bluuebunny/crossref_metadata_2025 huggingface dataset:
Stress‐Dose Corticosteroid Therapy for Sepsis and Acute Lung Injury or Acute Respiratory Distress Syndrome in Critically Ill Adults
Authors: MacLaren Robert , Jung Rose
Published: May 2004

Sepsis and acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) are associated with high mortality rates despite recent therapeutic advances. Both disease states involve uncontrolled host defense responses that lead to inflammation, endothelial damage, enhanced coagulation, diminished fibrinolysis and fibroproliferation to produce microthrombi, and relative adrenal insufficiency. Corticosteroids inhibit the host defense response and may offer an inexpensive therapeutic option. Results of several randomized, double‐blind studies demonstrated no survival benefit and higher secondary infection rates when supraphysiologic doses of corticosteroids were administered for less than 24 hours. Recently, the emphasis of research for corticosteroid therapy has involved adrenocortical replacement dosage regimens administered for several days to weeks, with doses corresponding to the stress level of the disease. Stress‐dose therapy with hydrocortisone in patients with septic shock who require vasopressor support, especially if adrenal insufficiency is present, accelerates hemodynamic stability and reduces mortality. The frequency of gastrointestinal hemorrhage was higher with corticosteroid therapy than with placebo, but the occurrence of secondary infections was similar to that of placebo. The only randomized, double‐blind study that evaluated stress‐dose methylprednisolone therapy for ARDS was terminated early after only 24 patients were enrolled because therapy with methylprednisolone was associated with enhanced survival despite higher secondary infection rates. A multicenter study investigating stress‐dose methylprednisolone for ARDS is under way and should provide valuable information. Sufficient data support stress‐dose hydrocortisone therapy for vasopressor‐dependent septic shock. Stress‐dose methylprednisolone therapy for ALI‐ARDS requires further study but may be warranted in cases of refractory infection‐induced ARDS when impending mortality is likely.
Angiotensin II Receptor Blocker‐Associated Angioedema: On the Heels of ACE Inhibitor Angioedema
Authors: Abdi Reza , Dong Victor M. , Lee Cynthia J. , Ntoso K. Adu
Published: May 2004

Angioedema and cough are known side effects of angiotensin‐converting enzyme (ACE) inhibitors. Angiotensin‐converting enzyme is a potent inhibitor of kinase II, which facilitates the breakdown of bradykinin. An increase in bradykinin levels results in continued prostaglandin E2 synthesis, vasodilation, increased vascular permeability, and increased interstitial fluid. In contrast, the angiotensin II receptor blockers (ARBs) do not increase bradykinin levels. Angioedema as a complication of ACE inhibitor therapy is not widely recognized; this complication is even less recognized with second‐line ARBs. We report angioedema associated with losartan (an ARB) in a patient who had experienced angioedema secondary to enalapril (an ACE inhibitor). Almost half of patients with ARB‐associated angioedema also had developed angioedema while receiving ACE inhibitor therapy. Clinicians should exercise caution when using ARBs in patients with a history of angioedema secondary to ACE inhibitors.
Angioedema Associated with Candesartan
Authors: Lo Kang‐Sha
Published: May 2004

Most large clinical trials report that the frequency of angioedema caused by angiotensin‐converting enzyme (ACE) inhibitors is 0.1–0.2%. The most common theory for this rare but potentially fatal adverse drug reaction cites ACE inhibitor‐mediated accumulation of bradykinin as the culprit. Because angiotensin II receptor blockers (ARBs) do not exert their effects on ACE, they are not expected to cause bradykinin accumulation and therefore angioedema. Recently, several cases of angioedema related to the administration of ARBs have been documented in the literature. The existence of ARB‐induced angioedema suggests that additional or alternate mechanisms not involving bradykinin are present in drug‐induced angioedema. While taking candesartan for hypertension, a 53–year‐old woman with known ACE inhibitor intolerance developed angioedema. During her hospitalization, candesartan was stopped and immunosuppressive therapy was administered. Within 24 hours, the angioedema had resolved completely and the patient was discharged. In light of the recent literature on ARB‐induced angioedema, ACE inhibitor‐intolerant patients who begin ARB therapy should receive appropriate counseling and be monitored closely for this adverse reaction.
Methotrexate‐Induced Toxic Leukoencephalopathy
Authors: Gowan Geri M. , Herrington Jon D. , Simonetta Alexander B.
Published: May 2004

Drug‐induced leukoencephalopathy is a devastating adverse event that can cause significant morbidity and mortality. Risk factors include advanced age, administration of certain chemotherapies, presence of an Ommaya device, central nervous system malignancy, and most important, exposure to cranial radiation. A 73–year‐old woman developed leukoencephalopathy 2 months after her last dose of intraventricular methotrexate. Although leukoencephalopathy is a severe adverse effect of the agent, her case is different because it occurred without prior exposure to cranial radiation.
Fentanyl‐Associated Syndrome of Inappropriate Antidiuretic Hormone Secretion
Authors: Kokko Heather , Hall Philip D. , Afrin Lawrence B.
Published: May 2004

