bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Deep Venous Thrombosis Prophylaxis in the Medical Intensive Care Unit
Authors: Khouli Hassan , Shapiro Janet , Pham Vinh Philip , Arfaei Asghar , Esan Olanrewaju , Jean Raymonde , Homel Peter
Published: November 2006

The purpose of this study was to determine the incidence of deep venous thrombosis in medical intensive care unit patients receiving deep venous thrombosis prophylaxis. This was a prospective cohort study of 141 consecutive adult patients anticipated to remain in the medical intensive care unit for >48 hours. Deep venous thrombosis prophylaxis was provided using subcutaneous unfractionated heparin or a sequential compression device according to risk-stratified protocol. Compression ultrasound was performed. Fourteen patients (9.9%) developed deep venous thrombosis on follow-up studies. Incidence of deep venous thrombosis was 7.9% per person year (95% confidence interval, 4.8-12.8). Two of 14 developed pulmonary embolism. Eight patients required full anticoagulation with intravenous heparin or coumadin. In-hospital mortality was similar in both groups. Patients with deep venous thrombosis had a statistically higher risk of pulmonary embolism: 14.2% (95% confidence interval, 2.0-43.0) versus 0.0% (95% confidence interval, 0-3; P= .009). Incidence of deep venous thrombosis is high in medical intensive care unit patients receiving standard prophylaxis. Adherence to strict deep venous thrombosis prophylaxis protocol and exploration of other prophylaxis regimens should be pursued.
Use of Molecular Adsorbent Recirculating System in Acute Liver Failure Attributable to Dengue Hemorrhagic Fever
Authors: Penafiel Alvin , Devanand Anantham , Tan Han Khim , Eng Philip
Published: November 2006

Fulminant liver failure is an uncommon but life-threatening complication of severe dengue infection. Molecular adsorbent recirculating system (MARS), which reverses hepatic encephalopathy, is an emerging important element in the armamentarium of organ support in the intensive care unit in patients suffering from acute liver failure. We report an intensive care unit case of fulminant liver failure secondary to dengue hemorrhagic fever, which was supported with MARS. MARS led to rapid reversal of biochemical profile and encephalopathy, resulting in early extubation and intensive care unit discharge.
Traditional and non-traditional risk factors contribute to the development of accelerated atherosclerosis in patients with systemic lupus erythematosus
Authors: De Leeuw K , Freire B , Smit A J , Bootsma H , Kallenberg C G , Bijl M
Published: November 2006

To determine risk factors of accelerated atherosclerosis in patients with systemic lupus erythematosus (SLE), 72 patients with inactive disease and 36 ageand sex-matched controls were included. The intima-media thickness (IMT) of the common carotid artery was determined by ultrasound. Traditional risk factors and disease-related factors were recorded. Cardiovascular risk was estimated using SCORE (systematic coronary risk evaluation). Markers of inflammation, endothelial activation and vascular remodelling (matrix metalloproteinases (MMP-3, MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1)) were determined.

IMT was increased in patients (0.67 mm 0.13 versus 0.61 mm 0.11, P 0.05). Prevalence of hypertension (33% versus 6%, P 0.001), SCORE (2.2 (1.7–4.2) versus 1.7 (1.3–2.1), P 0.001), as well as parameters of inflammation (CRP 1.8 (0.6–5.8) mg/L versus 0.6 (0.2–1.0) mg/L, P 0.001) and endothelial activation (VCAM-1 505 (389–683) ng/mL versus 374 (322–427) ng/mL, P 0.001) and von Willebrand factor (138 (59–208)% versus 48 (24–92)%, P 0.001), were increased in patients. Vascular remodelling was altered: MMP-3 and TIMP-1 were increased (18 (10–29) ng/mL versus 8 (5–11) ng/mL, P 0.001, and 275 (216–352) ng/mL versus 230 (197–268) ng/mL, P 0.001, respectively), and MMP-9 was decreased in SLE (266 (147–412) ng/mL versus 348 (226–530) ng/mL, P 0.05).

Univariate analyses revealed that in patients IMT was associated with age, systolic blood pressure, SCORE and disease duration. In multivariate analysis, age and SCORE were independent predictors of IMT.

In conclusion, SLE patients have an increased IMT, which is associated with traditional risk factors. Non-traditional risk factors, such as endothelial activation, altered vascular remodelling and disease duration, might play an additional role.
Successful treatment of cold agglutinin disease with anti-CD20 antibody (rituximab) in a patient with systemic lupus erythematosus
Authors: Kotani T , Takeuchi T , Kawasaki Y , Hirano S , Tabushi Y , Kagitani M , Makino S , Hanafusa T
Published: November 2006

Cold agglutinin disease (CAD) is a rare cause of anaemia in patients with systemic lupus erythematosus (SLE). CAD is usually refractory to glucocorticosteroid, and other immunosuppressive and/or cytotoxic therapies. We report the case of a 55-years old woman with SLE and CAD that did not respond to high-dose methylprednisolone, cyclosporin A, and double filtration plasma pheresis. Because several recent case reports and studies have indicated promising results of rituximab treatment for CAD and for SLE, rituximab was given weekly at 375 mg/m2 in two doses. The rituximab was well tolerated, and there were no adverse effects. The hemolysis and SLE improved markedly, and the patient remained disease free eight months later. This is the first report of successful rituximab treatment of CAD in a patient with SLE. We conclude that rituximab is worth trying in such patients if they fail to respond to conventional treatment.
Transcultural Dynamics in the Classroom
Authors: Gabb Diane
Published: November 2006

