bluuebunny/crossref_metadata_2025 huggingface dataset:
C‐isotope composition of CO2 respired by shoots and roots: fractionation during dark respiration?
Authors: KLUMPP K. , SCHÄUFELE R. , LÖTSCHER M. , LATTANZI F. A. , FENEIS W. , SCHNYDER H.
Published: January 2005

The CO2 respired by leaves is 13C‐enriched relative to leaf biomass and putative respiratory substrates (Ghashghaie et al., Phytochemistry Reviews 2, 145–161, 2003), but how this relates to the 13C content of root, or whole plant respiratory CO2 is unknown. The C isotope composition of respiratory CO2 (δR) from shoots and roots of sunflower (Helianthus annuus L.), alfalfa (Medicago sativa L.), and perennial ryegrass (Lolium perenne L.) growing in a range of conditions was analysed. In all instances plants were grown in controlled environments with CO2 of constant concentration and δ13C. Respiration of roots and shoots of individual plants was measured with an open CO2 exchange system interfaced with a mass spectrometer. Respiratory CO2 from shoots was always 13C‐enriched relative to that of roots. Conversely, shoot biomass was always 13C‐depleted relative to root biomass. The δ‐difference between shoot and root respiratory CO2 was variable, and negatively correlated with the δ‐difference between shoot and root biomass (r2 = 0.52, P = 0.023), suggesting isotope effects during biosynthesis. 13C discrimination in respiration (R) of shoots, roots and whole plants (eShoot, eRoot, ePlant) was assessed as e = (δSubstrate − δR)/(1 + δR/1000), where root and shoot substrate is defined as imported C, and plant substrate is total photosynthate. Estimates were obtained from C isotope balances of shoots, roots and whole plants of sunflower and alfalfa using growth and respiration data collected at intervals of 1 to 2 weeks. eplant and eShoot differed significantly from zero. eplant ranged between −0.4 and −0.9‰, whereas eShoot was much greater (−0.6 to −1.9‰). eRoot was not significantly different from zero. The present results help to resolve the apparent conflict between leaf‐ and ecosystem‐level 13C discrimination in respiration.
Exogenously applied sulphate as a tool to investigate transport and reduction of chromate in the duckweed Spirodela polyrhiza
Authors: KASZYCKI P. , GABRYŚ H. , APPENROTH K.‐J. , JAGLARZ A. , SEDZIWY S. , WALCZAK T. , KOLOCZEK H.
Published: January 2005

The accumulation of chromium in Spirodela polyrhiza was investigated in the presence and absence of exogenously applied sulphate. Precultivation (10 d) at minimum sulphate concentration (0.013 m m versus 1 m m in controls) enhanced the rate of chromium accumulation. This effect was caused by the increased number of sulphate transporters which transport chromate into cells. Chromate and sulphate compete for the available sulphate transporters. The kinetics of reduction Cr(VI)→Cr(V) was investigated by l‐band electron paramagnetic resonance (EPR) spectroscopy. The kinetic model developed previously (Appenroth et al., Journal of Inorganic Biochemistry 78, 235–242, 2000) was refined and extended to include chromate transport and reduction in the presence of competing ions. The following conclusions were drawn from the fitting procedure: without simultaneously applied sulphate, the rate constant of Cr(VI) transport from apoplast into plant cells and the rate constant of Cr(VI) to Cr(V) reduction within the apoplast are comparable (7.0 versus 5.7 h−1) demonstrating that these two processes are competing. Moreover, the rate constant of reduction Cr(V)→Cr(III) is much lower within cells than in apoplast (0.39 versus 7.0 h−1) showing that Cr(V) is stabilized in the symplast. The rate of transport of Cr(VI) into plant cells is at least one order of magnitude higher than that of Cr(V) or Cr(III). The treatment with sulphate (10 m m) decreases the rate constant of the transport of Cr(VI) into cells (2.0 h−1) confirming the competition of chromate and sulphate for the same transporters. Simultaneously, the rate constant of Cr(V)→Cr(III) reduction is increased in the apoplast (by the factor of 3) and decreased in the symplast (by the factor of 5). Treatment with higher sulphate concentrations (100 m m) increases the accumulation of chromium by enhancing the rate constant of Cr(VI) transport into cells leaving other processes essentially unchanged. We suggest that 100 m m sulphate opens a new pathway for chromate transport into cells.
Intermittent oral cyclosporin for recurrent herpes simplex‐associated erythema multiforme
Authors: Bakis Sophie , Zagarella Samuel
Published: January 2005

Recurrent erythema multiforme is one of three distinct clinical subtypes of erythema multiforme. We present a 42‐year‐old man with a 10‐year history of recurrent herpes simplex virus‐induced erythema multiforme. Our patient was debilitated by the frequency of his attacks and the associated pain, for which he often required leave from work. The frequency, duration and morbidity of the attacks were poorly controlled using oral prednisone and oral aciclovir. Three episodes of his recurrent herpes simplex virus‐induced erythema multiforme were treated with intermittent oral cyclosporin. Oral cyclosporin rapidly reduced his symptoms and led to rapid resolution of his erythema multiforme, provided the cyclosporin was commenced on day 1 or 2 of the erythema multiforme episode. Consequently, his quality of life has dramatically improved. We recommend the use of intermittent oral cyclosporin for recurrent, debilitating episodes of erythema multiforme.
Pseudoxanthoma‐like late‐onset focal dermal elastosis
Authors: Kossard Steven
Published: January 2005

