bluuebunny/crossref_metadata_2025 huggingface dataset:
Telephone Prescreening Enhancing a Model for Proactive Healthcare Practice
Authors: Korcz Irene R. , Moreland Sharron
Published: March 2003

PURPOSE: This article explicates the process of developing and implementing a contemporary, innovative program using the telephone as a tool for prescreening newly diagnosed cancer patients before their arrival at the cancer center. As another element of existing models of psychosocial care, this service lays the foundation for the efficient delivery of clinical social work services.

DESCRIPTION OF PROGRAM: In the Surgical Oncology Clinic of the M.D. Anderson Cancer Center in Houston, Tex, 28 patients were contacted as part of a telephone prescreening model of a practice program from February 1, 1995 through March 31, 1995. Using a structured telephone interview format, two clinic social workers contacted patients and provided information on social work services. Patients needing resource assistance were provided with community referrals. Using the information from the telephone call, a brief outpatient assessment was completed for each patient before his or her arrival at the clinic. During the initial clinic visit, each new patient was met by the social worker to conduct a qualitative interview and address specific treatment‐related concerns.

OUTCOME OF PROGRAM: The patients expressed their appreciation of the interest of the social work staff and their satisfaction with the information provided. In addition, obtaining patient information and identifying patient needs before the initial visit allowed social workers to use clinic time more efficiently. Because of restructuring, the Surgical Oncology Clinic was eliminated and use of the intervention suspended. Based on the encouraging results of the telephone prescreening model of care program, reinstating the program in the future would include expanding its hours of operation to reach individuals who are not at home during the hours of 8:00
am 25:00
pm and including language assistance to address the needs of the increasingly multicultural population.

CLINICAL IMPLICATIONS: Telephone prescreening is one strategy for personalizing psychosocial assessment. In this era of outpatient day surgery and cost‐controlled managed healthcare, the benefits of prescreening are empowerment for both patients and multidisciplinary team members. The future holds promise for telephone prescreening to become part of the collaborative clinical pathways model of the disease‐site centers concept.
Missed Cancer Screening Opportunities Among Older Women
Authors: Gulitz Elizabeth , Hernandez Marta Bustillo , Kent Ellen B.
Published: March 2003

PURPOSE
: The authors present an analysis of the literature and findings from a qualitative research study as a framework for discussion of potential strategies to increase utilization of breast and cervical cancer screening among older women. The qualitative findings are one component of a comprehensive two‐part study investigating why providers miss the opportunity to screen older women for cancer.

OVERVIEW
: Qualitative analysis of in‐depth interviews with experts in cancer control (academicians, clinicians, and cancer center administrators) and a survey of primary care providers revealed four emergent themes of patient, provider, office, and access barriers that contribute to underutilization of screening. Patient and provider barriers represent human factors or reasons why both groups may be reluctant to participate in screening. Office and access barriers exemplify systems factors that impede the screening process for both groups. Primary care providers may miss the opportunity to perform or recommend screening for underserved groups of older women because of their perceptions of these human and systems factors.

CLINICAL IMPLICATIONS
: In light of the critical importance of primary care providers' recommendations, health professionals and community leaders should collaborate in developing multifaceted programs to help providers feel more comfortable about promoting screening to their patients. Such comprehensive, coordinated initiatives, which adapt successfully proven strategies to community needs and resources, may be essential to increase utilization of screening among underserved groups of older American women.
Recruitment of African Americans into prostate cancer screening.
Authors: Weinrich SP , Boyd MD , Bradford D , Mossa MS , Weinrich M
Published: March 2003

PURPOSE: Both incidence and mortality rates for prostate cancer are significantly higher in African American men than in white men. This report identifies community sites for the optimal recruitment of African American men into prostate cancer screening. DESCRIPTION OF STUDY: A descriptive study was conducted, providing an educational program to 1369 African American men, 1264 of whom completed a survey on demographic data, prostate cancer knowledge, and prostate cancer screening history. The programs were offered at six different types of community sites, including various work sites, churches, housing projects, National Association for Advancement of Colored Persons (NAACP) sites, barber shops, and a state fairground. Free prostate cancer screening was offered to all participants. RESULTS: The advertised mass screening site (state fairground), the most common method used nationally to recruit African American men for cancer screening, was the least effective site, with only 16 men completing the survey. Of the 1264 men completing the survey at all community sites, 597 men (47%) did so at work sites and 438 (35%) did so at churches. Per site, the largest percentage of men who had never been screened was at work sites (n = 276, 46%) and NAACP sites (n = 22, 33.8%). The highest percentage of men who obtained free screening were at the state fairground (14 of 16), churches (256 of 438), and work sites (336 of 597). The most prostate cancers were detected at the housing projects, where 3 of 38 (7.9%) men who were screened received diagnoses of prostate cancer. CLINICAL IMPLICATIONS: To reduce prostate mortality rates in African American men, healthcare providers need to make a concerted effort to increase prostate cancer education and screening in this population. To be effective, recruitment of African American men must move from a provider/health site orientation to a consumer/community orientation. These findings indicate that recruitment strategies are more successful if efforts are based in the community or where a large number of African American men live and/or work. Because a history of screening has been shown to be a predictor for current participation, programs need to target men who have not had previous screening ever or within the last year. In addition, the large percentage of men recruited at work sites who had not been screened previously indicates an opportunity for collaboration with healthcare professionals in employee health programs. Efforts to increase participation in prostate cancer screening will be enhanced significantly by eliciting the active involvement of community leaders.
Self‐Help Intervention Project. Women receiving breast cancer treatment.
Authors: Braden CJ , Mishel MH , Longman AJ
Published: March 2003