A 43–year‐old woman with advanced pulmonary blastoma was admitted for worsening back pain. Her drug regimen included hydromorphone and benazepril. On admission, hydromorphone patient‐controlled analgesia (PCA) was started for acute pain control and dexamethasone for possible cord compression. Baseline laboratory tests were unremarkable, but magnetic resonance imaging revealed T3 and L3 lesions. Irradiation was started with improvement in her pain. In anticipation of discharge, a fentanyl transdermal patch was given, and PCA was tapered. Two days later, the patient became progressively confused and fell. Neurologic examination and computed brain tomography were normal. Her serum sodium was 119 mEq/L (normal 136–144 mEq/L) and was confirmed on repeat testing, urine sodium was 194 mEq/L, and urine and serum osmolalities were 554 mOsm/kg (normal 300–900 mOsm/kg) and 245 mOsm/kg (normal 280–300 mOsm/kg), respectively, consistent with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Fluids were restricted, hydromorphone PCA was started again, and fentanyl was discontinued. After 36 hours, her serum sodium increased to 136 mEq/L. Because we were unsure whether the fentanyl or her cancer was causative and were unable to find any published reports of fentanyl‐associated SIADH, we readministered the fentanyl patch 2 days later. Within 48 hours, serum sodium dropped to 123 mEq/L. Fentanyl was discontinued, fluids were restricted, and 3% saline was started. Her serum sodium increased to 132 mEq/L in 48 hours. The patient was prescribed oral hydromorphone and benazepril and was discharged. The repeated temporal relationship between the administration of fentanyl and the onset of SIADH strongly implicates fentanyl as the causative agent in this case. To our knowledge, this is the first report of fentanyl‐associated SIADH.
Long‐Term Lamivudine Therapy for Chronic Hepatitis B in Patients with and without Cirrhosis
Authors: Oh Jung Mi , Kyun Ms. Jinok , Won Cho Sung
Published: May 2004

Study Objective. To evaluate the effects and safety of 52‐week lamivudine therapy in Korean patients with chronic hepatitis B virus (HBV), with and without cirrhosis.

Design. Long‐term retrospective study

Setting. Ajoo University Medical Center, Soowon, Korea.

Patients. Twenty‐seven men and two women who had received oral lamivudine 100 mg/day for 52 weeks for treatment of biopsy‐proven chronic HBV; 11 patients had cirrhosis, 18 did not.

Measurements and Main Results. All 29 patients were positive for HBV DNA and hepatitis B surface antigen (HBsAg) before treatment began; 25 (86%) patients were positive for hepatitis B e antigen (HBeAg). Lamivudine therapy suppressed serum HBV DNA to undetectable levels in 26 (90%) patients within a median of 4 weeks. Serum HBV DNA of 28 patients (97%) fell significantly to undetectable levels within 12 weeks and remained undetectable in 24 (83%) patients after 52 weeks, and HBeAg had converted to negative in 10 (40%) of the 25 patients who were positive. Mean serum alanine aminotransferase (ALT) levels of the 29 patients decreased to within the normal range by 12 weeks and remained at 33–48 IU/L thereafter. Differences in responses of HBV DNA and ALT to lamivudine therapy in HBeAg‐positive and ‐negative patients were negligible (p=0.786 and p=0.225, respectively). Pretreatment HBV DNA and ALT levels had no effect on the efficacy of lamivudine (p=0.9116). Furthermore, differences in responses of HBV DNA (p=0.641), HBeAg seroconversion (p=0.386), and ALT (p=0.689) and in development of drug resistance (p=0.617) between patients with and without cirrhosis were negligible. No serious adverse effects were reported.

Conclusion. Lamivudine is an effective and well‐tolerated therapeutic agent for treating chronic HBV in patients with and without cirrhosis.
Effect of Age and Degree of Immune Activation on Cytochrome P450 3A4 Activity After Influenza Immunization
Authors: Hayney Mary S. , Buck Jessica M.
Published: May 2004

Study Objective. To measure age‐ or sex‐related changes in cytochrome P450 (CYP) activity secondary to influenza vaccination.

Design. Open‐label, single‐dose study.

Setting. General clinical research center at a university hospital.

Subjects. Fifteen healthy volunteers aged 22–51 years.

Intervention. Each subject was given an erythromycin breath test (ERMBT) to measure CYP3A4 activity before influenza immunization and again on day 7 after immunization. Blood was drawn before immunization and on day 28 after immunization to measure influenza antibody concentrations.

Measurements and Main Results. Age of subject and change in ERMBT results after influenza immunization were correlated (correlation coefficient −0.624, p<0.015). However, no correlations could be made between antibody concentrations after influenza immunization or change in antibody concentrations from baseline and age.

Conclusion. Decreases in CYP3A4 activity after influenza immunization are associated with increasing age. The decreases in CYP3A4 activity, however, are not associated with influenza antibody concentrations. This study bears repeating in an older cohort since the study sample did not include elderly individuals.
Individualized Drug Use Assessment in the Elderly
Authors: Raehl Cynthia L. , Bond C. A. , Woods Tresa , Patry Roland A. , Sleeper Rebecca B.
Published: May 2004

Study Objective. To quantify how seniors' ability to take oral prescription drugs safely may correlate with age, sex, socioeconomic status, education, cognitive impairment, depression, and drug self‐management.

Design. Cross‐sectional study.

Setting. Three retirement communities and an adult day care center.

Patients. Fifty‐seven elderly individuals (mean age 79.49 ± 7.26 yrs; mean education 11.33 ± 3.8 yrs; 72% women).

Intervention. After completing a comprehensive medical history, and with drug vials and pillboxes available for consultation, each subject described how he or she was taking prescribed oral drugs.

Measurements and Main Results. The MedTake test evaluated dosage, indication, food or water coingestion, and regimen. For each agent, the test was scored as percentage of correct actions, equally weighted, and compared with label directions or self‐expressed physician changes. A composite MedTake test score (0–100%) summarized a subject's overall ability to take their drug(s) safely. A follow‐up qualitative assessment by a single pharmacist assigned each agent to one of four potential risk categories: correct use, partial correct use without potential clinical significance, partial correct use with potential clinical significance, or incorrect use with high potential of clinical significance. Most subjects (80%) managed their own drug therapy; 70% used reminder systems (calendar, pillbox). The number of medical conditions and prescription drugs was 6.11 ± 4.2 and 5.88 ± 3.44, respectively. Of 325 agents, correct dosage was reported for 94% (306), correct indication for 95% (309), correct coingestion with food or water for 97% (314), and correct regimen for 89% (288). The composite MedTake test score was 88.5 ± 21.3%. The multivariate model, with that score as the dependent variable, adjusted for age and sex, used Mini‐Mental State Examination (p=0.002) and Medicaid assistance within 10 years (p=0.021) as significant factors. The most frequent problem was underdosing of cardiovascular drugs.