A 73‐year‐old woman presented with a 10‐year history of asymptomatic coalescent flat pale yellow lesions forming a cobblestone pattern that resembled pseudoxanthoma elasticum over her neck, upper trunk and axillae. Skin biopsies from both the neck and axilla showed focal upper dermal elastosis with increase in structurally normal elastic fibres. There was no evidence of either pseudoxanthoma elasticum or solar elastosis in either biopsy. This under‐recognized presentation has previously been identified as a distinct clinicopathological entity and termed late‐onset focal dermal elastosis.
Cheilitis caused by contact allergy to cocamidopropyl betaine in ‘2‐in‐1 toothpaste and mouthwash’
Authors: Agar Nita , Freeman Susanne
Published: January 2005

A 10‐year‐old girl presented with a 2‐year history of severe cheilitis. Despite cessation of any lip‐licking behaviour her symptoms continued to worsen, with only minimum relief from therapeutic measures. Patch testing proved strongly positive to cocamidopropyl betaine, which was noted to be present in the patient's ‘2‐in‐1 toothpaste and mouthwash’. Her cheilitis settled after avoidance of this product. Cocamidopropyl betaine, a surfactant, is a common allergen in hairdressers; however, this case highlights the importance of excluding a contact allergy to this product in patients with intractable cheilitis.
Lichen striatus in an adult following trauma
Authors: Shepherd Victoria , Lun Karyn , Strutton Geoffrey
Published: January 2005

A 36‐year‐old man presented with a linear erythematous eruption along his right forearm and dystrophy of his right thumbnail. These changes had developed 2 weeks after his right thumb had been pricked by a pineapple leaf and evolved over a 6‐week period. Histopathology revealed features consistent with lichen striatus. He complained of mild intermittent pruritus, which responded to moderate‐potency topical corticosteroids. At 12 months the skin eruption had improved, but the nail changes persisted.
Maffucci's syndrome with extensive gastrointestinal involvement
Authors: Shepherd Victoria , Godbolt Amanda , Casey Terence
Published: January 2005

A 10‐year‐old girl with cutaneous, oral and gastrointestinal vascular lesions was referred for consideration of laser treatment of her skin lesions. She was noted to have multiple venous malformations predominantly affecting the hands and feet, some of which had been present from birth. Her right hand was deformed by multiple venous malformations, and X‐rays of this hand revealed enchondromata within metacarpal and phalangeal bones. She was known to have extensive involvement of her gastrointestinal tract by venous malformations, resulting in refractory iron‐deficiency anaemia. In view of the multiple cutaneous and gastrointestinal vascular lesions, a diagnosis of blue rubber bleb naevus syndrome had been made many years earlier. However, after recognition of the characteristic enchondromata, this diagnosis has been revised to Maffucci's syndrome. In addition to her ongoing dermatological and paediatric follow up, she has now been referred to the orthopaedic surgeons for surveillance of her skeletal lesions.
Blau syndrome presenting with ichthyosis
Authors: Masel Grant , Halbert Anne
Published: January 2005

A 12‐year‐old girl presented with uveitis, joint disease and ichthyosis resembling ichthyosis vulgaris. A biopsy taken from the affected lower leg demonstrated sarcoidal‐type granulomas. Synovial biopsy from the knee also showed granulomas. There was a family history of similar clinical features in the patient's younger sister. There were no other systemic features present to suggest a diagnosis of sarcoidosis or other granulomatous disease such as Crohn's disease or tuberculosis. The familial nature of the condition also made these diagnoses less likely. A clinical diagnosis of Blau syndrome was made. Blau syndrome is an uncommon sarcoidosis‐like multisystem autosomal‐dominant granulomatous disorder caused by mutations in the CARD15 gene. This gene has also recently been found to be a factor in the development of psoriatic arthritis and Crohn's disease. Although many forms of skin involvement have been described in Blau syndrome, this is the first case described of ichthyosis as the primary skin manifestation.
Herpes zoster following cryosurgery
Authors: Lee Michael R , Ryman William
Published: January 2005

A 56‐year‐old man developed reactivation of herpes zoster infection on his right forehead after treatment of several solar keratoses with cryosurgery. The rash was blistering and painful. Treatment with oral aciclovir was instituted and the lesions healed within 2 weeks. Known risk factors for reactivation include age and decreased immunity. Previous case reports have indicated trauma may be a risk factor in herpes zoster. We report a case of herpes zoster as a complication of cryosurgery.
Paraneoplastic pemphigus: A brief update
Authors: Wade Martin S , Black Martin M
Published: January 2005

First described in 1990, paraneoplastic pemphigus is an autoimmune condition that causes considerable morbidity, is resistant to therapy and is frequently fatal. Clinical heterogeneity is being recognized as more cases are reported and the documented auto‐antigen profile is also increasing. Target antigens are now known to be not restricted to the skin, suggesting that this condition is part of a paraneoplastic autoimmune multiorgan syndrome.
Chronic constipation in children: Organic disorders are a major cause
Authors: Southwell BR , King SK , Hutson JM
Published: January 2005

