bluuebunny/crossref_metadata_2025 huggingface dataset:
Trial of a novel prostacyclin analog, UT-15, in patients with severe intermittent claudication
Authors: Mohler Emile R , Klugherz Bruce , Goldman Robert , Kimmel Stephen E , Wade Michael , Sehgal Chandra M
Published: January 2007

Prostacyclin is an endothelially derived vasodilator and inhibitor of platelet aggregation. Despite its therapeutic potential for peripheral arterial disease, the short half-life and chemical instability are barriers to routine therapy. Accordingly, prostacyclin analogs are being evaluated in patients with peripheral arterial disease. State-of-the-art non-invasive ultrasonography allows for serial testing of the hemodynamic effects of vasoactive drugs. The safety, efficacy and hemodynamic effects of UT-15, a novel, long-acting prostacyclin analog, were studied in patients with severe intermittent claudication. A total of eight patients with stable severe intermittent claudication, Fontaine classes IIb-III, were admitted to the hospital for intravenous infusion of UT-15. A symptom-limited, dose-escalation protocol was instituted, beginning with placebo and then with increasing dosage at 60-min intervals, followed by a 2-h period of maintenance dose at the maximum well-tolerated infusion rate. The hemodynamic response in the lower limbs was assessed with serial ultrasonography, segmental arterial pressures and pulse volumes. Blood flow in the common femoral artery increased 29% (p = 0.003) by the end of the maintenance period and remained above baseline throughout the washout period (p = 0.044). Blood velocity in the lower limb increased in most of the peripheral arteries. These increases achieved statistical significance in the common femoral artery (p = 0.025) and anterior tibial artery (p = 0.019), and approached significance in the popliteal artery (p=0.062). In two of four patients in whom blood flow was undetectable before the infusion, arterial blood flow at the ankle level became apparent on ultrasonography during maintenance infusion. UT-15 infusion improved the pulse volume recording (p = 0.016) but the ankle/brachial index did not change significantly. Common side effects at peak dose included headache and nausea. There were no serious adverse events attributable to UT-15 treatment. In most patients, the optimal infusion rate was 10-20 ng/kg per min. In conclusion, ultrasonography is a novel approach for assessing the hemodynamic response to vasoactive agents. UT-15 is well tolerated when given for up to 2 h and increases arterial blood flow and velocity in patients with severe intermittent claudication.
Mental stress opposes endothelium-dependent vasodilation in young healthy individuals
Authors: Sarabi Mahziar , Lind Lars
Published: January 2007

Mental stress has been shown to induce myocardial ischemia in people with coronary heart disease (CHD), both in the laboratory and in daily life. In order to investigate the role of the endothelium in the regulation of blood flow during stress, the endothelium-dependent (EDV) and endothelium-independent (EIDV) vasodilation was examined in the forearms of healthy people during a mental arithmetic test (MAT), a cold pressor test (CP) and an isometric handgrip test (ISO). A total of 10 young healthy volunteers (four men and six women, aged 20-25 years) underwent measurements of forearm vascular resistance (FVR) during local intra-arterial infusions of methacholine (MCh; inducing EDV) and sodium nitroprusside (SNP; inducing EIDV) at rest and during the different forms of stress by the use of venous occlusion plethysmography. MAT induced a significant increase in FVR during MCh infusion (4 mg/min, from 3.5 6 0.7 at rest to 4.2 6 1.4 mmHg/ml per min per 100 ml tissue during MAT; p, 0.01), while FVR during SNP infusion was unchanged by MAT. CP induced a significant increase in FVR during infusions with both MCh and SNP compared to resting levels (p, 0.01 for both), while ISO induced a significant increase in FVR during MCh infusion (p, 0.05) and a smaller increase in FVR during SNP infusion. When the SNP to MCh FVR ratio was used as an index of endothelial function, only MAT impaired endothelial function significantly (p, 0.01). In conclusion, mental stress induced by an arithmetic task selectively opposed EDV in the forearms of young healthy people, while cold pressor and isometric handgrip tests induced a more general attenuation in vasodilatation.
Cell-cell communication in the vessel wall
Authors: Dora Kim A
Published: January 2007

Intercellular communication between cells within the blood vessel wall plays an important role in the control of artery diameter. The endothelial cells lining the lumen of arteries can evoke smooth muscle hyperpolarization both by the release of a factor (EDHF) and by direct cell-cell coupling through gap junctions. Hyperpolarizing current can spread rapidly to cause widespread vasodilatation, and thus increase blood flow to that segment. In addition to the spread of current, small molecules, such as Ca2+, can also pass between cells, but at a much reduced rate. Instead of co-ordinating changes in diameter, intercellular Ca2+ signalling acts to amplify and, in special cases, modulate vascular responses. Together, direct cell-cell communication enables the blood vessel wall to act as a functional syncytium, which is influenced by surrounding tissues and nerves, and blood constituents.
Plasma levels of cystatin-C and mannose binding protein are not associated with risk of developing systemic atherosclerosis
Authors: Albert Michelle A , Rifai Nader , Ridker Paul M
Published: January 2007

