bluuebunny/crossref_metadata_2025 huggingface dataset:
Man to Man Prostate Cancer Support Groups
Authors: Coreil Jeannine , Behal Ravish
Published: March 2003

purpose
:

In this report, the authors describe Man to Man prostate cancer support group characteristics and functioning to identify ways to strengthen the program as it expands nationally and internationally.

description of study
:

A mail survey of 38 groups in Florida collected data on group meeting practices, facilitator background, training, and perceived needs, and on participant characteristics and satisfaction with the group. Descriptive statistics and bivariate analyses of survey data were performed.

results
:

Typical groups included both survivors and significant others, met on a monthly basis, and followed a format that combined educational content with sharing of personal experiences. Facilitators and participants alike were typically retired white men in their 60s and 70s from well‐educated professional backgrounds, who joined the groups after undergoing treatment for prostate cancer. High levels of satisfaction with the program's organization and functioning were reported. Perceived needs were in the areas of increasing access to support services, achieving a more diverse membership, and better outreach to newly diagnosed patients.

clinical implications
:

Healthcare professionals can play a key role in informing newly diagnosed prostate cancer patients about the availability of support groups in their communities. Earlier referral to support groups would enhance patients' access to shared experiences and resources for guidance in treatment decisions. Greater attention to psychosocial issues in Man to Man support groups might better meet the emotional needs of patients and families.
Screening to Predict Complicated Grief in Spouses of Cancer Patients
Authors: BrintzenhofeSzoc Karlynn M. , Smith Elizabeth D. , Zabora James R.
Published: March 2003

objectives: Grief is the expected reaction to the death of a family member or close friend and is accompanied by substantial distress for almost everyone who experiences it. For some the grief response becomes complicated. This pilot study sought to identify individuals at high risk for complicated grief, by 1) examining the relationships that exist between family functioning before the death, psychological distress, and the grief reaction of a family after the death, and 2) presenting the use of screening with standardized measures to identify those at risk.

materials and methods: This pilot study examined the relationships between family functioning, psychological distress, and grief reaction. A cross‐sectional design was used and the instrument included the Family Adaptability and Cohesion Evaluation Scale (FACES III), the Brief Symptom Inventory (BSI), and the Texas Revised Inventory of Grief (TRIG). Significant relationships were identified between the level of family functioning, psychological distress and grief reaction. Depression, anxiety, and general distress were significantly correlated with the two subscales of the TRIG.

conclusions: The findings clearly illustrate the merit of psychosocial screening of spouses and suggest the possible benefits of screening before the patient's death, using FACES III and the BSI to identify which spouses are at risk for complicated grief reactions.
Assessing Cultural Sensitivity in Printed Cancer Materials
Authors: Guidry Jeffrey J. , Walker Verrick D.
Published: March 2003

objectives: Printed cancer education materials (PCEMs) (pamphlets and fact sheets) are used to educate individuals about cancer prevention and awareness. Culture is an important variable affecting the retention and use of information in printed materials to African Americans that has not been fully addressed in the literature.

materials and methods: The major goal of the Cancer Prevention Materials for African Americans project, funded by the Texas Cancer Council, was to assess cultural sensitivity of currently disseminated PCEMs targeting African Americans. The project consisted of conducting focus groups, forming an advisory committee, and developing and using the Printed Cancer Education Materials for African Americans Cultural Sensitivity Assessment Tool.

results: Cultural sensitivity of PCEMs was assessed in terms of format, visual message, and written message. The majority of the PCEMs (56.2%) were culturally insensitive, with the visual message being the weakest component of all the materials.

conclusion: Future PCEMs targeting African Americans should include culturally sensitive visual messages to be more effective in delivering the cancer prevention message. The use of the assessment tool can assist cancer control specialists in developing culturally sensitive materials.
Delirium in Patients with Cancer at the End of Life
Authors: Cobb Janet L. , Glantz Michael J. , Nicholas Patrice K. , Martin Edward W. , Paul‐Simon Alexandra , Cole Bernard F. , Corless Inge B.
Published: March 2003

Purpose: Delirium is a common and distressing syndrome seen in patients with advanced cancer. Behavioral manifestations of delirium, such as agitation, may result in medical intervention, stress to family caregivers, and inpatient hospice admission. The purpose of this study was to examine the frequency, characteristics, and presumed causes of delirium in patients with advanced cancer.

Description of study: Records of all patients with cancer who were admitted to an inpatient hospice facility in 1995 were reviewed retrospectively (N = 210). Patients were classified as delirious based on the clinical judgment of the admitting physician.

Results: Delirium was the third most common reason for admission (20%). Male gender (P = .04) and the presence of a primary or metastatic brain tumor (P = .03) were significant risk factors for delirium, while advanced age and primary or metastatic liver, lung, or bone cancer were not. Resolution of the agitation, the most disruptive symptom of delirium, occurred in 69% of patients before death or discharge.