Abstract:  Diagnostic tools for paediatric chronic constipation have been limited, leading to over 90% of patients with treatment‐resistant constipation being diagnosed with chronic idiopathic constipation, with no discernible organic cause. Work in our institution suggests that a number of children with intractable symptoms actually have slow colonic transit leading to slow transit constipation. This paper reviews recent data suggesting that a significant number of the children with chronic treatment‐resistant constipation may have organic causes (slow colonic transit and outlet obstruction) and suggests new approaches to the management of children with chronic treatment‐resistant constipation.
Investigation of sleep disorders
Authors: Davey MJ
Published: January 2005

Abstract:  Polysomnography or sleep study is the main investigation for paediatric sleep disorders. It involves the continuous and simultaneous recording of multiple physiological parameters evaluating sleep and respiration. It is most commonly used to diagnose obstructive sleep apnoea and to monitor nocturnal non‐invasive ventilation requirements of children. Its role in other sleep related breathing disorders, narcolepsy and parasomnias is discussed.
Complementary and alternative medicine use in children with attention deficit hyperactivity disorder
Authors: Sinha D , Efron D
Published: January 2005

Objectives:  The use of complementary and alternative medicines (CAM) is increasing in the general population. Attention deficit hyperactivity disorder (ADHD) is a chronic condition that has a major impact on children's functioning and has no cure, therefore many families may try CAM at some stage. We aimed to determine (i) the lifetime incidence of CAM use in a clinical sample of children with ADHD; (ii) parents’ perceptions of the effectiveness of CAM for ADHD; and (iii) the proportion who informed their paediatrician.

Methods:  The sample was drawn from patients aged 5−17 years with ADHD attending Royal Children's Hospital, Melbourne outpatient clinics from May to September 2003. A 20‐item survey was posted to consenting families.

Results:  From 105 surveys, 75 were returned (response rate 71.4%). Mean child age was 11.1 (SD 2.9, range 5.0−16.9) years; 65 (86.7%) were boys. Fifty (67.6%) families reported current or past CAM use. Of the 23 different therapies reported, the most common were modified diet (33 families), vitamins and/or minerals (16), dietary supplements (12), aromatherapy (12) and chiropractics (10). Reported effectiveness was variable. The factors most frequently rated as important in choosing CAM were minimizing symptoms (40 families), adding to the benefit of conventional treatment (30) and avoiding side‐effects (29). Thirty‐two (64%) of 50 families reported that they informed their paediatrician of their CAM use.

Conclusion:  Complementary and alternative medicines are commonly used in children with ADHD. Paediatricians should enquire about the use of CAM, and use available resources to help guide families in their therapeutic choices.
Lupus nephritis in children in Malaysia
Authors: Khoo JJ , Pee S , Thevarajah B , Yap YC , Chin CK
Published: January 2005

Objectives : To determine the pattern of renal histology, clinical outcome of children with lupus nephritis and to identify any associated risk factors predicting renal failure in these children.

Methods:  Retrospectively, 27 children under 16 years of age with lupus nephritis who had renal biopsies done at Sultanah Aminah Hospital Johor, Malaysia from 1994 to 2002 were studied. The renal histology was graded according to WHO classification system (1982). The medical records, laboratory data and the clinical outcome of the patients were studied.

Results:  There were 24 cases of WHO Class IV, two cases of WHO Class II and a case of WHO Class V. Twenty children were in the good renal outcome group while six children progressed into the poor renal outcome group and required renal replacement. One child was lost to follow‐up. All six children in the poor renal outcome group had WHO Class IV histology. The 5‐year patient and renal survival rates were 84% and 75%, respectively. Age, sex, activity and chronicity indices in the renal histology, anaemia, elevated serum creatinine, depressed levels of C3 and C4, heavy proteinuria or presence of urinary active sediments were not associated with progression to renal failure.

Conclusions:  Presently, children with lupus nephritis appeared to have better patient and renal survival rates. Assessment of renal histology in these children was important for diagnosis, treatment and probably prognosis. In this study, there was a 25% incidence of loss of renal function over 5 years in children with WHO Class IV renal histology.
Cerebral palsy: What do medical students know and believe?
Authors: Martin HL , Rowell MM , Reid SM , Marks MK , Reddihough DS
Published: January 2005

Objectives:  Negative attitudes toward people with disabilities, including cerebral palsy, may be related to misunderstandings or lack of knowledge about the disability. If held by medical practitioners, they can have detrimental implications for the care of people with disabilities. The purposes of this study were to examine the knowledge and attitudes of medical students regarding cerebral palsy and to examine the effects of the videotape ‘Understanding Cerebral Palsy’ on these two areas.

Methods:  The attitudes and knowledge regarding cerebral palsy of 54 medical students in their penultimate year were measured before and after watching a video produced to educate health professionals about cerebral palsy. They were assessed using a self‐administered questionnaire constructed specifically for the study, adapted from previously validated questionnaires.

Results:  These medical students generally had limited knowledge about cerebral palsy and displayed negative attitudes toward people with cerebral palsy. It was also found that males had less positive attitudes than females (P = 0.014) and that students educated mainly in Asia had less positive attitudes than students educated mainly in Australia (P = 0.012). The videotape was shown to be effective in improving the students’ knowledge about cerebral palsy. A small but significant improvement in attitudes was also shown (P = 0.014), with the attitudes of some students improving dramatically. However, negative attitudes remained in many.

