bluuebunny/crossref_metadata_2025 huggingface dataset:
Case of leukoderma punctata after topical PUVA treatment
Authors: Park Jung‐Hun , Lee Mu‐Hyoung
Published: February 2004

An 11‐year‐old Korean girl presented with a 2‐year history of asymptomatic multiple punctiform, hypopigmented and achromic spots predominantly on the outer aspect of her right forearm. She had been treated for segmental vitiligo on her right forearm with topical PUVA six times a week for 4 years at a local clinic. The lesions were very distinct, round hypopigmented macules 1–2 mm in diameter, predominantly in nonfollicular distribution (Fig. 1). Not only the site where topical psolaren had been applied but also areas on her right forearm where UVA was exposed for a long time for treatment of vitiligo developed multiple punctiform hypopigmented spots. She also had PUVA lentigenes on her right forearm. Laboratory studies including complete blood cell count, biochemistry, and endocrinologic studies were all within normal limits. There was no history of inflammatory lesions antedating the hypopigmentation. Skin biopsy was taken from punctiform hypopigmented macules. There were no specific findings in the hematoxylin‐eosin stained sections. However, marked reduction of melanin and melanocytes was noted with the Fontana‐Masson stain (Fig. 2) and the S‐100 stain (Fig. 3). With these clinical and histological findings the patient was diagnosed as having leukoderma punctata.

Multiple, hypopigmented, and achromic spots on the right forearm

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Microscopic examination of a hypopigmented macule showing marked reduction of melanin (Fontana‐Masson stain, ×200)

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S‐100 stain showing marked reduction of melanocytes in the basal layer (S‐100 stain, ×200)

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Neutrophilic dermatosis of the hands: four new cases and review of the literature
Authors: Weenig Roger H. , Bruce Alison J. , McEvoy Marian T. , Gibson Lawrence E. , Davis Mark D. P.
Published: February 2004

Background  Isolated or predominantly hand involvement in Sweet's syndrome, pyoderma gangrenosum, or pustular vasculitis is a rare presentation in the spectrum of neutrophilic dermatoses and is often associated with an occult malignancy or other systemic inflammatory disorder. When these disorders occur on the hands, they are often clinically indistinguishable, but they can sometimes be separated histologically by the presence of papillary dermal edema (Sweet's syndrome), ulceration and necrosis (pyoderma gangrenosum), or vasculitis (pustular vasculitis). These distinctions may be arbitrary, however, and reflect differences in the temporal course of the disease and in the degree of inflammation at the time of biopsy.

Methods  We report four cases of neutrophilic dermatosis affecting the hands and a review of the literature for similar cases.

Results  Of the four patients presented, two had associated carcinomas and one had myelodysplasia in transition to leukemia. The cutaneous symptoms preceded the finding of an occult malignancy. Thirty‐two reported cases of neutrophilic dermatoses presenting on the hands showed clinicopathologic features similar to those in our series. Taken together, the mean age at diagnosis was 60.5 years, and 58% of the patients were female. Twenty‐five per cent (nine patients) also had myelodysplasia or leukemia, 14% (five patients) ulcerative colitis, 6% (two patients) carcinoma, 6% (two patients) Crohn's disease, and 6% (two patients) seropositive arthritis.

Conclusions  These cases illustrate the importance of recognizing that neutrophilic dermatoses may present uniquely or predominantly on the hands. This presentation is distinctive, and prompt diagnosis may prevent unnecessary medical or surgical therapy and may lead to the earlier diagnosis and treatment of an associated malignancy or other systemic disorder.
Lupus erythematosus induced by medications, ultraviolet radiation, and other exogenous agents: A review, with special focus on the development of subacute cutaneous lupus erythematosus in a genetically predisposed individual
Authors: Shapiro Michael , Sosis Arthur C. , Junkins‐Hopkins Jacqueline M. , Werth Victoria P.
Published: February 2004

Exogenous agents implicated in or suspected of precipitating subacute cutaneous lupus erythematosus (SCLE) and lupus erythematosus (LE) are reviewed. An illustrative case of environmentally induced SCLE is presented. A previously healthy 30‐year male homozygous for the tumor necrosis factor‐α (TNF‐α) 308. A promoter allele developed SCLE after spending several hours removing fertilizer‐ and pesticide‐containing hay from an agricultural barn in the springtime. The cutaneous eruption soon resolved, only to reappear 3 weeks later on the day the patient re‐entered the barn. An environmental agent present in the barn, coupled with springtime ultraviolet light, likely triggered the disease in this immunogenetically susceptible individual.
Surgical option for nonmelanoma skin cancer
Authors: Pichardo‐Velázquez Patricia , Domínguez‐Cherit Judith , Vega‐Memije Ma. Elisa , Moreno‐Coutiño Gabriela , Proy Héctor
Published: February 2004

Background  Basal cell carcinoma (BCC) is one of the most frequent malignancies in the general population. Its best treatment option is the complete excision of the lesion. Mohs’ micrographic surgery has demonstrated to be the surgical method with the highest cure rates, however, it is not available in many countries or institutions.

Methods  We propose, as a treatment option for high‐risk BCC, surgical resection of the tumor with transoperatory histological examination with the hematoxilin‐eosin technique, delaying closure of the wounds until the margins and surgical bed are tumor‐free.

Results  We studied 83 patients with BCC; 49 were treated with the transoperatory technique and delay closure. We observed no recurrence in any patient that we followed up and there were no complications resulting from the technique in a 25‐month follow up.