Cystatin-C, a cysteine protease inhibitor, and mannose binding lectin, an innate defense protein involved in microbial clearance, have both been hypothesized to mediate atherosclerotic plaque progression. Prospective data evaluating whether levels of these proteins are associated with incident cardiovascular disease are sparse. Employing a prospective, nested, case-control study design, baseline levels of cystatin-C and mannose binding protein were evaluated among 133 apparently healthy men who subsequently developed symptomatic peripheral arterial disease (cases) and among 133 age- and smoking-matched controls who remained free of reported vascular disease during 5 years of follow-up. Overall, median baseline levels of cystatin-C were virtually identical among case and control subjects (0.83 mg/l, p = 0.84), whereas median baseline levels of mannose binding protein among cases and controls were 2.32 mg/l and 2.20 mg/l respectively ( p = 0.69). No evidence of association was found between either cystatin-C or mannose binding protein and the development of peripheral arterial disease in analyses evaluating for linear trends or for threshold effects (all p-values ≤ 0.05). In contrast with prior retrospective and cross-sectional studies, no evidence was found that baseline levels of cystatin-C or mannose binding protein are associated with an increased risk of future arterial disease.
Reproducibility of skin microcirculatory measurements in humans, with special emphasis on capillaroscopy
Authors: Abbink Evertine J , Wollersheim Hub , Netten Paetrick M , Smits Paul
Published: January 2007

The reproducibility of capillaroscopic measurements of capillary blood cell velocity (CBV) in human nailfolds was investigated by use of the computerized system CapiFlow. Therefore, CBV measurements of two capillaries of each of three fingers together with laser Doppler fluxmetry (LDF) and skin temperature measurements were performed three times in five healthy volunteers. Short-term (1.5 h) intra-individual coefficient of variation (CV) of CBV was 18.4%. Long-term (7 days) CV amounted to 55.8%. Inter-individual CV was 55.9%. Short- and long- term intra-individual CVs of LDF were 25.4% and 37.3%. Inter-individual variation was 36.0%. Skin temperature showed short- and long-term CVs of 3.7% and 5.5% and inter-individual CV of 5.8%. In conclusion, measurement of CBV using CapiFlow is a suitable method to assess acute effects, but has limited value in investigating long-term effects. Because of the wide inter- individual variability in both CBV and LDF, power calculations will reveal large numbers to investigate. Skin temperature has a relatively small intra- and inter-individual variation and is more suitable for long-term studies.
Comparison of two progressive treadmill tests in patients with peripheral arterial disease
Authors: Riebe Deborah , Patterson Robert B , Braun Christina M
Published: January 2007

In a vascular rehabilitation program, 28% of our frail elderly patients are unable to be tested with traditional progressive exercise protocols at program entry due to the high (2.0 miles/h or 3.2 km/h) initial treadmill speeds. The purpose of this investigation was to compare a new progressive treadmill protocol which has a reduced initial speed (1.0 mile/h or 1.6 km/h) to an established protocol performed at 2.0 miles/h (3.2 km/h) to determine the comparability and reproducibility of the new protocol. Eleven patients with arterial claudication performed three symptom-limited exercise tests in random order. Two tests used the new protocol while the remaining trial used the established protocol. Claudication pain was measured using a 5-point scale. Oxygen consumption, heart rate, minute ventilation, respiratory exchange ratio and blood pressure at peak exercise were similar among the three trials. There were strong intra-class correlations for peak oxygen consumption ( r = 0.97), onset of claudication ( r = 0.96) and maximum walking time ( r = 0.98) between the two trials using the new protocol. There was also a significant correlation between the new protocol and the established protocol for peak oxygen consumption ( r = 0.90) and maximum walking time ( r = 0.89). The new progressive treadmill protocol represents a valid, reliable protocol for patients with arterial claudication. This protocol may be useful for testing patients with a low functional capacity so that clinically appropriate exercise prescriptions can be established and the efficacy of treatments can be determined.
PAD awareness, risk, and treatment: new resources for survival - the USA PARTNERS program
Authors: Hirsch Alan T , Hiatt William R ,   PARTNERS Steering Committee
Published: January 2007

Peripheral arterial disease (PAD) is a very common manifestation of atherosclerosis and is associated with a high risk of cardiovascular morbidity and mortality. Despite the magnitude of the problem, PAD is often under-recognized in clinical practice until its limb manifestations are severe or heart attack or stroke supervene. The PAD Awareness, Risk and Treatment: New Resources for Survival (PARTNERS) program, recently completed in the USA, had five aims: (1) creation of a method for detection of PAD in primary care practice; (2) assessment of the awareness of the PAD diagnosis in both patients and physicians; (3) assessment of the magnitude of the atherosclerotic risk factor burden and intensity of treatment of atherosclerotic risk factors in PAD patients; (4) assessment of the disease-specific and general quality of life of PAD patients in their communities; and (5) provision of an educational intervention to foster improved community-prescribed medical interventions for patients with PAD.