Conclusions:  Based on the findings, structured teaching about cerebral palsy is necessary within the medical curriculum at the University of Melbourne. Greater promotion of positive attitudes toward people with cerebral palsy and other disabilities is required.
Flucloxacillin associated neutropenia in children treated for bone and joint infections
Authors: Van Den Boom J , Kristiansen JB , Voss LM , Stott NS
Published: January 2005

Objective:  This report describes episodes of acute neutropenia associated with flucloxacillin use in children treated for bone and joint infections.

Methods:  A retrospective chart audit was performed on eight children who developed neutropenia when treated with flucloxacillin.

Results:  Eight children (aged 1 month to 13 years) had a diagnosis of neutropenia attributed to treatment with flucloxacillin, seven of whom received parenteral therapy. The time to onset of neutropenia averaged 27 days, with neutrophil counts returning to normal limits in all patients after 2 to 9 days. Two children were asymptomatic when the neutropenia was detected. The average flucloxacillin dose used was 65% (range 20−100%) of the recommended maximum dose.

Conclusions:  These cases suggest that flucloxacillin should be used with greater caution and guidelines for dosing and clinical monitoring (regular neutrophil counts) need to be reassessed, despite none of these patients experiencing serious sequelae.
Intended management of children with acute idiopathic thrombocytopenic purpura: A national survey
Authors: Marks MK , Vadamalayan B , Ekert H , South MJ
Published: January 2005

Objective:  In Australia acute idiopathic thrombocytopenic purpura (ITP) is mainly treated by paediatricians (either general paediatricians or paediatric haematologists/oncologists). A survey was conducted to gauge the current practice of treating children with acute ITP in Australia.

Methods:  All practising Australian paediatricians registered by the Royal Australasian College of Physicians were surveyed regarding their intended management of children with acute ITP. The questionnaire, adapted from a study of paediatric haematologists/oncologists in North America, presented four clinical scenarios of children with acute ITP with a platelet count of 3000 × 109/L, with and without mucosal bleeding (wet and dry purpura, respectively). Questionnaires were returned by mail or filled in online at a dedicated webpage.

Results:  Five hundred and sixty‐three of 1097 (51%) paediatricians responded to the survey. Data from 140 who had treated at least one child with ITP in the previous 12 months were analysed. Respondents indicated that children with acute ITP are usually or always hospitalised (58−92%) and that 48% would be given active treatment, even with dry purpura. Various regimens of i.v. immunoglobulin or corticosteroids are used when treatment is administered. In comparing Australian and North American management of acute ITP there were many similarities, although Australian paediatricians were less likely to arrange a bone marrow aspirate if corticosteroids were prescribed.

Conclusions:  There is great variation in the intended management of children with acute ITP in Australia. Previously published management recommendations regarding investigation and treatment have had little impact on intended practice. Prospective studies are required to evaluate hypotheses so as to produce evidence‐based recommendations for treatment of patients with acute ITP.
Vanishing white matter disease in a child presenting with ataxia
Authors: Wilson CJ , Pronk JC , Van der Knaap MS
Published: January 2005

Abstract:  Vanishing white matter disease is a recently described leukoencephalopathy that is characterized by chronic and episodic neurological deterioration. These episodes often follow periods of fever or minor head trauma. It frequently presents in childhood with problems of ataxia and tremor. Five genes have been identified for the disease, EIF2B1‐5, which encode the five subunits of translation initiation factor eIF2B. Mutations in each of the genes may independently cause the disease. The defect in eIF2B results in abnormalities in translation and its regulation, leading to abnormalities in protein synthesis and its regulation. Magnetic resonance imaging of the brain reveals extensive cerebral white matter abnormalities with evidence of white matter rarefaction and cystic degeneration, which has been confirmed pathologically. We report the first confirmed Australasian patient.
Congenital absence of portal vein presenting as hepatopulmonary syndrome
Authors: Cheung KM , Lee CY , Wong CT , Chan AKH
Published: January 2005

Abstract:  A 9‐year‐old girl presented with cyanosis and decreased exercise tolerance. Chest X‐ray, lung function and echocardiogram were normal. Contrasted echocardiogram showed intrapulmonary right to left shunt and computerized tomography of the thorax showed dilated pulmonary vasculature. There was no arteriovenous malformation. Computerized tomography of the abdomen revealed absence of the intrahepatic portion of the portal vein. The superior mesenteric and splenic veins joined as a common trunk, bypassed the liver and drained into the right atrium. We concluded that the patient had hepatopulmonary syndrome secondary to absence of the portal vein. This is the first report of hepatopulmonary syndrome in a female paediatric patient with a congenital absence of the portal vein. As all portal blood entered directly into systemic circulation, the condition was equivalent to congenital portosystemic shunt. Cases of congenital portosystemic shunt complicated by hepatopulmonary syndrome were also reviewed.
Study of subjectivity in the perception of cesarean birth
Authors: Park Chai Soon , Yeoum Soon Gyo , Choi Euy Soon
Published: January 2005

