bluuebunny/crossref_metadata_2025 huggingface dataset:
Overshoot and Undershoot: Control System Analysis of Haemodynamics in a Functional Transcranial Doppler Test
Authors: Rosengarten B. , Osthaus S. , Kaps M.
Published: April 2003

Background: Local cerebral blood flow is adjusted to cortical activity in a rapid and fine-tuned manner. The responsible mechanism, called neurovascular coupling, is suggested to be governed by a complex biological control system. The main characteristics of the regulative process can be modelled in terms of a control system of low order. We aimed to test the hypothesis that the overshoot and undershoot in haemodynamics are part of the regulative processes of the neurovascular coupling mechanism. Methods: Using a visual stimulation paradigm, the evoked blood flow velocity in the posterior cerebral artery was measured in 20 healthy volunteers (aged 24.7 ± 0.4 years, 12 males) with transcranial Doppler. The dynamic flow velocity response was evaluated according to a 5-parameter control system model. Results: The parameter time delay (1.2 ± 1; 2.2 ± 1.3; p < 0.05) and natural frequency (0.23 ± 0.06; 0.47 ± 0.18; p < 0.001) were significantly smaller, the parameter rate time (4.9 ± 2.3; 2.2 ± 1.6; p < 0.01) greater in conditions of stimulation. Conclusions: The finding of an identical control system model for both regulative conditions supports the hypothesis that the mechanism is mainly functionally governed and that the underlying biological elements do not appear to be limiting factors. The difference in parameters is suggested to reduce the time span of an initial hypoperfusion in conditions of cortical activation.
Primary Mediastinal Yolk Sac Tumor in a 66-Year-Old Woman
Authors: Coskun Ugur , Günel Nazan , Yildirim Yesım , Memis Leyla , Boyacıoglu Z. Melda
Published: April 2003

Objective: To report a rare case of nonseminomatous extragonadal germ cell tumor in a 66-year-old female with primary yolk sac tumor of the mediastinum. Clinical Presentation and Intervention: A 66-year-old female was admitted to our hospital with a history of chest pain for 1 month. Computerized tomography of the thorax showed a left paracardiac mass adjacent to the aortic arch, left main pulmonary artery and pericardium. Total surgical excision could not be performed, but several biopsies which were taken through a thoracotomy revealed yolk sac tumor of the mediastinum. Systemic chemotherapy was started, but no response was observed and the patient died after one course of chemotherapy. Conclusion: Nonteratomatous mediastinal germ cell tumors are virtually nonexistent in women. To our knowledge, this is the oldest female patient with a primary mediastinal germ cell tumor. Chemotherapy was not effective especially in an old patient. We suggest surgery should be considered as primary treatment modality if diagnosis is made at an early stage.
Delayed Post-Operative Pneumoperitoneum
Authors: Ceydeli Adil , Fahoum Bashar , Schein Moshe
Published: April 2003

We present a case of post-operative pneumoperitoneum (PP), which persisted for eight weeks. Postoperative retained air is the most common cause of PP. It does not require a surgical intervention and thus is defined as a ‘non-surgical PP’. The etiological factors contributing to the duration of the postoperative PP are controversial but the longest time described in the literature is 24 days. We review the relevant literature and discuss factors contributing to the duration of postoperative PP.
Corticosteroid-Resistant Pyoderma gangrenosum Associated with Crohn’s Disease: Rapid Cure with Infliximab
Authors: Grange F. , Djilali-Bouzina F. , Weiss A.M. , Polette A. , Guillaume J.C.
Published: April 2003

A 41-year-old woman with Crohn’s disease had a severe and rapidly extensive corticosteroid-resistant pyoderma gangrenosum (PG) of the leg. She had been treated 2 years previously with antibiotics and surgery for a similar lesion of the back of the hand which had been diagnosed as a fulminating infection. Infliximab 5 mg/kg was given at weeks 0, 5 and 9. A dramatic response was observed within 72 h with a favourable effect persisting for 4 weeks after each infliximab infusion. A complete healing was achieved at week 11. This case illustrates that (1) PG of the hand is frequently misdiagnosed as an infection and treated with inappropriate therapies; (2) infliximab may be an interesting alternative in corticosteroid-resistant PG associated with Crohn’s disease.
Mycosis-fungoides-Type Cutaneous T Cell Lymphoma of the Hands and Soles: A Variant Causing Delay in Diagnosis and Adequate Treatment of Patients with Palmoplantar Eczema
Authors: Spieth Konstanze , Grundmann-Kollmann Marcella , Runne Ulf , Staib Gyde , Fellbaum Christian , Wolter Manfred , Kaufmann Roland , Gille Jens
Published: April 2003

Background: The etiopathology of chronic eczematous lesions of the palms and/or soles remains elusive in a considerable proportion of patients. Accumulating evidence suggests that a rare variant of mycosis fungoides (MF)-type cutaneous T cell lymphoma (CTCL) restricted to the palms and/or soles may mimic common palmoplantar dermatoses. Objective: In the present study, we analyzed the clinical and histological characteristics of 3 adult patients with preexisting nonclassified chronic palmoplantar eczema poorly responding to standard therapies. Palmar and/or plantar MF was eventually diagnosed. Methods: The course of the disease, response to previous therapies and dermatological features are described, results of histochemical and immunohistochemical analyses are reported, including T cell receptor γ gene rearrangement where obtainable. Results: Onset of cutaneous lesions with broad clinical variation was experienced 2–10 years prior to diagnosis; conventional therapies led to short-time or partial remission only; except for 1 patient, the epidermotropic infiltrate was predominantly composed of CD4-positive cells; topical photochemotherapy seems to result in more durable responses. Conclusion: As therapeutic strategies for this disease variant differ from symptomatic standard treatment regimens, awareness of MF-type CTCL as a relevant differential diagnosis of palmoplantar eczema should be expanded to prevent delay in diagnosis and adequate therapy.
The Genome Organization of Pea Stem Necrosis Virus and Its Assignment to the Genus Carmovirus
Authors: Suzuki Shiho , Hase Shu , Takahashi Hideki , Ikegami Masato
Published: April 2003