Lack of public and physician interest in PAD contrasts with the high prevalence and poor medical prognosis of PAD. The intention of PARTNERS was to create a community-based program to measure current rates of PAD awareness, physician recognition and treatment intensity. Data obtained will form the basis of future clinical investigations to improve clinical care for PAD patients in the USA.
The effect of naftidrofuryl on transcutaneous oxygen tension during a treadmill test in patients with peripheral arterial occlusive disease
Authors: Mouren Xavier , Caillard Philippe , Bensoussan Jean-Jacques , Massonneau Marc , Gamand Solange , Stevens Wil HM
Published: January 2007

Tissue hypoxaemia can be evaluated by the noninvasive method of transcutaneous oxygen tension (tcpO2) measurement in patients with peripheral arterial occlusive disease (PAOD). The effects of naftidrofuryl (Praxilene®) on exercise-induced tissue ischaemia was objectively assessed by continuously measuring the tcpO2 in 30 patients during three treadmill tests over a 3-month period in a randomized double-blind, placebo controlled, parallel group study. To be included in the study, the tcpO2 and total walking distance had to be stable during the washout period (D-15-D0). The area under the tcpO2 curves was scanned and automatically calculated after identification of baseline and the end of the treadmill test. The treadmill test on D30 and D90 was terminated at a similar walking distance to that obtained on D0. On D0 both groups were comparable (p = 0.22). The area under the curve (AUC) reduced significantly in the naftidrofuryl group between D0 and D30 (p, 0.001) and D0 and D90 (p, 0.001). However, no significant tcpO2 AUC reduction was found in the placebo group (D0-D30, p = 0.58; D0-D90, p = 0.50). This was confirmed by calculation of the percentage of patients whose percentage change in the AUC on D90 was higher than the upper limit of the 90% confidence interval, calculated from the percentage change over the washout period. Of the 15 patients receiving naftidrofuryl, 66.6% exceeded this upper limit, compared with only 7% of patients receiving placebo (p = 0.0017). This study shows that naftidrofuryl has a protective effect on exercise-induced tissue ischaemia as measured by the tcpO2 AUC in PAOD stage II patients.
Calciphylaxis: a favorable outcome with hyperbaric oxygen
Authors: Dean Steven M , Werman Howard
Published: January 2007

A 66-year-old female with diabetes mellitus and end-stage renal disease presented with painful bilateral lower extremity livedo reticularis and necrotic ulcerations. Her distal lower extremity pulses were intact and plethysmographic studies confirmed relatively normal large vessel arterial perfusion. Extensive laboratory analysis was remarkable for an elevated calcium × phosphorous product and parathyroid hormone level.

An ulcer biopsy revealed small vessel medial calcinosis, and calciphylaxis was subsequently diagnosed. Despite aggressive wound debridements, antibiotics and subtotal parathyroidectomy, her ulcers failed to improve significantly prompting a trial of hyperbaric oxygen therapy. After 7 weeks of hyperbaric treatments, her ulcers had essentially healed.
Biochemical and inflammatory changes in the exercising claudicant
Authors: Tisi Paul V , Shearman Clifford P
Published: January 2007

Intermittent claudication is an early manifestation of atherosclerosis in the leg. The prognosis for the claudicating limb is reasonably good, but patients have excess cardiovascular morbidity and mortality rates compared with a control population. Increasing evidence suggests that the calf pain experienced when walking followed by rest generates a low-grade inflammatory response. The cumulative effects of these individual events may have an adverse effect on the progression of atherosclerosis.A review of the literature was performed to identify studies measuring the exercise-induced inflammatory response in claudicants and to try to identify the role of cumulative inflammatory changes in the progression of atherosclerosis. The effect of exercise training on these markers is briefly explored. Walking until the onset of calf pain (ischaemia) followed by rest (reperfusion) results in the generation of oxygen-derived free radicals, neutrophil activation and a generalized increase in vascular permeability. Baseline levels of chronic inflammatory markers such as acute-phase proteins are elevated in claudicants compared with controls, suggesting that the transient acute inflammatory response has longer-term consequences. Therapeutic exercise training appears to lead to an attenuation of these inflammatory markers.Intermittent claudication can be considered as part of an inflammatory disease process. However, the concerns that exercise training might potentiate the vascular inflammatory response appear to be unjustified, although further work is needed to clarify this. Exercise training should therefore be considered as an important treatment option for claudication.
New developments in intravascular ultrasound
Authors: Oshima Akio , Itchhaporia Dipti , Fitzgerald Peter
Published: January 2007

Intravascular ultrasound (IVUS) is a dynamic imaging modality that provides real-time in vivo visualization of atherosclerosis and other vascular pathology. The tomographic image presentation of IVUS permits detailed assessment of plaque morphology and its corresponding responses to interventional therapy. IVUS studies have confirmed vascular remodeling in vivo, have proposed a high-pressure stent implantation strategy and have shown two key mechanisms of restenosis after angioplasty: plaque proliferation and vessel shrinkage (negative remodeling). IVUS also provides accurate quantitative information regarding lumen size, vessel size and plaque burden. These observations, essential to achieving improved outcomes, have drastically changed the understanding of atherosclerotic artery disease and interventional procedures. IVUS has matured into an essential complement to daily peripheral and coronary interventional practice and is routinely incorporated as part of the interventional arsenal in the catheterization laboratory.