Conclusions  We recommend this technique for tumors with high‐risk of recurrence if Mohs’ micrographic surgery is not available.
Behavioral ecology of the Jeju pony (Equus caballus): Effects of maternal age, maternal dominance hierarchy and foal age on mare aggression
Authors: RHO Jeong Rae , SRYGLEY Robert Boxter , CHOE Jae Chun
Published: February 2004

On Jeju Island, Korea, dominance hierarchy and maternal care according to maternal age were studied in a herd of Jeju ponies (Equus caballus), consisting of 73 mares, their foals and one stallion. Dominance ranks were nearly linear and increased significantly with the age of mares. Most aggressive encounters involved mares under 5 years old. Mares under the age of 5 years have apparently not established their rank. The mean frequency of aggressive actions of mares per hour increased significantly as the day of parturition approached. Aggressive actions of mares with foals decreased significantly as their foals aged. The overall frequency of aggression of mares with foals also decreased significantly with the age of the mares. Our results suggest that the cost of maternal care is lower for older, more dominant mares than for subordinate ones.
Diagnosis of atrophic body gastritis in Chinese patients by measuring serum pepsinogen
Authors: Wu Kai Chun , Li Hong Tao , Qiao Tai Dong , Li Cai Ning , Ji Wan Sheng , Tian Feng Qi , Wang Xin , Wang Biao Luo , Miao Ji Yan , Ding Jie , Fan Dai Ming
Published: February 2004

OBJECTIVE:  Atrophic body gastritis (ABG) is common in China. Although histology via endoscopy is an efficient and reliable means of diagnosing ABG, it is an invasive procedure. Therefore, in the present study serum pepsinogen (PG) was used as a biomarker to develop a novel noninvasive test as the first option for screening of ABG in certain groups of Chinese.

METHODS:  The study population consisted of 81 selected dyspeptic patients (mean age, 64.8 ± 0.7 years; M:F, 43:38) who underwent diagnostic gastroscopy. At least four biopsy specimens were taken from the antrum and corpus of the stomach (two specimens from each site) for histological diagnosis. Blood samples for ELISA assays of serum pepsinogen I (PGI), pepsinogen II (PGII) and IgG antibodies against Helicobacter pylori (Hp IgG) were drawn after endoscopy. Cut‐off points were calculated using receiver operating curves (ROC).

RESULTS:  There was no correlation between serum PG and atrophy in the antral mucosa. The mean serum concentration of PGI was lower (P < 0.05) in patients with ABG (89.9 µg/L) than in those with normal mucosa (NM) and non‐ABG (123.7 µg/L and 139.1 µg/L). The mean ratio of PGI:PGII was also lower (P < 0.01) in patients with ABG (6.2) than in those with NM and non‐ABG (11.6 and 11.7). There was no difference in serum PGI or the PGI:PGII ratio between patients with and without H. pylori infection. For diagnosing ABG, the area under the ROC of PGI and the PGI:PGII ratio was 0.741(95% CI: 0.627–0.856) and 0.874(95% CI: 0.788–0.961), respectively. The maximum of the Youden's index (YI) of PGI and the PGI:PGII ratio was 0.426 and 0.722, respectively. The best cut‐off point for PGI was 97.1 µg/L with sensitivity of 67% and specificity of 76%, and for PGI:PGII ratio was 8.1 µg/L, with sensitivity of 89% and specificity of 83%.

CONCLUSIONS:  The serum PGI:PGII ratio appears to be a sensitive and specific assay for corpus atrophy, thus providing a noninvasive and indicative test for diagnosis of atrophic gastritis.
Construction and identification of polycistron adenoviral expression vector PCA13/FasL–IRES–iNOS
Authors: Qiu Jiang Feng , Wu Zhi Yong , Luo Chun Xia , Yu Fu Rong , Zhang Zhi Qi
Published: February 2004

OBJECTIVE:  To construct the Fas ligand (FasL) and inducible nitric oxide synthase (iNOS) coexpressed PCA13 plasmid used for packing of adenovirus, so as to observe the immunoprotective effect of FasL on the adenovirus vector.

METHODS:  By way of the internal ribosome entry site (IRES), gene engineering techniques such as preparation and transformation of competent cells, plasmid extraction, agarose gel electrophoresis and restriction enzymolysis were used for the construction of the polycistron adenoviral expression vector PCA13/FasL–IRES–iNOS, which could coexpress FasL and the iNOS gene after multisubcloning steps.

RESULTS:  FasL and iNOS connected with the IRES were successfully cloned to the PCA13 plasmid and verified by enzymolysis (600 bp FasL, 1000 bp IRES and 4000 bp iNOS) and the gene sequence was concordant with the gene bank.