The complete sequence of the single-stranded, positive-sense RNA genome of pea stem necrosis virus (PSNV) has been determined. The 4,048-nucleotide genome contains five open reading frames (ORFs). The 5′-proximal ORF encodes a 25-kD protein (p25). If the amber termination codon is read through, the ORF produces a read-through protein of 84 kD (p84). Two small, centrally located ORFs encoded a 7-kD protein (p7) and a 6-kD protein (p6), respectively. The 38-proximal ORF encodes a 38-kD (p38) capsid protein. Comparison of the genome organization with that of other viruses justifies the assignment of PSNV to the genus Carmovirus.
Efficient Haemodialysis Improves the Response to Hepatitis B Virus Vaccination
Authors: Kovacic Vedran , Sain Milenka , Vukman Valentina
Published: April 2003

Background: As patients on chronic haemodialysis (PCHD) elicit a weaker response to vaccination with recombinant hepatitis B virus surface antigen (HBsAg), we conducted this study to see how dialysis efficacy affects response to hepatitis B virus (HBV) vaccination. Methods: Study subjects consisted of 30 PCHD. All subjects were vaccinated with 4 × 40 µg HBsAg i.m. at 0, 1, 2, and 6 months. If a subject had an HBsAg antibody (HBsAb) level <10 IU/l after vaccination, he or she received a booster dose. Subjects were divided into groups according to the level of HBsAb: non-responders (<10 IU/l), weak responders (10–100 IU/l), and good responders (>100 IU/l). Results: The group of responders had a significantly more efficient dialysis (Kt/V) than the group of non-responders (p = 0.027). This difference was not observed between groups of non-responders and weak responders. The group of good responders had a significantly better Kt/V than the group of non-responders (p = 0.012). Good responders had a significantly better Kt/V than weak responders (p = 0.019). Kt/V values showed a significantly positive correlation with the HBsAb level (r = 0.47; p = 0.006). Conclusions: The HBV vaccination reaction was weaker in PCHD with inefficient dialysis. Efficient haemodialysis significantly improves the response to vaccination with recombinant HBsAg.
Role of CD83 in the Immunomodulation of Dendritic Cells
Authors: Lechmann Matthias , Zinser Elisabeth , Golka Antje , Steinkasserer Alexander
Published: April 2003

Glycoprotein CD83 is one of the best-known maturation markers for human dendritic cells (DCs). The fact that CD83 is strongly upregulated together with co-stimulatory molecules such as CD80 and CD86 during DC maturation suggests it plays an important role in the induction of immune responses. Infection studies with herpes simplex virus type 1 (HSV-1) and the inhibition of the CD83 mRNA specific transport from the nucleus to the cytoplasm suggested a possible functional role for CD83. The first clear proof that CD83 is indeed important for DC biology came from recently performed studies using a soluble form of the extracellular CD83 domain. DC-mediated T cell proliferation could be completely inhibited using this recombinant molecule. Additional studies elucidated immunostimulatory as well as regulatory effects of the CD83 molecule. Furthermore, CD83–/– knockout mice revealed a block in CD4+ T cell generation, a new possible immunomodulatory function of CD83.
New Approaches to Treatment of Acute Myocardial Infarction: Combination Antiplatelet and Fibrinolytic Therapy
Authors: Maranian Ara M. , Steinhubl Steven R.
Published: April 2003

Since the early 1980s, there has been a dramatic change in the management of acute myocardial infarction, leading to a decrease in the death and complication rates for this disorder. Outcomes are improved when flow is restored in the infarct-related artery as rapidly as possible. Therapies aimed at restoring flow have included strategies to inhibit platelet function and induce fibrinolysis, as well as strategies of mechanical reperfusion with percutaneous intervention. Although improvements have been made with regard to morbidity and mortality, reperfusion rates with fibrinolytics have been less then optimal. It is thought that thrombolytic-induced platelet activation may be an important reason for failure to induce perfusion or maintain reperfusion with standard fibrinolytic regimens that include aspirin alone for its antiplatelet effect. Recently, we have moved from platelet inhibition with just aspirin to combinations with newer, more potent platelet inhibitors, primarily the glycoprotein (GP) IIb/IIIa antagonists. Recent trials have been conducted to evaluate the efficacy and the safety of combining thrombolytic drugs with GP IIb/IIIa receptor antagonists as the primary mode of reperfusion. Ongoing trials of adjunctive combination therapy in patients in whom emergent mechanical reperfusion is anticipated may lead to virtually all patients with ST elevation myocardial infarction receiving a GP IIb/IIIa antagonist and fibrinolytics upon presentation.
Residual Caries Detection Using Visible Fluorescence
Authors: Lennon Á.M. , Buchalla W. , Switalski L. , Stookey G.K.
Published: April 2003