A variety of new imaging techniques are currently being designed and tested. These include combined therapeutic devices, further miniaturization, 3-D applications and tissue characterization. These techniques may evolve to provide increased favorable clinical outcomes and more accurate information of vessel geometry and plaque composition.
L-arginine and nitric oxide-related compounds in plasma: comparison of normal and arginine-free diets in a 24-h crossover study
Authors: Tangphao Oranee , Chalon Stephan , Coulston Ann M , Moreno Heitor , Chan Jason R , Cooke John P , Hoffman Brian B , Blaschke Terrence F
Published: January 2007

The amino acid l-arginine is the precursor of nitric oxide (NO), a powerful vasodilator with antiplatelet properties. The availability of l-arginine has been suggested to be a rate-limiting factor in the production of NO in conditions such as hypercholesterolemia. It was speculated that fluctuations in plasma concentrations of l-arginine during the day may be dependent upon dietary intake of the amino acid, or other variables, and might modify the elaboration of endogenous NO. Over a 24-h period, the plasma concentrations of l-arginine and NO-related compounds (NOx) were measured during an l-arginine and nitrate/nitrite-free diet (diet A) or a nitrate/nitrite-free diet with a fixed amount of l-arginine intake (3.8 g/d) (diet B) in eight healthy volunteers during a 2-day crossover study. Subjects were randomly selected to begin with diet A or diet B and consumed the other diet on the second day. During diet A, plasma l-arginine decreased significantly from 09.00 to 16.00 (21.4 ± 2.0 to 11.9 ± 1.1 mg/ml), rose slightly in the evening (to 16.6 ± 1.7mg/ml) and gradually increased during the night. During diet B, plasma larginine showed a peak after each meal (approximately 23 mg/ml). Plasma NOx concentrations measured by chemiluminescence did not show any circadian variation on either diet. Plasma l-arginine concentrations change during the day and are influenced by dietary intake. Importantly, plasma NOx do not seem to vary with this pattern in healthy individuals.
Different prevalence of asymptomatic atherosclerotic lesions in males and females
Authors: Kröger Knut , Suckel Andreas , Hirche Herbert , Rudofsky Gottfried
Published: January 2007

The detection of atherosclerotic lesions in asymptomatic healthy subjects is possible using ultrasound. Populations can be investigated in order to detect differences in early and asymptomatic atherosclerosis due to gender and risk factors. This study investigated 2605 male (21-69 years) and 1601 female (20-70 years) employees and civil servants of the city of Düsseldorf, Germany. The ultrasound investigations were performed with an ATL device, type Ultra-mark 4 plus, and a 7.5-MHz linear transducer on the carotid and proximal femoral arteries. An atherosclerotic lesion was defined as visibly different from the intima by its echogenicity and by being larger than 1 mm. A thickening of the intima media complex was not considered to be atherosclerosis.

The prevalence of atherosclerotic lesions in male subjects was higher than those in female subjects regardless of age. In male subjects it was 5.3% (30-39 years), 19.8% (40-49 years), 36.7% (50-59 years) and 47.7% (60-70 years). The female subjects had a prevalence of 2.1%, 8.4%, 17.5% and 37.7% in the corresponding age groups. Risk factors such as smoking, hyper-tension and hypercholesterolemia were higher in men than in women. The increase of atherosclerotic lesions from one decade to another was highest in women between 50 and 59 years and 60 and 70 years. This large increase could not be explained by a similar increase in risk factors. It was therefore concluded that male subjects had a higher prevalence of atherosclerosis at earlier ages than females, but female subjects showed a postmenopausal rise in prevalence.
An analysis of limb-threatening lower extremity wound complications after 1090 consecutive coronary artery bypass procedures
Authors: Thomas Terisa A , Taylor Spence M , Crane Martin M , Cornett Wendy R , Langan Eugene M , Snyder Bruce A , Cull David L
Published: January 2007

The objective of this study was to examine and characterize limb-threatening lower extremity wound or soft tissue complications after coronary artery bypass (CABG) and determine risk factors for their cause. While minor wound problems of the leg after CABG are not uncommon, serious limb-threatening complications, though less frequent, do occur and are often de-emphasized in the surgical literature.

A review of 1090 consecutive CABG procedures performed from January 1, 1995 through December 31, 1995 was instituted, which screened for limb-threatening lower extremity wound or soft tissue complications defined as wounds that: required additional surgery for treatment; prolonged the length of stay; or which required lengthy home health nursing for treatment. Minor lymph leaks, leg swelling, infections or wound problems treated as an outpatient were excluded.

Of 1090 patients, 54 (5.0%) experienced a limb-threatening lower extremity complication. Complications were categorized as vein harvest incision non-healing (n = 36, 66.7%), decubitus ulceration (n = 11, 20.4%), forefoot ischemia/embolization (n = 10, 18.5%), groin hematoma/abscess (n = 6, 11.1%), severe cellulitis (n = 3, 5.6%), or a combination (n = 12, 22.2%). Statistically significant risk factors by univariate and bivariate analysis for a complication included older age (68 years vs 62 years, p = 0.007), female sex (57% vs 28%, p, 0.001), diabetes (57% vs 33%, p = 0.005) and longer pump time (129 min vs 114 min, p = 0.009). These complications necessitated five major lower extremity amputations and nine revascularization procedures. Chronic lower extremity ischemia from peripheral vascular disease (PVD) was a major contributing factor for the development of wounds in at least 23 (42.6%) of these patients, though suspected in only 10 (43.5%) preoperatively. A non-healing vein harvest incision below the knee of a patient retrospectively found to have inadequate distal circulation for healing occurred in 17 (31.5%) of the total 54 cases.