CONCLUSIONS:  The polycistron adenoviral expression vector PCA13/FasL–IRES–iNOS was successfully constructed.
Cladribine followed by autologous stem‐cell transplantation in progressive multiple sclerosis
Authors: Grigg A. , Tubridy N. J. , Szer J. , Mitchell P. , Butzkueven H. , Shuttleworth P. , Kilpatrick T.
Published: February 2004

Abstract

We studied the safety of autologous peripheral blood stem‐cell transplantation (PBSCT) in four patients with progressive multiple sclerosis. Clinical and magnetic resonance imaging outcomes were secondary end‐points. Cladribine administration preceded filgrastim‐primed PBSC collection, aiming for lymphocyte depletion. Conditioning was with antithymocyte globulin and cyclophosphamide. The procedure was well tolerated, but without obvious clinical benefit. The study was ­terminated when other therapeutic options with lower morbidity became available. (Intern Med J 2004; 34: 66−69)
Designing questionnaires for nutrition research
Authors: Fehily Ann M. , Johns Anthony P.
Published: February 2004

When developing a questionnaire, whether the questionnaire is to be used to estimate nutrient intakes or for other data, a large number of factors need to be considered. Each of these is discussed, providing guidance to help overcome many of the problems that may occur in data collection and analysis. For a questionnaire to estimate nutrient intakes, first considerations are: the nutrient(s) to be assessed; the foods containing the nutrient(s); food portion sizes. For all questionnaires, it is necessary to consider: whether the questionnaire will be self‐administered or administered; whether a computerised interview or paper form will be used; location of questionnaire completion; whether questions will be open or closed format; length of the questionnaire; sequence and wording of questions; data coding for computer analysis; range and compatibility checks on data. If estimating nutrient intakes, additional considerations are: how nutrient intakes will be calculated; processing of missing values; validation of intake estimates. For all questionnaires, a pilot study is also essential. It is vital that adequate consideration is given to all of these factors at the design stage of the questionnaire in order to ensure that data collection and analysis can be carried out both effectively and efficiently.
A whole diet approach to healthy eating
Authors: E. Hannah, Theobald
Published: February 2004

This paper reviews the importance of a whole diet approach to healthy eating, detailing the development of the Balance of Good Health and explaining why such a healthy eating model works for the UK population. Comparisons are made between dietary recommendations (from the Balance of Good Health) and current eating patterns in the UK. This paper also discusses why it is important to consume foods from each of the four major food groups and discusses the health issues associated with cutting out a food group from the diet, as occurs in a number of popular diets.
Site‐Specificity
Authors: Rowe Dorothy
Published: February 2004

Books reviewed in this article:

Guy Lelong, Daniel Buren

Harriet F. Senie, The Tilted Arc Controversy: Dangerous Precedent

Miwon Kwon, One Place After Another: Site‐Specific Art and Locational Identity

John Ravenal, Outer and Inner Space: Pipilotti Rost, Shirin Neshat, Jane and Louise Wilson and the History of Video Art
Experience and Theory
Authors: Gerhart Mary , Russell Allan Melvin
Published: February 2004

N. R. Hanson's discussion of experience is criticized. Experience, though necessary for knowing, is insufficient as a basis for understanding in either science or religion. Experience alone can be misleading. We may begin with experience, but we cannot claim to understand until experience has been mediated by theory. The article is excerpted from Metaphoric Process: The Creation of Scientific and Religious Understanding (Gerhart and Russell 1984), Chapter 2.
Early learning experiences valued by physiotherapy students
Authors: Lindquist Ingrid , Engardt Margareta , Richardson Barbara
Published: February 2004

Healthcare education across Europe aims to prepare students for service in healthcare provision that increasingly focuses on client‐centred care. Broadening access to professional courses can result in student cohorts that include a range of ages and educational backgrounds. The aim of this study was to explore the learning experiences valued by first‐year physiotherapy students in two European universities. Eighteen students were strategically selected for diversity of gender, age, educational background and previous work experiences. A qualitative approach was taken. A commonly developed interview guide was used to guide data collection through semistructured interviews that were carried out at the end of the first and second semester of the first year. Thematic analysis of interview transcripts, within and across countries, revealed themes of valued learning experiences from participation in clinical contexts, observation in clinical practice settings, learning from others and self, and learning from support and feedback. The findings suggest that educators should look more closely to ensure a match between the learning experiences valued by their students and their own approach to teaching, if they want to enhance students’ preparation for the contemporary needs of the profession.
Faces of the Homeless: A Photo Essay
Authors: Zald Joan Kadri
Published: February 2004

These portraits were taken in shelters, soup kitchens, transitional housing, and on city streets. The intent was to record the faces of the homeless, capture their humanity, and show the diverse range of people who become homeless. Photographs were also selected to show the different kinds or stages of homelessness: the recently dislocated and the episodically, as well as the chronically, homeless.
Neighborhood Opportunities, Race, and Class: The Black Middle Class and Residential Segregation
Authors: Adelman Robert M.
Published: February 2004

Racial residential segregation has received considerable attention from social scientists who, in general, have found that African Americans, particularly those in large, northeastern and midwestern metropolitan areas have been highly segregated from whites since at least the beginning of the Great Migration. This analysis combines research on racial residential segregation with research about residential segregation based on social class in order to study the segregation of middle‐class blacks from middle‐class whites. By using Census data that incorporate consistent geographic definitions of Census tracts in 50 U.S. metropolitan areas from 1970 to 1990, I assess change in the levels of residential segregation between middle‐class blacks and middle‐class whites. The index of dissimilarity indicates that while there was a decrease in the segregation of middle‐class blacks from middle‐class whites between 1970 and 1990, in many metropolitan areas this segregation remained high through 1990. The analysis also shows that middle‐class blacks lived in neighborhoods, on average, with considerably more poverty, more boarded‐up homes, more female‐headed households, and fewer college graduates than neighborhoods inhabited by middle‐class whites. Overall, the results suggest that, for the most part, these groups remain residentially separated in U.S. metropolitan areas.
Ventricular Evoked Response as Clinical Marker for Hemodynamic Changes in Dilative Cardiomyopathy
Authors: EBNER ERICH , KRÄTSCHMER HANNES , DANILOVIC DEJAN , HRIBERNIGG MARTIN , HUTTEN HELMUT
Published: February 2004