Abstract This study defined the structural patterns of subjectivity in the perception of cesarean birth. Q methodology was used on 71 statements collected through interviews with seven persons and a literature review followed. Twenty‐nine Q samples were selected and administered to 22 persons, and four types of subjectivity were revealed by the QUANL PC Program. Type 1, or the ‘naturalist’, is characterized by a passive tendency and dislikes artificial methods, feeling that they are performed for hospital income and the trend for social preference. Type 2, ‘logical thinker’, thinks that cesarean birth should be selected if there are obstetric complications and severe anxiety about labor, even though it results in low intimacy with the baby. Type 3, ‘maternal instinctivism’, values the maternal‐baby relationship and the sense of accomplishment from childbirth. Type 4, ‘egocentric’, thinks that cesarean section should be chosen when the woman has severe anxiety about labor or when the obstetric condition becomes dangerous. Before commencement of the patient's labor pains, the nurses and medical personnel who are participating in the delivery should assess the structural pattern on parturient woman's subjectivity in the perception of cesarean section. As a further step, they should encourage the woman and her family to participate in the decision‐making process for considering the type of delivery the mother wants.
Evidence‐based care for the elderly with isolated systolic hypertension
Authors: Wong Julia , Wong Shirley
Published: January 2005

Abstract This paper reviews the epidemiology, pathophysiology and clinical significance of isolated systolic hypertension (ISH) in the elderly. Aging is associated with structural and functional changes in the arterial tree. Intimal thickening, migration of small muscle cells to the intima, medial fibrosis, and elastic fiber degeneration result in increased arterial stiffness and ISH. The augmented systemic vascular resistance in the elderly is mediated by increased arterial stiffness. Aging is correlated with overactivity of the sympathetic nervous system, reduced neuronal plasma norepinephrine uptake, and baroreceptor dysfunction. These functional changes all contribute to the development of ISH in elderly persons. Prospective and epidemiological studies have demonstrated that ISH is associated with coronary and cerebrovascular morbidity and mortality. There is good evidence indicating that lifestyle modifications such as weight reduction, increased physical activity, moderation of dietary sodium, and decreased alcohol intake, in combination with pharmacological therapy can effectively reduce blood pressure in elderly individuals with ISH. Primary health care providers can make significant contributions to the care of elderly persons with ISH. These contributions involve educating elderly people to control hypertension through lifestyle modification, monitoring the efficacy of antihypertensive therapy, and preventing complications associated with non‐compliance with therapeutic regimens.
Managing family centered palliative care in aged and acute settings
Authors: Street Annette Fay , Love Anthony , Blackford Jeanine
Published: January 2005

Abstract This paper reports on the management of family centered palliative care in different aged care and acute Australian inpatient settings, following the integration of palliative care with mainstream services. Eighty‐eight semistructured interviews were conducted and 425 questionnaires (Palliative Care Practices Questionnaire—PCPQ) were returned, completed from 12 regional and metropolitan locations. Transcribed interviews were analyzed using QSR NVivo and mean PCPQ scores from the four settings were compared. Scores on items from the PCPQ related to family centered care confirmed the analyses. Interviews revealed that factors contributing to the level of support for families offered in the various settings included the core business of the unit; the length of stay of the patients or residents; the acuity or symptom burden; and the coordinated involvement of the multidisciplinary team. Strategies for improving supportive family care are proposed.
Effects of ward rotation on subsequent transition processes of Japanese clinical nurses
Authors: Fujino Mitsuku , Nojima Yoshiko
Published: January 2005

Abstract The purpose of this study was to examine the experience of Japanese clinical nurses undertaking a ward rotation in a general hospital, and its effects on subsequent processes relating to: (i) perception of ward rotation; (ii) reactions to the ward transition process; and (iii) outcomes of ward rotation. In‐depth interviews were conducted with 21 Japanese clinical nurses who had an average of 8.8 years (SD = 5.50) clinical experience. Findings indicated that participants experienced role overload, role incongruity and/or role underload, role overqualification, or role ambiguity in the new environment. These role stresses created critical emotional distress during the transition process. The high desire for career development facilitated the transition process, while lack of preparation inhibited the transition process. To facilitate smooth transition, well‐prepared and structured supports based on reliable interpersonal relationships are necessary. The findings offer significant cues for effective ward rotation programs. The implication for nursing administrators is that appropriate ward rotations enhance confidence and promote effective role development in the new clinical setting.
Relationship between caloric intake and pregnancy outcome in diet‐treated gestational diabetes mellitus
Authors: Ho Lai‐Fong , Benzie Iris F. F. , Lao Terence T.
Published: January 2005

Abstract A prospective observational study was performed to examine the relationship between estimated caloric intake with maternal blood glucose profile and infant outcome in a group of Chinese women with gestational diabetes mellitus (GDM) treated by diet alone. Following the diagnosis of GDM according to the World Health Organization (WHO) criteria, and using a 75 g oral glucose tolerance test (OGTT), 62 non‐obese Chinese women who had completed a 5‐day dietary survey were recruited into the study. They were categorized by their mean caloric intake over 5 days into tertiles for comparison of gestational weight gain, glycemic control and pregnancy outcome. Subjects in the highest tertile had a mean intake close to the prescribed intake. No differences were seen in maternal characteristics, gestational weight gain, OGTT, other postprandial glucose concentrations, or infant outcome among the tertiles. Our findings indicated that as long as the caloric intake did not exceed that prescribed, the infant outcome remained satisfactory.
Mind and body in spiritual perspectives
Authors: Kim Susie
Published: January 2005