Clinical implications: Delirium is common in hospice patients with cancer and is an important cause of family distress and increased cost of care. The recognition of early clinical signs and predisposing factors should facilitate prompt diagnosis. Appropriate intervention is usually successful in alleviating the most distressing symptoms of delirium.
Early Postsurgery Experience of Prostate Cancer Patients and Spouses
Authors: Phillips Catherine , Gray Ross E. , Fitch Margaret I. , Labrecque Manon , Fergus Karen , Klotz Laurence
Published: March 2003

Purpose: The authors describe the experience of men with prostate cancer and their spouses in the early recovery period after surgery.

Description of study: As part of a longitudinal qualitative study, semistructured interviews were held with 34 patients who had prostate cancer and their spouses 8 to 10 weeks after surgery.

Results: Five components of experience emerged from the interviews: 1) hearing news about the extent of their cancer after surgery influenced how patients viewed their cancer experience and, in many cases, their recovery; 2) men placed great emphasis on recovering their physical capacity quickly; 3) couples connected with each other through working out care routines and managing periods of irritability; 4) couples described a range of responses to surgery side effects and complications; and 5) the meaning of cancer varied for couples, with most seeing the experience as a temporary disruption.

Clinical implications: Physicians, nurses, social workers, and other health professionals working with patients before and after prostatectomies may assist couples to prepare better for the early recovery period by being both sensitive to the men's need to recover physical capacity quickly while helping them to understand that recovery takes time. Accurate information about expected periods of irritability, side effects, and possible complications would diminish the likelihood of distress during this period.
Cancer Survivor Identity and Quality of Life
Authors: Zebrack Brad J.
Published: March 2003

Purpose: The purpose of this article is to propose a framework for enhancing an understanding of quality of life among cancer survivors that takes into account individuals' subjective experiences and attributions of self as they relate to their own experience with cancer.

Overview: This review of a small yet burgeoning cancer survivorship literature posits that there is room to expand the theoretical context for understanding cancer and its impact on quality of life by assuming that the experience of cancer involves changes in social roles and identity. In turn, changes in the way cancer survivors see themselves in relation to the world, including the ability to carry out roles and responsibilities, may affect quality of life. This perspective suggests that a cancer diagnosis initiates a survival trajectory and a social role that extends over the remainder of one's life, regardless of life expectancy.

clinical Implications: Expanding the understanding of quality of life and the factors that contribute to it should help subsequent investigations of who might benefit from which psychosocial support interventions provided when (i.e., during early diagnostic stage, treatment stage, or both or in the long term). Equipped with this understanding, clinicians and agencies providing services to cancer survivors and their families can develop appropriate supportive interventions that facilitate and enhance quality of life.
Oncologists' and Naturopaths' Nutrition Beliefs and Practices
Authors: Novak Kerri L. , Chapman Gwen E.
Published: March 2003

Purpose: Despite the widespread use of complementary and alternative therapies by persons with cancer, little is known about how the understandings of complementary and alternative practitioners of these therapies compare with those of conventional physicians. The broad purpose of this research was, thus, to explore the beliefs of physicians and complementary and alternative health practitioners, their use of scientific and other types of evidence, and their counseling practices. The specific issue addressed was the beliefs and practices of oncologists and naturopaths regarding the role of diet in breast cancer prevention and treatment.

Description of study: A qualitative research design was used, involving in‐depth semistructured interviews with 10 oncologists and 11 naturopaths. Interviews were tape‐recorded, transcribed verbatim, and analyzed using qualitative methods.

Results: The oncologists believed that there is little evidence of a role for diet in breast cancer prevention and treatment, citing the lack of evidence from randomized controlled trials. They reported that they provide only general advice on healthy eating to patients. The naturopaths believed that diet is strongly implicated in breast cancer development, prevention, and treatment. They justified this belief by using scientific evidence from a variety of types of studies, logic or common sense, and their clinical experiences. Naturopaths reported that they provide patients with specific suggestions for foods to avoid or to emphasize in diets.

Clinical implications: The differences in the advice provided by oncologists and naturopaths are associated with different decision‐making or knowledge construction systems. Educating patients about these differences will help patients to make more informed healthcare choices.
Altered Sexual Patterns after Treatment for Prostate Cancer
Authors: Berterö Carina
Published: March 2003

Purpose: The purpose of this study was to identify and describe the impact of prostate cancer and its treatment on men's sexuality and intimate relationships from the perspective of the men's lived experiences.

Description of the study: Ten men diagnosed with prostate cancer were interviewed. Verbal transcripts were analyzed using an interpretive phenomenological approach based on Heidegger's philosophy.

Results: “Altered sexual patterns” was identified as the major theme, which in turn was influenced by five minor themes: choice of consequences; age affecting sexual life; hope of improvement; acceptance of altered sexual life; and image of manliness. Choice of consequences showed that survival is paramount, as interviewees often felt that they were choosing between death or sexual dysfunction. Age affecting sexual life identified sexual dysfunction as caused by natural effects of aging. Hope of improvement showed that several men hoped for improvement in sexual function, although it had been years since their treatment. Acceptance of altered sexual life illustrated that the men often felt the need to accept their altered sex life, with their wives playing an important role in this acceptance. Finally, the theme image of manliness showed the men's attempts to acknowledge and cope with the changes in their self‐image.