It was concluded that non-healing vein incisions, decubitus ulcers and forefoot ischemic lesions frequently occurring in older diabetic females with undetected pre-existing PVD, comprise the majority of limb-threatening leg complications after CABG. Nearly one-third of the complications may have been avoided had the vein harvest incision not been made at the ankle of a patient with unappreciated PVD.
Iron-mediated cardiovascular injury
Authors: Horwitz Lawrence D , Rosenthal Eli A
Published: January 2007

Iron is an essential element for normal cellular function and general health. However, iron may play a pathologic role in certain cardiac conditions including reperfusion injury, hemochromatosis, b-thalassemia and coronary atherosclerosis. It also may play a role in injury due to anthracycline cardiotoxicity. Removal of iron via phlebotomy for hemochromatosis and chelation therapy for b-thalassemia are proven treatments. Cell culture, and isolated organ and animal studies suggest that depleting iron stores may prevent reperfusion injury, restenosis and even atherogenesis. This article will review mechanisms by which iron overload states and normal iron stores contribute to cardiovascular pathophysiology and the accumulating evidence that iron chelation may prevent restenosis and atherogenesis.
Imaging in abdominal trauma
Authors: Wherry David C , Punzalan Corazon May K
Published: January 2007

Prompt recognition and timely intervention both play a crucial role in managing patients with blunt abdominal trauma. In most cases of multiply injured patients, where physical examination is indeterminate, a rapid and accurate screening method is a valuable adjunct for care-providers. Through the years, different imaging techniques have been utilized for this purpose; among them are diagnostic peritoneal lavage (DPL), ultrasonography (US) and computed tomography (CT). Proponents of each modality have their own beneficial reasons for adopting that particular method of imaging. Needless to say, despite the high sensitivity and specificity values cited for each, all the methods have their own limitations. After having reviewed the advantages and disadvantages of these three modalities, this article suggests that there is not one single modality that is considered the best. Rather, all three can be complementary and the use of each can be appropriate for a particular subset of patients, given a particular clinical situation, and taking into account the resources available.
Regional anaesthesia in trauma
Authors: Elliot JM
Published: January 2007

Regional anaesthesia is very effective in alleviating pain due to trauma, and is also used to provide anaesthesia for trauma surgery. It has the advantage of producing localized but complete pain relief, whilst avoiding the side effects of systemic analgesics or anaesthetics. However, regional anaesthetic drugs and techniques have potentially life-threatening complications, which the practitioner must be able to manage. This article discusses the use of regional anaesthesia, and the benefits and disadvantages of specific regional techniques in various traumatic conditions.
Adult trauma scoring models: a critical review
Authors: Batchelor JS , McGuinness A , Ryan J
Published: January 2007

Since the development of the TRISS (Revised Trauma Score and Injury Severity Score) trauma scoring model several alternative models have been developed. Trauma scoring systems can be broadly categorized into anatomically based injury severity models, e.g. NISS (New Injury Severity Score) and ASCOT (A Severity Characterization of Trauma) or data driven models, e.g. ICISS (Insternational Classification of Diseases Injury Severity Score). Trauma scoring models using death/survival as the outcome measure can either be developed using logistic regression or a neural network approach. Assessment of the worth of a model is most commonly performed using receiver operating curve analysis or the Hosmer-Lemeshow statistic. Both of these statistical methods have their inherent weaknesses when applied to trauma scoring model development. This article aims to review four trauma scoring models and to discuss the limitations of the statistical methods used to assess the worth of these models.
Trauma teams
Authors: Brooks Adam , Burton Tom , Williams James , Mahoney Peter
Published: January 2007

Although the value of a team approach in the resuscitation of the trauma patient has been recognized for more than 30 years, the integration of teams into United Kingdom (UK) hospitals has been slow. The multidisciplinary trauma team needs to be horizontally organized and the members require precise role allocation and practice so that they work together efficiently. To ensure that the trauma team is activated appropriately, criteria need to be defined. The role of the team leader is paramount in effective team-based resuscitation.
Changes in the causes of trauma in the last 20 years
Authors: Girolami A , Foex BA , Little RA
Published: January 2007

Trauma is the third largest cause of death world-wide. In 1990, it caused 10% of all deaths. As it particularly affects young people, trauma is the biggest cause of economic loss and potential years of life lost. Furthermore, for every death there are at least two cases of permanent disability. Trauma is likely to touch all our lives, to a greater or lesser extent. Over the past 20 years, the total number of deaths from injury has fallen across the world despite a concomitant rise in the population. However, this decrease has occurred mainly in developed countries. Elsewhere, death rates due to injury have been increasing since the mid-1980s. Even in developed countries, violent deaths are assuming increasing importance as infectious and parasitic diseases are no longer so prominent. The causes of violent death vary over time. This article will look at trends in these changes over the past two decades.
Interhospital transfer of the trauma patient
Authors: Oakley Peter A
Published: January 2007