PURPOSE: The purpose of this study was to determine the efficacy of self‐care/self‐help promotion and uncertainty management interventions offered by the Self‐Help Intervention Project (SHIP) for women receiving chemotherapy, radiation therapy, or hormone therapy for breast cancer. DESCRIPTION OF STUDY: One hundred ninety‐three women were randomly assigned either to one of three intervention groups (self‐ help course, uncertainty management, or self‐help course plus uncertainty management) or to a control group. Data were analyzed by a repeated measures multivariate analysis of variance procedure using a two‐level blocking factor (high and low resourcefulness) and four outcome variables (self‐care, self‐help, psychological adjustment, and confidence in cancer knowledge). Data were collected at baseline (T1), which was after initiation of adjuvant therapy, allowing for the emergence of treatment‐related side effects; 6 to 8 weeks after T1 (T2); and 3 months after T2 (T3). RESULTS: At baseline, women having high resourcefulness compared with women having low resourcefulness evidenced greater self‐care, self‐help, psychological adjustment, and confidence in cancer knowledge. Participation in SHIP interventions resulted in higher levels of self‐care, self‐help, psychological adjustment, and confidence in cancer knowledge by time effect in a significant number of women regardless of their baseline resourcefulness. Women participating in SHIP interventions who had low baseline resourcefulness demonstrated the greatest change over time in the outcome variables. Post hoc results indicated that the effect primarily was the result of changes in psychological adjustment, confidence in cancer knowledge, and self‐care. CLINICAL IMPLICATIONS: The findings of this study address both the treatment effect for supportive care interventions and the needs that have emerged from review of the last 20 years of supportive care research. Some SHIP interventions evidenced more strength than others; data indicated that large percentages of women with low resourcefulness who received no SHIP interventions experienced a decrement in self‐care, self‐help, confidence in cancer knowledge, and psychological adjustment over the time that they received adjuvant therapy. Women's level of confidence in their knowledge about cancer being sufficient for self‐management and self‐help activities was not linked to baseline resourcefulness level. Thus, inherent resourcefulness was not a factor in need for supportive services that could maintain or increase confidence in cancer knowledge usefulness for self‐management and self‐help. Healthcare providers should note that although the women with low resourcefulness benefited the most from the interventions, women who evidenced high resourcefulness at baseline reported the same level of need for confidence in cancer knowledge and for self‐help.
Reintegration After Bone Marrow Transplantation
Authors: Baker Frank , Zabora James , Polland Adrienne , Wingard John
Published: March 2003

objectives: This study examines the problems of bone marrow transplantation (BMT) survivors in returning to “normal” life in the community after BMT.

materials and methods: Before being released from The Johns Hopkins Oncology Center, 84 recipients of BMT were interviewed regarding their quality of life and psychosocial adaptation. Survivors were reinterviewed at 6 months, and at 1 year post‐BMT, producing considerable qualitative data regarding their problems in living. Eighty‐four patients who had received BMT completed qualitative interviews and standardized measures before treatment, before the return home, and at 6 and 12 months post‐BMT. The interviews were subjected to a content analysis methodology to establish units and categories to examine the body of material.

results: Content analysis of these interviews from the first year after BMT identified three areas of psychosocial morbidity: 1) physical problems, which included fatigue, appearance, troubles in eating, and physical restrictions; 2) psychological problems, which included fears about the future, sense of loss of control, anxiety, and depression; and 3) community reintegration problems, which included difficulty in returning to former social roles, separation from home, family, and friends, difficulty in resuming social relations, dealing with stigmatization, problems with family and children, and financial and employment difficulties.

conclusions: Identification of these problems for BMT survivors can be used to guide the development of specific materials and services to prepare recipients of BMTs and their families for life after the transplant. These qualitative results can also be used to direct the development of assessment tools to identify potential patient and family problems.
A Qualitative Study of Patient Perspectives on Colorectal Cancer
Authors: Sahay Tina B. , Gray Ross E. , Fitch Margaret
Published: March 2003

Objectives: The purpose of this study was to use qualitative methods to contribute to a complete patient perspective on the psychosocial impact of colorectal cancer.

Materials and methods: A qualitative descriptive study was conducted in 20 patients attending a gastrointestinal follow‐up clinic at the Toronto‐Sunnybrook Regional Cancer Centre. The data documented included patient satisfaction and perceptions regarding to quality of care, information received, involvement in decision making, and long‐term management of the illness.