In every classroom where interactivity is part of the learning process, teachers become facilitators. Facilitating in the multicultural classroom presents special challenges for teachers in overcoming psychosocial problems that may be present when people from different cultural and linguistic backgrounds interact. Students represent different cohorts: citizens, permanent residents, and international student sojourners, the latter required to return home on completion of their studies. Meeting students’ long-term needs also requires a curriculum with international relevance and the skills required for globalisation. At the heart of facilitating multicultural education, there remain the importance or otherwise placed on classroom dynamics and whether teaching staff are equipped to manage these to enhance individual well-being, learner satisfaction, and learner effectiveness. This article addresses some of the cultural and psychosocial dynamics found in transcultural interactions in the classroom that may make or break the learning environment, particularly in the tutorial where discussion forms the means of instruction.
Qualitative Health Research in the Era of Evidence-Based Practice
Authors: Grypdonck Maria H. F.
Published: November 2006

Evidence-based health care (EBHC) sets the tone in health care and health care research nowadays. Qualitative health researchers have to position themselves in a world that is dominated by it. The popularity of EBHC is not due to the rationality of its tenets. In this article, the author addresses major problems in EBHC. Qualitative research is important for providing the understanding that is necessary to apply findings from quantitative research properly and safely. Basic studies about the human experience in illness and regarding human behavior and meaning in general remain of great value, even in the era of EBHC. Qualitative research also plays an important role in developing scholarship.
Draw-and-Tell Conversations With Children About Fear
Authors: Driessnack Martha
Published: November 2006

As the demand to include children in research increases, researchers are discovering that few methods exist that are specifically designed with children in mind. In this article, the author introduces the draw-and-tell conversation as a child-centered and child-directed approach to data collection and illustrates its use in a qualitative study of children’s fear experiences. Twenty-two children, ages 7 and 8 years, participated. Sequential mixed qualitative analyses suggest that children’s draw-and-tell conversations provide new insight into how children describe and experience fear and highlight the unique nature of information accessed when using this approach.
An Examination of Temporal Variables and Relationship Quality on Promotability Ratings
Authors: Harris Kenneth J. , Kacmar K. Michele , Carlson Dawn S.
Published: November 2006

Previous research has shown the positive impact of relationship quality on promotability ratings and inconsistent results for temporal variables and these same ratings. The authors integrated these findings by examining the joint impact of supervisor-subordinate relationship quality and temporal variables (measured with three types of tenure: relationship, job, and organizational) on supervisor promotability ratings. Using a matched set of 180 supervisor-subordinate dyads, the results supported the interactive effects of time as measured by organizational and relational tenure with relationship quality, whereas job tenure had no impact. Furthermore, the findings suggested that relationship tenure had the strongest impact on the relationship quality-promotability relationship. Implications and directions for future research are discussed.
Adult Science Learning from Local Television Newscasts
Authors: Miller Jon D. , Augenbraun Eliene , Schulhof Julia , Kimmel Linda G.
Published: October 2006

American adults learn about science and health from numerous sources including television. The Pew studies demonstrate that half of American adults watch a local television news show three times a week or more, making local television news the most widely used news medium. This study examines the impact of a program to increase the use of science and health stories in local newscasts. The results show substantial story recall and information retention. The analysis suggests that science and health stories in local television newscasts may either enhance viewers’ existing science/health schemas or foster the development of new schemas for less well-known constructs.
Success Through Teamwork in the Home Health Setting: The Role of Occupational Therapy
Authors: Toto Pamela E.
Published: November 2006

Since 2002 and the introduction of outcome-based quality improvement reports by the Centers for Medicare and Medicaid Services, all home health professionals have recognized a heightened importance in the measurement of change in the daily functioning of patients from onset to discharge of the agency's service. As health care professionals whose expertise focuses on safe and meaningful participation in occupations of daily living, occupational therapists can play a key role on the inter-disciplinary team in a home health care agency. This article outlines the potential benefits of expanding the role of the occupational therapist as an interdisciplinary team member and explores challenges and solutions to maximize collaborative opportunities with the occupational therapy practitioner in home health.
Preventing Falls in Older Adults: A Multifactorial Approach
Authors: Weinstein Marcie , Booth Japhia
Published: November 2006

As people age they become increasingly at risk for falling with the potential for serious injury. With the boom of individuals over age 65 enjoying an increasing life expectancy, falls will be an increasingly important health care issue. Research into fall prevention and treatment emphasizes a multi-factorial approach. This approach involves carrying out a comprehensive assessment of the whole person and surrounding environment, determining factors that create risk, and then treating all of these factors. The approach is effective because it specifically designs an intervention to target each of the factors that puts a person at risk for falling. To maximize that effectiveness, a multidisciplinary team is employed that draws on the expertise and specific skill sets of each team member. By making people aware of their increased risk for falling and providing strategies for prevention, the team can help individuals more safely remain in their homes and communities.
Trauma injuries sustained by cyclists
Authors: Kloss F R , Tuli T , Haechl O , Gassner R
Published: October 2006

The aim of this article is to review the pertinent literature and to analyse our own data on facial trauma related to bicycling and mountain-biking. This article focuses on the mechanisms and the variety of bicycle related injuries and addresses the advantages of wearing protection clothes.