Clinical implications: It is important that healthcare professionals adopt a comprehensive approach in communicating information about prostate cancer treatment choices and potential side effects that includes the patient and his partner. Communication and counselling about treatment options, potential side effects, and potential strategies to manage side effects should be offered both at the time of diagnosis and at post‐treatment follow‐up.
Exercise Discussions During Cancer Treatment Consultations
Authors: Jones Lee W. , Courneya Kerry S.
Published: March 2003

purpose: Physical exercise has been shown to help cancer survivors cope with treatment side effects. The purpose of this study was to examine the role of the oncologist in promoting exercise in cancer survivors.

description of study: Cancer survivors who had recently completed treatment (N = 311) were mailed a self‐administered questionnaire that assessed the following: whether exercise was discussed during any of their treatment consultations; whether they preferred that exercise be discussed during this time; their perceived oncologist approval for exercise; and the amount of exercise they performed during treatment.

results: Descriptive statistics showed that 28.4% of cancer survivors reported that their oncologist initiated a discussion of exercise during their treatment consultation, that 13.9% said that they initiated a discussion, and that 57.8% said that exercise was not discussed. Survivors younger than 60 years of age were more likely to initiate a discussion of exercise than were older survivors. Survivors whose oncologist initiated a discussion of exercise also reported a stronger normative belief for exercise, performing more frequent exercise during treatment, and performing more total minutes of exercise during treatment. Most (82.2%) survivors preferred that the oncologist initiate the discussion of exercise.

clinical implications: These findings indicate that most cancer survivors responding to this survey preferred that their oncologist initiate a discussion of exercise. Such a discussion appears to increase survivor exercise levels during treatment. If confirmed in a prospective, randomized, controlled trial, the implication is that an oncologist‐initiated discussion of exercise during treatment consultations may be a cost‐effective strategy for promoting exercise in cancer survivors.
An Evaluation of the Man to Man Self‐Help Group in Colorado and Utah
Authors: Smith Roberta L. , Crane Lori A. , Byers Tim , Nelson‐Marten Paula
Published: March 2003

purpose: Two surveys were conducted to evaluate the Man to Man program, a prostate cancer self‐help group of the American Cancer Society (ACS).

description of study: The study involved two surveys in Colorado and Utah in 2001, one of program participants, the other of area urologists, respectively. A focus group also was conducted of African American men with prostate cancer in Denver, Colo.

results: In total, 112 participants in the Man to Man program and 66 urologists participated in the study. Results of the participant survey indicated that men and their families found out about the group through other prostate cancer survivors, doctors, or the ACS. Monthly attendance at the groups ranged from 2 to 50 participants. Participants valued the prostate cancer treatment information, physician presentations, and social aspects that were offered. The results of the urologist survey indicated that 67% were aware of the Man to Man program, but most were not aware of the services it offered. Urologists learned of the group through Man to Man participants, other physicians, and the ACS. Focus group results suggested that a personal preference for access to other sources of support and information was a primary reason for nonattendance at Man to Man meetings.

clinical implications: Attendance at Man to Man meetings is likely to be enhanced by focusing on basic prostate cancer information topics. Future evaluations of Man to Man meeting participation should focus on the role of women in the program. Most urologists were not familiar with the services offered by Man to Man. The ACS and the organizers of local Man to Man programs should target urologists in future outreach efforts.
Macroevolution is more than repeated rounds of microevolution
Authors: Erwin Douglas H.
Published: March 2003

SUMMARYArguments over macroevolution versus microevolution have waxed and waned through most of the twentieth century. Initially, paleontologists and other evolutionary biologists advanced a variety of non‐Darwinian evolutionary processes as explanations for patterns found in the fossil record, emphasizing macroevolution as a source of morphologic novelty. Later, paleontologists, from Simpson to Gould, Stanley, and others, accepted the primacy of natural selection but argued that rapid speciation produced a discontinuity between micro‐ and macroevolution. This second phase emphasizes the sorting of innovations between species. Other discontinuities appear in the persistence of trends (differential success of species within clades), including species sorting, in the differential success between clades and in the origination and establishment of evolutionary novelties. These discontinuities impose a hierarchical structure to evolution and discredit any smooth extrapolation from allelic substitution to large‐scale evolutionary patterns. Recent developments in comparative developmental biology suggest a need to reconsider the possibility that some macroevolutionary discontinuites may be associated with the origination of evolutionary innovation. The attractiveness of macroevolution reflects the exhaustive documentation of large‐scale patterns which reveal a richness to evolution unexplained by microevolution. If the goal of evolutionary biology is to understand the history of life, rather than simply document experimental analysis of evolution, studies from paleontology, phylogenetics, developmental biology, and other fields demand the deeper view provided by macroevolution.
From phenotype to genotype
Authors: Streelman J. Todd , Kocher Thomas D.
Published: March 2003