The potential value of ventricular evoked response (VER) evaluation by implantable pacemakers as clinical marker for disease induced hemodynamic changes in the heart, has so far not been explicitly evaluated. We conducted a study to evaluate the reproducibility of the R spike and T wave measurements (R(VER) and T(VER)) under controlled clinical conditions and examine the correlation between VER parameters and standard echocardiographic measurements in the left ventricle. Additionally, the utility of the VER as a marker for NYHA classification and the presence of cardiomyopathy was investigated. The Physios CTM 01 pacemaker capable of recording authentic VER signal morphology, was used with low polarization fractal coated pacing leads to obtain high‐fidelity VER recordings in 26 patients with conventional pacing indications (mean age: 69.1 ± 11.8 years; 20 men). Three patients suffered from dilative cardiomyopathy (DCM), 14 from hyperthropic nonobstructive cardiomyopathy (HNCM), and nine had no myopathy but suffered from coronary artery disease (CAD). Five patients were in NYHA Class IV, 19 in Class III, and two in Class II. Mean R(VER) and T(VER) amplitudes were calculated from one‐minute VER recordings. Standard echocardiography parameters were determined during this recording. Two follow‐ups at a mean distance of 11.3 ± 5.7 month were performed. The reproducibility of R(VER) or T(VER) (correlation factors: 0.992 and 0.981, respectively) was superior to the reproducibility of any echocardiographic parameter (correlation factors 0.404–0.943). There was no strong correlation between VER and any echo parameter. Both R(VER) and T(VER) were significantly reduced in NYHA Class IV patients (P < 0.05), and nearly significantly reduced in DCM versus other patients (P = 0.05–0.09). HNCM made no difference to CAD. The investigation shows that analysis of VER parameters bears a promising potential for dynamic monitoring of diseases affecting the hemodynamics, and of therapeutic effects, by means of regular, nonburdening pacemaker follow‐up examinations. (PACE 2004; 27:166–174)
ECG Criteria for Localizing the Pulmonary Vein Origin of Spontaneous Atrial Premature Complexes:
Authors: RAJAWAT YADAVENDRA S. , GERSTENFELD EDWARD P. , PATEL VICKAS V. , DIXIT SANJAY , CALLANS DAVID J. , MARCHLINSKI FRANCIS E.
Published: February 2004

We have shown that pacemapping from each of the pulmonary veins reveals unique surface ECG characteristics. However, application of these criteria to spontaneous atrial premature complexes is often difficult because of obscuration by the prior T wave. We hypothesized that the pulmonary vein of origin of spontaneous atrial premature complexes can be determined by measuring characteristics of the P wave whether or not the P wave was superimposed on the prior T wave. We analyzed 58 spontaneous atrial premature complexes of known pulmonary vein origin in 30 patients referred for atrial fibrillation ablation. The origin of all the atrial premature complexes was documented by detailed, intracardiac multipolar catheter mapping. Based on previous work, the criteria for distinguishing right‐sided from left‐sided pulmonary vein origin of atrial premature complex includes: (1) P wave duration < 120 ms; (2) P wave amplitude in lead I > 0.05 mV; and (3) P wave amplitude in leads II/III > 1.25. The criteria to separate superior from inferior pulmonary veins included the sum of the P wave amplitude in all the inferior leads greater than 0.3 mV. The combination of the P wave duration < 120 ms and the ratio of the P wave amplitude in leads II/III > 1.25, distinguished right‐sided from left‐sided pulmonary vein origin of spontaneous atrial premature complexes with a sensitivity of 82% and specificity of 100%. The sum of the P wave amplitude in leads II, III, and aVF > 0.3mV distinguished superior from inferior pulmonary vein of origin with a sensitivity of 39% and specificity of 73%. The pulmonary vein origin of spontaneous atrial premature complexes can often be localized using careful quantitative analysis of the surface ECG despite superimposition of the P wave upon the T wave. Separation of right‐sided from left‐sided pulmonary vein origin of spontaneous atrial premature complexes can be determined with good specificity and sensitivity, while the ability to distinguish inferior from superior pulmonary vein origin is limited. (PACE 2004; 27:182–188)
Electrophysiological Evaluation of the Sinus Node and the Cardiac Conduction System Following the Maze Procedure for Atrial Fibrillation
Authors: ALBÅGE ANDERS , LINDBLOM DAN , INSULANDER PER , KENNEBÄCK GÖRAN
Published: February 2004