Within the world of bicycling, the popularity of mountain-biking has increased the most dramatically. The main risk factors for the growing number of bicycle-related injuries are not wearing a helmet, age, male sex, unsafe riding techniques and intoxication. Bikers most commonly collide or fall in daily traffic whereas mountain-bikers get hurt whilst descending. The most common types of injury apart from superficial lesions are dentoalveolar trauma and facial fractures. Wearing protective clothing such as a helmet is demonstrably beneficial and so we suggest that the obligatory use of protective wear should be introduced. For a better insight into overall cycling-related trauma further research will be required.
Monitoring the injured patient
Authors: Hulme Jonathan
Published: October 2006

Monitoring of the injured patient is important. It includes clinical assessment, following the ABCDE approach, and the use of instruments found from the prehospital to critical care setting.

Correctly used, these provide important information about the patient's current physiological state and response to treatment plus diagnostic and prognostic implications that are useful to the clinician involved in the care of injured patients.
Third Way/ve
Authors: Genz Stéphanie
Published: October 2006

This article argues that the ‘Third Way’ philosophy that has been adopted by centre-left parties throughout Europe and the United States provides the conceptual framework to analyse contemporary postfeminism and its contentious micro-politics that emerges out of personal and daily gender-based struggles. The notion of a postfeminist micro-politics complicates the critical perception of postfeminism as a depoliticized and anti-feminist backlash and offers a dynamic model of political action that takes into account the multiple agency positions of individuals today. Postfeminism and the politics it endorses differ from emergent political movements such as third wave feminism in that they are not founded on second wave feminist theory and activism. Instead, postfeminist politics adopts a Third Way perspective to reconcile a number of conflicting concerns, from feminist calls for female equality and theoretical debates on anti-essentialism to the consumerist demands of capitalist society. These controversial new junctures are examined by paying particular attention to postfeminism’s female sexual agent who becomes the ‘entrepreneur’ of her own image, buying into standardized femininities while also seeking to resignify their meanings. In particular, the article discusses the paradoxical possibilities of ‘active consumption’ and ‘fashion feminism’ whereby women endeavour to achieve empowerment by exerting their consumer agency and using their bodies as political tools within the parameters of a capitalist economy.
Auguste D
Authors: Page Sean , Fletcher Tracey
Published: November 2006

Auguste D. is regarded as being the first case described by Alois Alzheimer to highlight the disease that would later be named for him. Auguste is described in terms of her illness, of her disturbances and ultimately of her neuro-pathology. In the past 100 years since her death in 1906 there has been almost no attempt to consider her as a person or as a fellow human being outside the context of illness. This article takes a social research approach to place those things we know about the person Auguste and places them in an appropriate social context for a working class woman of Imperial Germany at the close of the 19th century. By doing so her status is raised beyond that of a pitiful victim of disease and we begin to appreciate her lived experience before the onset of dementia.
Predictive Value of Ischemic Lesion Volume Assessed With Magnetic Resonance Imaging for Neurological Deficits and Functional Outcome Poststroke: A Critical Review of the Literature
Authors: Schiemanck S. K. , Kwakkel G. , Post M. W. M. , Prevo A. J. H.
Published: November 2006

Objective. Ischemic lesion volume is assumed to be an important predictor of poststroke neurological deficits and functional outcome. This critical review examines the methodological quality of MRI studies and the predictive value of hemispheric infarct volume for neurological deficits (at body function level) and functional outcome (at activities level).

Methods. Using Medline, PiCarta, and Embase to identify studies, 13 of the 747 identified studies met the authors’ inclusion criteria. Subsequently, studies were tested for adherence to the key methodological criteria for internal, statistical, and external validity. Each criterion was weighted binary, and studies with 6 points or more were judged to be valid for assessing the predictive value of MRI for outcome.

Results. The 13 included studies had several methodological weaknesses with respect to internal validity, and none of them took lesion location into account. Only a few used outcome measures according to the International Classification of Functioning, Disability and Health and followed patients beyond 6 months. Correlation coefficients between MRI lesion volume and outcomes were higher for outcomes defined at body function level (National Institutes of Health Stroke Scale; median 0.67; range: 0.57-0.91) than for those defined at the level of activities (Barthel Index; median -0.49; range: -0.33 to -0.74).

Conclusions. Methodological shortcomings of most studies confound the prognostic value of MRI in predicting stroke outcome, and few studies have focused on functional outcome. Future studies should investigate the added value of MRI volume over clinical neurological variables in predicting functional outcome beyond 6 months poststroke.
The Scale for Contraversive Pushing: A Reliability and Validity Study
Authors: Baccini Marco , Paci Matteo , Rinaldi Lucio A.
Published: November 2006

Objective. Pushing toward the hemiplegic side can interfere with mobility training after stroke. This study estimated the internal consistency, interrater reliability, and validity of the Scale for Contraversive Pushing (SCP).

Methods. Twenty-six patients with recent stroke were diagnosed with pusher behavior (PB). Two testers, randomly selected from 3 other examiners, independently assessed each patient using the SCP on the same day within 3 days of admission for rehabilitation. Cohen kappa coefficient was used to determine the agreement between the clinical and SCP diagnosis. The interrater reliability of the scale was estimated by calculation of the intraclass correlation coefficient. Cronbach’s alpha coefficient and Pearson’s coefficients were used to estimate the internal consistency of the scale and correlations between the subscores and the total score.