Despite the considerable interest in trauma care which has developed over the past 10 years, little attention has been given to interhospital transfer. Yet a third of major trauma cases admitted to neurosurgical centres have been transferred from other hospitals, often after considerable delay and with deficiencies in diagnosis or management. Following major trauma, head injury remains the commonest indication for transfer by far. Safe transport should allow medical treatment to be continued without detrimental effects to the patient. Physiological stabilization is of paramount importance, including vigorous avoidance of hypotension after major head injury, but unnecessary delay must also be avoided. The transfer process can be considered in four phases with good communication an essential component throughout. An experienced transfer or retrieval team is required, together with robust portable equipment and a set of versatile drugs. Further tools to aid transfer include golden rules and a handover template. Current developments include specific training programmes for safe transfer and the setting and implementation of standards of care.
Wrist instability
Authors: Waldram MA
Published: January 2007

Hidden in the diagnosis of ‘the sprained wrist’ is the missed ligament tear. A resultant carpal instability pattern can cause persistent pain and late osteoarthritis. The carpal bones act as a link system of two rows between the forearm and hand, held together by both an intrinsic and an extrinsic ligament system. Two common patterns of carpal collapse occur, the first at the scapho-lunate joint, where a tear results in scaphoid flexion and lunate extension (dorsal intercalated segment instability - DISI). The second occurs at the luno-triquetral joint, and results in lunate flexion (volar flexed intercalated segment instability - VISI). Further instability patterns are now emerging; those at the triquetro-hamate joint producing ulnar-sided wrist pain and midcarpal laxity, and complex dislocations, with or without fracture. Careful clinical examination, plain X-rays, magnetic resonance imaging (MRI) scan and wrist arthroscopy can enable a clear diagnosis to be made for most instability patterns. Treatment consists of acute open repair, soft tissue stabilization procedures or limited intercarpal fusion, depending on the time from injury.
Early imaging of spinal trauma
Authors: Johnson Graham
Published: January 2007

Spinal injury has the ability to maim and kill, but appropriate diagnosis and early treatment should result in minimization of secondary neurological injury and the restoration of the integrity of the spinal column. Rapid early diagnosis is essential and an impressive array of imaging technology is now available to the clinician. However, plain radiography remains the starting point for imaging of patients with potential spinal injury. This article reviews the role of plain radiography and the indications for further imaging, specifically with computerized tomography and magnetic resonance imaging.
Paediatric prehospital trauma care
Authors: Gaffney Paul , Johnson Graham
Published: January 2007

Trauma is the major cause of avoidable death in children in the UK. For many injured children, their initial contact with medical care is with the ambulance service. The main focus of this article is paediatric prehospital trauma care in the UK. It identifies its strengths and highlights areas where improvements are needed. For comparison’s sake, mention is also made of the prehospital care for traumatized children in the USA, which is part of a system termed ‘Emergency Medical Services for Children’ (EMSC). Training and equipment issues, field triage and the ABC of advanced life support of injured children is examined.

Future directions for this important aspect of emergency care are discussed, as are issues relevant to research and audit in this area.
Trauma systems/centres: a japanese perspective
Authors: Mashiko Kunihiro
Published: January 2007

The history of trauma services and systems and emergency medical services in Japan is very recent, the first agency being established in 1947. From a very modest beginning, systems have now been devised and put into place which provide a comprehensive national network of centres for the seriously ill and injured. Included are a number of Emergency and Critical Care Medical Centres reaching USA and European Level 1 Trauma Centre standards. Supporting these centres is a prehospital system that includes paramedics and emergency life-saving technicians. Further developments have included the establishment of the Department of Emergency and Critical Care Medicine, which supervises and accredits doctors training in these fields. The overall result of these initiatives is that the standard of care for the seriously ill and injured in Japan is now reaching levels found in leading centres globally.
Third World trauma
Authors: Bewes Peter
Published: January 2007

Trauma care has made great strides worldwide in recent years. This is especially noticeable in the more affluent countries, where new methodology has brought the seemingly impossible within reach - especially in fracture care.

In parts of the so-called ‘Third World’ however, where expenditure on health care is around $2 per person per year, yet where trauma is rife, new methodologies are not within the reach of the rural poor. Nevertheless, a system of trauma care that works is evolving in many parts of the Third World, and a literature on the subject is growing. ‘Third World trauma’, developed by an army of trauma workers in the field, details the challenges and appropriate response to trauma cases. This paper gives surgeons hoping to work in the trauma field in the Third World examples of the thinking behind these developments, some recommended reading, and advice on preparation for work in the ‘Third World’.
Influence and Political Processes in Cyberspace
Authors: Elron Efrat , Vigoda-Gadot Eran
Published: January 2007

The ways team members choose to influence each other and the political processes that take place within the team have important implications for the team’s effectiveness. We present an exploratory investigation of the ways both phenomena occur in global virtual teams. Based on interviews with team members and managers, combined with existing knowledge of these processes, we present a preliminary model that includes familiarity, team centrality and task focus as variables mediating the relationship between the multicultural and virtual aspects of the teams and the use of influence and politics. Our findings also suggest that the use of hard influence tactics and political actions is milder in global virtual teams in relation to collocated teams.
Organizational Information, Organizational Commitment and Intention to Quit
Authors: Addae Helena M. , Parboteeah K. Praveen
Published: January 2007