Transient sinus node dysfunction has been demonstrated by noninvasive methods following the maze procedure for atrial fibrillation (AF). However, extensive data from invasive electrophysiological studies have not been previously reported. Thirty‐seven patients, mean age 54 ± 10 years, underwent the maze (III) procedure. Electrophysiological studies with recordings of SNRT, CSNRT, AVN‐ERP, point of Wenckebach block, AH, PA, and HV interval, were performed preoperatively and 6 and 15 months postoperatively. Induction of atrial flutter/AF was attempted postoperatively. Based on electrophysiological study evaluation, the maze (III) procedure did not cause permanent damage to the sinus node in any patient with a documented normal sinus node function preoperatively (CSNRT max 541 ± 210 vs 587 ± 437 ms, P = 0.26). Postoperative AV node function was normal in all patients with a documented normal AV node function before surgery. One patient had an iatrogenic third degree AV block. There was no difference in PA or HV interval after surgery. Sustained atrial tachyarrhythmias could be induced in 5 patients, of whom 4 developed permanent AF/atrial flutter late after surgery. At late follow‐up, (mean 45 months), 27 (73%) patients were in sinus rhythm, 5 (13%) patients had permanent pacing, and 5 patients had recurrent AF requiring His bundle ablation (n = 2) or medical treatment (n = 3). Based on electrophysiological studies, the maze (III) procedure does not cause permanent damage to the sinus or AV nodes or to the right atrial and His‐Purkinje conduction systems. Electrophysiological study evaluation may predict the need for postoperative pacemaker. Induction attempts of atrial arrhythmias may predict future recurrences and guide therapeutic efforts. (PACE 2004; 27:194–203)
Radiofrequency Catheter Ablation in Small Children:
Authors: BLAUFOX ANDREW D. , PAUL THOMAS , SAUL J. PHILIP
Published: February 2004

Little data exists to support the use of procedural modifications during radiofrequency catheter ablation (RFCA) in small children. A single institution database was reviewed for patients under 15 kg undergoing RFCA from January 1998 to August 2001. Of 268 RFCA procedures, 18 were done in 14 patients under 15 kg (median weight 5.7 kg, 3.5–13.7; age 5.8 months, 1.2–19.8). Six patients had normal hearts, 4 had congenital heart disease, and 4 patients had cardiomyopathy. Diagnoses were orthodromic reciprocating tachycardia (ORT) in nine patients/nine studies, chaotic atrial tachycardia (CAT) in one patient/two studies, and VT in four patients/seven studies. RFCA variables included maximum temperature (69°C, 50–78), total applications (10, 2–21), applications > 20 seconds (5, 0–15), and total application time (331 s, 26–1,006 s). Complications were pericardial effusion in 1 patient, mild mitral regurgitation in 1, and myocardial infarction in 1 patient. When indexed for weight, the number of applications with a duration > 20 seconds in the ORT group was significantly greater in complicated versus uncomplicated procedures (0.7 applications/kg vs 0.16 applications/kg, P = 0.05). In addition, for the ORT subgroup, the indexed total application time trended higher in complicated versus uncomplicated procedures (40.6 s/kg, vs 6.6 s/kg, P = 0.1). RFCA success was 9/9 in ORT, 6/7 in VT, and 0/2 in CAT. RFCA can be successful in small children; however, complications appear to be related to RF dose indexed for body size. Thus, the decision to proceed with RFCA, and the application duration and number should be guided by patient size, balanced against the risks of the arrhythmia, and reserved for dire circumstances. (PACE 2004; 27:224–229)
Delayed Presentation of Totally Avulsed Right Superior Vena Cava After Extraction of Permanent Pacemaker Lead
Authors: LEACCHE MARZIA , KATSNELSON YAN , ARSHAD HASSAN , MIHALJEVIC TOMISLAV , RAWN JAMES D. , SWEENEY MICHAEL O. , BYRNE JOHN G.
Published: February 2004

Pacemaker lead extraction has been shown to be an effective and safe treatment for infected permanent pacemaker leads, however, they may lead to potentially serious complications, usually occurring during the extraction procedure. This report describes a case of a 48‐year‐old woman with a patent persistent left SVC and an infected permanent pacemaker lead of a DDD pacing system who underwent transvenous laser‐assisted lead extraction using a combined SVC and femoral approach. Two days after the procedure the patient developed symptoms of SVC obstruction requiring surgical intervention. The right SVC was found to be almost completely destroyed with only a thin strip of the lateral wall intact and active bleeding. The probable causative mechanisms and surgical management are discussed. (PACE 2004; 27:262–263)
Pulpal diagnosis
Authors: SIGURDSSON ASGEIR
Published: February 2004

Correct pulpal diagnosis is the key to all predictable endodontic treatment. It is paramount that prior to proceeding with a treatment that will affect the contents of the pulp chamber that a clinical diagnosis of the pulp and the periapical tissues is established. This diagnosis should be based on presenting symptoms, history of symptoms, diagnostic tests and clinical findings. If it is not possible to establish the diagnosis or one diagnosis is not dominant within a differential diagnosis, therapy should not be initiated until further evaluation has been performed. In this review, current knowledge on pulpal and periapical status as it pertains to diagnosis will be reviewed. Additionally, most common diagnostic tests will be presented and critically reviewed.
Second generation Tibetan lowlanders acclimatize to high altitude more quickly than Caucasians
Authors: Marconi Claudio , Marzorati Mauro , Grassi Bruno , Basnyat Buddha , Colombini Angelo , Kayser Bengt , Cerretelli Paolo
Published: February 2004