Results. The agreement between SCP and clinical diagnosis was very low when the original cutoff criterion for SCP diagnosis was used but was almost perfect with a modified criterion. The interrater reliability was good to excellent with regard both to each sub-score and to the total score. The internal consistency was very high, along with correlations between subscores and total score of the scale.

Conclusions. The results provide support for use of the SCP based on its reliability and validity using a modified cutoff criterion to make a diagnosis of PB.
Expression of the granzyme B inhibitor PI9 predicts outcome in nasal NK/T-cell lymphoma: results of a Western series of 48 patients treated with first-line polychemotherapy within the Groupe d'Etude des Lymphomes de l'Adulte (GELA) trials
Authors: Bossard Céline , Belhadj Karim , Reyes Felix , Martin-Garcia Nadine , Berger Françoise , Kummer Jean Alain , Brière Josette , Baglin Anne-Catherine , Cheze Stéphane , Bosq Jacques , Ribrag Vincent , Gisselbrecht Christian , Mounier Nicolas , Gaulard Philippe
Published: November 2006

Nasal NK/T-cell lymphoma is a rare disease entity with a poor outcome. Expression of antiapoptotic proteins has not been extensively investigated in this entity. Forty-eight patients with nasal T/NK-cell lymphoma who received first-line polychemotherapy (n = 44) or chemoradiotherapy (n = 4) were analyzed for expression of active caspase-3 (aC3), granzyme B protease inhibitor 9 (PI9), and Bcl-2 proteins. Lymphomas were CD3+/CD5−/granzyme B+ and EBV-associated. Median age was 46 years. Stage I/II disease was present in 75% of the cases and an International Prognostic Index (IPI) score less than 1 in 65%. With a median follow-up of 6.3 years, 5-year event-free survival (EFS) and overall survival (OS) rates were 39% and 49%, respectively. Apoptotic index was scored as high in 32% of cases and PI9 expression as positive in 68%, whereas 35% disclosed a high number of aC3+ tumor cells. Univariate analysis showed that absence of PI9 and low apoptotic index were associated with poor outcome, but not aC3 expression nor IPI score. By multivariate analysis, both parameters affected independently EFS (P = .02 and .08, respectively) and OS (P = .009 and .04). In view of its constitutive expression by normal NK cells, it is suggested that loss of PI9 expression in tumor cells may reflect some mechanism associated with progression.
Expiratory flow limitation detected by forced oscillation and negative expiratory pressure
Authors: Dellacà R. L. , Duffy N. , Pompilio P. P. , Aliverti A. , Koulouris N. G. , Pedotti A. , Calverley P. M. A.
Published: November 2006

The within-breath change in reactance (ΔX̄rs) measured by forced oscillation technique (FOT) at 5 Hz reliably detects expiratory flow limitation in chronic obstructive pulmonary disease (COPD). The present study compared this approach to the standard negative expiratory pressure (NEP) method.

In total, 21 COPD patients were studied by applying both techniques to the same breath and in 15 patients the measurements were repeated after bronchodilator. For each patient and condition five NEP tests were performed and independently scored by three operators unaware of the FOT results.

In 180 tests, FOT classified 53.3% as flow limited. On average, the operators scored 27.6% of tests flow limited and 47.6% non-flow limited, but could not score 24.8%. The methods disagreed in 7.9% of cases; in 78% of these the NEP scores differed between operators. Bronchodilation reduced NEP and ΔX̄rsscores, with only the latter achieving significance. Averaging the operators′ NEP scores, a threshold between 24.6–30.8% of tidal volume being flow limited by NEP produced 94% agreement between methods.

In conclusion, when negative expiratory pressure and forced oscillation technique were both available they showed good agreement. As forced oscillation technique is automatic and can measure multiple breaths over long periods, it is suitable for monitoring expiratory flow limitation continuously and identifying patients′ breathing close to the onset of expiratory flow limitation, where intermittent sampling may be unrepresentative.
Eotaxin-2 in sputum cell culture to evaluate asthma inflammation
Authors: Scheicher M. E. , Teixeira M. M. , Cunha F. Q. , Teixeira A. L. , Filho J. T. , Vianna E. O.
Published: November 2006

The aim of the present study was to elucidate whether the culture of cells recovered from induced sputum may represent a suitable model to evaluate cytokine and chemokine production by airway inflammatory cells.

Sputum induction was performed in 21 normal subjects and 30 asthmatic patients. A total of 21 out of the 30 asthmatic patients were taking inhaled corticosteroids, while the remaining nine were steroid-naive asthmatics. The steroid-naive group was evaluated before and after a 14-day treatment with oral prednisone (40 mg·day−1). The supernatant of lysed and centrifuged sputum and the supernatant of sputum cell culture were analysed. Tumour necrosis factor-α, interleukin (IL)-8 (CXCL8), IL-1β, IL-13 and eotaxin-2 (CCL24) concentrations were determined by specific ELISA.