SUMMARY Advances in the field of genomics have made it possible to decipher the genetic and transcriptional changes that underlie differences among organisms. Here we discuss the merits and drawbacks of these strategies as they relate to evolutionary biology. We suggest that the molecular basis of natural variation can best be interpreted via the intersection of genomic and transcriptome approaches. We outline how this might be accomplished in practice and assemble the components of a method to comprehend the evolutionary interplay between genotype and phenotype.
Evolutionary relationships between the amphibian, avian, and mammalian stomachs
Authors: Smith Devyn M. , Grasty Rayetta C. , Theodosiou Nicole A. , Tabin Clifford J. , Nascone‐Yoder Nanette M.
Published: March 2003

SUMMARY Although the gut is homologous among different vertebrates, morphological differences exist between different species. The most obvious variation in the guts of extant vertebrates appears in the stomach. To investigate the evolution of this structure, we compared the histology of the stomach and gastrointestinal tract in amphibian (Xenopus laevis), avian (Gallus gallus), and mammalian (Mus musculus) organisms, and defined the expression patterns of several genes within the developing guts of these lineages. In all three groups, we find that the anterior portion of the stomach has a similar glandular histology as well as a common embryonic expression of the secreted factors Wnt5a and BMP‐4. Likewise, within the amniote lineages, the posterior nonglandular stomach and pyloric sphincter regions are also comparable in both histological and molecular phenotypes. The posterior stomach expresses Six2, BMPR1B, and Barx1, whereas the pyloric sphincter expresses Nkx2.5. Although the adult Xenopus stomach exhibits both glandular and aglandular regions and a distinct pyloric sphincter similar to that of the amniotic vertebrates, the histology of the Xenopus tadpole gut shows less distinct variation in differentiation in this region, which is most likely a derived condition. The molecular signature of the embryonic Xenopus gut correlates with the more derived morphology of the larval phase. We conclude that the global patterning of the gut is remarkably similar among the different vertebrate lineages. The distinct compartments of gene expression that we find in the gut be necessary for the unique morphological specializations that distinguish the stomachs from terrestrial vertebrates.
Morphogenesis of the turtle shell: the development of a novel structure in tetrapod evolution
Authors: Gilbert Scott F. , Loredo Grace A. , Brukman Alla , Burke Ann C.
Published: March 2003

SUMMARY The turtle shell is an evolutionary novelty that is synapomorphic for chelonians. The carapace is initiated by the entrapment of the ribs by the carapacial ridge (CR), a lateral bulge of the dorsal ectoderm and dermal mesoderm. The mechanisms by which the CR is initiated, the ribs entrapped and the dorsal dermis ossified, remains unknown. Similarly, the formation of the plastron remains unexplained. Here, we present a series of anatomical investigations into plastron and carapace formation in the red‐eared slider, Trachemys scripta, and the snapping turtle, Chelydra serpentina. We document the entrapment of the ribs by the CR and the formation of the plastron and carapacial bones by intramembranous ossification. We note the formation of the ossification centers around each rib, which suggest that the rib is organizing dermal ossification by secreting paracrine factors. The nuchal ossification center is complex and appears to involve multiple bone‐forming regions. Individual ossification centers at the periphery of the carapace form the peripheral and pygial bones. The intramembranous ossification of the plastron proceeds from nine distinct ossification centers, and there appear to be interactions between the spicules of apposing centers as they draw near each other.
Bias in the introduction of variation as an orienting factor in evolution
Authors: Yampolsky Lev Y. , Stoltzfus Arlin
Published: March 2003

SUMMARY According to New Synthesis doctrine, the direction of evolution is determined by selection and not by “internal causes” that act by way of propensities of variation. This doctrine rests on the theoretical claim that because mutation rates are small in comparison to selection coefficients, mutation is powerless to overcome opposing selection. Using a simple population‐genetic model, this claim is shown to depend on assuming the prior availability of variation, so that mutation may act only as a “pressure” on the frequencies of existing alleles, and not as the evolutionary process that introduces novelty. As shown here, mutational bias in the introduction of novelty can strongly influence the course of evolution, even when mutation rates are small in comparison to selection coefficients. Recognizing this mode of causation provides a distinct mechanistic basis for an “internalist” approach to determining the contribution of mutational and developmental factors to evolutionary phenomena such as homoplasy, parallelism, and directionality.
Molecular studies of hemichordate development: a key to understanding the evolution of bilateral animals and chordates
Authors: Tagawa Kuni , Satoh Nori , Humphreys Tom
Published: March 2003