Tibetan highlanders develop at altitude peak aerobic power levels close to those of Caucasians at sea level. In order to establish whether this feature is genetic and, as a consequence, retained by Tibetan lowlanders, altitude‐induced changes of peak aerobic performance were assessed in four groups of volunteers with different ethnic, altitude exposure and fitness characteristics, i.e. eight untrained second‐generation Tibetans (Tib 2) born and living at 1300 m; seven altitude Sherpas living at ∼2800–3500 m; and 10 untrained and five trained Caucasians. Measurements were carried out at sea level or at Kathmandu (1300 m, Nepal) (PRE), and after 2–4 (ALT1), 14–16 (ALT2), and 26–28 (ALT3) days at 5050 m. At ALT3, of untrained and trained Caucasians was –31% and –46%, respectively. By contrast, of Tib 2 and Sherpas was –8% and –15%, respectively. At ALT3, peak heart rate (HRpeak) of untrained and trained Caucasians was 148 ± 11 and 149 ± 7 beats min−1, respectively; blood oxygen saturation at peak exercise was 76 ± 6% and 73 ± 6%, and haemoglobin concentration ([Hb]) was 19.4 ± 1.0 and 18.6 ± 1.2 g dl−1, respectively. Compared to Caucasians, Tib 2 and Sherpas exhibited at ALT3 higher HRpeak (179 ± 9 and 171 ± 4 beats min−1, P < 0.001), lower [Hb] (16.6 ± 0.6 and 17.4 ± 0.9 g dl−1, respectively, P < 0.001), and slightly but non‐significantly greater average values (82 ± 6 and 80 ± 7%). The above findings and the time course of adjustment of the investigated variables suggest that Tibetan lowlanders acclimatize to chronic hypoxia more quickly than Caucasians, independent of the degree of fitness of the latter.
Theory of reliability in structural design
Authors: Raizer Vladimir
Published: February 2004

The article presents a review of the theory of reliability and its use for design code making procedures based on the probabilistic approach. Principles of structural safety in design code making are considered. To do so, the basic principles of the limit state methods in the form of partial factors and ways of their development are analyzed. The problem of manufactured structures or specimen reliability evaluation is discussed according to the control test results. Classification of loads and actions, which were adopted during the code making, is presented. Descriptions of the load combinations are considered. Evaluation of the risk in civil engineering is observed and estimations of the acceptable and optimal risk are discussed. Development of reliability based design principles is also presented. Based on review of preceding work, general requirements for probabilistic codes are described and the critical observations of the modern methods of the analysis of the failure probability are presented. This review article cites 125 references.
Restriction Fragment Length Polymorphisms and Sequence Analysis: an Approach for Genotyping Infectious Pancreatic Necrosis Virus Reference Strains and Other Aquabirnaviruses Isolated from Northwestern Spain
Authors: Cutrín J. M. , Barja J. L. , Nicholson B. L. , Bandín I. , Blake S. , Dopazo C. P.
Published: February 2004

Reference strains of infectious pancreatic necrosis virus resembling the 10 recognized serotypes and local isolates of aquabirnaviruses isolated in northwestern Spain from reservoirs (mollusks) and from asymptomatic and carrier cultured fish were genotyped by restriction fragment length polymorphism (RFLP) and nucleic acid sequence analyses. The RFLP analysis yielded seven genogroups, each of which was clearly correlated with a serotype. Sequence analysis of the three open reading frames provided quite similar results in terms of genogrouping. Based on the results of this study and in order to unify the two types of assays, we propose placing aquabirnaviruses into six genogroups, four of which can be subdivided into two genotypes based on a two-step restriction analysis. The genotyping corresponds with serotyping as follows: genogroup I includes two genotypes corresponding to serotypes A9 (genotype I.1) and A1 (genotype I.2); genogroup II corresponds to serotype A3; genogroup III includes genotypes III.1 (serotype A2) and III.2 (serotype B1); genogroups IV and V include two genotypes, each corresponding to serotypes A5, A6, A7, and A8 (genotypes IV.1, IV.2, V.1, and V.2, respectively);and genogroup VI corresponds to serotype A4. As expected, most local isolates belonged to genotype III.1 and genogroup II. However, a few local isolates corresponded to the American types of genogroup I. Finally, based on the results of this study and due to its simplicity, the two-step restriction analysis assay is proposed as a method for typing new isolates of aquabirnaviruses, and the results correspond to the results of conventional serotyping.
Aquatic Plants Stimulate the Growth of and Biofilm Formation by
Mycobacterium ulcerans
in Axenic Culture and Harbor These Bacteria in the Environment
Authors: Marsollier Laurent , Stinear Timothy , Aubry Jacques , Saint André Jean Paul , Robert Raymond , Legras Pierre , Manceau Anne-Lise , Audrain Christine , Bourdon Sandra , Kouakou Henri , Carbonnelle Bernard
Published: February 2004

Mycobacterium ulcerans
is the causative agent of Buruli ulcer, one of the most common mycobacterial diseases of humans. Recent studies have implicated aquatic insects in the transmission of this pathogen, but the contributions of other elements of the environment remain largely unknown. We report here that crude extracts from two green algae added to the BACTEC 7H12B culture medium halved the doubling time of
M. ulcerans
and promoted biofilm formation. Using the 7H12B medium, modified by the addition of the algal extract, and immunomagnetic separation, we also demonstrate that
M. ulcerans
is associated with aquatic plants in an area of the Ivory Coast where Buruli ulcer is endemic. Genotype analysis showed that plant-associated
M. ulcerans
had the same profile as isolates recovered in the same region from both aquatic insects and clinical specimens. These observations implicate aquatic plants as a reservoir of
M. ulcerans
and add a new potential link in the chain of transmission of
M. ulcerans
to humans.
Effect of Condensed Tannins on Bacterial Diversity and Metabolic Activity in the Rat Gastrointestinal Tract
Authors: Smith Alexandra H. , Mackie Roderick I.
Published: February 2004