Eotaxin-2 production by cell culture was higher in the asthma group (131±108 pg·mL−1) than in the control group (36±41 pg·mL−1) and treatment with oral corticosteroids eliminated this difference. In addition, reduction of eotaxin-2 levels by corticosteroid treatment was greater in cell culture (81.3% reduction) than in sputum (26.4%). There was correlation between the decrease in eotaxin-2 production and the decrease in blood eosinophil number and between eotaxin-2 and eosinophils in sputum.

Eotaxin-2 may play an important role in asthma and the response to corticosteroid treatment suggests that analysis of sputum cell culture is relevant as an inflammatory parameter.
Noninvasive and invasive evaluation of pulmonary arterial pressure in highlanders
Authors: Kojonazarov B. K. , Imanov B. Z. , Amatov T. A. , Mirrakhimov M. M. , Naeije R. , Wilkins M. R. , Aldashev A. A.
Published: November 2006

The purpose of the present study was to evaluate Doppler echocardiography for the detection of pulmonary hypertension in high-altitude inhabitants.

In total, 60 (55 male) patients aged 18–71 yrs were recruited from an ECG screening programme applied to 1,430 inhabitants living at an altitude of 2,500–3,600 m in Kyrgyzstan. Of these, 44 met ECG criteria for right ventricular hypertrophy. All underwent Doppler echocardiography followed by a cardiac catheterisation within 7 days of arrival in Bishkek (Kyrgyzstan; altitude 760 m). Pulmonary flow acceleration time and the maximum velocity of tricuspid regurgitation were measured.

Sufficient quality tricuspid regurgitant jets were recovered in only 28% of the patients. Therefore, pulmonary artery pressure was estimated from the pulmonary flow acceleration time, which was recovered in 100% of the patients. It was found that 37 (62%) of the patients had pulmonary hypertension on echocardiography. Pulmonary hypertension was confirmed in 29 patients on catheterisation. Pulmonary hypertension was detected with 70% sensitivity and 88% specificity by echocardiography, as compared to 59% sensitivity and 81 % specificity by ECG. The correlation coefficient between echocardiography and catheterisation studies was r2 = 0.78.

It is concluded that a combination of ECG and echocardiography may be useful for screening high-altitude pulmonary hypertension.
Ethnic differences in the time trend of female breast cancer incidence: Singapore, 1968 – 2002
Authors: Sim Xueling , Ali R Ayesha , Wedren Sara , Goh Denise Li-Meng , Tan Chuen-Seng , Reilly Marie , Hall Per , Chia Kee-Seng
Published: November 2006

Background

From 1968 to 2002, Singapore experienced an almost three-fold increase in breast cancer incidence. This increase appeared to be different across the three main ethnic groups: Chinese, Malays and Indians. This paper used age-period-cohort (APC) modelling, to determine the effects of age at diagnosis, calendar period, and birth cohort on breast cancer incidence for each ethnic group.

Methods

This study included all breast cancer cases (n = 15,269) in the three ethnic groups, reported to the Singapore Cancer Registry from 1968 to 2002 between the ages 25 to 79. Age-specific fertility rates from the Department of Statistics were used to explore the role of fertility.

Results

In the 1970s, Indian women had the highest age-standardized breast cancer but by the mid-1980s the highest rates were seen among the Chinese. Remarkable differences were seen in the age-specific incidence rates by ethnic groups. After age 49, the incidence rates for the Chinese and Malays leveled off whereas it continued to rise in the Indians. While our analyses provided some evidence that an age-drift model described the trend seen in the Indians, age-period-cohort model and age-cohort model had the best fit for the Chinese and Malays aged 25 to 79 respectively. Overall, Chinese and Malay women born in later cohorts were at increased risk of developing breast cancer relative to their counterparts in the earlier cohorts. The three ethnic groups experienced similar changes in their fertility in the 1970s, which likely explained much of the increase in their breast cancer incidence but not the ethnic differences. There was a stronger inverse association between total fertility rate and pre-menopausal breast cancer incidence in the Chinese and Malays than the Indians.

Conclusion

The observed dissimilarity among ethnic groups suggests ethnic differences in exposure or response to certain risk factors. It is likely that longer and subtler differences in childbearing trends and other risk factors may further explain these ethnic differences.
Direct and indirect costs of Multiple Sclerosis in Baix Llobregat (Catalonia, Spain), according to disability
Authors: Casado Virginia , Martínez-Yélamos Sergio , Martínez-Yélamos Antonio , Carmona Olga , Alonso Lucia , Romero Lucia , Moral Esther , Gubieras Laura , Arbizu Txomin
Published: November 2006

Background

Multiple sclerosis (MS) is an incurable chronic disease that predominantly affects young adults. It has a high socio-economic impact which increases as disability progresses. An assessment of the real costs of MS may contribute to our knowledge of the disease and to treat it more efficiently. Our objective is to assess the direct and indirect costs of MS from a societal perspective, in patients monitored in our MS Unit (Baix Llobregat, Catalonia) and grouped according to their disability (EDSS).

Methods

We analysed data from 200 MS patients, who answered a questionnaire on resource consumption, employment and economical status. Mean age was 41.6 years, mean EDSS 2.7, 65.5% of patients were female, 79.5% had a relapsing-remitting course, and 67.5% of them were receiving immunomodulatory treatment (IT). Patients were grouped into five EDSS stages. Data from the questionnaires, hospital charts, Catalan Health Service tariffs, and figures from Catalan Institute of Statistics were used to calculate the direct and indirect costs. The cost-of-illness method, and the human capital approach for indirect costs, were applied. Sensitivity analyses were performed to strengthen results.

