages 13-14 (N=420) living in Bangkok, Thailand. Cross-sectional data were collected using a random sample of households methodology. Three outcomes were assessed: (1) intention to engage in sexual intercourse, (2) pre-coital behaviors, and (3) sexual initiation. Bivariate analysis indicated that parental disapproval of sex, exposure to pornographic media, refusal self-efficacy and having a boyfriend/girlfriend had the strongest relationships with all three outcomes. Multivariate analyses found that parental disapproval of sex and exposure to pornographic media (internet or TV) were significantly associated with all three outcomes. Having a boyfriend or girlfriend was associated with pre-coital behaviors and intentions and sexual refusal self efficacy was correlated with pre-coital behaviors only. The potential competing influences of parent disapproval and exposure to pornographic media on adolescent sexual behaviors should be considered when adapting HIV prevention interventions for Thai youth.
Estimation and Validation of a Multiattribute Model of Alzheimer Disease Progression
Authors: Stallard Eric , Kinosian Bruce , Zbrozek Arthur S. , Yashin Anatoliy I. , Glick Henry A. , Stern Yaakov
Published: December 2010

Objectives. To estimate and validate a multiattribute model of the clinical course of Alzheimer disease (AD) from mild AD to death in a high-quality prospective cohort study, and to estimate the impact of hypothetical modifications to AD progression rates on costs associated with Medicare and Medicaid services. Data and Methods. The authors estimated sex-specific longitudinal Grade of Membership (GoM) models for AD patients (103 men, 149 women) in the initial cohort of the Predictors Study (1989—2001) based on 80 individual measures obtained every 6 mo for 10 y. These models were replicated for AD patients (106 men, 148 women) in the 2nd Predictors Study cohort (1997—2007). Model validation required that the disease-specific transition parameters be identical for both Predictors Study cohorts. Medicare costs were estimated from the National Long Term Care Survey. Results. Sex-specific models were validated using the 2nd Predictors Study cohort with the GoM transition parameters constrained to the values estimated for the 1st Predictors Study cohort; 57 to 61 of the 80 individual measures contributed significantly to the GoM models. Simulated, cost-free interventions in the rate of progression of AD indicated that large potential cost offsets could occur for patients at the earliest stages of AD. Conclusions. AD progression is characterized by a small number of parameters governing changes in large numbers of correlated indicators of AD severity. The analysis confirmed that the progression of AD represents a complex multidimensional physiological process that is similar across different study cohorts. The estimates suggested that there could be large cost offsets to Medicare and Medicaid from the slowing of AD progression among patients with mild AD. The methodology appears generally applicable in AD modeling.
Interactive Media for Diabetes Self-Management: Issues in Maximizing Public Health Impact
Authors: Glasgow Russell E.
Published: December 2010

Background . Diabetes self-management presents a series of challenging tasks, and primary care, where the majority of cases of adult diabetes are treated, is hard-pressed to address these issues given competing demands. This article discusses how interactive media (IM) can be used to support diabetes self-management. Methods . Following a brief review of the literature, the 5 As framework for enhancing the effectiveness of health behavior counseling and the RE-AIM model for estimating and enhancing public health impact are used to frame discussion of the strengths and limitations of IM for diabetes shared decision making and self-management support. Results . Data and lessons learned from a series of randomized trials of IM for diabetes self-management education are summarized around 2 key issues. The first is enhancing patient engagement in decision making and includes enhancing user experience and engagement, improving quality of care, and promoting collaborative action planning and follow-up. The second is getting such resources into place and sustaining them in real-world primary care settings and involves enhancing participation at patient, clinician, and health care system levels and enhancing the generalizability of results. Conclusions . Key opportunities for IM to support diabetes self-management include assessment of information for shared decision making, assistance with problem-solving self-management challenges, and provision of follow-up support. A key current challenge is the linkage of IM supports to the rest of the patient’s care, and collection of cost-effectiveness data is a key need for future research.
Electronic Health Records to Coordinate Decision Making for Complex Patients: What Can We Learn from Wiki?
Authors: Naik Aanand D. , Singh Hardeep
Published: December 2010