SUMMARY Using the Hawaiian acorn worm, Ptychodera flava, we began molecular studies on the development of hemichordates, a phylum previously unstudied at this level. Here we review results garnered from the examination of a few specific genes selected to help understand the evolution of vertebrate structures. These studies suggest new ideas about the evolution of developmental mechanisms in the deuterostomes. In a seminal observation, we noted an unexpected zone of expression of the Brachyury gene in the early anterior embryonic ectoderm where the mouth will form. Typically, the Brachyury gene is closely linked to development of the notochord and is expressed around the blastopore and in the posterior mesoderm in most animals. This first expression of Brachyury at the blastopore may represent a regulatory program associated with organizing the original animal head and gut opening, as suggested by the expression of Brachyury during hypostome formation in hydra. We believe that the anterior expression of Brachyury in deuterostomes represents the cooption of the program for organizing the original animal gut opening to form the deuterostome mouth. Recent data from the trochophore larva of a polychaete show that an anterior zone of expression of Brachyury is produced in this protostome by splitting of the Brachyury field during the formation of a gut with a mouth and anus by the lateral fusion of the sides of the blastopore. The ability to initiate independently a secondary regulatory program to organize the new mouth leading to an anterior field of Brachyury expression may be a signal event in the evolution of the deuterostomes. We also noted that the P. flava homolog of T‐brain/Eomes, a gene closely related by sequence and expression around the blastopore to Brachyury and associated with development of the vertebrate brain, also exhibits early posterior expression around the blastopore and a field of de novo anterior ectoderm expression during later embryogenesis. The tissue in the zone of de novo anterior ectoderm expression of Pf‐Tbrain produces the apical organ, a larval neural structure that has been touted as an evolutionary precursor of the chordate dorsal brain. The gene regulatory mechanisms responsible for initiating the anterior zone of de novo expression of T‐brain may represent a cooption to specify early neuroectoderm of the regulatory program evolved first to drive anterior Brachyury expression for deuterostome mouth formation. It will be interesting to examine the possibilities that an ability to initiate the de novo anterior expression of the program that includes T‐brain may be a key event in the evolution of the developmental mechanisms leading to the chordate dorsal nervous system.
A novel mode of ecdysozoan growth in Caenorhabditis elegans
Authors: Knight Christopher G. , Patel Mavji N. , Azevedo Ricardo B. R. , Leroi Armand M.
Published: March 2003

SUMMARY Whereas growth in many ecdysozoa is associated with only molting, larval growth in nematodes, specifically Caenorhabditis elegans, is thought to be continuous and exponential. However, this has never been closely investigated. Here we report several detailed studies of growth in wild‐type and dwarf C. elegans strains. We find that apparent exponential growth between hatching and adulthood comprises a series of linear phases, one per larval stage, with the linear growth rate increasing at successive molts. Although most structures grow continuously, the buccal cavity does not; instead, it grows saltationally at molts, like arthropod structures. We speculate that these saltational changes in mouth size permit changes in growth rate and that molting exists in nematodes to facilitate rapid growth. We study the cellular basis of this growth in the hypodermis. At each larval stage, lateral seam cells produce daughters that fuse with hyp7, a syncytium covering most of the worm. We find that seam cells and fusing daughter cells obtain larger sizes in successive molts. The total seam cell volume remains constant relative to the size of the worm. However, fusing daughter cells contributes only a very small amount directly to hypodermal growth, suggesting that most hyp7 growth must be intrinsic. Thus, dwarfism mutations studied principally act via adult syncytial growth, with cell size being near normal in both dbl‐1 and dpy‐2 mutant worms. We speculate that the main function of seam cell proliferation may be to supply the hypodermis with additional genomes for the purpose of growth.
Expression of a homologue of the fushi tarazu (ftz) gene in a cirripede crustacean
Authors: Mouchel‐Vielh Emmanuèle , Blin Maryline , Rigolot Catherine , Deutsch Jean S.
Published: March 2003

SUMMARY In Metazoa, Hox genes control the identity of the body parts along the anteroposterior axis. In addition to this homeotic function, these genes are characterized by two conserved features: They are clustered in the genome, and they contain a particular sequence, the homeobox, encoding a DNA‐binding domain. Analysis of Hox homeobox sequences suggests that the Hox cluster emerged early in Metazoa and then underwent gene duplication events. In arthropods, the Hox cluster contains eight genes with a homeotic function and two other Hox‐like genes, zerknullt (zen)/Hox3 and fushi tarazu (ftz). In insects, these two genes have lost their homeotic function but have acquired new functions in embryogenesis. In contrast, in chelicerates, these genes are expressed in a Hox‐like pattern, which suggests that they have conserved their ancestral homeotic function.

We describe here the characterization of Diva, the homologue of ftz in the cirripede crustacean Sacculina carcini. Diva is located in the Hox cluster, in the same position as the ftz genes of insects, and is not expressed in a Hox‐like pattern. Instead, it is expressed exclusively in the central nervous system. Such a neurogenic expression of ftz has been also described in insects. This study, which provides the first information about the Hox cluster in Crustacea, reveals that it may not be much smaller than the insect cluster. Study of the Diva expression pattern suggests that the arthropod ftz gene has lost its ancestral homeotic function after the divergence of the Crustacea/Hexapoda clade from other arthropod clades. In contrast, the function of ftz during neurogenesis is well conserved in insects and crustaceans.
Coevolution in bicoid‐dependent promoters and the inception of regulatory incompatibilities among species of higher Diptera
Authors: Shaw P. J. , Wratten N. S. , McGregor A. P. , Dover G. A.
Published: March 2003