Results

The mean total annual cost of MS per patient results 24272 euros. This cost varied according to EDSS: 14327 euros (EDSS = 0), 18837 euros (EDSS = 1–3), 27870 euros (EDSS = 3.5–5.5), 41198 euros (EDSS = 6–7) and 52841 euros (EDSS>7.5). When the mean total annual costs was adjusted by the mean % of patients on IT in our Unit (31%) the result was 19589 euros. The key-drivers for direct costs were IT in low EDSS stages, and caregiver costs in high stages. Indirect costs were assessed in terms of the loss of productivity when patients stop working. Direct costs accounted for around 60% of total costs in all EDSS groups. IT accounts from 78% to 11% of direct costs, and decreased as disability progressed.

Conclusion

The total mean social costs of MS in a cohort from Baix Llobregat (Catalonia) were estimated at 24272 euros per patient/year, and ranged between 14327 euros (EDSS = 0) and 52841 euros (EDSS = 7.5–9.5). Total costs, and particularly informal and direct costs, increased as the disability progressed. IT should be able to delay the progression of disability to be efficient and not only effective.
Genomic presence of recombinant porcine endogenous retrovirus in transmitting miniature swine
Authors: Martin Stanley I , Wilkinson Robert , Fishman Jay A
Published: November 2006

The replication of porcine endogenous retrovirus (PERV) in human cell lines suggests a potential infectious risk in xenotransplantation. PERV isolated from human cells following cocultivation with porcine peripheral blood mononuclear cells is a recombinant of PERV-A and PERV-C. We describe two different recombinant PERV-AC sequences in the cellular DNA of some transmitting miniature swine. This is the first evidence of PERV-AC recombinant virus in porcine genomic DNA that may have resulted from autoinfection following exogenous viral recombination. Infectious risk in xenotransplantation will be defined by the activity of PERV loci in vivo.
Molecular Predictors of Outcome With Gefitinib in a Phase III Placebo-Controlled Study in Advanced Non–Small-Cell Lung Cancer
Authors: Hirsch Fred R. , Varella-Garcia Marileila , Bunn Paul A. , Franklin Wilbur A. , Dziadziuszko Rafal , Thatcher Nick , Chang Alex , Parikh Purvish , Pereira José Rodrigues , Ciuleanu Tudor , von Pawel Joachim , Watkins Claire , Flannery Angela , Ellison Gillian , Donald Emma , Knight Lucy , Parums Dinah , Botwood Nicholas , Holloway Brian
Published: October 2006

Purpose

The phase III Iressa Survival Evaluation in Lung Cancer (ISEL) trial compared gefitinib with placebo in 1,692 patients with refractory advanced non–small-cell lung cancer. We analyzed ISEL tumor biopsy samples to examine relationships between biomarkers and clinical outcome after gefitinib treatment in a placebo-controlled setting.

Methods

Biomarkers included epidermal growth factor receptor (EGFR) gene copy number by fluorescence in situ hybridization (n = 370); EGFR (n = 379) and phosphorylated Akt (p-Akt) protein expression (n = 382) by immunohistochemistry; and mutations in EGFR (n = 215), KRAS (n = 152), and BRAF (n = 118).

Results

High EGFR gene copy number was a predictor of a gefitinib-related effect on survival (hazard ratio [HR], 0.61 for high copy number and HR, 1.16 for low copy number; comparison of high v low copy number HR, P = .045). EGFR protein expression was also related to clinical outcome (HR for positive, 0.77; HR for negative, 1.57; comparison of high v low protein expression HR, P = .049). Patients with EGFR mutations had higher response rates than patients without EGFR mutations (37.5% v 2.6%); there were insufficient data for survival analysis. No relationship was observed between p-Akt protein expression and survival outcome, and the limited amount of data collected for KRAS and BRAF mutations prevented any meaningful evaluation of clinical outcomes in relation to these mutations.

Conclusion

EGFR gene copy number was a predictor of clinical benefit from gefitinib in ISEL. Additional studies are warranted to assess these biomarkers fully for the identification of patients most likely to benefit from gefitinib treatment.
Disabled-2 is a novel αIIb-integrin-binding protein that negatively regulates platelet-fibrinogen interactions and platelet aggregation
Authors: Huang Chien-Ling , Cheng Ju-Chien , Stern Arnold , Hsieh Jer-Tsong , Liao Chang-Hui , Tseng Ching-Ping
Published: October 2006

Platelet aggregation plays a pivotal role in the haemostatic process and is involved in the pathological counterpart of arterial thrombosis. We have shown that the adapter protein disabled-2 (DAB2) is expressed abundantly in platelets. In this study, DAB2 was found to distribute in the platelet α-granules and was released from the granular compartment upon platelet activation. The secreted DAB2 binds to the extracellular region of αIIbβ3 integrin on the platelet surface through the phosphotyrosine-binding domain. The DAB2-platelet interactions result in the inhibition of agonist-induced platelet aggregation with the exception of thrombin, a DAB2 protease that renders DAB2 inactive. Biochemical and mutational analysis revealed that the DAB2 cell-adhesion Arg-Gly-Asp (RGD) motif (amino acid residues 64-66) and the αIIb-integrin–fibrinogen-binding region (amino acid residues 171-464) are important for the DAB2-platelet interactions. Such interactions compete for the binding of αIIb integrin with fibrinogen and provide a mechanism for DAB2 to inhibit platelet aggregation. Accordingly, the synthetic RGD-motif-containing DAB2 peptide PDARGDKM also elicited anti-platelet aggregation activity. These findings demonstrate for the first time that DAB2 is an αIIb-integrin-binding protein that plays a novel role in the control of platelet-fibrinogen interactions and platelet aggregation.
Jet propulsion in the cold: mechanics of swimming in the Antarctic scallopAdamussium colbecki
Authors: Denny Mark , Miller Luke
Published: November 2006