Background . Processes of communication that guide decision making among clinicians collaboratively caring for complex patients are poorly understood and vary based on local contexts. In this paper, the authors characterize these processes and propose a wiki-style communication model to improve coordination of decision making among clinicians using an integrated electronic health record (EHR). Methods . A narrative review of current patterns of communication among clinicians sharing medical decisions focusing on the emerging and potential roles of EHRs to enhance communication among clinicians caring for complex patients. Results . The authors present the taxonomy of decision making and communication among clinicians caring for complex patients. They then adapt wiki-style communication to propose a novel model of communication among clinicians for decision making within multidisciplinary disease management programs. Future innovations using wiki-style communication among clinicians are also described and placed in the context of medical decisions by clinicians working together in disease management programs. Conclusions . EHR-based wiki-style applications may have the potential to improve communication and care coordination among clinicians caring for complex patients. This could lead to improved quality and safety within multidisciplinary disease management programs.
AHRQ White Paper: Use of Clinical Decision Rules for Point-of-Care Decision Support
Authors: Ebell Mark
Published: December 2010

Translation of research into clinical practice remains a barrier, with inconsistent adoption of effective treatments and useful tests. Clinical decision rules (CDRs) integrate information from several clinical or laboratory findings to provide quantitative estimates of risk for a diagnosis or clinical outcome. They are increasingly reported in the literature and have the potential to provide a bridge that helps translate findings from original research studies into clinical practice. Unlike formal aids for shared decision making, they are pragmatic solutions that provide discrete quantitative data to aid clinicians and patients in decision making. These quantitative data can help inform the informal episodes of shared decision making that frequently take place at the point of care. Methods used to develop CDRs include expert opinion, multivariate models, point scores, and classification and regression trees Desirable CDRs are valid (make accurate predictions of risk), relevant (have been shown to improve patient-oriented outcomes), are easy to use at the point of care, are acceptable (with good face validity and transparency of recommendations), and are situated in the clinical context. The latter means that the rule places patients in risk groups that are clinically useful (i.e., below the test threshold or above the treatment threshold) and does so in adequate numbers to make use of the CDR a worthwhile investment in time. CDRs meeting these criteria should be integrated with electronic health records, populating the point score or decision tree with individual patient data and performing calculations automatically to streamline decision making.
Silver-filled electrically conductive epoxy and silver nitrate-plated textile composite materials for EMC
Authors: Perumalraj R. , Anilkumar A. , Nirmala Devi A.S. , Saranya B. , Deepa P. , Karthika R. , Maheshwari N.
Published: December 2010

A study on the effect of silver-filled electrical epoxy materials and the effect of electroless silver nitrate-plated woven fabrics on electromagnetic shielding effectiveness of various woven fabrics has been reported. Polyester, cotton, polyester/viscose blend, and polyester/cotton blend fabrics were treated with silver-filled electrical epoxy by pad-cure method. The polyester fabrics were treated with various levels of silver nitrate concentration, temperature, and time to analyze EMSE. The electromagnetic shielding effectiveness of these silver-filled electrical epoxy-coated fabrics and electroless silver nitrate-plated woven fabrics has been measured in the frequency range 20—18,000 MHz using network analyzer equipment with MIL-STD 285 and also the morphological structures of the silver-filled electrical epoxy-coated woven materials and electroless silver nitrate-plated woven fabrics were analyzed using scanning electron microscope. It is observed that the silver-filled electrical epoxy cotton fabric has better electromagnetic shielding effectiveness than the polyester/cotton blend, polyester/viscose blend, and polyester fabric in the frequency range 20—18,000 MHz. It is also observed that the silver-filled electrical epoxy-coated cotton fabric has maximum shielding effectiveness (50—69 dB) in the frequency range 60—15,000 MHz. It is observed that the silver nitrate concentration and temperature have a significant influence on electromagnetic shielding effectiveness of silver nitrate-plated fabrics. It is also observed that the maximum EMSE (45—55 dB) was obtained in the frequency range 180—8000 MHz.
Willingness to Use Mental Health Services Among Older Residents in Assisted Living
Authors: Park Nan Sook , Jang Yuri , Lee Beom Seok , Schonfeld Lawrence , Molinari Victor
Published: December 2010

Examining the importance of mental health care in assisted living (AL) settings, the present study examines older AL residents’ willingness to use mental health services and its predictors. Data based on face-to-face interviews with 150 older residents from 17 AL settings in Florida are used in the analyses ( Mage = 82.8, SD = 9.4). Multivariate logistic regression is used to estimate the likelihood of willingness to use mental health services in relation to predisposing (demographics and physical health), mental health needs (depressive symptoms), and enabling variables (social network, instrumental support, emotional support, informational support, satisfaction with support, and previous use of mental health services). Willingness to use mental health services is predicted by younger age, unmarried status, lower levels of emotional support, and higher levels of informational support. The relationship of informational support to higher willingness to use mental health services suggests that AL residents could benefit from educational interventions on late life depression.
Review of the Literature on Older Lesbians
Authors: Averett Paige , Jenkins Carol
Published: December 2010