This study examines an often-ignored area, namely the relationship between organizational information and organizational commitment, using a sample of employees from Trinidad and Tobago. Basing our arguments on research in Anglo cultures, we postulated that organization information would be positively related to organizational commitment and the latter mediates the relationship between organization information and job satisfaction. Furthermore, we also predicted that job satisfaction would mediate the relationship between organizational commitment and turnover intentions. Finally, it was hypothesized that job alternatives will moderate the relationship between job satisfaction and intention to quit. The hypothesized relationships yielded mostly significant results. The latter is not surprising given that Trinidad and Tobago’s cultural context is fairly similar to Anglo cultures. We discuss both theoretical and practical implications of our findings in the context of cross cultural management.
Real Teaching and Real Learning vs Narrative Myths about Education
Authors: Gregory Marshall
Published: January 2007

All real classrooms are saturated in the fictional narratives about education from TV and movies that swirl about thickly and persistently in western culture, yet the influence that these fictions exert on real teachers and real students is seldom examined. This article argues that since these fictional narratives nearly always deal in recycled stereotypes of both students and teachers, and that since these stereotypes are both ubiquitous and compelling, and that since they seldom receive critical attention, the influence they exert on real teachers and real students is to mislead, confuse, and impoverish their evaluations of and expectations about the nature of genuine education.
Designing and Assessing Online Learning in English Literary Studies
Authors: Colbert Benjamin , Miles Rosie , Wilson Francis , Weeks Hilary
Published: January 2007

This article offers an account of online experimentation and innovation that has taken place in the English department of the University of Wolverhampton from 2003 to 2005. Focusing on an introductory first-year module and two third-year modules, it explores how and to what extent a virtual learning environment (VLE) can enhance the teaching of English literary studies in higher education. Using a ‘blended learning’ model of English teaching, in which face-to-face and online teaching are integrated, the study examines how VLEs can be incorporated into a coordinated assessment regime within individual modules, and considers the strategies for implementing VLE assessment in a staged progression across an English programme. The authors argue that online activities need to be both integrated into English courses and assessed.When balanced properly, VLE work offers no ‘easy option’ for students but effectively complements more traditional forms of assessment in English, such as essays and exams.
from developmental-constructivism to socio-cultural theory and practice
Authors: Edwards Suzy
Published: January 2007

In recent years, sociocultural theory has become an increasingly popular theoretical explanation for development and learning in early childhood education. The articulation of sociocultural theory to practice by teachers used to a predominately developmental-constructivist theoretical perspective represents an area of emerging research interest. This article examines the appropriation of sociocultural theory by a group of Australian early childhood educators participating in a professional development program informed by Developmental Work Research (DWR). The DWR methodology offers the opportunity to examine the processes involved for educators when learning to operate within a new conceptual framework and the implications this holds for their practice. The findings suggest that appropriation of a new theoretical framework such as sociocultural theory involves educators critiquing and analysing existing practices, participating in opportunities to implement new models of work in addition to reflection on new ways of seeing children, growth, learning and development.
Form and Meaning in the Earliest Cities: A New Approach to Ancient Urban Planning
Authors: Smith Michael E.
Published: January 2007

This article describes a new model for urban planning in ancient and preindustrial cities that moves beyond the traditional simplistic dichotomy of planned versus organic cities. The model has two components: coordination of buildings and spaces, and standardization among cities. A variety of coordinated arrangements of buildings reflect urban planning, including simple coordination, formality and monumentality, orthogonal layouts, other forms of geometric order, and access and visibility (view-shed). Standardization among cities is analyzed in terms of architectural inventories, spatial patterns, orientation, and metrology. The political and social significance of ancient urban planning is then discussed using Amos Rapoport's model of levels of meaning in the built environment.
GATA3 up-regulation associated with surface expression of CD294/CRTH2: a unique feature of human Th cells
Authors: De Fanis Umberto , Mori Francesca , Kurnat Rebecca J. , Lee Won Kyung , Bova Maria , Adkinson N. Franklin , Casolaro Vincenzo
Published: January 2007

GATA-3 and T-box expressed in T cells (T-bet) play central roles in Th-cell development and function. Consistently, studies in mice document their selective expression in Th1 and Th2 cells, respectively. In contrast, it is not clear whether these genes are regulated in human Th cells. Here we show that T-bet expression is polarized to a comparable degree in human and mouse Th-cell cultures, while only mouse GATA3 is subject to substantial regulation. This did not reflect differential skewing efficiency in human versus mouse cultures, as these contained similar frequencies of IFN-γ– and IL-4–producing cells. However, GATA-3 was expressed at significantly higher levels in human IL-4–producing cells enriched via capture with monoclonal antibodies (mAbs) against the PGD2 receptor, CRTH2, the best selective Th2-cell surface marker to date. Along with increased IL-4 and GATA-3, CRTH2+ Th cells isolated from Th2-skewed cultures or the circulating memory pool exhibited markedly decreased IFN-γ and T-bet expression. Thus, the human GATA-3 gene is not regulated in response to polarizing signals that are sufficient to direct Th2-specific expression in mouse cells. This postulates the involvement of an additional level of complexity in the regulation of human GATA-3 expression and stresses the existence of nontrivial differences in the regulation of human versus mouse T-cell function.
TC-PTP–deficient bone marrow stromal cells fail to support normal B lymphopoiesis due to abnormal secretion of interferon-γ
Authors: Bourdeau Annie , Dubé Nadia , Heinonen Krista M. , Théberge Jean-François , Doody Karen M. , Tremblay Michel L.
Published: January 2007