Results: Overall, patients were satisfied with their treatment, including the quality and timeliness of the information they received, the quality of their healthcare, and the level of involvement in decision making. However, some patients were dissatisfied with information concerning long‐term management of their illness. Patient care, including information and social support, was provided by cancer specialists, family physicians, family, and friends. Patients looked to cancer specialists as their primary source of information, but relied on family physicians to fill in gaps in understanding, to provide support, to manage overall care, and to act as a sounding board for ideas and treatment options. Social support was also provided by family and friends. All patients had a relatively positive outlook on their illness experience, although those with colostomies had some added difficulty. Despite the focus on positive change, many patients acknowledged difficulty coping with the side effects of treatment.

Conclusions: These data indicate that patient information needs to be provided in the most common terms and the most straightforward language. Information also may need to be repeated and should include attention to long‐term management of the illness. Health professionals should assume that patients may have difficulty in illness management and should encourage a discussion of patients' concerns.
Attitudes Toward Genetic Testing in Patients with Colorectal Cancer
Authors: Kinney Anita Yeomans , Choi Yeon‐Ah , DeVellis Brenda , Millikan Robert , Kobetz Erin , Sandler Robert S.
Published: March 2003

Purpose: The purpose of this study was to examine risk perceptions and interest in genetic testing among African American and White patients with colorectal cancer.

Description of study: In this cross‐sectional study, 98 patients with colorectal cancer participated in a brief structured telephone interview. Information was collected on knowledge and risk perceptions regarding colorectal cancer genetics, health behaviors, knowledge about the availability of genetic testing, and interest in genetic testing for colorectal cancer susceptibility.

Results: Sixty‐one percent of the participants were worried about their relatives' risk of colorectal cancer, and 64% were concerned about being a colorectal cancer susceptibility gene carrier. Although 81% of the participants reported that they had never heard about a genetic test for colorectal cancer susceptibility, 72% stated that they would want to take the test if it were available. Predictors of intention to have a genetic test were younger age, less advanced stage of disease, and more frequent thoughts about colorectal cancer being hereditary.

Clinical implications: These results suggest that the demand for genetic testing may be great, despite a general lack of knowledge about colorectal cancer genetics and the potential risks and limitations of testing. Education and counseling about cancer genetics and genetic testing may clarify misconceptions about hereditary colorectal cancer and help patients with colorectal cancer and their family members make informed decisions about whether to undergo testing.
Developing a Community Program on Cancer Pain and Fatigue
Authors: Grant Marcia , Golant Mitch , Rivera Lynne , Dean Grace , Benjamin Harold
Published: March 2003

Purpose: The overall purpose of this project was to establish a community‐based educational model on pain and fatigue management for individuals with cancer. The specific aims were: 1) to develop an appropriate educational program; 2) to pilot test this program in a community setting that supported a self‐care approach; and 3) to evaluate the program process and outcomes.

Description of program: The I Feel Better program was implemented through a two‐session educational workshop taught by masters‐prepared oncology nurses and was held at four Southern California sites of The Wellness Community. The focus of the sessions was to provide participants with general information about each symptom, assessment and management of those symptoms, and strategies for effectively communicating with their healthcare providers. Sessions of 2.5‐hour duration were held on Saturday mornings and required preregistration.

Results: The participants were primarily female and White, with an average age of 58 years. Participants reported considerable pain and fatigue. They also lacked accurate information about pain management. Program evaluation revealed that the content and format were well received by the participants. They rated the program as extremely useful and reported positive outcomes after the first session.

Clinical implications: This pilot educational intervention program has strong implications for multidisciplinary educational approaches for patients with cancer. Limitations resulted from the setting selected and the possibility that participants were already active in their fight against cancer. Generalization to other community settings may not be as successful. Programs could be cosponsored by several collaborating institutions to share resources. Referral to community programs by physicians, nurses, and social workers can occur as needed when identified during patient interventions. The voluntary participation of health professionals in community education programs could provide a valuable service for patients and a rewarding experience for educators.
Breast and Cervical Cancer Screening among Chinese American Women
Authors: Yu Elena S. H. , Kim Katherine K. , Chen Edwin H. , Brintnall Ruth Ann
Published: March 2003

Purpose: The purpose of this study was to describe breast and cervical cancer screening knowledge and practices of a representative sample of Chinese American women and to examine the factors associated with screening practices.

Description of study: A random sample of 332 Chinese American women, 40 to 69 years of age, from the Chinatown area of Chicago, Illinois, were interviewed face to face, using both Chinese Mandarin (or Putunghua) and Cantonese versions of the National Health Interview Survey (NHIS) Cancer Control Supplement Questionnaire. Knowledge and use of mammogram, clinical breast examination (CBE), breast self‐examination (BSE), and Pap smear test were assessed.

Results: The results showed a low level of knowledge of cancer screening tests and low use rates. Multiple logistics regression analysis showed that women with spoken English fluency were more likely to have knowledge and use of CBE, BSE, Pap test, and mammograms. Women with better than an elementary education were more likely to have knowledge and use of CBE, BSE, and Pap test. The source of medical care was statistically significant for having had a mammogram. Knowledge of cancer warning signs and symptoms was significant for knowledge of mammogram and BSE and for the use of BSE.