This article reviews the academic literature from 1997 to 2010 on older lesbians ( n = 28) and provides implications for education, practice, and research. While there is an ongoing lack of research focused solely on older lesbians, we found a growing interest in this population. Importantly, there was an increase in empirical studies and, in particular, those using qualitative methods: 9 articles reported results of interviews with a total of 159 older lesbians. Overall, the research reviewed here indicates that older lesbians evidence a great deal of adaptive capacity to deal with the challenges they face, including societal marginalization and discrimination. There remains a great need for research focused solely on older lesbians, especially studies that are more inclusive in terms of diversity in age, race, and ethnicity.
Autoimmune Limbic Encephalitis as an Emerging Pediatric Condition: Case Report and Review of the Literature
Authors: McCoy Bláthnaid , Akiyama Tomoyuki , Widjaja Elysa , Go Cristina
Published: December 2010

Limbic encephalitis, first described in the 1960s as a paraneoplastic condition, has emerged as an autoimmune condition, occurring often without evidence of an underlying tumor. Many novel autoantibodies have been identified, and this diagnosis is increasingly being made in the pediatric population. This article reports the case of a 16-year-old boy who presented following gastrointestinal illness with subacute evolution of neuropsychiatric symptoms. Brain magnetic resonance imaging revealed progressive hippocampal signal abnormality and swelling. N-methyl-D-aspartate (NMDA) receptor antibody was detected in serum. The patient responded well to pharmacological immunotherapy but has residual cognitive deficits. The available literature on this condition is reviewed. Limbic encephalitis should be considered in the differential diagnosis in children presenting with encephalopathy, particularly with neuropsychiatric manifestations. Long-term surveillance and close follow-up are required to accurately clarify tumor risk and natural history of this condition in children and balance these factors with risks of radiation exposure through imaging.
Efficacy and Safety of Rituximab in Pediatric Neuromyelitis Optica
Authors: Mahmood Naznin A. , Silver Kenneth , Onel Karen , Ko Michael , Javed Adil
Published: December 2010

Neuromyelitis optica is a central nervous system disease characterized by optic neuritis and transverse myelitis. It is a devastating illness, and early treatment may prevent future relapses and severe disability. However, there is much variability in protocols used for treatment. In limited studies, rituximab has shown efficacy in adult neuromyelitis optica patients. There is a paucity of literature on the efficacy and tolerability of rituximab in the pediatric population. The authors report the use of rituximab in 2 pediatric patients with neuromyelitis optica, demonstrating its efficacy, dosing, and tolerability. This report may be a useful guide for administering rituximab safely in pediatric neuromyelitis optica patients.
Early ‘‘Relapse’’ After Herpetic Encephalitis: Extensive White Matter Lesions in an Infant With Interferon Production Deficit
Authors: Maia Raquel , Gouveia Catarina , Moreira Ana , Casanova Jean Laurent , Sancho-Shimizu Vanessa , Brito Maria João
Published: December 2010

Acute secondary neurological deterioration after herpes simplex encephalitis has been reported. An immune-mediated process is thought to be responsible for some cases. The authors report the case of an infant who presented with fever, irritability, and orofacial involuntary movements, 15 days after herpes encephalitis onset. Polymerase chain reaction for herpes simplex virus was negative, and the magnetic resonance imaging revealed extensive white matter lesions. Chorea appeared only 11 days later. Raised immunoglobulin G index with oligoclonal bands and spreading of white matter lesions corroborated an immune-mediated etiology. An interferon production deficit was also detected. This case alerts that this form of ‘‘relapse’’ appears earlier than previously reported. A high level of suspicion is needed in the presence of atypical neurological deterioration and early white matter lesions should be considered as a warning sign. This case is also relevant because it associates, for the first time, an immune-mediated ‘‘relapse’’ to an interferon production deficit.
Arts and Leisure Participation Among IT Users
Authors: Robinson John P.
Published: December 2010