WHO defines health as ‘not merely the absence of disease but the integration of physical, emotional and social well‐being and harmony’. A holistic well‐being state of peace can be considered as the true meaning of health. According to current trends in nursing, special attention will be given to the principles of evidence‐based practice, with examples provided on empirical research studies of spiritual concepts, in order to illustrate the need for and importance of holistic care that also includes spiritual care.
Mind and body in genetic perspectives
Authors: Tsukahara Masato
Published: January 2005

The author's focus is the importance of genetic education among nursing students (baccalaureate, master and doctoral courses), nurse practitioners and nurse educators for providing appropriate health care to patients with genetic problems based on a better understanding of human mind and body.
Bringing nursing research to the public: Making media matter
Authors: Stern Phyllis N.
Published: January 2005

Through historical research we are working to elevate the image of nursing from one who takes orders, to that of ‘vital participant in health care’ through education, research and service. By getting this message to the public, we hope to make nursing a more respected, valued and attractive career choice for women and men.
Mind and body in biobehavioral perspective
Authors: Heitkemper Margaret
Published: January 2005

Nurse scientists have an important role to play in providing the evidence to support therapeutic approaches as well as providing important mechanistic information on the connection between the mind and the body.
The mind‐body connection in elderly
Authors: Kim Oksoo
Published: January 2005

Depression is an illness affecting mind and body. Depression in people aged 65 years and older is a major public health problem. Because many older people are unaware that they need treatment for depression, as depression in the elderly is insidious. The consequences of undiagnosed depression can be fatal, as depression is a leading cause of suicide among elders. Late‐life depression is particularly tricky in that the relationship between depression, disability and illness is very difficult to disentangle. Specific symptoms and signs of depression may impair some functions and not others. Medical disorders accompanying geriatric depression can cause disability, independent of the depressive syndrome or in synergy with it. There is growing evidence that treating depression in patients with a chronic physical condition may improve their medical condition, reduce the degree of pain, increase activity and lessen disability, enhance their quality of life and increase their ability to follow their treatment plan. Health care providers, elderly and their family should be aware of geriatric depression.
Laparoscopic approaches in urology
Authors: Abdelmaksoud Alaa , Biyani Chandra Shekhar , Bagheri Fariborz , Janetschek Günter
Published: January 2005

The use of laparoscopy was one of the most important steps in the progress of medicine, and has developed through the 20th century. Gynaecologists took the initial lead in introducing this technology, followed by general surgeons. Since the first laparoscopic nephrectomy in 1990, most ablative and reconstructive urological surgery has been attempted laparoscopically. Laparoscopic urological surgical approaches include conventional transperitoneal and extraperitoneal; in this review the different approaches, with the relevant anatomical considerations, are discussed.
Identity Theories of Truth and the Tractatus
Authors: Sullivan Peter M.
Published: January 2005

The paper is concerned with the idea that the world is the totality of facts, not of things – with what is involved in thinking of the world in that way, and why one might do so. It approaches this issue through a comparison between Wittgenstein's Tractatus and the identity theory of truth proposed by Hornsby and McDowell. The paper's positive conclusion is that there is a genuine affinity between these two. A negative contention is that the modern identity theory is vulnerable to a complaint of idealism that the Tractatus can deflect.
Operations and Truth‐Operations in the Tractatus
Authors: Gallerani Cuter João Vergílio
Published: January 2005

Formal series are associated with ascriptions of numbers. They are ordered by formal operations that, unlike negation and disjunction, are not truth‐operations. In spite of this, they are required to build propositions involving generic reference to numbers, and are essential to the Tractarian version of the logicist project.
Approaches to Wittgenstein: Collected Papers
Authors: Kanterian Edward
Published: January 2005

Book reviewed:

Brian McGuinness, Approaches to Wittgenstein: Collected Papers, Routledge, 2002, xv + 299 pp, £55.00
Atheism, Morality and Meaning
Authors: Carey Rosalind
Published: January 2005

Book reviewed:

Michael Martin, Atheism, Morality and Meaning, 2002, Prometheus Books, 330pp, price £21.00 pb.
Extended antiretroviral treatment interruption in HIV‐infected patients with long‐term suppression of plasma HIV RNA
Authors: Achenbach CJ , Till M , Palella FJ , Knoll MD , Terp SM , Kalnins AU , Murphy RL
Published: January 2005

Objectives

Evaluation of extended treatment interruption (TI) in chronic HIV infection among patients successfully treated with antiretroviral therapy.

Methods

An observational analysis of 25 patients in a prospectively followed cohort with chronic HIV infection, viral loads <500 HIV‐1 RNA copies/mL for at least 6 months, and an interruption in therapy of ≥28 days duration was carried out. Follow up was divided into 3‐month time periods for analysis. The effects of time period, stratification group and stratification group by time period interactions on CD4 counts were tested using a mixed model. Univariate comparisons among patient characteristics and responses were performed using Fisher's exact test or the Wilcoxon rank sum test.