This study investigated the ability of a new fluorescence method to detect residual caries in vitro. Gross caries was removed from 40 teeth with D2 caries. Samples were excited with violet-blue light and viewed through a 530-nm high-pass filter. Residual caries (orange-red fluorescing dentin) was detected in all samples. Further tooth substance was removed from half of the samples until no residual caries was detectable using the new method. Half of the samples remained untreated. A blinded examiner checked all samples for residual caries using DIAGNOdent, a visual tactile examination, and Caries Detector® dye. Presence or absence of residual caries in each sample was determined using a fluorescent nucleic acid stain in conjunction with confocal microscopy. The new method, Visible Fluorescence, had the greatest sensitivity, specificity, percent correct score and predictive values of any of the methods tested. The new method had significantly higher percent correct score than any of the other methods and significantly higher specificity than visual tactile and Caries Detector. It was concluded that Visible Fluorescence is an improvement on the currently available aids for residual caries detection.
Evaluation of a Computer Program for Caries Risk Assessment in Schoolchildren
Authors: Hänsel Petersson G. , Twetman S. , Bratthall D.
Published: April 2003

The ‘Cariogram’ is an interactive PC program for caries risk evaluation. It takes into account the interactions between caries-related factors and expresses a graphic assessment of the risk. The aim of this study was to assess the caries risk in schoolchildren using the Cariogram and to evaluate the program by comparing the caries risk assessments with the actual change in DMF. A 2-year prospective study on 446 schoolchildren, 10–11 years old, was conducted. At baseline, data on general health, diet, oral hygiene and use of fluoride were obtained. Saliva analyses included mutans streptococci and lactobacilli counts, buffer capacity and secretion rate. DMFT and DMFS were calculated from records and bitewing radiographs. Scores were entered and caries risk was assessed. Re-examination for caries was done after 2 years. The children were divided into 5 groups according to the assessed caries risk at baseline. Where the Cariogram predicted a 0–20% (high risk), 21–40%, 41–60%, 61–80% and 81–100% (low risk) chance of avoiding new lesions, 8, 35, 42, 73 and 83%, respectively, had no new lesions 2 years later. Logistic regression analyses were carried out. When the Cariogram was included, only two factors, the Cariogram (p < 0.001) and the DMFS at baseline, i.e. past caries experience (p = 0.001), turned out to be significantly associated with caries increment. The Cariogram was the most powerful explanatory variable. When the Cariogram was excluded, lactobacillus count, mutans streptococci, diet intake frequency and DMFS at baseline were significantly associated with caries increment. The Cariogram predicted caries increment more accurately than any included single-factor model. How this finding can be translated into daily practice in the best and most practical way is a matter for future research.
An Acoustic Study of Contrasting Plosives and Click Accompaniments in Xhosa
Authors: Jessen Michael
Published: April 2003

The phonetic manifestation of distinctive plosive types and click accompaniments in Xhosa was investigated with measurements of voice onset time (VOT), closure duration, voicing during closure, and burst amplitude. There is a high degree of interspeaker as well as token-to-token variability in the voiceless unaspirated plosives and clicks concerning their pronunciation with or without audible ejection. The plosives are much more frequently ejective than the corresponding clicks. If present, ejection is manifested by increased VOT, burst amplitude, or both. Duration of voicing during closure is substantial only in the implosive, but not in the ‘voiced’ plosives and clicks. After nasals the percentage of voicing during closure is high in ‘voiced’ plosives due to the very short closure duration found in that context; in the post-nasal ‘voiced’ clicks closure is mostly reduced to zero. Aspirated plosives and clicks in Xhosa show VOT values that are on average relatively long when compared to other languages. Closure duration tends to be shorter in aspirated plosives and clicks than in other categories.
Functional Results in Stapedotomy with and without CO2 Laser
Authors: Motta Gaetano , Moscillo Luca
Published: April 2003

The authors have studied the use of the CO2 laser in performing primary stapedotomy in 451 patients affected by otosclerosis, operated between 1996 and 2000. Footplate perforation was practised with a traditional method, by means of a microdrill, in 169 subjects. A CO2 laser was instead used in other 282 cases; the authors effected the platinotomy with a single spot, repeated if necessary, with the diameter adjusted to the caliber of the prosthesis. This procedure allowed a smooth-edged perforation to be obtained. In the 282 laser-operated patients, there was a significantly higher proportion having closure of the cochlear reserve within 10 dB than that found in the cases where the microdrill was used. Moreover, no postoperative anacusia or severe vertigo were recorded; this confirms the safety of the CO2 laser as regards the inner ear. The functional results, therefore, document the validity of the exposed technique.
Postoperative Pain in Tonsillectomy: Comparison of Ultrasonic Tonsillectomy versus Blunt Dissection Tonsillectomy
Authors: Sugiura Natsuki , Ochi Kentaro , Komatsuzaki Yasushi , Nishino Hirohito , Ohashi Toru
Published: April 2003

Intraoperative blood loss, postoperative pain, and postoperative appetite were compared between 15 adult patients who underwent tonsillectomy using an ultrasonically activated scalpel (UT) and 15 adult patients who underwent blunt dissection tonsillectomy with cold steel instruments (BT). The average intraoperative blood loss of the UT group was 4.6 ± 1.9 ml (mean ± standard deviation), while that of BT group was 41.9 ± 12.9 ml. This difference was highly statistically significant (p < 0.0001). In contrast, there were no significant differences in the VAS pain and appetite scores between patients who underwent UT and those who underwent BT on any day in the 6-day postoperative period. Our current results show that UT is a safe technique, and we believe that it should be considered a useful alternative for tonsil surgery.
Massive Hematuria after Transurethral Resection of the Prostate: Management by Intra-Arterial Embolization
Authors: Barbieri Antonio , Simonazzi Marta , Marcato Carla , Larini Pietro , Barbagallo Maria , Frattini Antonio , Cortellini Pietro
Published: April 2003