A major concern about new technologies like IT is how much they might displace time on media and other daily activities. Three highly-publicized early studies of the initial impact of IT indicated it was reducing time on both social life and mass media use. However, data from a number of high-quality national surveys since then—from the Pew Center, the General Social Survey (GSS), the Survey of Public Participation in the Arts (SPPA) and the American Time Use Survey (ATUS)—have not replicated these results, in some cases finding increased social life and media use (especially reading) among IT users. The present article examines data from two separate national surveys (the GSS 2002 and the SPPA 2008), Even though the two studies asked different IT questions and examined different arts activities over different periods of Internet diffusion, progressively higher arts participation was found among Internet users, before and after education and other predictors of arts activity were controlled. The SPPA data also show that users and heavier IT users were also more active in a variety of other free time activities like attending movies, volunteering and sports. IT use here then becomes a away of extending or enhancing live attendance rather than displacing it. However, the results also raise questions about whether these correlations result from a “response set” of respondents overestimating their activity participation.
Fall Risk Factors in Community-Dwelling Elderly Who Receive Medicaid-Supported Home- and Community-Based Care Services
Authors: Yamashita Takashi , Jeon Haesang , Bailer A. John , Nelson Ian M. , Mehdizadeh Shahla
Published: December 2010

Objective: This study identifies fall risk factors in an understudied population of older people who receive community-based care services. Method: Data were collected from enrollees of Ohio’s Medicaid home- and community-based waiver program (preadmission screening system providing options and resources today [PASSPORT]). A total of 23,182 participants receiving PASSPORT services in 2005/2006 was classified as fallers and nonfallers, and a variety of risk factors for falling was analyzed using logistic regressions. Results: The following factors were identified as risk factors for falling: previous fall history, older age, White race, incontinence, higher number of medications, fewer numbers of activity of daily living limitations, unsteady gait, tremor, grasping strength, and absence of supervision. Discussion: Identifying risk factors for the participants of a Medicaid home- and community-based waiver program are useful for a fall risk assessment, but it would be most helpful if the community-based care service programs incorporate measurements of known fall risk factors into their regular data collection, if not already included.
Juvenile systemic lupus erythematosus in the Sultanate of Oman: Clinical and immunological comparison between familial and non-familial cases
Authors: Abdwani R , Hira M , Al-Nabhani D , Al-Zakwani I
Published: December 2010

Consanguineous marriage is quite prevalent in the Sultanate of Oman, with up to 45% of marriages being consanguineous. The aim of this study was to determine demographic, clinical and serological characteristics between familial and non-familial cases of juvenile systemic lupus erythematosus (SLE) in a highly consanguineous region such as Oman. Hospital medical records were retrospectively reviewed for 44 consecutive children with juvenile SLE seen at Sultan Qaboos University Hospital, 16 with familial SLE and 28 with non-familial SLE. All the children included in the study were Omani, diagnosed before 13 years of age, and fulfilled the 1982 revised ACR criteria. Analyses were performed using descriptive statistics. There were largely no significant differences in the clinical and serological manifestations between the two cohorts. However, the familial SLE group was associated with worse SLEDAI score at onset of diagnosis compared with the non-familial cohort (12 vs. 17; p = 0.003) suggesting a greater severity of disease in the familial group. Even though the rate of familial SLE is higher in Oman (36%) compared with the Western world (10–12%), it appears that familial and non-familial SLE cases are in fact similar disease entities in both the West and the Middle Eastern countries.
Evaluation of adherence to drug treatment in patients with systemic lupus erythematosus in Brazil
Authors: Oliveira-Santos M , Verani JFS , Klumb EM , Albuquerque EMN
Published: December 2010

The objectives of this study were to measure the prevalence of adherence to drug treatment and analyze associations with characteristics pertaining to the treatment, disease, health professionals and services, and socio-demographic issues in patients with systemic lupus erythematosus (SLE) in the city of Rio de Janeiro, Brazil. A sample of 246 women with SLE was analyzed. The data were collected through individual interviews and a review of patient charts. Adherence was estimated according to the Morisk criteria, and the associated factors were analyzed by hierarchical modeling. The percentage of patients classified as adherent to treatment was 31.7%. The reasons cited for non-adherence were: carelessness with drug administration times (52.43%), forgetfulness (38.21%), adverse drug reaction (13.8%), and interruption of treatment due to improvement in symptoms (7.72%). Factors associated with adherence were: behavior towards the presence of adverse drug reaction, hematological alterations, presence of mucocutaneous manifestations, legibility of the medical prescription, schooling, and family support. The study concludes that adherence to drug treatment in SLE is a complex and multifactorial phenomenon, and the results corroborate findings from studies conducted in developed countries. The hierarchical modeling proved to be a good alternative for evaluating adherence, since it allowed visualizing the various stages in the analysis.
Perceptions and measurements of physical activity in patients with systemic lupus erythematosus
Authors: Mancuso CA , Perna M , Sargent AB , Salmon JE
Published: December 2010