Clinical implications: Multiple strategies are needed. These might include the following: 1) integration of research with population‐based care by physicians and scientists; 2) coordinated public health education on cancer screening and postscreening support in Chinese languages; and 3) replication of the NHIS survey methodology and adaptive application of these instruments across several states and regions, combined with the assessment of screening performance in Chinese American populations.
A Weekend Camp for Bereaved Siblings
Authors: Creed Joan , Ruffin Julian E. , Ward Marsha
Published: March 2003

Purpose: The purpose of this article is to describe a weekend bereavement camp for children age 6 to 18 years who have lost a brother or sister to cancer. A description of the planning for the camp and the weekend program is included.

Overview: Camp New Horizons is a weekend camp for children age 6 to 18 years who have lost a sibling to cancer. At the camp, the children are divided into age‐appropriate groups and spend time, through various activities, learning about the grief process to reduce their feelings of isolation, to express grief appropriately, and to move forward in the grief process. Similar programs, as well as the uniqueness of this program, are discussed.

Clinical implications: Camp New Horizons has met many of the educational and support needs of bereaved siblings. Networks of support and friendship have formed that allow the children to reach out to one another when needed. Parents and children have increased their communication about the death in their family, thus accepting their feelings and increasing support in the family system. Continued collaboration between centers will create ongoing support for the healthcare professionals and the programs they provide.
Healthcare Professionals' Awareness of Cancer Support Services
Authors: Matthews B. Alex , Baker Frank , Spillers Rachel L.
Published: March 2003

purpose: This study was conducted to provide baseline information about the awareness, attitude, and willingness of oncology healthcare providers (HCPs) to recommend quality‐of‐life cancer education and support services to their patients.

description of study: A brief survey questionnaire was mailed to a random sample of 2000 physicians, nurses, and social workers who were active members of their respective oncology associations.

results: A total of 1241 questionnaires were returned (62% reply rate), resulting in a final sample of 1180 HCPs (61% response rate). Among HCPs who referred patients to cancer organizations, the American Cancer Society (ACS; 83%), the National Cancer Institute (NCI; 55%), and the Leukemia and Lymphoma Society ([formerly Leukemia Society of America] 42%) ranked at the top. More than 70% of HCPs indicated that they had heard about specific ACS programs and services or the NCI information hotline. Less than 60% of HCPs recommended or thought these same services were helpful to patients. Awareness, referrals, and attitudes toward cancer support services among HCPs were significantly related (P < .001). Qualitative comments qualified quantitative results.

clinical implications: Although a surprising number of HCPs were aware of support services, fewer recommended or reported satisfaction with these services. HCPs' referrals and attitudes toward cancer psychosocial support services may be improved by assembling a concise directory of locally available resources, directing this information to HCPs who refer directly to cancer organizations, improving collaboration between agencies, increasing staff support, and targeting particular services in specific areas of the country for program monitoring and development.
Exploring Loss to Follow‐up
Authors: Hunt Linda M. , De Voogd Katherine B. , Soucy Mark D. , Longworth Judith C.
Published: March 2003

purpose: The loss of patients to follow‐up for abnormal findings from Pap screenings is an important public health concern, particularly among poor and minority women. This study explores factors affecting incomplete follow‐up among a group of Hispanic women with low incomes.

description of study: A qualitative descriptive study was conducted of 11 Hispanic patients with incomplete Pap smear follow‐up at a public clinic in a major city in south Texas. Patients were interviewed using a semistructured, open‐ended schedule of questions, and their medical records were abstracted. The clinic's five staff members also were interviewed. Comparative chronologies were constructed for each case, contrasting patient and staff accounts of the same set of events. All data were coded by at least two investigators.

results: All study patients had mildly abnormal Pap smear results and had not met the follow‐up criteria, but all understood and were committed to Pap screening. Although viewed by staff as noncompliant, none of the patients viewed her behavior this way. This staff‐patient discrepancy was attributable to poor communication, mixed messages, clinic errors, and, perhaps most importantly, to a conflict between program policies and the specific circumstances of individual cases. Two case examples are presented to illustrate key points.

clinical implications: Strategies that may help to reduce loss to follow‐up among similar patients include the following: allowing clinic staff more flexibility in follow‐up procedures for women who have consistently normal follow‐up tests, including Spanish translations of written messages; enlisting patients' agreement in setting appointments; and updating patient records to reflect follow‐up care that had been received in other clinics.
Amphioxus goosecoid and the evolution of the head organizer and prechordal plate
Authors: Neidert Adam H. , Panopoulou Georgia , Langeland James A.
Published: March 2003