A case of severe hemorrhage after TURP leading to hypovolemic shock and its successful management by superselective unilateral arterial embolization is described. The authors conclude that arterial embolization is a safe and effective procedure for severe prostatic hemorrhage that may be performed in selected cases when conservative means or fulguration of the prostatic fossa have failed to achieve the control of the bleeding. Adequate selection of the patients, correction of any underlying coagulation defects and a proper resection technique are surely the most important issues in preventing any postoperative bleeding.
Drug Scene in the Czech Republic and Slovakia during the Period of Transformation
Authors: Csémy Ladislav , Kubička Luděk , Nociar Alojz
Published: April 2003

The article describes the development of drug-related problems in the context of the rapid sociopolitical and economic changes in the Czech Republic and the Slovak Republic. The period of the last decade is marked by an increase in drug use in both countries; 17% of adults in the Czech Republic and 12% of the Slovaks report lifetime drug use. The respective figures are even higher for the population of adolescents. According to the data from the ESPAD survey carried out in 1999, 35% of young Czechs and 19% of young Slovaks used marijuana. Metamphetamine is the most misused substance among problem drug users in the Czech Republic, and heroin dominates in Slovakia. The response of the society to social and health problems caused by drugs is discussed in the following areas: institutional differentiation, political coordination and legislative development. The need for further social research is stressed.
Therapeutic Drug Monitoring of Lamotrigine in Patients Suffering from Resistant Partial Seizures
Authors: Benetello Pierpaola , Furlanut Marco , Baraldo Massimo , Tonon Agnese , Furlanut Mario
Published: April 2003

Sixty patients, all potential candidates for ongoing lamotrigine (LTG) treatment as add-on therapy for resistant partial seizures and receiving carbamazepine (CBZ) and/or valproate (VPA) treatment, were submitted to therapeutic drug monitoring (TDM). The aim was to evaluate the possible relation between serum levels and the clinical effect of LTG, to verify whether CNS toxicity has to be considered the result of a pharmacokinetic or a pharmacodynamic interaction with CBZ, and to investigate whether possible changes in the clinical response during long-term treatment are dependent on LTG serum level variations. Sixteen patients achieved complete control, 26 a ≧50% reduction in seizures, the remainder did not respond. Mean LTG serum concentrations were higher in responders than in nonresponders, the difference being statistically insignificant. The best results were observed in VPA-cotreated patients with the highest LTG blood levels. CNS toxicity occurred after giving LTG to subjects who subsequently developed the highest LTG concentrations, whereas CNS toxicity seemed unrelated to CBZ and CBZ-epoxide serum concentrations. No decrease in LTG, CBZ and VPA serum levels was observed even in patients showing a reduction in the response during long-term treatment.
Increased Detection of 14-3-3 Protein in Cerebrospinal Fluid in Sporadic Creutzfeldt-Jakob Disease during the Disease Course
Authors: Giraud Pierric , Biacabe Anne-Gaëlle , Chazot Guy , Later Roger , Joyeux Olivier , Moene Yves , Perret-Liaudet Armand
Published: April 2003

Diagnosis of Creutzfeldt-Jakob Disease (CJD) is based on neurological signs associated with characteristic electroencephalographic activity or detection of 14-3-3 protein in cerebrospinal fluid. However, the time course of 14-3-3 protein release during sporadic CJD is unknown. We report two observations in which the level of the detected 14-3-3 protein increased significantly with time. These preliminary cases suggest that there may be an increased release of 14-3-3 protein during the course of CJD as already proven for iatrogenic CJD.
Current Status of HER2 Testing
Authors: Di Leo Angelo , Dowsett Mitch , Horten Bruce , Penault-Llorca Frédérique
Published: April 2003

HER2 gene amplification and receptor overexpression by tumors seems to be associated with poorer prognosis and may be predictive of response to certain anticancer therapies. Furthermore, and paramount to the clinician and patient, a positive HER2 status is a prerequisite eligibility requirement for Herceptin® (trastuzumab) therapy in women with metastatic breast cancer. As a consequence, issues relating to accurate and reliable laboratory assessment of HER2 status are a matter of significant debate to pathologists and oncologists. Out of a wide range of techniques that have been used in research for the detection of HER2 status, two technologies are now predominant in the routine clinical pathology laboratory: determination of HER2 protein overexpression by immunohistochemistry (IHC) and HER2 gene amplification by fluorescence in-situ hybridization (FISH). This article discusses some of the recent experiences, guidelines, and opinions of pathologists and clinicians concerning aspects of HER2 testing with respect to when to test (at initial diagnosis or pretreatment), the relative advantages/disadvantages of IHC and FISH, and where to test (local or centralized laboratories).
Transfection of p27Kip1 Threonine Residue 187 Mutant Type Gene, Which Is Not Influenced by Ubiquitin-Mediated Degradation, Induces Cell Cycle Arrest in Oral Squamous Cell Carcinoma Cells
Authors: Kudo Yasusei , Kitajima Shojiro , Sato Sunao , Ogawa Ikuko , Miyauchi Mutsumi , Takata Takashi
Published: April 2003