Results

At initiation of TI, the median CD4 count was 799 cells/μL. TI duration was a median of 7.1 months. HIV RNA rebounded to a median maximum level of 75 000 copies/mL. Maximum viral rebound was significantly greater in patients who were male, had lipodystrophy and had zenith HIV RNA prior to TI of ≥50 000 copies/mL. Lower CD4 cell counts were observed during TI in patients with lipodystrophy, zenith HIV RNA ≥50 000 copies/mL, history of AIDS, HIV infection ≥5 years and presuppression CD4 count ≤350 cells/μL. Patients who reinitiated therapy had shorter TI duration, presuppression CD4 count ≤350 cells/μL, previous AIDS diagnosis and lipodystrophy. No patients developed adverse or AIDS‐defining events during TI.

Conclusions

Long‐term TI resulted in greater immune deterioration in patients with high viral set points or low CD4 cell counts prior to initiation of suppressive antiretroviral therapy.
Advantages of flow cytometry immunophenotyping for the diagnosis of central nervous system non‐Hodgkin's lymphoma in AIDS patients
Authors: Subirá D , Górgolas M , Castañón S , Serrano C , Román A , Rivas F , Tomás JF
Published: January 2005

Background

Neurological disorders are common in HIV‐infected patients. Central nervous system (CNS) lymphoma should always be considered because it is an important cause of morbidity and mortality.

Objectives

To investigate the clinical utility of flow cytometry immunophenotyping (FCI) in diagnosing or discarding leptomeningeal involvement in HIV‐infected patients and to compare its sensitivity with that of conventional cytological methods.

Methods

Fifty‐six cerebrospinal fluid (CSF) samples from 29 HIV‐infected patients were independently evaluated by flow cytometry and cytology. The description of an aberrant immunophenotype was the criterion used to define the malignant nature of any CSF cell population.

Results

FCI and cytology gave concordant results for 48 of the 56 CSF samples studied: 37 were negative for malignancy and 11 had evidence of CNS lymphoma. Discordant results were obtained for eight CSF samples, and the accuracy of the FCI findings could be demonstrated for four CSF samples described as positive for malignancy according to the FCI criteria.

Conclusions

A high level of agreement was found between the results obtained using the two methods, but FCI gave at least 25% higher sensitivity than conventional cytomorphological methods for the detection of malignant cells. This advantage suggests that, in case of negative flow cytometry results, disorders other than non‐Hodgkin's lymphoma should be strongly considered.
Chlamydia pneumoniae infection in HIV‐positive patients: prevalence and relationship with lipid profile
Authors: Tositti G , Rassu M , Fabris P , Giordani MT , Cazzavillan S , Reatto P , Zoppelletto M , Bonoldi M , Baldo V , Manfrin V , De Lalla F
Published: January 2005

Objectives

The aims of this study were to evaluate the prevalence and impact of Chlamydia pneumoniae infection in HIV‐positive patients and to establish the relationship between C. pneumoniae infection and lipid profile.

Methods

Detection of C. pneumoniae was by polymerase chain reaction (PCR) on Peripheral Blood Mononuclear Cells (PBMCs) collected from 97 HIV‐positive patients. Samples were collected after overnight fast in EDTA‐treated tubes. On the same day, patients were also tested for routine chemistry, HIV viral load, CD3, CD8 and CD4 cell counts and lipid profile [cholesterol, high‐density lipoproteins (HDLs), low‐density lipoproteins (LDLs) and triglycerides].

Results

The overall prevalence of C. pneumoniae was 39%. The prevalence of C. pneumoniae was inversely related to the CD4 lymphocyte count (P=0.03). In the naive group, C. pneumoniae‐positive patients had both significantly higher HIV load (71 021±15 327 vs. 14 753±14 924 HIV‐1 RNA copies/mL; P=0.03) and lower CD4 cell count (348.0±165.4 vs. 541.7±294.8; P=0.04) than C. pneumoniae‐negative patients. Moreover, treatment‐naive patients with C. pneumoniae infection had significantly higher mean levels of cholesterol (185.3±56.2 vs. 124.8±45.9 mg/dL; P=0.01), triglycerides (117.2±74.7 vs. 68±27.6 mg/dL; P=0.04) and LDL (122.4±60.1 vs. 55.6±58 mg/dL; P=0.05) than C. pneumoniae‐negative patients.

Conclusions

These data indicate that, in HIV‐positive subjects, C. pneumoniae infection is relatively frequent and is associated with both low CD4 cell count and high HIV load. Furthermore, C. pneumoniae appears to be associated with hyperlipidaemia and might therefore represent a further risk factor for cardiovascolar disease in HIV‐positive patients.
Successful administration of aggressive chemotherapy concomitant to tuberculostatic and highly active antiretroviral therapy in a patient with AIDS‐related Burkitt's lymphoma
Authors: Lehmann C , Wyen C , Hoffmann C , Fätkenheuer G
Published: January 2005