SUMMARY The organizer is a central feature of vertebrate embryogenesis and is functionally subdivided into the head organizer that gives rise primarily to the prechordal plate and induces forebrain structures, and the trunk/tail organizer that gives rise primarily to the notochord and induces more posterior structures. Goosecoid (gsc) encodes a homeodomain‐containing transcription factor that is expressed in the vertebrate head organizer and prechordal plate, and can induce a secondary axis when expressed ectopically. To investigate the evolution of the vertebrate head organizer and prechordal plate, we have cloned and characterized a gsc homolog from the cephalochordate amphioxus. Amphioxus, it is important to note, lacks a prechordal plate in that the notochord extends to the extreme anterior end of the animal, and lacks elaborate differentiation of its forebrain. Gsc expression in amphioxus is initially localized during gastrulation to the mesendodermal layer of the dorsal lip of the blastopore. However, gsc expression in amphioxus is not maintained in anterior axial mesoderm, as is the case with the vertebrate prechordal plate. Rather, gsc is expressed in the dorsal axial mesoderm of the blastopore lip throughout gastrulation, appearing transiently in the presumptive notochord that underlies all regions of the amphioxus brain. The similarities in gsc expression in amphioxus and vertebrates suggest that a primitive version of the head organizer evolved prior to the origin of the vertebrates. The differences in gsc expression can be interpreted either as the loss of the prechordal plate domain in the cephalochordate lineage, or the gain of a distinct gsc‐expressing prechordal plate that plays a role in forebrain induction in the vertebrate lineage.
Evolution and development of gastropod larval shell morphology: experimental evidence for mechanical defense and repair
Authors: Hickman Carole S.
Published: March 2003

SUMMARY The structural diversity of gastropod veliger larvae offers an instructive counterpoint to the view of larval forms as conservative archetypes. Larval structure, function, and development are fine‐tuned for survival in the plankton. Accordingly, the study of larval adaptation provides an important perspective for evolutionary‐developmental biology as an integrated science. Patterns of breakage and repair in the field, as well as patterns of breakage in arranged encounters with zooplankton under laboratory conditions, are two powerful sources of data on the adaptive significance of morphological and microsculptural features of the gastropod larval shell. Shells of the planktonic veliger larvae of the caenogastropod Nassarius paupertus[Gould] preserve multiple repaired breaks, attributed to unsuccessful zooplankton predators. In culture, larvae isolated from concentrated zooplankton samples rapidly repaired broken apertural margins and restored the “ideal” apertural form, in which an elaborate projection or “beak” covers the head of the swimming veliger. When individuals with repaired apertures were reintroduced to a concentrated mixture of potential zooplankton predators, the repaired margins were rapidly chipped and broken back. The projecting beak of the larval shell is the first line of mechanical defense, covering the larval head and mouth and potentially the most vulnerable part of the shell to breakage. Patterns of mechanical failure show that spiral ridges do reinforce the beak and retard breakage. The capacity for rapid shell repair and regeneration, and the evolution of features that resist or retard mechanical damage, may play a more prominent role than previously thought in enhancing the ability of larvae to survive in the plankton.
Development and evolution of the mammalian limb: adaptive diversification of nails, hooves, and claws
Authors: Hamrick Mark W.
Published: March 2003

SUMMARY Paleontological evidence indicates that the evolutionary diversification of mammals early in the Cenozoic era was characterized by an adaptive radiation of distal limb structures. Likewise, neontological data show that morphological variation in distal limb integumentary appendages (e.g., nails, hooves, and claws) can be observed not only among distantly related mammalian taxa but also among closely related species within the same clade. Comparative analysis of nail, claw, and hoof morphogenesis reveals relatively subtle differences in mesenchymal and epithelial patterning underlying these adult differences in distal limb appendage morphology. Furthermore, studies of regulatory gene expression during vertebrate claw development demonstrate that many of the signaling molecules involved in patterning ectodermal derivatives such as teeth, hair, and feathers are also involved in organizing mammalian distal limb appendages. For example, Bmp4 signaling plays an important role during the recruitment of mesenchymal cells into the condensations forming the terminal phalanges, whereas Msx2 affects the length of nails and claws by suppressing proliferation of germinal epidermal cells. Evolutionary changes in the form of distal integumentary appendages may therefore result from changes in gene expression during formation of mesenchymal condensations (Bmp4, posterior Hox genes), induction of the claw fold and germinal matrix (shh), and/or proliferation of epidermal cells in the claw matrix (Msx1, Msx2). The prevalence of convergences and parallelisms in nail and claw structure among mammals underscores the existence of multiple morphogenetic pathways for evolutionary change in distal limb appendages.
Embryonic development of mouse external genitalia: insights into a unique mode of organogenesis
Authors: Suzuki Kentaro , Ogino Yukiko , Murakami Ryutaro , Satoh Yoshihiko , Bachiller Daniel , Yamada Gen
Published: March 2003

SUMMARY The mammalian external genitalia are specialized appendages for efficient copulation, internal fertilization and display marked morphological variation among species. In this paper, we described the embryonic development of mouse genital tubercle (GT), an anlage of the external genitalia utilizing the scanning electron microscope (SEM) analysis. It has been shown that the Distal Urethral Epithelium (DUE) may fulfill an essential role in the outgrowth control of the GT. Our present SEM analysis revealed a small distal protrusion at the tip of the GT of normal embryos as well as some morphological differences between male and female embryonic external genitalia. Previous analysis shows that the teratogenic dose of Retinoic Acid (RA) induces a drastic marformation of the urethral plate, but not gross abnormalities for GT outgrowth. Interestingly, a small distal protrusion at the tip of GT was clearly observed also after RA treatement. Furthermore, we showed that treatment with anti‐androgen flutamide resulted in the demasculinization of the GT in males. The unique character of GT development and the sexual dimorphism are discussed.