The effect of dietary condensed tannins (proanthocyanidins) on rat fecal bacterial populations was ascertained in order to determine whether the proportion on tannin-resistant bacteria increased and if there was a change in the predominant bacterial populations. After 3 weeks of tannin diets the proportion of tannin-resistant bacteria increased significantly (
P
< 0.05) from 0.3% ± 5.5% to 25.3% ± 8.3% with a 0.7% tannin diet and to 47.2% ± 5.1% with a 2% tannin diet. The proportion of tannin-resistant bacteria returned to preexposure levels in the absence of dietary tannins. A shift in bacterial populations was confirmed by molecular fingerprinting of fecal bacterial populations by denaturing gradient gel electrophoresis (DGGE). Posttreatment samples were generally still distinguishable from controls after 3.5 weeks. Sequence analysis of DGGE bands and characterization of tannin-resistant isolates indicated that tannins selected for
Enterobacteriaceae
and
Bacteroides
species. Dot blot quantification confirmed that these gram-negative bacterial groups predominated in the presence of dietary tannins and that there was a corresponding decrease in the gram-positive
Clostridium leptum
group and other groups. Metabolic fingerprint patterns revealed that functional activities of culturable fecal bacteria were affected by the presence of tannins. Condensed tannins of
Acacia angustissima
altered fecal bacterial populations in the rat gastrointestinal tract, resulting in a shift in the predominant bacteria towards tannin-resistant gram-negative
Enterobacteriaceae
and
Bacteroides
species.
Evaluation of Structural Changes Induced by High Hydrostatic Pressure in
Leuconostoc mesenteroides
Authors: Kaletunç Gönül , Lee Jaesung , Alpas Hami , Bozoglu Faruk
Published: February 2004

Scanning electron microcopy (SEM), transmission electron microscopy (TEM), and differential scanning calorimetry (DSC) were used to evaluate structural changes in
Leuconostoc mesenteroides
cells as a function of high-hydrostatic-pressure treatment. This bacterium usually grows in chains of cells, which were increasingly dechained at elevated pressures. High-pressure treatments at 250 and 500 MPa also caused changes in the external surface and internal structure of cells. Dechaining and blister formation on the surface of cells increased with pressure, as observed in SEM micrographs. TEM studies showed that cytoplasmic components of the cells were affected by high-pressure treatment. DSC studies of whole cells showed increasing denaturation of ribosomes with pressure, in keeping with dense compacted regions in the cytoplasm of pressure-treated cells observed in TEM micrographs. Apparent reduction of intact ribosomes observed in DSC thermograms was related to the reduction in number of viable cells. The results indicate that inactivation of
L. mesenteroides
cells is mainly due to ribosomal denaturation observed as a reduction of the corresponding peak in DSC thermograms and condensed interior regions of cytoplasm in TEM micrographs.
Distribution and Phylogenetic Analysis of Family 19 Chitinases inActinobacteria
Authors: Kawase Tomokazu , Saito Akihiro , Sato Toshiya , Kanai Ryo , Fujii Takeshi , Nikaidou Naoki , Miyashita Kiyotaka , Watanabe Takeshi
Published: February 2004

In organisms other than higher plants, family 19 chitinase was first discovered inStreptomyces griseusHUT6037, and later, the general occurrence of this enzyme inStreptomycesspecies was demonstrated. In the present study, the distribution of family 19 chitinases in the classActinobacteriaand the phylogenetic relationship ofActinobacteriafamily 19 chitinases with family 19 chitinases of other organisms were investigated. Forty-nine strains were chosen to cover almost all the suborders of the classActinobacteria, and chitinase production was examined. Of the 49 strains, 22 formed cleared zones on agar plates containing colloidal chitin and thus appeared to produce chitinases. These 22 chitinase-positive strains were subjected to Southern hybridization analysis by using a labeled DNA fragment corresponding to the catalytic domain of ChiC, and the presence of genes similar tochiCofS. griseusHUT6037 in at least 13 strains was suggested by the results. PCR amplification and sequencing of the DNA fragments corresponding to the major part of the catalytic domains of the family 19 chitinase genes confirmed the presence of family 19 chitinase genes in these 13 strains. The strains possessing family 19 chitinase genes belong to 6 of the 10 suborders in the orderActinomycetales, which account for the greatest part of theActinobacteria. Phylogenetic analysis suggested that there is a close evolutionary relationship between family 19 chitinases found inActinobacteriaand plant class IV chitinases. The general occurrence of family 19 chitinase genes inStreptomycineaeand the high sequence similarity among the genes found inActinobacteriasuggest that the family 19 chitinase gene was first acquired by an ancestor of theStreptomycineaeand spread among theActinobacteriathrough horizontal gene transfer.
Disinfection of Contaminated Water by Using Solar Irradiation
Authors: Caslake Laurie F. , Connolly Daniel J. , Menon Vilas , Duncanson Catriona M. , Rojas Ricardo , Tavakoli Javad
Published: February 2004

Contaminated water causes an estimated 6 to 60 billion cases of gastrointestinal illness annually. The majority of these cases occur in rural areas of developing nations where the water supply remains polluted and adequate sanitation is unavailable. A portable, low-cost, and low-maintenance solar unit to disinfect unpotable water has been designed and tested. The solar disinfection unit was tested with both river water and partially processed water from two wastewater treatment plants. In less than 30 min in midday sunlight, the unit eradicated more than 4 log
10
U (99.99%) of bacteria contained in highly contaminated water samples. The solar disinfection unit has been field tested by Centro Panamericano de Ingenieria Sanitaria y Ciencias del Ambiente in Lima, Peru. At moderate light intensity, the solar disinfection unit was capable of reducing the bacterial load in a controlled contaminated water sample by 4 log
10
U and disinfected approximately 1 liter of water in 30 min.
Comparison of Survival of
Campylobacter jejuni
in the Phyllosphere with That in the Rhizosphere of Spinach and Radish Plants
Authors: Brandl Maria T. , Haxo Aileen F. , Bates Anna H. , Mandrell Robert E.
Published: February 2004