Objective: It is well known that reduction of the cyclin-dependent kinase inhibitor p27Kip1 protein correlates with the malignant behavior of various cancers including oral squamous cell carcinoma (OSCC). The loss of p27Kip1 protein is suggested to be due to the enhancement of its posttranslational degradation. In the present study, to evaluate the effects of p27Kip1 transfection on the cell cycle, we transfected OSCC cell lines with a high activity of p27Kip1 degradation with p27Kip1 threonine 187-to-alanine (T187A) mutant gene, which is not influenced by ubiquitin-mediated degradation, as well as with wild type gene. Methods: We transfected p27Kip1 T187A mutant and wild type gene into OSCC cell lines (HSC2 and HSC3) by using an ecdysone-inducible gene expression system. Results: After treatment with ponasterone A, we could find an induction of both p27Kip1 wild type and T187A mutant protein. Both wild type and T187A mutant protein induced by 5 µM ponasterone A inhibited cell growth and increased cell number at the G1 phase. After treatment with 1 µM ponasterone A, ectopic p27Kip1 protein was degraded in wild type clones, but not in T187A mutant clones. Moreover, transfection of the T187A mutant gene was more effective in inhibiting cell growth even by induction of a small amount of protein. Conclusion: We suggest that the transfection of the p27Kip1 T187A mutant gene can be a modality of cancer gene therapy for OSCC.
Clinicopathological Significance of Human Macrophage Metalloelastase Expression in Esophageal Squamous Cell Carcinoma
Authors: Ding Yongzeng , Shimada Yutaka , Gorrin-Rivas Manuel J. , Itami Atsushi , Li Zhigang , Hong Tao , Maeda Masato , Komoto Izumi , Kawabe Atsushi , Kaganoi Junichi , Imamura Masayuki
Published: April 2003

Objective: Human macrophage metalloelastase is referred to as matrix metalloproteinase (MMP-12), its function in tumors is contradictory. The current study was undertaken to investigate the role of MMP-12 in esophageal squamous cell carcinoma (SCC). Patients and Methods: We analyzed the levels of MMP-12 mRNA expression in 67 patients with primary esophageal SCC by Northern blot analysis and the tissues were subjected to in situ hybridization analysis for MMP-12. Immunohistochemical staining was performed to detect the macrophages infiltrated in esophageal SCCs. Results: MMP-12 mRNA was detected in 27 of 67 esophageal SCC samples by Northern blot analysis. In situ hybridization and immunohistochemical staining revealed that MMP-12 mRNA signals are located mainly in tumor cells. The frequency of lymph node metastasis was significantly higher in the MMP-12-positive (MMP-12(+)) subgroup than MMP-12-negative (MMP-12(–)) subgroup (p < 0.05); furthermore, invasion was significantly deeper in the MMP- 12(+) subgroup than in the MMP-12(–) subgroup (p < 0.01). MMP-12 mRNA was inversely correlated with prognosis (p < 0.05). However, Cox multivariate analysis revealed that upregulation of MMP-12 was not related to prognosis. Conclusions: MMP-12 gene expression was associated with the progression of esophageal SCC; however, it was not an independent prognostic factor.
Exclusion in Girls' Peer Groups: Ethnographic Analysis of Language Practices on the Playground
Authors: Harness Goodwin Marjorie
Published: April 2003

Many of our models of female behavior are the legacy of a ‘two cultures’ perspective on moral development and have investigated children''s reasoning about moral situations rather than moral action itself. By examining the practices that make up the life world of a particular social group we can investigate how morality is lodged within the actions and stances that children take up in interaction with their peers. Forms of social exclusion in girls'' groups call into question the notion that girls are fundamentally interested in cooperative interaction and a morality based on principles of relatedness, care, and equity. The argument is based on ethnographic study of a girls'' peer group of mixed ethnicities and social classes in an elementary school in Southern California carried out over a three-year period.
Axon Guidance and the Formation of Specific Connections in the Hippocampus
Authors: Heimrich Bernd , Vogt Johannes , Simbürger Eva , Skutella Thomas , Glumm Robert
Published: April 2003

Pathfinding by growing axons towards their appropriate targets is an essential step prior to the formation of specific synaptic connections. Diffusible and membrane-bound molecules are known to exert either a chemoattractive or chemorepellent function on outgrowing axons during the sensitive period of axonal pathfinding. In the hippocampus, extrinsic and intrinsic afferents terminate in a non-overlapping fashion in the various hippocampal laminae. Recent studies using in vitro techniques and knockout animals provide evidence for guiding cues during the development of the hippocampus. These signals are expressed in a well-defined spatio-temporal pattern, indicating their important role for the establishment of the typical layer-specific termination of afferents in the hippocampus. Among the secreted molecules, netrin 1 is specifically involved in the formation of crossed projections in the CNS. Depletion of this gene prevents commissural fibres from crossing the midline towards the developing contralateral hippocampus. Moreover, the altered termination of hippocampal afferents in the dentate gyrus suggests an additional role for netrin 1 in target recognition.
Discrete Placental Dysfunction: The Overlooked Player in Prenatal Roots of Neuropsychiatric Diseases?
Authors: Schmitz Christoph , Frank Hans-Georg
Published: April 2003