Promoting physical activity should be a priority for patients with systemic lupus erythematosus (SLE) because a sedentary lifestyle compounds patients’ already disproportionately high risk for cardiovascular events and other adverse health outcomes. The objectives of this pilot study were to assess physical activity in 50 patients with SLE and to compare activity levels with clinical and psychosocial variables, such as fatigue, depressive symptoms, and social support and stress. Patients were asked open-ended questions about physical activity, and responses were coded according to Grounded Theory. Patients then completed the Paffenbarger Physical Activity and Exercise Index, a survey of lifestyle energy expenditure reported in kilocalories/week, performed a 2-minute walk test according to a standard protocol, and completed questionnaires measuring fatigue, depressive symptoms and social support and stress. Most patients (92%) were women, had a mean age of 45 years, and did not have extensive SLE. In response to open-ended questions, patients reported they avoided physical activity because they did not want to exacerbate SLE in the short term. However, if they could overcome initial hurdles, 46 patients (92%) thought physical activity ultimately would improve SLE symptoms. Walking was the preferred activity and 45 (90%) thought they could walk more. According to the Paffenbarger Index, mean energy expenditure was 1466 ± 1366 kilocalories/week and mean time spent in moderate-intensity activity was 132 ± 222 min/week. In total, 18 patients (36%) and 14 patients (28%) met physical activity goals for these values, respectively. Mean distance walked during the 2-minute test was 149 ± 28 m, equivalent to two blocks, which is similar to reports for stable patients with other chronic diseases. Patients with more social stress and more fatigue reported less physical activity. We conclude that the proportion of patients meeting physical activity goals was low; however, patients performed well on a standard walking test. Most patients believed physical activity provided long-term benefits for SLE and that they could be more physically active.
Studies of Filipino patients with systemic lupus erythematosus: Autoantibody profile of first-degree relatives
Authors: Navarra SV , Ishimori ML , Uy EA , Hamijoyo L , Sama J , James JA , Holers VM , Weisman MH
Published: December 2010

This study surveyed the frequency of autoantibodies among un-affected first-degree relatives (FDRs) of Filipino systemic lupus erythematosus (SLE) patients compared with healthy un-related Filipino controls. The sensitivity, specificity and predictive value of the autoantibodies for SLE diagnosis were also assessed in this Filipino cohort. Filipino patients included in the University of Santo Tomas (UST) Lupus Database and un-affected FDRs were recruited. Healthy controls included those with no known personal or family history of autoimmune disease. The following autoantibodies were tested in all subjects: anti-nuclear antibody (ANA), anti-dsDNA, anti-Ro/SSA, anti-chromatin, anti-thyroid microsome, and anti-cardiolipin antibodies. Participants included 232 SLE patients, 546 FDRs, and 221 healthy controls. Median age of patients was 27 (range 8–66) years with median disease duration of 27.5 (range 1–292) months. Median age of FDRs was 42.0 (range 5–87) years. Compared with healthy controls, there were significantly more FDRs with positive ANA at titers 1 : 40 to 1 : 160 ( p < 0.001) and 1 : 320 ( p = 0.003), anti-Ro/SSA (4.94% versus 0.45%, p = 0.003), and anti-dsDNA ≥ 5.0 IU/ml (4.58% versus 1.36%, p = 0.031). ANA titer ≥1  :  160, anti-dsDNA, anti-Ro/SSA and anti-chromatin had the highest predictive value for SLE diagnosis. These findings reinforce the role of genetic influence in SLE risk among Filipinos, with a significant proportion of un-affected FDRs of SLE patients testing positive for autoantibodies compared with healthy Filipino controls. A longitudinal observational study in this same cohort will determine which proportion of these un-affected FDRs will evolve into clinical SLE disease in the future.
Chronic autoimmune urticaria as the first manifestation of juvenile systemic lupus erythematosus
Authors: Spadoni MS , Jacob CMA , Aikawa NE , Jesus AA , Fomin ÂB , da Silva CA
Published: December 2010