SUMMARY To what extent and in what way do gene promoters and their transacting regulatory proteins coevolve? In this and in earlier publications we show that the Bicoid‐dependent promoters of the segmentation genes hunchback and tailless in species of higher Diptera (Drosophila, Musca, Calliphora, and Lucilia) are different with respect to the copy number, spacing, sequence, and orientation of Bicoid binding sites. At the same time there are significant amino acid differences in the Bicoid homeodomain. To test these interspecific differences, we used a series of functional assays, starting with the analysis of Bicoid binding affinities of individual sites, through to transgene rescue experiments, to compare within‐species with between‐species mixtures of Bicoid homeo‐ domains and hunchback or tailless promoters. We observed that components taken from different species interact with less efficiency compared with those taken from within the same species. Our interpretation is that such interspecific incompatibilities are a consequence of interactive genetic elements coevolving one with another, hence maintaining functional compatibility within each species. At the same time such a process allows differences to accumulate between species regarding the precise molecular basis whereby the common function is effected.
Clinical Trials of Type I and In Vitro Studies of Type II Immunoadsorbents for Systemic Lupus Erythematosus Therapy
Authors: Kong De‐Ling , Chen Chang‐Zhi , Lin En‐Fu , Yu Yao‐Ting
Published: March 2003

A highly selective immunoadsorbent was prepared by immobilization of DNA on carbonized resin beads (Type I) for the removal of the pathogenic antibodies of systemic lupus erythematosus (SLE) patients. Thirty cases of clinical trials of this SLE therapy were performed at 12 hospitals in China. The levels of anti‐DNA antibodies after whole blood perfusion were decreased 40–70%. Almost all the symptoms were relieved, and some patients were freed from medicine administration. A new immunoadsorbent was prepared using aminated cellulose beads (Type II) having a higher DNA immobilization capacity of 0.6 mg/ml than the 0.4 mg/ml capacity for Type I. Stationary adsorption tests with the sera of SLE patients showed that the Type II immunoadsorbent could remove 60% of the pathogenic antibodies, which is much higher than the 30% for the Type I adsorbent.
Alteration of the Traditional Extracorporeal Bypass Circuit to Accommodate Port‐Access Minimally Invasive Cardiac Procedures Using Endovascular Based Cardiopulmonary Bypass
Authors: Groh Mark A. , Fallen David M.
Published: March 2003

Port‐Access minimally invasive cardiac surgery systems (Heartport, Inc., Redwood City, CA, U.S.A.) enable surgeons to perform many procedures including valve surgery and complete coronary artery revascularization of all surfaces of the heart through small anterior thoracotomies. The endovascular based EndoCPB (Heartport, Inc.) cardiopulmonary bypass system uses a modified extracorporeal circuit to afford the same level of myocardial protection through cardioplegic cardiac arrest and bypass as is provided in traditional open chest surgery. We describe the changes required to convert a conventional CPB pump circuit to perform Port‐Access procedures and make recommendations based on clinical experience to facilitate establishing a Port‐Access surgical team and interpreting EndoCPB pressure and flow data. Specific emphasis is placed on the expanded role of the perfusionist in these cases.
Assessment of Bovine Platelet Life Span with Biotinylation and Flow Cytometry
Authors: Baker Linda C. , Kameneva Marina V. , Watach Mary J. , Litwak Philip , Wagner William R.
Published: March 2003

Reduced platelet life span is associated with the implantation of a variety of cardiovascular devices and may be used as a gauge of device biocompatibility. In the bovine model, platelet life span has previously been assessed with radioisotope labeling of removed platelets followed by reinjection and periodic gamma counting of blood samples. We report here the use of protein‐reactive biotin (sulfo‐N‐hydroxysuccinimido [NHS]‐biotin) as an alternative to radioisotope techniques whereby reinjected biotinylated platelets are subsequently detected in blood samples using phycoerythrin‐streptavidin and flow cytometric techniques. Platelet life span was quantified in a normal calf (4.9 days) and in a calf prior to (6.1 days) and following (3.1 days) implantation of a Nimbus Axial Flow Pump ventricular assist device. The assessment of bovine platelet life span with biotinylation and flow cytometry avoids the technical, regulatory, and safety considerations associated with radioisotope usage and appears readily amenable to application in cardiovascular device testing.
BeStent—The Serpentine Balloon Expandable Stent: Review of Mechanical Properties and Clinical Experience
Authors: Roguin Ariel , Beyar Rafael
Published: March 2003