Prenatal complications and damaging environmental influences during pregnancy are known to be connected to the risk for a variety of neuropsychiatric diseases such as schizophrenia, autism, and attention deficit hyperactivity disorder. However, uniform mechanisms of direct fetotoxic influences could not be shown so far. Recently, maternal preeclampsia has been found to be a risk factor for schizophrenia in the offspring. As preeclampsia is primarily a placental disease, this finding may serve as a starting point to consider discrete placental dysfunction in general as an important contribution to the etiopathogenesis of several neuropsychiatric diseases. Here, we briefly review the current knowledge concerning links between prenatal conditions, genetic factors, and disturbed placental development, as well as between prenatal conditions, genetic factors, and the etiopathogenesis of several neuropsychiatric diseases. Furthermore, interrelations between disturbed placental development and the etiopathogenesis of these neuropsychiatric diseases are discussed. It is shown that disturbed placental development and the etiopathogenesis of several neuropsychiatric diseases show a variety of amazing similarities and interrelations. Therefore, we hypothesize that disturbances of placental development and maturation form a crucial and overlooked link between genetic predisposition, damaging environmental influences during pregnancy and the etiopathogenesis of several neuropsychiatric diseases, ultimately due to discrete abnormalities of uteroplacental and/or fetoplacental blood flow. Prospects and limitations of testing this hypothesis in human beings and in animal models are discussed. It is suggested that confirmation of this hypothesis will establish a new basis for research on prenatal roots of several neuropsychiatric diseases, with new avenues to effective primary prevention of these diseases by therapeutic intervention already during pregnancy.
Laparoscopic Surgery for the Management of Ovarian Endometrioma
Authors: Yoshida Souichi , Harada Tasuku , Iwabe Tomio , Terakawa Naoki
Published: April 2003

The purpose of this study was to evaluate the effects of laparoscopic surgery on the symptoms associated with ovarian endometrioma. We also examined serum IL-6 concentrations in patients with endometrioma. Ninety-two patients who underwent laparoscopic surgery for ovarian endometrioma were enrolled in this study. The mean duration of follow-up was 27.6 months. Transvaginal ultrasound examinations revealed a recurrence of endometrioma in 13% of the cases. We evaluated the severity of dysmenorrhea using a 0–3-point verbal rating scale, and found that the dysmenorrhea score was statistically improved after the operation. Follicular growth was preserved in 94%, and the pregnancy rate was 43%. We measured serum IL-6 concentrations in 14 patients with ovarian endometrioma and 4 patients with benign gynecologic disease without endometriosis. IL-6 was significantly higher in patients with endometrioma than in those without endometriosis at the time of diagnosis. The mean serum IL-6 concentration significantly decreased after the operation. In conclusion, laparoscopic surgery is effective for alleviating pain and preserving fertility in patients with endometrioma. Measurements of serum IL-6 concentrations may be useful for the management of endometrioma.
Impact of Burn Size and Initial Serum Albumin Level on Acute Renal Failure Occurring in Major Burn
Authors: Kim Gheun-Ho , Oh Kook Hwan , Yoon Jong Woo , Koo Ja-Ryong , Kim Hyung Jik , Chae Dong-Wan , Noh Jung Woo , Kim Jong Hyun , Park Yoon Kyu
Published: April 2003

Background: Acute renal failure (ARF) is not a rare occurrence in severe burns and is an important complication leading to an increase in mortality. The severity of the burn is largely determined by the burn size, and severe burns are likely to cause enough loss of extracellular fluid and albumin from plasma volume to produce shock and hypoalbuminemia. Hypothesis: We hypothesized that initial serum albumin level may be useful as an indicator of prognosis and severity of injury in burned patients. Methods: The clinical characteristics of 147 adult patients with second- and third-degree burns covering 30% or more of their body surface area were analyzed retrospectively. Logistic regression was used to estimate the relative risks of ARF and mortality associated with the larger burn size and the lower serum albumin level at admission. Results: Mean burned body surface was 60.0 ± 21.8% (range 30–100%). Twenty-eight (19.0%) out of 147 patients experienced ARF, defined as a serum creatinine ≧2 mg/dl, during the admission. The patients with ARF had larger burn size (79.5 ± 15.4 vs. 55.3 ± 20.5%, p < 0.0001) and lower serum albumin concentration at admission (1.92 ± 0.66 vs. 2.48 ± 0.82 g/dl, p < 0.0005) compared with those without ARF. All patients with ARF expired, whereas 29.4% (35/119) of the patients without ARF died. The burn size ≧65% was associated with a risk of ARF that was 9.9 times and with a risk of death that was 14.2 times as high as that for the burn size <65%. The initial serum albumin level <2.5 g/dl was associated with a risk of death that was 2.7 times as high as that for the initial serum albumin level ≧2.5 g/dl. Conclusions: When major burns are complicated by ARF, the mortality rate increases significantly. Burn size is an independent predictor of ARF occurring in major burns. Initially depressed serum albumin level is associated with an increase in mortality in the major burn patients.
Human Paraoxonase1 Gene Polymorphisms and the Risk of Coronary Heart Disease: A Community-Based Study
Authors: Watzinger N. , Schmidt H. , Schumacher M. , Schmidt R. , Eber B. , Fruhwald F.M. , Zweiker R. , Kostner G.M. , Klein W.
Published: April 2003