Chronic urticaria (daily or almost daily symptoms lasting for more than six weeks) is characterized by wheals and erythema, with or without itching. A few case reports have shown chronic autoimmune urticaria at the beginning of systemic lupus erythematosus (SLE), particularly in adults. However, the prevalence of this manifestation in a lupus paediatric population was not studied. During 27 consecutive years, 5419 patients were followed up at our University Hospital and 271 (5%) had juvenile SLE (American College of Rheumatology criteria). Two of them (0.7%) had chronic and painless autoimmune urticaria as the first manifestation of juvenile SLE, and were reported herein. One case was a five-year old female with continuous widespread urticaria (duration 120 days), antinuclear antibodies (ANA) 1:640 (dense fine speckled pattern) and elevated complement levels. The juvenile SLE diagnosis was established after one year. The other case was a 13-year old female who had chronic widespread urticaria (lasting 45 days), ANA 1:160 (fine speckled pattern) and normal complement levels. The juvenile SLE diagnosis was established after three years. In conclusion, chronic autoimmune urticaria is very rare and may be the first lupus manifestation, particularly associated with the presence of autoantibodies. This study reinforces the importance of a rigorous follow-up in children and adolescents suffering from autoimmune urticaria due to the possibility of connective tissue disorders, such as paediatric lupus.
Adenosine 2A receptor is protective against renal injury in MRL/lpr mice
Authors: Zhang L , Yang N , Wang S , Huang B , Li F , Tan H , Liang Y , Chen M , Li Y , Yu X
Published: December 2010

Objective. Adenosine is considered as a potent endogenous anti-inflammatory and immunosuppressive molecule. We examined the roles of A2A-adenosine receptor (A2AR) in the progression of lupus nephritis. Methods. MRL/lpr mice were given a selective A2AR agonist, CGS21680 (0.4 mg/kg per day, i.p.) while control mice received saline only. After 8 weeks of treatment, mice were sacrificed for assessment of functional and histological parameters as well as inflammatory infiltration in the kidneys. MCP-1, IFN-γ, MHC-II and A2AR mRNA expression was evaluated by RT-PCR. Expression of A2AR and nuclear NFκB p65 protein was determined by Western blot analysis. Levels of anti-dsDNA antibody and IFN-γ were measured by ELISA. Results. CGS21680 treatment resulted in significant decrease in proteinuria, blood urea and creatinine as well as improvement in renal histology. Renal macrophage and T-cell infiltration were significantly attenuated in association with suppressed expression of MCP-1, IFN-γ and MHC-II. CGS21680 treatment reduced the level of serum anti-dsDNA and renal immune complex deposition. CGS21680 inhibited the activation of NFκB and suppressed the expression of IFN-γ, MCP-1 and MHC-II in MRL/lpr splenocytes. Conclusions. A2AR activation suppressed inflammation in the kidneys of MRL/lpr mice and can be considered as a novel therapeutic approach for human lupus nephritis.
Therapeutic Potential for Protein Kinase C Inhibitor in Vascular Restenosis
Authors: Ding Richard Qinxue , Tsao Jerry , Chai Hong , Mochly-Rosen Daria , Zhou Wei
Published: December 2010

Vascular restenosis, an overreaction of biological response to injury, is initialized by thrombosis and inflammation. This response is characterized by increased smooth muscle cell migration and proliferation. Available pharmacological treatments include anticoagulants, antiplatelet agents, immunosuppressants, and antiproliferation agents. Protein kinase C (PKC), a large family of serine/threonine kinases, has been shown to participate in various pathological stages of restenosis. Consequently, PKC inhibitors are expected to exert a wide range of pharmacological activities therapeutically beneficial for restenosis. In this review, the roles of PKC isozymes in platelets, leukocytes, endothelial cells, and smooth muscle cells are discussed, with emphasis given to smooth muscle cells. We will describe cellular and animal studies assessing prevention of restenosis with PKC inhibitors, particularly targeting -α, -β, -δ, and -ζ isozymes. The delivery strategy, efficacy, and safety of such PKC regulators will also be discussed.
Mechanism of Sarpogrelate Action in Improving Cardiac Function in Diabetes
Authors: Goyal Ramesh K. , Elimban Vijayan , Xu Yan-Jan , Kumamoto Hideo , Takeda Nobuakira , Dhalla Naranjan S.
Published: December 2010