The objective of this study was to present the engineering and clinical aspects of a new balloon expandable coronary stent. A new tubular, serpentine design stainless steel balloon‐expandable stent, the beStent, was designed based on clinical requirements for stents and has been clinically evaluated in multiple sites. The stent is featured by terminal gold markers and rotational junctions that assure no shortening upon expansion and lead to orthogonal locking, maximizing radial strength. In terms of methods and results, the stent was clinically evaluated in the framework of a pilot evaluation in a variety of lesion types. The short‐ and long‐term results evaluated during the course of the beStent multicenter pilot evaluation and in our single center study are reported. A variety of patients were included, including patients with long complex lesions, restenosis lesions, and total occlusions. Short‐term clinical success with stenting was achieved in more than 97% of the cases. Subacute thrombosis was low in 1% of the cases. Clinical restenosis rates were acceptable with an overall 85% 6 month event free survival. In conclusion, the mechanical features of the stent providing its flexibility, scaffolding properties, radial strength, and absence of shortening were tested in a clinical study, showing that it is safe and effective for treating simple as well as long and complex lesions associated with coronary disease with a relatively low rate of complications.
Molecular Adsorbent Recycling System (MARS): Clinical Results of a New Membrane‐Based Blood Purification System for Bioartificial Liver Support
Authors: Stange  , Mitzner  , Risler  , Erley  , Lauchart  , Goehl  , Klammt  , Peszynski  , Freytag  , Hickstein  , Löhr  , Liebe  , Schareck  , Hopt  , Schmidt
Published: March 2003

The use of xenogenic or genetically engineered cell types in bioartificial liver support systems requires separation methods between the patients' blood and the liver support bioreactors that guarantee the sufficient transfer of pathophysiologically relevant substances but prevent complications. The present paper describes a new membrane separation system that is nearly impermeable to proteins but enables the exchange of water soluble and protein bound toxins by a special membrane and a recycled protein containing dialysate. Because the full range of toxins in hepatic failure has still not been identified, the value of this membrane separation method was evaluated clinically. Thirteen patients suffering from life threatening hepatic failure who had not responded to state of the art therapy were treated with this device, the molecular adsorbent recycling system (MARS). The overall survival rate was 69%. All patients showed positive response to the therapy, indicating that the presented membrane separator combines therapeutic effectivity with the highest safety criteria for the patient by cutting the exchange of substances below the level of proteins.
Push/Pull Hemodiafiltration: Technical Aspects and Clinical Effectiveness
Authors: Miwa Masamiki , Shinzato Toru
Published: March 2003

Abstract: Push/pull hemodiafiltration (HDF) is characterized by alternate repetition of filtration and backfiltration during hemodialysis with high‐flux membrane. In the pressure‐controlled push/pull (PC P/P) HDF system, which is the newest push/pull HDF system, there are about 25 repetitions of dilution and concentration of the blood while it passes through the hemodiafilter. Hence, the PC P/P is functionally close to the predilution mode of on‐line HDF. In the PC P/P, body fluid is replaced usually by more than 120 L of dialysate during the 4 h treatment. In selecting a hemodiafilter for PC P/P, one must be certain that the blood flow channels in the hemodiafilter do not collapse by the positive pressure on the dialysate side in the backfiltration phase. Thus, the polyacrylonitrile hollow‐fiber hemodiafilter and polysulfon hollow‐fiber hemodiafilter are suitable for PC P/P. In the short term, PC P/P has been reported to be effective against joint pain, itchiness, insomnia, irritability, and restless leg syndrome experienced by hemodialysis patients. Midterm clinical effectiveness of PC P/P includes the requisite lowering of the erythropoietin dose and improvement in skin pigmentation. The albumin loss per treatment with the PC P/P was significantly lower than that with the conventional HDF approach when a protein‐permeable membrane is used. In terms of the removal rate of prolactin, no significant difference was found between PC P/P and conventional HDF. On the other hand, the removal rates of myoglobin and β2M, where molecular size was smaller than prolactin, was significantly greater with the PC P/P than with conventional HDF.
Evaluation of Modified Alginate‐Chitosan‐Polyethylene Glycol Microcapsules for Cell Encapsulation
Authors: Chandy Thomas , Mooradian Daniel L. , Rao Gundu H.R.
Published: March 2003

Abstract: A bioartificial pancreas, a medical device entrapping islets of Langerhans (islets) in an immunoisolative membrane, has been regarded as one of the most promising approaches to treat insulin‐dependent diabetic patients. In this study, various modifications of alginate‐chitosan microcapsules were made such as the inclusion of polyethylene glycol (PEG) and the use of crosslinkers such as carbodiimide (EDC) and glutaraldehyde (GA) in the core and onto the microcapsule membrane surface. A characterization of the modified microcapsules in terms of mechanical stability and albumin diffusion as well as their surface properties using SEM was performed. A mild GA treatment greatly enhanced the mechanical stability of the microcapsules, and this treatment did not affect the coating process of chitosan or PEG. The biological response to such microcapsules was evaluated by microencapsulation of red blood cells (RBC) and subsequent observation of their hemoglobin release. The encapsulated RBC in the PEG‐GA coated microcapsules were found to be less hemolytic and had improved stability and biocompatibility. The results suggest the possibility of developing biological assist organs by microencapsulation of mammalian cells such as islets or liver cells in immunoisolative microcapsules in the near future.
Thoughts and Progress
Authors: Noghnogh Abd A. , Reid Ralston W. , Nawab Zeenat M. , Swartz Richard D. , Kjellstrand Carl M. , Ing Todd S.
Published: March 2003

It is the goal of this section to publish material that provides information regarding specific issues, aspects of artificial organ application, approach, philosophy, suggestions, and/or thoughts for the future. Preparation of Ethanol‐Enriched, Bicarbonate‐Based Hemodialysates