Conclusion. Seniors' ability to take oral prescription drugs safely was affected by cognitive function and socioeconomic status. Although the MedTake test helped identify some problems with therapy adherence, a pharmacist's follow‐up evaluation of comprehensive medical and drug histories identified additional potentially clinically significant problems in 20% of subjects.
Modification of High‐Density Lipoprotein Cholesterol in the Management of Cardiovascular Risk
Authors: Koeller Jim , Talbert Robert L.
Published: May 2004

Although several clinical trials clearly demonstrate a decrease in mortality and morbidity rates for various patient populations with cardiovascular disease, this disease continues to be the leading cause of death in the United States. Based on various practice surveys and descriptive reports, clinicians apparently are not identifying patients at risk or not treating them to established goals set by national guidelines. Most evidence, including the updated National Cholesterol Education Program Adult Treatment Panel III guidelines, support low‐density lipoprotein cholesterol (LDL) as the principal target for intervention. The guidelines also emphasize that a low level of high‐density lipoprotein cholesterol (HDL) alone or in association with hypertriglyceridemia increases the risk of cardiovascular disease; also, epidemiologic data taken as a whole signify that a 1% decrease in HDL levels is associated with a 2–3% increase in risk of coronary heart disease. Low HDL levels occur more frequently than once thought, especially in selected populations such as patients with type 2 diabetes and men. Therapeutic lifestyle changes should be implemented first for any lipid disorder. In patients for whom this approach is not adequate, LDL levels need to be lowered to goals based on risk assessment. In addition, low HDL levels and/or hypertriglyceridemia should be managed with a niacin or fibrate product. However, increases in HDL levels and reductions in triglyceride levels are modest with fibrates compared with the dose‐related changes seen with niacin products. Reformulation of niacin into an extended‐release form minimizes common adverse effects seen with crystalline or sustained‐release niacin, and the beneficial effects on the lipid profile are maintained.
Cefditoren, a New Aminothiazolyl Cephalosporin
Authors: Balbisi Ebrahim A.
Published: May 2004

Cefditoren pivoxil, an oral third‐generation cephalosporin, was approved by the Food and Drug Administration in September 2001. It has been used in Japan for several years. The greatest therapeutic potential of cefditoren appears to be its activity against gram‐positive and gram‐negative organisms causing respiratory tract infections and skin and skin‐structure infections, such as Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. Cefditoren is also effective against methicillin‐susceptible strains of Staphylococcus aureus. Nevertheless, cefditoren has no activity against atypical pathogens, including Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella sp. Moreover, cefditoren does not inhibit Pseudomonas aeruginosa or Bacteroides fragilis. In virtually all studies, cefditoren has compared favorably against other orally administered antibiotics used against the most commonly isolated respiratory tract pathogens. Its side effect profile includes diarrhea, nausea, vomiting, headache, and dyspepsia. Cefditoren is indicated for treatment of mild‐to‐moderate acute exacerbations of chronic bronchitis, pharyngitis‐tonsillitis, and uncomplicated skin and skin‐structure infections caused by susceptible strains of organisms in adults and adolescents (≥ 12 yrs of age). Based on its reported antimicrobial activity, cefditoren has potential for empiric management of most commonly encountered respiratory tract infections. Additional studies will further define its role in clinical practice.
A Retrospective Cohort Analysis of the Clinical Effectiveness of a Physician‐Pharmacist Collaborative Drug Therapy Management Diabetes Clinic
Authors: Irons Brian K. , Lenz Ranee J. , Anderson Stephanie L. , Wharton Benita L. , Habeger Butch , Anderson H. Glenn
Published: May 2004

The glycemic control of patients with diabetes in a physician‐supervised, pharmacist‐managed primary care clinic was compared with that of patients receiving standard care in the same health care system. We retrospectively analyzed the glycemic control of 87 men with type 1 or type 2 diabetes whose diabetes‐related drug therapy was managed by clinical pharmacists compared with a control group of 85 similar patients whose care was not augmented by clinical pharmacists. Primary outcomes were differences in fasting blood glucose (FBG) and glycosylated hemoglobin (A1C) levels between groups. Secondary outcomes were relative risk (RR) for achieving an A1C of 7% or below, frequency of diabetes‐related scheduled and unscheduled clinic visits, and frequency of hypoglycemic events. The study group had 864 clinic visits and the control group had 712 between October 1997 and June 2000. No statistical differences were noted in FBG or A1C between groups. The RR of achieving an A1C of 7% or below was significantly higher in the study cohort (RR 5.19, 95% confidence interval [CI] 2.62‐10.26). The frequency of hypoglycemic events did not differ between groups. The mean ± SD frequency of unscheduled diabetes‐related clinic visits/patient/year was higher in the control group (1.33 ± 3.74) than in the study group (0.11 ± 0.46, p=0.003). Pharmacist‐managed diabetes care was effective in improving glycemic control and was not associated with an increased risk for hypoglycemic events or unscheduled diabetes‐related clinic visits.
Effect of Telephone Follow‐up on the Physical Well‐Being Dimension of Quality of Life in Patients with Cancer
Authors: Beney Johnny , Devine E. Beth , Chow Valby , Ignoffo Robert J. , Mitsunaga Lisa , Shahkarami Mina , McMillan Alex , Bero Lisa A.
Published: May 2004

Objective. To evaluate the effect of telephone follow‐up on the physical wellbeing dimension of health‐related quality of life in patients with cancer.