The T-cell protein tyrosine phosphatase (TC-PTP) is a negative regulator of the Jak/Stat cytokine signaling pathway. Our study shows that the absence of TC-PTP leads to an early bone marrow B-cell deficiency characterized by hindered transition from the pre-B cell to immature B-cell stage. This phenotype is intrinsic to the B cells but most importantly due to bone marrow stroma abnormalities. We found that bone marrow stromal cells from TC-PTP−/− mice have the unique property of secreting 232-890 pg/mL IFN-γ. These high levels of IFN-γ result in 2-fold reduction in mitotic index on IL-7 stimulation of TC-PTP−/− pre-B cells and lower responsiveness of IL-7 receptor downstream Jak/Stat signaling molecules. Moreover, we noted constitutive phosphorylation of Stat1 in those pre-B cells and demonstrated that this was due to soluble IFN-γ secreted by TC-PTP−/− bone marrow stromal cells. Interestingly, culturing murine early pre-B leukemic cells within a TC-PTP–deficient bone marrow stroma environment leads to a 40% increase in apoptosis in these malignant cells. Our results unraveled a new role for TC-PTP in normal B lymphopoiesis and suggest that modulation of bone marrow microenvironment is a potential therapeutic approach for selected B-cell leukemia.
Comparative genomic analysis of the family Iridoviridae: re-annotating and defining the core set of iridovirus genes
Authors: Eaton Heather E , Metcalf Julie , Penny Emily , Tcherepanov Vasily , Upton Chris , Brunetti Craig R
Published: January 2007

Background

Members of the family Iridoviridae can cause severe diseases resulting in significant economic and environmental losses. Very little is known about how iridoviruses cause disease in their host. In the present study, we describe the re-analysis of the Iridoviridae family of complex DNA viruses using a variety of comparative genomic tools to yield a greater consensus among the annotated sequences of its members.

Results

A series of genomic sequence comparisons were made among, and between the Ranavirus and Megalocytivirus genera in order to identify novel conserved ORFs. Of these two genera, the Megalocytivirus genomes required the greatest number of altered annotations. Prior to our re-analysis, the Megalocytivirus species orange-spotted grouper iridovirus and rock bream iridovirus shared 99% sequence identity, but only 82 out of 118 potential ORFs were annotated; in contrast, we predict that these species share an identical complement of genes. These annotation changes allowed the redefinition of the group of core genes shared by all iridoviruses. Seven new core genes were identified, bringing the total number to 26.

Conclusion

Our re-analysis of genomes within the Iridoviridae family provides a unifying framework to understand the biology of these viruses. Further re-defining the core set of iridovirus genes will continue to lead us to a better understanding of the phylogenetic relationships between individual iridoviruses as well as giving us a much deeper understanding of iridovirus replication. In addition, this analysis will provide a better framework for characterizing and annotating currently unclassified iridoviruses.
p38 Mitogen-Activated Protein Kinase Mediates Palmitate-Induced Apoptosis But Not Inhibitor of Nuclear Factor-κB Degradation in Human Coronary Artery Endothelial Cells
Authors: Chai Weidong , Liu Zhenqi
Published: January 2007

Plasma free fatty acids are elevated in patients with type 2 diabetes and contribute to the pathogenesis of insulin resistance and endothelial dysfunction. The p38 MAPK mediates stress, inflammation, and apoptosis. Whether free fatty acids induce apoptosis and/or activate nuclear factor-κB inflammatory pathway in human coronary artery endothelial cells (hCAECs) and, if so, whether this involves the p38 MAPK pathway is unknown. hCAECs (passages 4–6) were grown to 70% confluence and then incubated with palmitate at concentrations of 0–300 μm for 6–48 h. Palmitate at 100, 200, or 300 μm markedly increased apoptosis after 12 h of incubation. This apoptotic effect was time (P = 0.008) and dose (P = 0.006) dependent. Palmitate (100 μm for 24 h) induced a greater than 2-fold increase in apoptosis, which was accompanied with a 4-fold increase in p38 MAPK activity (P < 0.001). Palmitate did not affect the phosphorylation of Akt1 or ERK1/2. SB203580 (a specific inhibitor of p38 MAPK) alone did not affect cellular apoptosis; however, it abolished palmitate-induced apoptosis and p38 MAPK activation. Palmitate significantly reduced the level of inhibitor of nuclear factor-κB (IκB). However, treatment of cells with SB203580 did not restore IκB to baseline. We conclude that palmitate induces hCAEC apoptosis via a p38 MAPK-dependent mechanism and may participate in coronary endothelial injury in diabetes. However, palmitate-mediated IκB degradation in hCAECs is independent of p38 MAPK activity.