Published data on the association between paraoxonase1 (PON1) polymorphisms and coronary heart disease (CHD) have yielded controversial results. The objective of this study was to determine the possible relationship between the two human PON1 amino acid variants, the Leu55Met and the Gln192Arg polymorphism, and the risk of CHD in a community-dwelling cohort of European ancestry. PON1 genotypes of 152 women and 151 men out of 1,998 randomly selected individuals aged 44–75 years were determined by polymerase chain reaction-based restriction enzyme digestion. Study participants underwent cardiological examination including a structured clinical interview, resting ECG, exercise testing and echocardiography. The diagnosis of CHD was based on history and/or appropriate findings during cardiac examination. Evidence for CHD was found in 43 (14.2%) study participants. The Leu/Leu (LL), Leu/Met (LM) and Met/Met (MM) genotypes at position 55 were noted in 131 (43.2%), 128 (42.2%) and 44 (14.5%) subjects; the Gln/Gln (QQ), Gln/Arg (QR) and Arg/Arg (RR) genotypes at codon 192 occurred in 167 (55.1%), 118 (38.9%) and 18 (5.9%) individuals, respectively. Homozygosity for the 55L-allele was significantly associated with CHD (p = 0.02), while the Gln192Arg polymorphism had no effect (p = 0.16). Logistic regression analysis demonstrated age (odds ratio 1.06/year), smoking (odds ratio 2.86), HDL cholesterol (odds ratio 0.94/mg/dl) and the paraoxonase LL genotype (odds ratio 2.25) to be significant predictors of CHD. These data suggest that the paraoxonase LL genotype at position 55 may present a risk factor for CHD.
Transcultural Genetic Counselling in the UK
Authors: Karbani G.A.
Published: April 2003

Objectives: Transcultural genetic counselling is not about being an expert on any given culture, rather it is a way of thinking about patients that acknowledges and values culture. Transcultural genetic counselling aims to provide a service, and to focus attention on aspects of the genetic counselling process which can easily be overlooked as we strive to improve the ways in which complex genetic information is delivered to all of the cultural groups we seek to serve. Subjects and Methods: Two specific examples to illustrate particular problems will be given: (1) a UK Pakistani family with a lethal skin disorder and Down syndrome diagnosed prenatally, and (2) a Caucasian family who presented with a twin pregnancy and a history of infertility. Results and Discussion: This article examines the way in which patients perceive and try to make sense of genetic diseases, the information given, and the course of action taken which may play a part in this process. We are also interested in how clinicians imagine the manner in which different cultures may influence the way they interact with patients. Genetic counsellors who view these differences as positive attributes will be most likely to meet, and resolve, the challenges that arise in transcultural genetic counselling.
Multiple Palmar Epidermoid Cysts
Authors: Yokogawa Maki , Egawa Kiyofumi , Dabanaka Kumi , Wada Emi , Miyoshi Ken , Ikeda Mitsunori , Honda Yumi , Kitasato Hidero , Kodama Hajime
Published: April 2003

Implantation of epidermal fragments into the dermis has been pointed out as the cause of common epidermal cysts. However, some palmoplantar epidermoid cysts have been reported to be caused by human papillomavirus (HPV) infection or to be derived from eccrine ducts. A 65-year-old left-handed woman presented with extraordinary multiple epidermoid cysts on the palm and volar aspect of the fingers of her left hand. HPV infection was not detected by immunohistochemistry, in situ hybridization and polymerase chain reaction. Histological investigation revealed syringeal structures within the cyst wall and in the cyst cavity. Carcinoembryonic antigen was observed in these syringeal structures but was not specifically stained in the cyst wall cells by immunohistochemistry. The cytokeratin composition of the cyst wall cells was similar to that of the nonadnexal epidermis.
Structure and Function of Human Stratum corneum under Deformation
Authors: Lévêque Jean-Luc , Hallégot Philippe , Doucet Jean , Piérard Gérald
Published: April 2003

Background: The stratum corneum (SC) has an important barrier function. The effect of a mechanical stress applied to the SC is controversial on this important physiological parameter. Objective and Methods: To assess both in vitro and in vivo the structure and function of human SC submitted to controlled strains, we measured the transepidermal water loss (TEWL), in vivo, on human skin submitted to controlled strains ranging from 0 to 20% extension imposed by a Densi-score device. We also looked at the structure of the SC by means of X-ray diffraction and transmission electron microscopy. Results: Transmission electron microscopy and X-ray diffraction analysis were performed on harvested and stretched human SC. TEWL was not significantly influenced by the relative deformation applied to the skin. At high strain (60%) imposed in vitro to the SC, lipid bilayers and corneosomes were detached from corneocytes. Only rare corneosomes showed internal disruption. X-ray analysis did not reveal modifications in the supramolecular organization of intercellular lipids while stretching the SC. Conclusion: Submitting human SC to an extension force up to 20% elongation does not significantly alter the barrier function.
Characterisation of Infant Food Modifications in the European Union
Authors: Koletzko Berthold , Ashwell Margaret , Beck Birgit , Bronner Andrée , Mathioudakis Basil
Published: April 2003