Design. Randomized, controlled trial.

Setting. Public teaching hospital.

Patients. One hundred fifty patients with cancer who were discharged to home from the hospital.

Intervention. Patients received a telephone follow‐up call 48–72 hours after discharge. Information was solicited regarding drug‐related (and other) problems. Problems were addressed, and advice and support were given.

Measurements and Main Results. Analysis of variance revealed no differences in the physical well‐being dimension of health‐related quality of life between patients who received telephone follow‐up and a control group who did not. Sixty‐eight percent of the follow‐up group and 40% of the control group (p=0.007) reported having had at least one contact with a health professional.

Conclusion. One possible explanation for the lack of effect of the intervention is that high‐risk patients in the control group received a similar intervention from other health care professionals. We suggest that telephone follow‐up be coordinated among health professionals.
Effect of Food on Everolimus Absorption: Quantification in Healthy Subjects and a Confirmatory Screening in Patients with Renal Transplants
Authors: Kovarik John M. , Hartmann Stefan , Figueiredo Joaquim , Rordorf Christiane , Golor Georg , Lison Arno , Budde Klemmens , Neumayer Hans H.
Published: May 2004

Study Objective. To quantify the influence of a high‐fat meal on the oral bioavailability of the immunosuppressant everolimus in a single‐dose study in healthy subjects and to confirm the results in a small food‐effect screening assessment in patients with renal transplants who were receiving multiple‐dose everolimus.

Design. Randomized, open‐label, crossover, single‐dose study and confirmatory screening.

Setting. Phase 1 unit for the single‐dose study and two German hospitals for the patient screening.

Subjects. Twenty‐four healthy male volunteers; six clinically stable patients with renal transplants who were originally part of a phase I dose‐escalation study.

Intervention. The 24 healthy men received everolimus 2 mg orally under fasting conditions and after a high‐fat meal. The six patients received everolimus 2.5 mg/day orally, in addition to cyclosporine and prednisone. On two occasions, a pharmacokinetic profile was obtained over the dosing interval after drug administration under fasting conditions and after a high‐fat meal in a randomized sequence.

Measurements and Main Results. In the single‐dose study in healthy subjects, a high‐fat meal delayed everolimus time to maximum concentration (Tmax) by a median 1.25 hours, reduced peak blood concentration (Cmax) by 60%, and reduced area under the concentration‐time curve (AUC) by 16%. In the multiple‐dose screening in patients with renal transplants, a high‐fat meal delayed (Tmax by a median 1.75 hours and reduced Cmax by 53% and AUC by 21%. Everolimus trough levels showed no food effect, whereas the peak‐trough fluctuation was dampened by 52%.

Conclusions. A high‐fat meal modestly reduced everolimus AUC. To minimize longitudinal variability in exposure, everolimus should be administered consistently either with food or without food.
Economic Impact of Asthma Therapy with Fluticasone Propionate, Montelukast, or Zafirlukast in a Managed Care Population
Authors: Pathak Dev S. , Davis E. Anne , Stanford Richard H.
Published: May 2004

Study Objective. To compare asthma‐related health care expenditures among patients newly prescribed fluticasone propionate 44 or 110 μg, montelukast 5 or 10 mg, or zafirlukast 20 mg.

Design. Retrospective cohort analysis of medical and pharmacy claims.

Setting. University‐affiliated health outcomes research center.

Patients. Seven hundred eighty‐one patients (aged ≥ 4 yrs) with asthma treated with controller therapy for 9 months (postindex period), with no claim for an inhaled corticosteroid or leukotriene modifier in the previous 9 months (preindex period).

Intervention. Asthma‐related medical and pharmacy data from insurance claims of four managed care plans (two Northeastern, one Midwestern, and one Western) were tabulated over the pre‐ and postindex periods.

Measurements and Main Results. Numbers of patients identified were 284 beginning fluticasone propionate; 302, montelukast; and 195, zafirlukast. Fluticasone propionate treatment was associated with significantly (p<0.001) lower risk‐adjusted asthma‐related charges compared with montelukast and zafirlukast treatment: $528, $967, and $1359, respectively. In this cohort, fluticasone propionate also was associated with fewer hospitalizations, less need for additional controller agents, and longer maintenance on the index drug compared with montelukast and zafirlukast.

Conclusions. Based on these real‐world data, as well as established national and international asthma guidelines, consideration should be given to inhaled corticosteroid therapy, particularly fluticasone propionate, for first‐line, long‐term effective management of asthma.
Pharmacokinetics of Levofloxacin During Continuous Venovenous Hemodiafiltration and Continuous Venovenous Hemofiltration in Critically Ill Patients
Authors: Guenter Sven G. , Iven Heiko , Boos Carsten , Bruch Hans‐Peter , Muhl Elke
Published: May 2004

Study Objective. To assess the pharmacokinetics of levofloxacin during continuous venovenous hemodiafiltration (CVVHDF) and continuous venovenous hemofiltration (CVVH).

Design. Nonrandomized pharmacokinetic evaluation.

Setting. University surgical intensive care unit.

Patients. Six critically ill patients.

Intervention. Five patients received levofloxacin 500 mg/day and one patient received levofloxacin 125 mg/day. All patients received continuous renal replacement therapy: CVVHDF on day 1 and CVVH on day 2, using an acrylonitrile hollow‐fiber 0.9‐m2 filter, constant blood flow rate of 90 ml/minute, substitution flow rate of 1 L/hour predilution, and dialysate flow rate of 1 L/hour (CVVHDF).