Unlike most bivalves, scallops are able to swim, relying on a shell with reduced mass and streamlined proportions, a large fast-twitch adductor muscle and the elastic characteristics of the shell's hinge. Despite these adaptations, swimming in scallops is never far from failure, and it is surprising to find a swimming scallop in Antarctica, where low temperature increases the viscosity of seawater, decreases the power output of the adductor muscle and potentially compromises the energy storage capability of the hinge material (abductin, a protein rubber). How does the Antarctic scallop, Adamussium colbecki, cope with the cold? Its shell mass is substantially reduced relative to that of temperate and tropical scallops, but this potential advantage is more than offset by a drastic reduction in adductor-muscle mass. By contrast, A. colbecki's abductin maintains a higher resilience at low temperatures than does the abductin of a temperate scallop. This resilience may help to compensate for reduced muscle mass,assisting the Antarctic scallop to maintain its marginal swimming ability. However, theory suggests that this assistance should be slight, so the adaptive value of increased resilience remains open to question. The high resilience of A. colbecki abductin at low temperatures may be of interest to materials engineers.
Growth and photosynthesis of two Mediterranean corals, Cladocora caespitosa and Oculina patagonica, under normal and elevated temperatures
Authors: Rodolfo-Metalpa Riccardo , Richard Cécile , Allemand Denis , Ferrier-Pagès Christine
Published: November 2006

The Ligurian Sea (NW Mediterranean) experienced warm summers in 1998, 1999 and from 2003 to 2005. The temperature was 1-3°C higher than the mean summer value (24°C) and remained high over a long period. During these summers, mass-mortality events, affecting several sessile benthic species,were reported. In the present study, we tested the long-term (3-7 weeks)effect of different temperatures (20°C measured in spring and autumn,24°C observed in summer, and 26°C and 28°C abnormal summer values)on two Mediterranean corals, Cladocora caespitosa and Oculina patagonica. Growth rate, photosynthetic efficiency(Fv/Fm), relative electron transport rate (ETR), zooxanthellae and chlorophyll (chl) contents were measured during 48 days incubation. At 20°C, all parameters remained constant during the whole experiment for both species. At higher temperatures, most physiological parameters were affected by only 2-5 weeks at 24°C, and were severely depressed at higher temperatures. Small replicate samples (nubbins) of O. patagonica significantly decreased their zooxanthellae and chl concentrations at all temperatures, after 2 weeks of incubation. Their Fv/Fm values, as well as their growth rates, were also gradually reduced during the incubation at all temperatures. However, only a few nubbins maintained at 28°C showed signs of tissue necrosis after 34 days, and these gradually recovered tissue when temperature was returned to normal. In nubbins of C. caespitosa, chl and zooxanthellae concentrations decreased only after 34 days of incubation at 26°C and 28°C. At the same time, tissue necrosis was observed,explaining the loss of the symbionts. Fv/Fm was reduced only after 34 days of incubation at the different temperatures, and growth rate was first enhanced, before collapsing by 30% at 24°C and by 90-100% at 26°C and 28°C. All samples maintained at 26°C and 28°C had died, due to tissue necrosis, by the end of the experiment. Results obtained suggest that O. patagonica is more able than C. caespitosa to resist high temperature conditions because of its rapid bleaching capacity. In contrast,it seems that C. caespitosa is living close to its thermal limit during the summer period; therefore, a long-term increase at 24°C or above could be lethal for this coral, just as was observed in situ during the recent warm summers.
Response characteristics of visual altitude control system in Bombus terrestris
Authors: Tanaka Kensaku , Kawachi Keiji
Published: November 2006

Frequency response characteristics of bumblebees to vertical visual oscillations were measured and analyzed. We measured the vertical force of the bees at four oscillation frequencies (0.9, 1.8, 3.6 and 7.4 Hz), and summarized their response characteristics in terms of amplitude and phase differences. The amplitude was almost constant throughout the examined frequency domain, whereas the phase gradually lagged with increasing frequency. In order to view the relationship between the input (visual oscillation) and output (response of the bee) more clearly as a control system, we compared them in the same dimension; we calculated hypothetical positions of the tethered bees on the basis of the measured variation in the vertical force, and compared them with the visual stripe positions. The resultant gain and phase data were plotted on a Bode plot. A transfer function was identified from the Bode plot, revealing that the response characteristics of the measured system could be represented as a simple expression.