Keyword: external genitalia; genital tubercle; urethral plate; outgrowth; morphogenesis; Fgf; retinoic acid; androgen
Starting from fins: parallelism in the evolution of limbs and genitalia: the fin‐to‐genitalia transition
Authors: Rosa‐Molinar Eduardo , Burke Anne Campbell
Published: March 2003

SUMMARY Organizers of the symposium Starting from Fins: Parallelism in the Evolution of Limbs and Genitalia intended it 1) to begin debates and discussions about parallelism, serial homology and transitions in development, as well as evolution of gene function and theories of origins and 2) to examine closely the potential significance of serial homology in understanding the evolution of morphology. This issue of Evolution and Development focuses on unpaired fin to genitalia transitions; the July‐August issue will focus on paired fins to limbs, revisit the issues raised in the symposium, and point to future directions.

Minelli's opening presentation introduced the central theme of the symposium by suggesting that body appendages such as arthropod and vertebrate limbs, chordate tails and external genitalia are evolutionarily divergent duplicates (paramorphs) of the main body axis. Suzuki's and Podlasek's presentations focused on the development of mammalian genitalia. Suzuki presented Suzuki et al investigations of the role of fibroblast growth factor (Fgf) and Sonic hedgehog (Shh) as signaling molecules during murine external genitalia formation, and Podlasek presented Podlasek et al investigations to elucidate a rudimentary pathway of essential developmental genes and transcriptional regulators such as Hox genes, Sonic hedgehog (Shh), and Bone morphogenetic proteins 2 and 4 (BMP‐2; BMP‐4), found in the limb.

Discussions and questions emerging from the symposium point to the need to recognize that claims of phylogenetic cause must be based on something more than similarities; research must focus on the extent to which comparisons can be taken as well as on the evolutionary significance of similarities.
Virtual Percutaneous Transluminal Coronary Angioplasty System for an Educational Support System
Authors: Yambe Tomoyuki , Yoshizawa Makoto , Tabayashi Kou‐ichi , Takeda Hiroshi , Nitta Shin‐ichi
Published: March 2003

With the increase of ischemic diseases of the circulatory system in Japan, the necessity for cardiovascular intervention continues to increase. However, because intervention operations have been developed only recently, the education system for the corresponding specialists in our country has not been established yet. In this study, an intervention educational support system using a virtual reality (VR) technique was developed. Of course, intervention includes percutaneous transluminal coronary angioplasty (PTCA). PTCA is an operation enlarging the stenosis of the coronary artery with a balloon through a guide catheter. The technique that lets the guide wire for the PTCA balloon cross the stenosis is one of the most difficult. A simulation system for the manipulation of a torque device for the PTCA guide wire was developed with this technology for VR. In virtual space, reconstitution of the 3‐dimensional coronary artery with atherosclerosis was performed, and the virtual PTCA system was produced experimentally. An interesting system was produced experimentally as a system for the training of doctors studying to become interventional specialists. After the system was combined with an Expert system for treating ischemic heart diseases, its usefulness was steadily increased. With the development of more sophisticated VR methodology in the future, a PTCA training system without using a patient will be embodied.
The Controlled Release of Antibiotic by Hydroxyapatite: Anionic Collagen Composites
Authors: Martins Virginia Conceic¸ão Amaro , Goissis Gilberto , Ribeiro Antonio Carlos , Marcantônio Jr Elcio , Bet Marcos Roberto
Published: March 2003

Major problems with the treatment of osteomyelitis are associated with poor antibiotic distribution at the site of infection due to limited blood circulation to the skeletal tissue. Improved treatment procedures have been used in drug delivery systems that include bioceramics and natural and synthetic polymers. This work reports the development of anionic collagen:hydroxyapatite composite paste for sustained antibiotic release. Antibiotic release by the composite was characterized by two steps. In the first, 15.0 ± 4.9% was released in the first 5 h (n = 53) by a normal Fick diffusion mechanism. In the second step, only 16.8 ± 2.2% was released after 7 days. In conclusion, hydroxyapatite:anionic collagen composite can be an efficient support for sustained antibiotic release in the treatment of osteomyelitis because most of the antibiotic release may be associated with composite bioresorption, thus permitting antibiotic release throughout the healing process. Hydroxyapatite:anionic collagen paste showed good biocompatibility associated with bone tissue growth with material still being observed after 60 days from the time of implants.
The Chemical Protecting Group Concept Applied in Crosslinking of Natural Tissues with Glutaraldehyde Acetals
Authors: Goissis Gilberto , Yoshioka Sergio Akinobu , Braile Domingo Marcolino , Ramirez Vladimir Donizeti Aparecido
Published: March 2003