Measurements and Main Results. Serum, ultrafiltrate, and dialysate concentrations of levofloxacin were determined by high‐performance liquid chromatography. Extracorporeal clearance was 26.05 ± 4.66 ml/hour during CVVHDF and 15.71 ± 2.73 ml/hour during CVVH (p<0.05). Elimination half‐life was 28.08 ± 4.5 hours and 45.9 ± 17.7 hours, and distribution volume was 1.51 ± 0.52 L/kg and 1.42 ± 0.42 L/kg for CVVHDF and CVVH, respectively. Saturation was 0.76 ± 0.13 for CVVHDF versus a sieving coefficient of 0.77 ± 0.16 for CVVH.

Conclusion. Marked extracorporeal elimination of levofloxacin occurs, requiring a dosage adjustment that can be calculated from the characteristics of CVVH and CVVHDF.
Pharmacist Impact on Posttraumatic Seizure Prophylaxis in Patients with Head Injury
Authors: Brophy Gretchen M. , Tesoro Eljim P. , Schrote Gretchen L. , Garnett William R.
Published: May 2004

Phenytoin is the most commonly administered antiepileptic agent for the prevention of early (≤ 7 days) posttraumatic seizures. Use of the agent, however, requires strict monitoring due to its narrow target range and nonlinear pharmacokinetics. The impact of a clinical pharmacist participating in the care of patients with head injury on posttraumatic seizure prophylaxis with regard to phenytoin dosing and monitoring, cost avoidance, and patient outcome, was measured retrospectively. Parameters from time periods before (BP) and after (AP) a clinical pharmacist participated in patient care were compared. The average number of days that phenytoin was given was 13.4 (BP) and 7.6 (AP), and the duration of phenytoin prophylaxis was 7 days or less in 35% and 65% of patients, respectively. The average number of phenytoin levels drawn from each patient was 10.3 (BP) and 3.4 (AP). Seizures occurred in 4.7% (BP) and 1.5% (AP) of patients. A cost savings of approximately $28,000 was observed for the AP group. A clinical pharmacist reduced the use of posttraumatic seizure prophylaxis and associated costs without jeopardizing patient outcomes.
Evaluation of the Use of Complementary and Alternative Medicine in the Largest United States‐Mexico Border City
Authors: Rivera José O. , Ortiz Melchor , Lawson Mark E. , Verma Kalpana M.
Published: May 2004

Study Objective. To evaluate the use of complementary and alternative medicine (CAM) in the El Paso, Texas, region.

Design. Prospective observational study conducted from April‐October 2000.

Setting. Several hospitals and clinics.

Subjects. Five hundred forty‐seven participants.

Intervention. Semi‐structured interview with a bilingual questionnaire.

Measurements and Main Results. Complementary and alternative medicine was used in 77% of our population. The most common CAM providers were massage therapists (19.4%) and herbalists (12.4%). The most common herbal or home remedies were chamomile (13.1%) and aloe vera (8.5%). The most common nutritional or commercial products were multivitamins (16%), ginseng (3.6%), and ginkgo biloba (2.8%). We identified 599 CAM usages that could result in drug interactions, disease interactions, or adverse reactions.

Conclusions. A wide range of CAM use was documented in this study. Our results indicate that Hispanics in this area use CAM at a higher rate than national trends. Many of these therapies can adversely affect a variety of disease states and drug therapies.
Class and teaching
Authors: Nesbit Tom
Published: May 2004

Given the roots of critical theory in Marxist analysis of class and economy, it is essential that critical educators not lose sight of the importance of these factors to everyday practices.
Challenges to the classroom authority of women of color
Authors: Lee Ming‐yeh , Johnson‐Bailey Juanita
Published: May 2004

Two women of color professors use the themes of authority, mastery, voice, and positionality to examine the theoretical and practical underpinnings of feminist pedagogy.
Breaking the cult of rationality: Mindful awareness of emotion in the critical theory classroom
Authors: Callahan Jamie L.
Published: May 2004

Emotions play a more significant part in the process of critique than many acknowledge, and we must take them into account when thinking about adult education practices.
Partial rebound of molten‐metal droplets impacting on solid substrates
Authors: Megaridis Constantine M. , Boomsma Kevin , Bayer Ilker S.
Published: June 2004

This study investigates droplet/wall impact events resulting in partial rebound, an overlooked regime between deposition and splash. Because of its relevance to the microelectronics manufacturing industry, high‐purity 63%Sn–37%Pb molten solder is used. The target wall consists of a smooth, flat, unyielding silicon substrate. Droplet diameters range from 0.7 to 1.4 mm, and impact velocities from 0.7 to 1.4 m/s. These conditions correspond to Re = O(1000), We = O(10), Fr = O(10–100), Bo = O(0.1), and Oh = O(10−3). High‐speed imaging is performed to determine droplet lateral spread and apparent contact angles, and examine how these quantities affect the impact outcome (deposition vs. partial rebound). The results indicate that partial rebound is favored by higher impact velocities and smaller droplet diameters. A recent rebound model is evaluated as a predictive tool for the impact outcome in this transition impact regime. In addition, three existing correlations are evaluated in terms of their ability to predict the current experimental data on droplet maximum spread. © 2004 American Institute of Chemical Engineers AIChE J, 50: 1356–1363, 2004
Undetectable maternal serum uE3 and postnatal abnormal sterol and steroid metabolism in Antley–Bixler syndrome
Authors: Cragun Deborah L. , Trumpy Sharon K. , Shackleton Cedric H.L. , Kelley Richard I. , Leslie Nancy D. , Mulrooney Neil P. , Hopkin Robert J.
Published: June 2004