Treatment of AIDS‐related malignant lymphoma (ARL) remains a therapeutic challenge. There are concerns not only about infectious and haematological complications in HIV‐infected patients during intensive chemotherapy, but also about potential interactions between chemotherapy and highly active antiretroviral therapy (HAART). Current data on patients treated concomitantly with intensive chemotherapy and HAART are limited, and no data exist on patients with ARL suffering from active opportunistic infections. We report the case of a 38‐year‐old man with advanced HIV‐1 infection, pulmonary tuberculosis and Burkitt's lymphoma. Intensive chemotherapy was administered in parallel with tuberculostatic therapy and HAART. Six months later, the patient achieved not only a complete remission of Burkitt's lymphoma and sustained viral suppression, but also a full recovery from tuberculosis. This case report provides some useful observations on the successful application of intensive chemotherapy in addition to tuberculostatic therapy and HAART in HIV‐infected patients.
Protease inhibitor exposure and increased risk of cardiovascular disease in HIV‐infected patients
Authors: Iloeje UH , Yuan Y , L'Italien G , Mauskopf J , Holmberg SD , Moorman AC , Wood KC , Moore RD
Published: January 2005

Objectives

To study the relationship between exposure to protease inhibitor (PI) therapy and increased risk of cardiovascular events in HIV‐infected patients.

Methods

We estimated the risk of cardiovascular disease (CVD) events with PI exposure in a cohort of HIV‐infected patients using a time‐dependent Cox proportional hazards model adjusting for the major CVD risk factors. Only the first CVD event for each subject was counted.

Results

Of a total of 7542 patients, 77% were exposed to PIs. CVD event rates were 9.8/1000 and 6.5/1000 person–years of follow‐up (PYFU) in the PI‐exposed and nonexposed groups, respectively (P=0.0008). PI exposure ≥60 days was associated with an increased risk of CVD event [adjusted hazards ratio (HRadj) 1.71; 95% confidence interval (CI) 1.08–2.74; P=0.03]. Results from a subgroup of patients aged between 35 and 65 years were similar (HRadj 1.90; 95% CI 1.13–3.20; P=0.02). Other significant risk factors included smoking status, age, hypertension, diabetes mellitus and pre‐existing CVD.

Conclusions

Patients exposed to PI therapy had an increased risk of CVD events. Clinicians should evaluate the risk of CVD when making treatment decisions for HIV‐infected patients.
The initial phase of exercise hyperpnoea in humans is depressed during a cognitive task
Authors: Bell Harold J. , Feenstra Wya , Duffin James
Published: January 2005

Increased wakefulness is known to suppress the initial ventilatory response to passive movement and the steady‐state ventilatory response to exercise. However, the effect of increased wakefulness upon the integrated ventilatory response at the onset of exercise is not known. We hypothesized that increasing wakefulness via a cognitive task would attenuate the initial ventilatory response to exercise, and so we examined the response to active leg extensions under two conditions: with and without concurrently solving a puzzle. At rest before exercise, subjects demonstrated greater minute ventilation while solving a puzzle (mean ±s.e.m., 12.38 ± 0.55 versus 10.12 ± 0.51 l min−1, P < 0.001), due to a higher mean breathing frequency (mean ±s.e.m., 17.1 ± 0.93 versus 13.6 ± 0.59 breaths min−1, P < 0.001). At the start of exercise, subjects did not increase their ventilation significantly while solving the puzzle (P= 0.170), but did by a mean ±s.e.m. of 6.16 ± 1.12 l min−1 (P < 0.001) when not puzzle solving. The ventilation achieved at the start of exercise in absolute terms was also lower while solving the puzzle (14.6 ± 1.1 versus 16.3 ± 1.3 l min−1, P= 0.047). Despite differences in the rapid ventilatory response to exercise between conditions, the steady‐state responses were not different. We conclude that the performance of a cognitive task decreases the initial phase of exercise hyperpnoea, and suggest that this might occur because of either a competitive interaction between drives to breathe or a behavioural distraction from the ‘task’ of exercise.
R–R interval–blood pressure interaction in subjects with different tolerances to orthostatic stress
Authors: Gulli Giosuè , Claydon Victoria Elizabeth , Cooper Victoria Louise , Hainsworth Roger
Published: January 2005

In addition to the gain, the time delay in the input–output response in a feedback system is crucial for the maintenance of its stability. Patients with posturally related (vasovagal) syncope have inadequate control of blood pressure and one possible explanation for this could be prolonged latency of the baroreflex. We studied 14 patients with histories of syncope and poor orthostatic tolerance (assessed by a progressive orthostatic stress test) and 16 healthy controls. We performed spontaneous sequence analysis of the fluctuations of R–R period (ECG) and systolic arterial pressure (SAP, Finapres) recorded during a 20 min supine period and during 20 min 60 deg head‐up tilt (HUT). The baroreflex latency was determined by identifying the lag between the changes in SAP and in R–R interval from which the highest correlation coefficient was obtained. During the supine period, 74% of sequences in control subjects and 54% in patients occurred with zero beats of delay (i.e. R–R interval changed within the same R–R interval). The remaining sequences occurred with delays of up to four beats. HUT shifted the baroreflex delay to be approximately one heartbeat slower and again patients showed more sequences with prolonged response. The delay in heartbeats was transformed into delay in time. In control subjects, 75% of baroreflex responses occurred within 1 s. In patients, 75% of baroreflex responses took more than 2 s to occur. The results showed that syncopal patients with poor orthostatic tolerance have increased baroreflex latency. This may lead to instability and inadequate blood pressure control and may predispose to vasovagal syncope.