Improvements in the understanding of human milk composition, in dietetic effects on physiological outcomes in infants, and in food technology have lead to modifications in infant formulas and other dietetic products for infants. In Europe, new ingredients may be added to infant formula and follow-on formulas if their suitability for particular use by infants from birth has been established by generally accepted scientific data. However, there is uncertainty as to the nature of the evaluation needed to evaluate whether modifications in dietetic products for infants can be regarded as suitable and safe. Moreover, there is no agreement on the nature of evidence required to justify the scientific validity of potential effects on infant health and well-being, which might provide the basis for the communication of such effects to health professionals and consumers. Therefore, a scientific workshop was held under the auspices of the Child Health Foundation, Munich, Germany, and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition to discuss issues arising in this area among participants representing academia, infant food industry, consumer organisations, the European Commission, and food regulatory bodies of some European Union member states. This article summarises the outcomes of this workshop. The participants agreed on general concepts of evaluation of innovations and on establishing evidence for benefits, but felt that further discussion would be necessary on the principles and practicalities involved in setting up a central register of clinical trials and of a central repository of trial data.
Validation of Additional Domains in Activities of Daily Living, Culturally Appropriate for Muslims
Authors: Margolis Stephen A. , Carter Tom , Dunn Earl V. , Reed Richard L.
Published: April 2003

Background: Measurement of activities of daily living (ADL) is an integral part of geriatric care. Prayer is a central part of the life of practicing Muslims. Objectives: To validate additional domains of ADL based on the functional capacity of Muslims to perform prayer, a culturally appropriate measure for those practicing the Islamic faith. Methods: Functional capacity was measured using 2 scales: an 8-domain scale (ADL-8) and a 3-component domain scale assessing the key components of Islamic prayer: washing for prayer, physical motion during prayer and the words spoken. A randomly selected sample of 132 community-based practicing Muslim people from Arabic-speaking countries, aged 65+ years were assessed. Results: The mean age ± standard deviation was 72.6 ± 7.0 with a female to male ratio of 0.97. The correlation between the summation scores for the prayer ADL and the ADL-8 was r = 0.922 (p < 0.001), while correlation with prayer ADL and each of the 8 components in the ADL-8 ranged from r = 0.806 (p < 0.001) to r = 0.906 (p < 0.001). There was a high level of construct validity with the reliability coefficient for the 3 components of the prayer ADL being 0.933 with a standardized item α of 0.935, with a range of 0.746–0.896 for the subscales. Conclusion: The prayer ADL domains provide an additional valid, short, simple and culturally orientated functional assessment for those of the Islamic faith.
Total Parenteral Nutrition in Bone Marrow Transplant: What Is the Appropriate Energy Level?
Authors: Forchielli M.L. , Azzi N. , Cadranel S. , Paolucci G.
Published: April 2003

Objectives: Total parenteral nutrition (TPN), recommended during bone-marrow transplant (BMT), is often withheld following complications. We aim to determine the effective amount of energy supplied and its short-term effects in children requiring BMT. Methods: Twenty children (11 males, 9 females, mean age 8 years, range 1–18 years) receiving 13 allogenic and 7 autologous BMT for malignant (13) and nonmalignant (7) diseases, were retrospectively evaluated for energy/protein intakes, weight changes, time to engraftment and on TPN, occurrence of complications, and metabolic abnormalities. Results: Each child received approximately 72% of the prescribed calories, an average of 0.87 ± 0.2 × basal-metabolic rate, 1.14 ± 0.4 g protein/kg/day, and 176 ± 34:1 nonprotein calories:nitrogen ratio. Body weight improved during the 35 days (range 14–62) of TPN, with loss thereafter. Engraftment occurred in 20 ± 7.5 days. Caloric intake and time to engraftment were related (p = 0.002). Ten central-venous-line and 12 gastrointestinal infections occurred. Among laboratory abnormalities, liver function tests resulted temporarily altered in 10 patients, and permanently in 1 child with cholestasis. Eight children developed graft-versus-host disease. Five died of cancer. Conclusions: The energy supplied with TPN in BMT is less than expected and approximately covers the BMR with mixed effects. Energy intake needs to be calibrated during TPN and adjusted during feeding resumption to expedite recovery.
Combination Therapy with Granisetron, Methylprednisolone and Droperidol as an Antiemetic Prophylaxis in CDDP-Induced Delayed Emesis for Gynecologic Cancer
Authors: Sagae Satoru , Ishioka Shin-ichi , Fukunaka Noriyoshi , Terasawa Katsuhiko , Kobayashi Kanji , Sugimura Masaki , Nishioka Yoshihiro , Kudo Ryuichi , Minami Masaru
Published: April 2003

Objective: To better control both acute and delayed emesis resulting from cisplatin(CDDP)-based chemotherapy for gynecological malignancies, we designed a ‘cocktail therapy’ (CCT) using granisetron (GRN) in combination with methylprednisolone (MPD) plus droperidol (DRP). Methods: Two crossover clinical trials were carried out to compare the efficacy and safety of (a) GRN alone (3 mg/patient) with that of GRN, MPD (250 mg/patient) and DRP (0.5 ml/patient) in 42 patients (CCT group) and (b) GRN and MPD (CMB group) with that of the CCT group in 27 patients during the first 7 days of chemotherapy, independent of the weight/body surface of the patients. One of these regimens was administered intravenously for the first 3 days of chemotherapy, in case of failure for a maximum of 5 days. Results: For acute emesis, complete protection from nausea and vomiting by the end of the 1st day was achieved in 64.3% receiving GRN and in 92.9% receiving CCT (p < 0.01). For delayed emesis, complete protection was best achieved in CCT on days 2–3, showing statistical significance compared to GRN treatment (p < 0.01). Comparing the three kinds of treatment during 7 days, the lowest protection was 38.1% in the GRN group, 51.9% in the CMB group and 72.5% in the CCT group, especially on days 2 or 3. Conclusions: The CCT combination is useful for the control of delayed and/or anticipatory emesis resulting from CDDP-based chemotherapy for women with gynecological malignancies.