Antley–Bixler syndrome (ABS) is a rare condition characterized by radiohumeral synostosis, craniosynostosis, midface hypoplasia, bowing of the femora, multiple joint contractures, and urogenital defects. Several reports have implicated errors of steroid or sterol metabolism in the pathogenesis of ABS. Evidence for this has included association with maternal luteomas, fetal 21‐hydroxylase deficiency, early pregnancy exposure to high‐dose fluconazole, lanosterol 14‐α‐demethylase deficiency, and a unique urinary steroid profile consistent with apparent pregnene hydroxylation deficiency (APHD). We report two sibs with classic ABS. During both pregnancies, mid‐trimester maternal serum screening demonstrated undetectable levels of uncongugated estriol (uE3). The brother had ambiguous genitalia and increased serum levels of progesterone and 17‐α‐hydroxyprogesterone. Postnatal tests performed on the sister demonstrated both the unique urinary steroid profile that defines APHD and evidence of impaired lanosterol 14‐α‐demethylase activity. Our results suggest that in at least some patients with ABS, the skeletal findings and altered steroidogenesis are not associated with genes specific to individual sterol or steroid pathways but rather are related to an element, such as NADPH cytochrome P450 reductase (CPR) or cytochrome b5 (CYb5), that is common to all of these pathways. © 2004 Wiley‐Liss, Inc.
Synthesis of superabsorbent polymers by irradiation and their applications in agriculture
Authors: Chen Peng , Zhang Wei'An , Luo Wei , Fang Yue'e
Published: June 2004

The superabsorbent polymers (SAPs) were synthesized by grafting copolymerization of acrylic acid and acrylamide onto starch by using γ‐ray radiation technique and poly(ethylene glycol) (PEG) as a crosslinker. The samples were characterized by IR spectroscopy. The effect of various synthetic parameters such as irradiation dose, irradiation dose rate, monomer concentration, monomer/starch ratio, and PEG content were studied. The effects of different drying methods on water absorbency of the SAPs were also studied. The experimental results showed that the water absorbency of the SAPs depends largely on the specific conductance of water when the specific conductance is below 500 μs/cm. The water retention of sand and soil was enhanced by using the SAPs. Effects of the SAPs on the germination of seeds and growth of young plants were investigated. © 2004 Wiley Periodicals, Inc. J Appl Polym Sci 93: 1748–1755, 2004
Removal of concentrated heavy metal ions from aqueous solutions using polymers with enriched amidoxime groups
Authors: Kavaklı Pınar Akkaş , Güven Olgun
Published: June 2004

Particulate and fibrous adsorbents with enriched amidoxime groups were synthesized by using a novel monomer N,N′‐dipropionitrile acrylamide. The adsorption properties of amidoximated poly(N,N′‐dipropionitrile acrylamide) [poly(DPAAm)] particles and a nonwoven fabric grafted with the same for UO22+, Pb2+, Cu2+, and Co2+ at high concentrations were investigated by batch process. Metal ion adsorption studies were conducted from metal ion solutions with different initial concentrations (100–1500 ppm). It was shown that particulated amidoximated poly(DPAAm) has higher adsorption capacity than amidoximated nonwoven fabrics for all metal ions, especially for uranyl ions. The results of the adsorption studies showed that the interaction between UO22+ and amidoximated groups agree with the Langmuir‐type isotherm. From the Langmuir equation, the adsorption capacities were found as 400 mg UO22+/g dry amidoximated poly(DPAAm) and 250 mg UO22+/g dry amidoximated graft polymer. © 2004 Wiley Periodicals, Inc. J Appl Polym Sci 93: 1705–1710, 2004
Porous polyimide films prepared by thermolysis of porogens with hyperbranched structure
Authors: Kim Dong Wook , Kang Yongku , Jin Moon Young , Seok Sangil , Won Jong Chan , Lee Changjin , Yi Jungboon , Kim Jeongsoo , Kang Jongku , Shin Jae Sup
Published: June 2004

Two hyperbranched molecules, benzenetricarboxylic acid dendritic benzyl ether ester (BTRC–BE) and benzenetricarboxylic acid polyethylene glycol ester (BTRC–PEG), were prepared and tested as pore‐generating agents (porogens) for the preparation of porous polyimide. The hyperbranched molecules were thermally stable during the imidization process and completely decomposed well below the degradation temperature of polyimides, indicating that they possessed desirable thermal decomposition characteristics as porogens for the porous polyimide. From the SEM analysis dispersed domains were observed in the poly(amic acid) films containing BTRC–BE, whereas no phase separation was observed in the poly(amic acid) films containing BTRC–PEG. This may be attributable to the different polarities of the porogens because the hydrophobic BTRC–BE was phase‐separated in the hydrophilic poly(amic acid) matrix but BTRC–PEG was well mixed with poly(amic acid). The morphology developed in the poly(amic acid) film was retained after imidization and decomposition of the porogens; thus only BTRC–BE produced the porous polyimide. As the content of BTRC–BE decreased from 20 to 5 wt %, the pore size decreased from 390 ± 100 to 90 ± 50 nm and the pore density also decreased. © 2004 Wiley Periodicals, Inc. J Appl Polym Sci 93: 1711–1718, 2004
Effects of calcium carbonate as the expanding inhibitor on the structural and mechanical properties of expanded starch/polyvinyl alcohol blends
Authors: Yang June‐Ho , Park Jongshin , Kim Daehyun , Lee Daehoon
Published: June 2004