This work describes the results of the controlled crosslinking of collagen matrices by glutaraldehyde based on a double protection strategy, glutaraldehyde acetals and lysine protonation due to the acidic conditions of acetal formation. Materials crosslinked by this approach were characterized by thermal stability comparable to those obtained by conventional procedures with mechanical properties expected for bioprosthesis manufacture and with a higher stability toward collagenase hydrolysis. The integrity of the microfibrillar structure was confirmed by optical and scanning electronic microscopy. The results indicate that the glutaraldehyde acetals procedure may be of potential use for the crosslinking of bovine pericardium used in the manufacture of bioprosthetic devices. Advantages may be related to the production of materials with homogeneous crosslinking distributions, associated with better definition in the nature of the chemical link that they introduce, due to a better distribution of glutaraldehyde within the tissue matrix before the crosslinking reaction is allowed to occur. As a result, materials with improved biological and mechanical properties are expected.
The Type of Aortic Cannula and Membrane Oxygenator Affect the Pulsatile Waveform Morphology Produced by a Neonate‐Infant Cardiopulmonary Bypass System In Vivo
Authors: Ündar Akif , Lodge Andrew J. , Daggett Casey W. , Runge Thomas M. , Ungerleider Ross M. , Calhoon John H.
Published: March 2003

Although the debate still continues over the effectiveness of pulsatile versus nonpulsatile perfusion, it has been clearly proven that there are several significant physiological benefits of pulsatile perfusion during cardiopulmonary bypass (CPB) compared to nonpulsatile perfusion. However, the components of the extracorporeal circuit have not been fully investigated regarding the quality of the pulsatility. In addition, most of these results have been gathered from adult patients, not from neonates and infants. We have designed and tested a neonate‐infant pulsatile CPB system using 2 different types of 10 Fr aortic cannulas and membrane oxygenators in 3 kg piglets to evaluate the effects of these components on the pulsatile waveform produced by the system. In terms of the methods, Group 1 (Capiox 308 hollow‐fiber membrane oxygenator and DLP aortic cannula with a very short 10 Fr tip [n =2]) was subjected to a 2 h period of normothermic pulsatile CPB with a pump flow rate of 150 ml/kg/min. Data were obtained at 5, 30, 60, 90, and 120 min of CPB. In Group 2 (Capiox 308 hollow‐fiber membrane oxygenator and Elecath aortic cannula with a very long 10 Fr tip [n =7]) and Group 3 (Cobe VPCML Plus flat sheet membrane oxygenator and DLP aortic cannula with a very short 10 Fr tip [n =7]), the subjects' nasopharyngeal temperatures were reduced to 18°C followed by 1 h of deep hypothermic circulatory arrest (DHCA) and then 40 min rewarming. Data were obtained during normothermic CPB in the pre‐ and post‐DHCA periods. The criteria of pulsatility evaluations were based upon pulse pressure (between 30 and 40 mm Hg), aortic dp/dt (greater than 1000 mm Hg/s), and ejection time (less than 250 ms). The results showed that Group 1 produced flow which was significantly more pulsatile than that of the other 2 groups. Although the same oxygenator was used for Group 2, the quality of the pulsatile flow decreased when using a different aortic cannula. Group 3 did not meet any of the criteria for physiologic pulsatility. In conclusion these data suggest that in addition to a pulsatile pump, the aortic cannula and the membrane oxygenator must be chosen carefully to achieve physiologic pulsatile flow during CPB.
A Simple and Early Prognostic Index for Acute Renal Failure Patients Requiring Renal Replacement Therapy
Authors: Yuasa Shigekazu , Takahashi Norihiro , Shoji Tetsuo , Uchida Koichi , Kiyomoto Hideyasu , Hashimoto Mayuko , Fujioka Hiroshi , Fujita Yoko , Hitomi Hirofumi , Matsuo Hirohide
Published: March 2003

Recent advances in technology have not substantially changed the high mortality rate associated with acute renal failure (ARF). To obtain a simple, valid prognostic index, we retrospectively evaluated the relative importance of demographic data, causes (acute insults) of renal failure, and comorbid clinical conditions for the outcome in 102 ARF patients who received renal replacement therapy with an overall mortality rate of 65% (66 of 102). There were no significant differences between survivors and nonsurvivors in age and gender. Mortality according to acute insults was similar to that of the whole population studied. Of the 10 clinical conditions at the time of the first renal replacement therapy, mechanical ventilation (p = 0.0002), cardiac failure (p = 0.0006), hepatic failure (p = 0.003), central nervous system dysfunction (p = 0.005), and oliguria (p = 0.04) were found to be significantly related to mortality by univariate analysis. Furthermore, multivariate analysis demonstrated that only mechanical ventilation, cardiac failure, and hepatic failure were significant risk factors. Survival was directly related to the number of significant variables in univariate analysis: zero, 89% (8 of 9); one, 62% (21 of 34); two, 19% (5 of 27); three, 10% (2 of 20); four, 0% (0 of 8); five, 0% (0 of 4). This simple and early prognostic index, derived from the assessment of clinical conditions which were easily de‐termined at the patient's bedside, could be useful for outcome prediction in ARF patients requiring renal replacement therapy.
Centrifugal Pumps as Left Ventricular Assist for Coronary Revascularization on a Beating Heart
Authors: Waldenberger Ferdinand R. , Haisjackl Markus , Holinski Sebastian , Lengsfeld Michael , Konertz Wolfgang
Published: March 2003