Campylobacter jejuni
has been isolated previously from market produce and has caused gastroenteritis outbreaks linked to produce. We have tested the ability of this human pathogen to utilize organic compounds that are present in leaf and root exudates and to survive in the plant environment under various conditions. Carbon utilization profiles revealed that
C. jejuni
can utilize many organic acids and amino acids available on leaves and roots. Despite the presence of suitable substrates in the phyllosphere and the rhizosphere,
C. jejuni
was unable to grow on lettuce and spinach leaves and on spinach and radish roots of plants incubated at 33°C, a temperature that is conducive to its growth in vitro. However,
C. jejuni
was cultured from radish roots and from the spinach rhizosphere for at least 23 and 28 days, respectively, at 10°C. This enteric pathogen also persisted in the rhizosphere of spinach for prolonged periods of time at 16°C, a temperature at which many cool-season crops are grown. The decline rate constants of
C. jejuni
populations in the spinach and radish rhizosphere were 10- and 6-fold lower, respectively, than on healthy spinach leaves at 10°C. The enhanced survival of
C. jejuni
in soil and in the rhizosphere may be a significant factor in its contamination cycle in the environment and may be associated with the sporadic
C. jejuni
incidence and campylobacteriosis outbreaks linked to produce.
Biodegradation of Benzene by Halophilic and Halotolerant Bacteria under Aerobic Conditions
Authors: Nicholson Carla A. , Fathepure Babu Z.
Published: February 2004

A highly enriched halophilic culture was established with benzene as the sole carbon source by using a brine soil obtained from an oil production facility in Oklahoma. The enrichment completely degraded benzene, toluene, ethylbenzene, and xylenes within 1 to 2 weeks. Also, [
14
C]benzene was converted to
14
CO
2
, suggesting the culture's ability to mineralize benzene. Community structure analysis revealed that
Marinobacter
spp. were the dominant members of the enrichment.
Improved Laboratory Enrichment for Enterohemorrhagic
Escherichia coli
by Exposure to Extremely Acidic Conditions
Authors: Grant Michael A.
Published: February 2004

Analysis of food samples for
E. coli
O157:H7 using the standard U.S. Food and Drug Administration procedure is frequently complicated by overgrowth of nontarget microorganisms. A new procedure was developed for enrichment of enterohemorrhagic
E. coli
(EHEC) which utilizes exposure to pH 2.00 for 2 h. This procedure yielded larger populations of EHEC than the standard method by factors ranging from 2.7 to 7.7 and, when age-stressed cultures were used, by factors ranging from 2.7 to 11.5. Cultures of competing enterics were more effectively inhibited by the new enrichment protocol as well.
Effect of Overexpression of
Actinobacillus succinogenes
Phosphoenolpyruvate Carboxykinase on Succinate Production in
Escherichia coli
Authors: Kim Pil , Laivenieks Maris , Vieille Claire , Zeikus J. Gregory
Published: February 2004

Succinate fermentation was investigated in
Escherichia coli
strains overexpressing
Actinobacillus succinogenes
phosphoenolpyruvate carboxykinase (PEPCK). In
E. coli
K-12, PEPCK overexpression had no effect on succinate fermentation. In contrast, in the phosphoenolpyruvate carboxylase mutant
E. coli
strain K-12
ppc
::
kan
, PEPCK overexpression increased succinate production 6.5-fold.
NorM, an
Erwinia amylovora
Multidrug Efflux Pump Involved in In Vitro Competition with Other Epiphytic Bacteria
Authors: Burse Antje , Weingart Helge , Ullrich Matthias S.
Published: February 2004

Blossoms are important sites of infection for
Erwinia amylovora
, the causal agent of fire blight of rosaceous plants. Before entering the tissue, the pathogen colonizes the stigmatic surface and has to compete for space and nutrient resources within the epiphytic community. Several epiphytes are capable of synthesizing antibiotics with which they antagonize phytopathogenic bacteria. Here, we report that a multidrug efflux transporter, designated NorM, of
E. amylovora
confers tolerance to the toxin(s) produced by epiphytic bacteria cocolonizing plant blossoms. According to sequence comparisons, the single-component efflux pump NorM is a member of the multidrug and toxic compound extrusion protein family. The corresponding gene is widely distributed among
E. amylovora
strains and related plant-associated bacteria. NorM mediated resistance to the hydrophobic cationic compounds norfloxacin, ethidium bromide, and berberine. A
norM
mutant was constructed and exhibited full virulence on apple rootstock MM 106. However, it was susceptible to antibiotics produced by epiphytes isolated from apple and quince blossoms. The epiphytes were identified as
Pantoea agglomerans
by 16S rRNA analysis and were isolated from one-third of all trees examined. The promoter activity of
norM
was twofold greater at 18°C than at 28°C. The lower temperature seems to be beneficial for host infection because of the availability of moisture necessary for movement of the pathogen to the infection sites. Thus,
E. amylovora
might employ NorM for successful competition with other epiphytic microbes to reach high population densities, particularly at a lower temperature.