Although sarpogrelate, a 5-HT2A receptor antagonist, has been reported to exert beneficial effects in diabetes, the mechanisms of its action are not understood. In this study, diabetes was induced in rats by an injection of streptozotocin (65 mg/kg) and the animals were assessed 7 weeks later. Decreased serum insulin as well as increased serum glucose, cholesterol, and triglyceride levels in diabetic animals were associated with increased blood pressure and heart/body weight ratio. Impaired cardiac performance in diabetic animals was evident by decreased heart rate, left ventricular developed pressure, rate of pressure development, and rate of pressure decay. Treatment of diabetic animals with sarpogrelate (5 mg/kg) or insulin (10 units/kg) daily for 6 weeks attenuated the observed changes in serum insulin, glucose, and lipid levels as well as blood pressure and cardiac function by varying degrees. Protein content for membrane glucose transporters (GLUT-1 and GLUT-4) was depressed in diabetic heart; the observed alteration in GLUT-4 was partially prevented by both sarpogrelate and insulin, whereas that in GLUT-1 was attenuated by sarpogrelate only. Incubation of myoblast cells with sarpogrelate and insulin stimulated glucose uptake; these effects were additive. 5-hydroxytryptamine was found to inhibit glucose-induced insulin release from the pancreas; this effect was prevented by sarpogrelate. These results suggest that sarpogrelate may improve cardiac function in chronic diabetes by promoting the expression of membrane glucose transporters as well as by releasing insulin from the pancreas.
Is the Standard Weight-Based Dosing of Dobutamine for Stress Testing Appropriate for Patients of Widely Varying Body Mass Index?
Authors: Kittipovanonth Maytinee , Bernheim Alain M. , Scott Christopher G. , Barnes Marion E. , Shub Clarence , Pellikka Patricia A.
Published: December 2010

Background: Although a gradual increase in heart rate (HR) during dobutamine stress testing (DST) is desired, few data exists regarding whether this is similarly achieved in patients of widely varying body mass index (BMI). Whether difference in BMI contributes to variation in the hemodynamic and symptomatic response to dobutamine is also unknown. Methods: From prospectively acquired data of 2776 consecutive patients who underwent DST according to standard weight-based clinical protocol, we classified patients into 4 groups of BMI (kg/m 2): <25 (normal), 25 to 29.9 (overweight), 30 to 39.9 (obese), and ≥40 (severely obese) and compared the rate of increase of HR, mean blood pressure, and development of symptoms for the groups. Results: Age was 68 + 12 years, 52% were men, BMI was 29.8 + 6.6 kg/m2 (range 14.5-81.4), 198 (7%) had BMI ≥40, and target HR was achieved in 2433 (88%). The rate of increase in HR was similar for each group of BMI after adjustment for age, gender, baseline HR, negative chronotropic use, and atropine administration. The percentage of patients in each group who achieved target HR was similar and the percentage of target HR achieved at each stage of dobutamine was essentially equivalent. Blood pressure responses and development of symptoms were similar in the 4 groups of BMI. Independent predictors of failure to achieve target HR included age, diabetes mellitus, treatment with negative chronotropic medications, and baseline HR; BMI was not a predictor (odds ratio [OR] 0.98, P = .086). Conclusion: The current weight-based protocol of dobutamine dosing for DST results in similar increases in HR and blood pressure for patients of widely varying BMI.
Sampling and mass spectrometric analytical methods for five antineoplastic drugs in the healthcare environment
Authors: Pretty Jack R , Connor Thomas H , Spasojevic Ivan , Kurtz Kristine S , McLaurin Jeffrey L , B’Hymer Clayton , Debord D Gayle
Published: December 2010

Context. Healthcare worker exposure to antineoplastic drugs continues to be reported despite safe handling guidelines published by several groups. Sensitive sampling and analytical methods are needed so that occupational safety and health professionals may accurately assess environmental and biological exposure to these drugs in the workplace.

Objective. To develop liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) analytical methods for measuring five antineoplastic drugs in samples from the work environment, and to apply these methods in validating sampling methodology. A single method for quantifying several widely used agents would decrease the number of samples required for method development, lower cost, and time of analysis. Methods for measuring these drugs in workers’ urine would also be useful in monitoring personal exposure levels.

Results. LC-MS/MS methods were developed for individual analysis of five antineoplastic drugs in wipe and air sample media projected for use in field sampling: cyclophosphamide, ifosfamide, paclitaxel, doxorubicin, and 5-fluorouracil. Cyclophosphamide, ifosfamide, and paclitaxel were also measured simultaneously in some stages of the work. Extraction methods for air and wipe samples were developed and tested using the aforementioned analytical methods. Good recoveries from the candidate air and wipe sample media for most of the compounds, and variable recoveries for test wipe samples depending on the surface under study, were observed. Alternate LC-MS/MS methods were also developed to detect cyclophosphamide and paclitaxel in urine samples.