During recent years, coronary bypass surgery has progressed toward minimizing invasiveness. One important feature of this approach is performing surgery on a beating heart. During the crucial phase of such surgery, the mechanical support of the heart with a left ventricular assist device (LVAD) is a possible option. During the period from October 1, 1994 until June 30, 1997, we employed a centrifugal pump system in 118 cases of coronary artery bypass graft (CABG) procedures with LVAD support (mechanically supported CABG [SUPPCAB]). A total of 179 distal anastomoses with an average of 1.5 ± 0.5 coronary anastomoses per patient was performed. Three types of pumps were used: 23 BioPump, 87 Isoflow, and 8 Capiox systems. The median time on mechanical support was 44 min (range, 16–116 min). The mean flow rate during support time was 3.5 ± 0.8 L/min, which results in a calculated flow of 1.7 ± 0.6 L/min/m2 body surface area (BSA). The average flow was 3.2 ± 0.8 L/min with the BioPump and 3.7 ± 0.8 L/min with the Isoflow pump, respectively (p < 0.01). The mean arterial pressure during mechanical support was 75 ± 12 mm Hg. In 2 patients, the pump system was kept running postoperatively in the ICU. Eight of the patients received operations under resuscitation or in cardiogenic shock. Nine (7.9%) of the patients did not survive the early postoperative phase. For coronary revascularization of the anterolateral and diaphragmatic parts of the heart, the SUPPCAB procedure is feasible with excellent mechanical support of the heart by centrifugal pumps. Especially in high risk cases, this procedure can be recommended.
Succinylated Collagen Crosslinked by Thermal Treatment for Coating Vascular Prostheses
Authors: Noishiki Yashuharu , Ma Xiao Hua , Yamane Yoshihisa , Satoh Shinichi , Okoshi Takafumi , Takahashi Kazuhiro , Iwai Yoshihiro , Kosuge Takayuki , Ichikawa Yukio , Yamazaki Ichiya , Mo Makoto
Published: March 2003

Vascular prostheses coated with collagen carefully prepared to avoid contamination were tested to see if it could induce endothelial cell lining throughout the graft surface in a natural way. The collagen fibers were succinylated. Hydrogel produced with the succinylated collagen was used for the sealant to reduce the amount of solid substance. To avoid contamination and the side effects of chemical reagents, the collagen thermally crosslinked under sterile conditions. A suspension of the collagen fibers was enmeshed in the interstices of Dacron fibers of fabric prostheses, which were then thermally crosslinked at 130°C for 20 h. The prostheses were porous when the collagen fiber network was dry. Under wet conditions, however, the water permeability of the grafts was reduced to 0.1 ml/min from the 1,250 ml/min of the original prostheses. Three weeks after implantation in the abdominal aortas of dogs, 81.2 ± 11% of the luminal surface was macroscopically thrombus free, and 56 ± 14% was endothelialized. More than 95% of the coated collagen had been absorbed. Numerous fibroblasts had migrated into the graft walls, and capillary blood vessels had infiltrated the inside of the graft walls without foreign body reaction. In the controls, thrombus free areas averaged 9.0 ± 5%, and endothelialized areas averaged 5.2 ± 4%. Many giant cells, plasma cells, and lymphocytes had migrated into the graft walls, but no fibroblasts. These results suggest that rapid endothelialization is possible when clean collagen is used.
Treatment of End‐Stage Renal Disease in Central and Eastern Europe: Overview of Current Status and Future Needs
Authors: Rutkowski Bolesław , Ciocalteu Aleksandru , Djukanovic Ljubica , Kiss Istvan , Kovac Aleksander , Polenakovic Momir , Puretic Zvonimir , Rozental Rafail , Stanaityte Maria , Tareyeva Irina , Teplan Vladimir , Zavitz Jeff , Stefan Krivoshiev , Rado Kveder
Published: March 2003

The situation of end‐stage renal disease (ESRD) patients in central and eastern Europe was very poor for many years during the so called socialistic era. Economical and political liberation resulted in the significant growth of renal replacement facilities in this region. The number of hemodialysis units increased significantly (56%) during the period 1990–1996, and the number of patients treated with this modality has risen by 75%. More dramatic progress was achieved in peritoneal dialysis. The number of units performing this method of renal replacement therapy (RTT) increased by 277% and the number of patients by more than 300%. Not only quantitative but also qualitative changes were observed. More modern hemodialysis machines installed in the vast majority of units allow for the performance of bicarbonate dialysis, controlled ultrafiltration, and sodium profile modeling. Also, a wider choice of biocompatible dialyzers has become available during the last few years. The number of centers performing renal transplantation has increased significantly, but the number of renal transplants has not followed this progress. Despite all the progress, further development of all RRT methods is necessary to achieve acceptance rates comparable to those observed in developed countries.