We describe a method to produce bicarbonate‐based dialysates containing ~100 mg/dl ethanol by introducing the alcohol into one of the dialysate concentrate solutions geared for the production of bicarbonate‐based dialysates.
Auxiliary Total Artificial Heart: A Compact Electromechanical Artificial Heart Working Simultaneously with the Natural Heart
Authors: Andrade Aron , Nicolosi Denys , Lucchi Julio , Biscegli Jose , Arruda Antonio C. F. , Ohashi Yukio , Mueller Juergen , Tayama Eiki , Glueck Julie , Nosé Yukihiko
Published: March 2003

Abstract: Leading international institutions are designing and developing various types of ventricular assist devices (VAD) and total artificial hearts (TAH). Some of the commercially available pulsatile VADs are not readily implantable into the thoracic cavity of smaller size patients because of size limitation. The majority of the TAH dimensions requires the removal of the patients' native heart. A miniaturized artificial heart, the auxiliary total artificial heart (ATAH), is being developed in these authors' laboratories. This device is an electromechanically driven ATAH using a brushless direct current (DC) motor fixed in a center metallic piece. This pusher plate‐type ATAH control is based on Frank‐Starling's law. The beating frequency is regulated through the change of the left preload, assisting the native heart in obtaining adequate blood flow. With the miniaturization of this pump, the average sized patient can have the surgical implantation procedure in the right thoracic cavity without removing the native heart. The left and right stroke volumes are 35 and 32 ml, respectively. In vitro tests were conducted, and the performance curves demonstrate that the ATAH produces 5 L/min of cardiac output at 180 bpm (10 mmHg of left inlet mean pressure and 100 mm Hg of left outlet mean pressure). Taking into account that this ATAH is working along with the native heart, this output is more than satisfactory for such a device.
Fractionated Plasma Separation and Adsorption System: A Novel System for Blood Purification to Remove Albumin Bound Substances
Authors: Falkenhagen Dieter , Strobl Wolfram , Vogt Gerd , Schrefl Andreas , Linsberger Ingrid , Gerner Franz Joseph , Schoenhofen Michael
Published: March 2003

The removal of albumin bound substances has gained increasing interest in different diseases, especially in acute and chronic liver disease. Therefore, a new system, the fractionated plasma separation and adsorption (FPSA) system, was developed based on combined membrane and adsorbent blood purification techniques. The most important contribution to the FPSA system was the development of a new polysulfone hollow‐fiber filter, which is characterized by a sieving coefficient of 0.89 for human serum albumin (HSA) but only of 0.17 for fibrinogen, and 0 (zero) for IgM immunoglobulins. Using a closed filtrate circuit connected to the new polysulfone filter which integrates 1 or 2 adsorption columns and also a high flux dialyzer adapted to a dialysis machine, the FPSA system opens excellent possibilities for the relatively specific removal of albumin bound substances from the blood such as albumin bound bilirubin or even tryptophan. In comparison to other systems (for example, the Molecular Adsorbent Recirculating System [MARS] and albumin dialysis systems), the FPSA system enables much higher elimination of strongly bound albumin substances. The first clinical investigations have recently started based on a modified dialysis machine designed with all necessary safety measures.
Ultracompact, Completely Implantable Permanent Use Electromechanical Ventricular Assist Device and Total Artificial Heart
Authors: Honda Nobuhisa , Inamoto Taro , Nogawa Masamichi , Takatani Setsuo
Published: March 2003

An ultracompact, completely implantable permanent use electromechanical ventricular assist device (VAD) and total artificial heart (TAH) intended for 50–60 kg size patients have been developed. The TAH and VAD share a miniature electromechanical actuator that comprises a DC brushless motor and a planetary roller screw. The rotational force of the motor is converted into the rectilinear force of the roller screw to actuate the blood pump. The TAH is a one piece design with left and right pusher plate type blood pumps sandwiching an electromechanical actuator. The VAD is one half of the TAH with the same actuator but a different pump housing and a backplate. The blood contacting surfaces, including those of the flexing diaphragm and pump housing, of both the VAD and TAH were made of biocompatible polyurethane. The diameter, thickness, volume, and weight of the VAD are 90 mm, 56 mm, 285 cc, and 380 g, respectively, while those of the TAH are 90 mm, 73 mm, 400 cc, and 440 g, respectively. The design stroke volume of both the VAD and TAH is 60 cc with the stroke length being 12 mm. The stroke length and motor speed are controlled solely based on the commutation signals of the motor. An in vitro study revealed that a maximum pump flow of 7.5 L/min can be obtained with a pump rate of 140 bpm against a mean afterload of 100 mm Hg. The power requirement ranged from 4 to 6 W to deliver a 4–5 L/min flow against a 100 mm Hg afterload with the electrical‐to‐hydraulic efficiency being 19–20%. Our VAD and TAH are the smallest of the currently available devices and suitable for bridge to transplant application as well as for permanent circulatory support of 50–60 kg size patients.