Conclusions. The sampling and analytical methods were suitable for determining worker exposure to antineoplastics via surface and breathing zone contamination in projected surveys of healthcare settings.
Backwards and forwards in space and time: Recalling dance movement from long-term memory
Authors: Stevens Catherine J. , Ginsborg Jane , Lester Garry
Published: December 2010

Recall of complex non-verbal motor sequences, such as contemporary dance, provides insights into the structure and mechanics of human memory — specifically, cues and associations in long-term memory (LTM). In this study, four dancers recalled material — eight exercises in the form of short dances — that they had not performed for between three and 31 years. The dancers initially recalled the exercises in silence, although each one had been learned to a particular piece of music. The exercises were recalled either immediately or after an unfilled delay and using self-motion or a mannequin. Recall rates were similar across immediate and delayed conditions; self versus mannequin motion had little impact on the length of material recalled. Qualitative data indicated that music and dancer movement were important cues to LTM; transitions were sometimes forgotten; images associated with movement recall were kinaesthetic, verbal, visual and auditory. The results are consistent with accounts of LTM for other temporal arts and suggest activation of multimodal associates and images.
Is prevention a fantasy, or the future of medicine? A panoramic view of recent data, status, and direction in cardiovascular prevention
Authors: Kones Richard
Published: December 2010

Americans are under assault by a fierce epidemic of obesity, diabetes, and cardiovascular disease, of their own doing. Lowered death rates from heart disease and reduced rates of smoking are seriously threatened by the inexorable rise in overweight and obesity. Latest data indicate that 32% of children are overweight or obese, and fewer than 17% exercise sufficiently. Over 68% of adults are overweight, 35% are obese, nearly 40% fulfill criteria for the metabolic syndrome, 8–13% have diabetes, 34% have hypertension, 36% have prehypertension, 29% have prediabetes, 15% of the population with either diabetes, hypertension, or dyslipidemia are undiagnosed, 59% engage in no vigorous activity, and fewer than 5% of the US population qualifies for the American Heart Association (AHA) definition of ideal cardiovascular health. Health, nutrition, and exercise illiteracy is prevalent, while misinformation and unrealistic expectations are the norm. Half of American adults have at least one cardiovascular risk factor. Up to 65% do not have their conventional risk biomarkers under control. Of those patients with multiple risk factors, fewer than 10% have all of them adequately controlled. Even when patients are treated according to evidence-based protocols, about 70% of cardiac events remain unaddressed. Undertreatment is also common. Poor patient adherence, probably well below 50%, adds further difficulty in reducing cardiovascular risk. Available data indicate that only a modest fraction of the total cardiovascular risk burden in the population is actually now being eliminated. A fresh view of these issues, a change in current philosophy, leading to new and different, multimechanistic methods of prevention may be needed. Adherence to published guidelines will improve substantially outcomes in both primary and secondary prevention. Primordial prevention, which does not allow risk values to appear in a population, affords more complete protection than subsequent partial reversal of elevated risk factors or biomarkers. Current evidence supports recent calls for massive educational programs supporting primordial prevention, individual responsibility and pride in achieving population-wide ideal cardiovascular health through lifestyle modification. Environmental and social changes will be necessary, along with major supportive adjustments in the food industry and the assistance of the media. Cooperation is critical to the success of such an initiative.
Safety and efficacy of triple antithrombotic therapy after percutaneous coronary intervention in patients needing long-term anticoagulation
Authors: Singh Param Puneet , Singh Mukesh , Bedi Updesh , Molnar Janos , Arora Rohit , Khosla Sandeep
Published: December 2010

Background: Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) is currently undefined in patients requiring long-term anticoagulation. Previous studies comparing triple therapy (TT) of warfarin, aspirin and clopidogrel with standard dual therapy (DT) of aspirin and clopidogrel have yielded conflicting results. Meta-analysis of these studies was performed to evaluate safety and efficacy of TT.

Methods: A total of 1482 patients from 6 studies were analyzed using the Mantel–Haenszel random effect model to extract incidence of major bleeding. The secondary end point assessed by three of these studies was major adverse cardiac events (MACEs: cardiovascular death, myocardial infarction and thromboembolic complications). The incidence of MACEs was computed using the Mantel–Haenszel fixed effect model. Combined relative risks (RRs) across all of the studies and the 95% confidence intervals (CIs) were determined. A two-sided alpha error <0.05 was considered statistically significant.

Results: Baseline characteristics were similar in both groups. Compared with patients receiving DT, the risk of major bleeding was significantly higher in the TT group (RR: 2.74, CI: 1.08–6.98; p = 0.034). However, risk of MACE was significantly lower in the TT group (RR: 0.72, CI: 0.56–0.98; p = 0.014).

Conclusion: In patients requiring long-term anticoagulation after PCI, TT may be superior to DT in reducing the incidence of MACEs, however risk of major bleeding complications is increased significantly.