The dynamic control characteristics of the bumblebees were analyzed on the basis of the frequency response data. First, we showed that the measured system possesses a substantial stability margin. This means that the control system has substantial damping characteristics, and was suitable for stable flight control. In addition, our results showed that the measured bumblebee system possesses superior steady state and quick-response characteristics in comparison with a human pilot-vehicle system. Such excellence in both the steady state and transient characteristics (i.e. damping and quick response characteristics) provide the evidence that bumblebees can effectively control their flight with stability and maneuverability.
Stage II glottic carcinoma: Prognostic factors and management
Authors: Kaplan Michael J. , Johns Michael E. , Mclean W. Copley , Slaughter G. FITZ‐HUGH , Clark David A. , Boyd James C. , Cantrell Robert W.
Published: November 2006

Three hundred thirty‐six patients with squamous cell carcinoma of the glottic larynx treated at the University of Virginia Medical Center from 1960 through 1977 were reviewed. Seventy patients with T2N0M0 disease, grouped according to the criteria of the American Joint Committee on Cancer, 1978, form the basis of this report. The 5‐year actuarial survivals, recurrences, salvages, and prognostic factors were examined. Treatment was radiation, surgery, or a combination of radiation and surgery.

Impaired vocal cord mobility in Stage II glottic squamous cell carcinoma is the crucial significant prognostic factor in predicting response to therapy, survival, and response to salvage therapy for recurrences. The 90% 5‐year recurrence‐free rate with freely mobile cords is comparable to that achieved with Stage I lesions. Impaired mobility resulted in a 5‐year recurrence‐free rate of 73%, which is comparable to that of T3N0 lesions.

We support the concept of reclassifying Stage II disease into Stage Ha (mobile cords) and Stage IIb (impaired mobility).

Based on this review and those reported in the literature, we recommend radiation therapy for Stage IIa disease. Surgery results in fewer recurrences and in longer survival than irradiation when the vocal cords are not freely mobile (Stage IIb).
Combined preoperative radiotherapy and surgery in the treatment of carcinoma of the anterior two‐thirds of the tongue
Authors: Holm Lars‐Erik , Lundquist Per‐Gotthard , Bengt‐Inge Rudén  , Silfverswärd Claes , Sobin Aron , Wersäll Jan
Published: November 2006

Sixty‐three patients with squamous cell carcinoma of the anterior two‐thirds of the tongue were treated with preoperative external radiotherapy (mean target dose 42.60 Gray or 4260 rad) and surgery. The expected 5‐year survival, expressed as life table estimate of percent of survivors, was 77% for patients with Stage I tumors, 69% with Stage II, and 13% for patients with tumors in Stages III‐IV (p < 0.001). Fourteen patients experienced local recurrences, 7 had homolateral neck metastases, 4 had contralateral neck metastases and 3 had distant metastases. In 15 cases no cancer could be detected at review of the surgical specimens, but 2 of these died of their cancers. In 43 cases cancer was present in the specimens, and 26 of these died of their cancer (p < 0.01).
Morphological changes in the normal and neomycin‐perfused guinea pig cochlea following chronic prosthetic implantation.
Authors: Duckert Larry G.
Published: November 2006

The effects of chronic prosthetic implantation and interval electrical stimulation were studied in the normal and neomycin‐perfused cochlea of the guinea pig. One group of guinea pigs was implanted with a multiple‐electrode prosthesis in the scala tympani. During a 4‐week period, the device was stimulated for 3 hours weekly with a continuous, 1 kHz sinusoidal current of constant intensity. A second group of guinea pigs underwent identical implantation and stimulation except that cochlear perfusion with .1 M neomycin was performed at the time of implantation. Current intensities ranged from .1 to .6 mA RMS. Two complementary control groups were implanted but not stimulated. The animals were sacrificed, the cochleae were perfused with a fixative, and the temporal bones were prepared for examination under a light, transmission, or scanning electron microscope.

In the electrically stimulated cochleae, degenerative changes occurred in both the inner and outer hair cells and supporting elements. A decrease was apparent in spiral ganglion cell and nerve fiber populations in areas of inner hair cell depletion and did not seem to correspond to the survival of supporting cells. The electrically active electrodes were uniformly surrounded by a connective tissue matrix and areas of immature bone. These changes occurred at all the intensities tested, and did not monotonically relate in severity to current intensity. None of the changes was apparent in the normal control ears. Morphological changes induced by the ototoxic drug neomycin were so severe is both stimulated and unstimulated cochleae that comparison was not possible; this form of pretreatment is apparently unsuitable for use in studies of electrically induced damage. It appears that in the normal animal, chronic implantation with interval electrical stimulation results in a cumulative form of sensory and neural damage histologically similar to that proceeding from chronic noise exposure as well as other ototoxic agents. Such effects should be minimized if surviving sensorineural and supporting elements in the functionally compromised cochlea are to be preserved.
Hurthle cell tumors of the thyroid gland.
Authors: Miller Robert H. , Estrada Rolando , Sneed William F. , Mace Myles L.
Published: November 2006

Hurthle cell lesions of the thyroid gland, which are derived from follicular cells, occur in a variety of thyroid diseases. Hurthle cell neoplasms are generally easy to differentiate from non‐neoplastic lesions, but the separation of benign from malignant Hurthle cell tumors is difficult on a purely histologic basis unless capsular or vascular invasion or metastases are present. Since this distinction is so difficult to make, the authors recommend treating all Hurthle cell neoplasms as potentially malignant. Treatment includes total thyroidectomy, peritracheal node dissection and if palpable jugular nodes are present, a regional node dissection. A series of 11 patients with this disease and the literature are reviewed to document these recommendations.