In this study, expanded starch/PVA/CaCO3 blends (ESPCs) were prepared using the pilot system composed of a supermixer and a twin‐screw extruder to investigate the effects of CaCO3 as the expanding inhibitor on the structural and mechanical properties of ESPCs. The pore ratio of ESPCs with the interconnecting open‐cell structure decreased with increasing CaCO3 content and the structure of ESPCs became more compact. The inhibiting process of CaCO3 during the expansion of starch/PVA blends was proposed and certified by FTIR spectroscopy and X‐ray diffraction. At least two parts of CaCO3 were required to obtain a sufficient inhibiting effect on the expansion. The mechanical properties of ESPCs such as tensile strength, elongation at break, modulus, and specific work of rupture were improved by the addition of CaCO3 as the expanding inhibitor. As CaCO3 content increased from one to four parts, the tensile strength increased 2.6‐fold, from 70 to 180 kPa, whereas elongation at break increased about 1.5‐fold. The moduli of ESPCs also increased with increasing CaCO3 content. © 2004 Wiley Periodicals, Inc. J Appl Polym Sci 93: 1762–1768, 2004
TTT‐cure diagram of an anhydride‐cured epoxy system including gelation, vitrification, curing kinetics model, and monitoring of the glass transition temperature
Authors: Teil H. , Page S. A. , Michaud V. , Månson J.‐A. E.
Published: June 2004

The curing reaction of an epoxy resin [diglycidyl ether of bisphenol A (DGEBA)] combined with a methyl‐hexahydrophtalic anhydride (MHHPA) hardener and a benzyldimethylamine (BDMA) accelerator was studied over a temperature range of 60–140°C to build its isothermal time‐temperature‐transformation (TTT)–cure diagram. This includes gelation and vitrification measurements using rheological measurement techniques, monitoring of the glass transition temperature and the reaction kinetics by differential scanning calorimetry, and determination of the following critical glass transition temperatures: Tg0, GelTg, and Tg∞. A new curing kinetics model, based on the Sesták‐Berggren model, was developed including both chemical‐ and diffusion‐controlled stages of reaction. Then, the TTT‐cure diagram was built by numerical integration of the kinetics model, and good agreement was obtained by comparison with experimental data. Additionally, for the first time, this model takes into account the incomplete cure, which occurs when the thermosetting system is cured below its ultimate glass transition temperature, leading to a more realistic description of the cure evolution after vitrification. © 2004 Wiley Periodicals, Inc. J Appl Polym Sci 93: 1774–1787, 2004
Nonisothermal crystallization of metallocene propylene–decene‐1 copolymers
Authors: Xu Jun‐Ting , Xue Liang , Fan Zhi‐Qiang
Published: June 2004

The nonisothermal crystallization behavior of one metallocene‐based isotactic polypropylene and three propylene–decene‐1 copolymers was studied. The effects of comonomer content and cooling rate were investigated. It was found that comonomer units enchained systematically reduce the crystallization temperature (Tc), melting temperature (Tm), fusion enthalpy (ΔHf), and crystallinity (Xc). Such an effect becomes more evident at a faster cooling rate. With increasing comonomer content, the supercooling required for crystallization increases and the overall crystallization rate is reduced. The Avrami equation is applicable to describe the nonisothermal crystallization kinetics of propylene–decene‐1 copolymer. It was shown that, although the reduced crystallization rate constant Zc increases with comonomer content, the Avrami exponent decreases with comonomer content and cooling rate, leading to the smaller overall crystallization rate and larger crystallization half‐time of the copolymer with higher comonomer content. © 2004 Wiley Periodicals, Inc. J Appl Polym Sci 93: 1724–1730, 2004
Cocatalyst‐originated aluminum residues in fibrous, very high molar mass polyethylene
Authors: Turunen Jani P. J. , Haukka Matti , Pakkanen Tuula T.
Published: June 2004

In this work, fibrous very high molar mass polyethylene was prepared by Cp2TiCl2, which was supported on methylaluminoxane (MAO) pretreated mesoporous silica fiber. After the polymerization, an “ordinary” washing procedure was not sufficient to remove the aluminum residues of the cocatalyst MAO from the polymerization product. When hydrochloric acid was used in the termination of the polymerization, the aluminum existed as [Al(H2O)6]Cl3, the presence of which causes additional signals to DSC and XRD grams of the polyethylene. These signals have previously been interpreted to be attributed to the extended chain crystal structure of the polyethylene. © 2004 Wiley Periodicals, Inc. J Appl Polym Sci 93: 1812–1815, 2004
Spatial arrangement and physical characteristics of structural woody habitat in a lowland river in south‐eastern Australia
Authors: Koehn John D. , Nicol Simon J. , Fairbrother Peter S.
Published: May 2004

The importance of structural woody habitat (SWH) as instream fish habitat in eastern Australia has been well documented. In response, many native fish restoration programmes are returning SWH to rivers where it had previously been removed. However, there is little information to direct the placement of this SWH within a river landscape.

Low‐level, high‐resolution aerial photographs were used to investigate the spatial pattern of SWH in the Murray River between Lake Mulwala and Tocumwal. It was found that SWH occurred in aggregations that were closely associated with eroding banks on meanders.

The physical characteristics of the SWH in these aggregations varied (basal diameter range 0.44–2.45 m, length range 1–44 m); however, small‐ to medium‐sized trees (basal diameter range 0.7–1.4 m, length range 5–20 m) were most common.

The association between eroding banks and SWH suggests that bank erosion may be an important determinant in the formation of SWH aggregations.

Copyright © 2004 John Wiley & Sons, Ltd.
Synthesis of New 2‐[1(2H)‐Phthalazinon‐2‐yl]acetamide and 3‐[1(2H)‐Phthalazinon‐2‐yl]propanamide Derivatives as Antinociceptive and Anti‐inflammatory Agents
Authors: Dogruer Deniz S. , Kupeli Esra , Yesilada Erdem , Sahin M. Fethi
Published: June 2004

As a consequence of our ongoing studies on heterocyclic compounds for new antinociceptive and anti‐inflammatory agents bearing lactam functional group, new 2‐[1(2H)‐phthalazinon‐2‐yl]acetamide and 3‐[1(2H)‐phthalazinon‐2‐yl]propanamide derivatives have been synthesized. Among the compounds synthesized, compound 4e was found the most active derivative in terms of antinociceptive and anti‐inflammatory activities, without gastric lesions and bleeding at the given dose.
[1, 2‐Bis(2, 6‐difluoro‐3‐hydroxyphenyl)ethylene‐diamine]platinum(II) Complexes, Compounds for the Endocrine Therapy of Breast Cancer ‐ Mode of Action I: Antitumor Activity Due to the Reduction of the Endogenous Estrogen Level
Authors: Schertl Sabine , Hartmann Rolf W. , Batzl‐Hartmann Christine , Bernhardt Günther , Spruß Thilo , Beckenlehner Karin , Koch Marion , Krauser Rudolf , Schlemmer Richard , Gust Ronald , Schönenberger Helmut
Published: June 2004

Aqua[meso‐1, 2‐bis(2, 6‐difluoro‐3‐hydroxyphenyl)ethylenediamine]sulfatoplatinum(II) (meso‐3‐PtSO4) and its racemate (rac‐3‐PtSO4) are highly active on the hormone‐sensitive MXT‐M‐3, 2 breast cancer of the mouse. In vitro, on the MXT+ cell culture derived from this tumor, however, they are inactive (meso‐3‐PtSO4) or moderately active (rac‐3‐PtSO4) in concentrations corresponding to levels of these drugs in animal experiments. The in vivo effect is mainly caused by a reduction of the endogenous estrogen level in the host animals due to an interference with the ovarian steroid biosynthesis as demonstrated for meso‐3‐PtSO4. Therefore, a reversal of the breast cancer inhibiting effect of meso‐3‐PtSO4 can be achieved by simultaneous estrone administration. Histological results on ovaries, uterus, and tumor of meso‐3‐PtSO4‐treated mice also favor such a mode of action. However, especially for rac‐3‐PtSO4 cytotoxic effects contributing to the anti‐breast cancer activity cannot be excluded. Considerations on the mode of action of Pt‐complexes which inhibit breast cancer by interference with estrogen receptor mediated processes of growth control and with DNA replication are presented.
New Total Synthesis of Niphatesine C and Norniphatesine C Based on a Sonogashira Reaction
Authors: Krauss Jürgen , Bracher Franz
Published: June 2004

The pyridine alkaloid niphatesine C and its analogue norniphatesine C were prepared in a short and efficient way starting from commercially available 3‐iodopyridine and undec‐10‐yn‐1‐ol using a Sonogashira reaction as the key step. The resulting alkylpyridines were tested for antimicrobial activity against several bacteria and fungi. The cytotoxic activities were determined in the MTT assay against HL 60 cells.
Intramolecular Distribution of Hydrophobicity Influences Pharmacological Activity of Propafenone‐type MDR Modulators
Authors: Pleban Karin , Hoffer Claudia , Kopp Stephan , Peer Michael , Chiba Peter , Ecker Gerhard F.
Published: June 2004

Lipophilicity is one of the major determining physicochemical descriptors for P‐glycoprotein (P‐gp) inhibitory activity. Recently, Pajeva and Wiese showed that in case of P‐gp interaction, lipophilicity may be regarded as space‐directed property. In the present study, a series of propafenone‐type P‐gp inhibitors with systematically varying hydrophobicity distribution within the molecules were synthesised and pharmacologically tested. QSAR studies on the basis of multiple linear regression analysis showed that with increasing lipophilicity of the substituents on the amine moiety, the statistical significance of the indicator variables, denoting the substitution pattern on the central aromatic ring system, also increases. This indicates that the distribution of hydrophobicity within the molecules influences the mode of interaction with P‐gp.
Antibodies against cyclic citrullinated peptide and IgA rheumatoid factor predict the development of rheumatoid arthritis
Authors: Rantapää‐Dahlqvist Solbritt , de Jong Ben A. W. , Berglin Ewa , Hallmans Göran , Wadell Göran , Stenlund Hans , Sundin Ulf , van Venrooij Walther J.
Published: June 2004

Objective

To evaluate the prevalence and predictive value of anti–cyclic citrullinated peptide (anti‐CCP) antibodies in individuals who subsequently developed rheumatoid arthritis (RA) and to determine the relationship to rheumatoid factor (RF) of any isotype.

Methods

A case–control study was nested within the Northern Sweden Health and Disease Study and the Maternity cohorts of Northern Sweden. Patients with RA were identified among blood donors whose samples had been taken years before the onset of symptoms. Control subjects matched for age, sex, date of sampling, and residential area were selected randomly from the same cohorts. Anti‐CCP antibody and RFs were determined using enzyme immunoassays.

Results

Eighty‐three individuals with RA were identified as having donated blood before presenting with any symptoms of joint disease (median 2.5 years [interquartile range 1.1–4.7] before RA). In samples obtained before the onset of RA, the prevalence of autoantibodies was 33.7% for anti‐CCP, 16.9% for IgG‐RF, 19.3% for IgM‐RF, and 33.7% for IgA‐RF (all highly significant compared with controls). The sensitivities for detecting these autoantibodies >1.5 years and ≤1.5 years before the appearance of any RA symptoms were 25% and 52% for anti‐CCP, 15% and 30% for IgM‐RF, 12% and 27% for IgG‐RF, and 29% and 39% for IgA‐RF. In conditional logistic regression models, anti‐CCP antibody and IgA‐RF were found to be significant predictors of RA.

Conclusion

Anti‐CCP antibody and RFs of all isotypes predated the onset of RA by several years. The presence of anti‐CCP and IgA‐RF predicted the development of RA, with anti‐CCP antibody having the highest predictive value. This indicates that citrullination and the production of anti‐CCP and RF autoantibodies are early processes in RA.