bluuebunny/crossref_metadata_2025 huggingface dataset:
So‐called ‘adenosarcoma’ of the kidney a novel adult renal tumor with a cystic appearance
Authors: Sameshima Naoki , Marutsuka Kousuke , Tsukino Hiromasa , Kamoto Toshiyuki , Kono Shinji , Asada Yujiro
Published: March 2011

We describe a novel cystic renal tumor consisting of benign epithelial and malignant stromal components in a 56‐year‐old woman who was admitted to hospital with macroscopic hematuria. Enhanced computed tomography revealed a multilocular 3.4 × 2.7‐cm tumor in the center of the left kidney. After total left nephrectomy, the excised tumor appeared extensively cystic with a well defined border on the cut surface. Histologically, the tumor was composed of biphasic a benign epithelial lining on tubules or cysts with a typically hobnailed appearance, and anaplastic sarcomatous stroma with frequent mitosis. Periepithelial cuffing of the sarcoma cells was evident without an epithelial‐stromal transition. Carcinomatous nests, blastemic elements, ovarian‐like stroma or differentiated mesenchyme were not evident in the stroma. The epithelial cells were reactive with cytokeratins, epithelial membrane antigen (EMA), vimentin and transducin‐like enhancer protein 1 (TLE1). Stromal cells were reactive with vimentin, CD99 and TLE1, partly reactive with CD34 and CD10, and non‐reactive with cytokeratins, EMA, Wilm's tumor protein (WT‐1), estrogen receptor (ER), progesterone receptor (PgR), CD57, HMB45 or Bcl2. SYT‐SSX fusion gene was not detected with reverse transcription polymerase chain reaction. Because these findings did not coincide with established descriptions of cystic renal neoplasms, we preferred the term, ‘adenosarcoma’. This could become a new classification for adult cystic renal tumors.
iDynoMiCS: next‐generation individual‐based modelling of biofilms
Authors: Lardon Laurent A. , Merkey Brian V. , Martins Sónia , Dötsch Andreas , Picioreanu Cristian , Kreft Jan‐Ulrich , Smets Barth F.
Published: March 2011

Individual‐based modelling of biofilms accounts for the fact that individual organisms of the same species may well be in a different physiological state as a result of environmental gradients, lag times in responding to change, or noise in gene expression, which we have become increasingly aware of with the advent of single‐cell microbiology. But progress in developing and using individual‐based modelling has been hampered by different groups writing their own code and the lack of an available standard model. We therefore set out to merge most features of previous models and incorporate various improvements in order to provide a common basis for further developments. Four improvements stand out: the biofilm pressure field allows for shrinking or consolidating biofilms; the continuous‐in‐time extracellular polymeric substances excretion leads to more realistic fluid behaviour of the extracellular matrix, avoiding artefacts; the stochastic chemostat mode allows comparison of spatially uniform and heterogeneous systems; and the separation of growth kinetics from the individual cell allows condition‐dependent switching of metabolism. As an illustration of the model's use, we used the latter feature to study how environmentally fluctuating oxygen availability affects the diversity and composition of a community of denitrifying bacteria that induce the denitrification pathway under anoxic or low oxygen conditions. We tested the hypothesis that the existence of these diverse strategies of denitrification can be explained solely by assuming that faster response incurs higher costs. We found that if the ability to switch metabolic pathways quickly incurs no costs the fastest responder is always the best. However, if there is a trade‐off where faster switching incurs higher costs, then there is a strategy with optimal response time for any frequency of environmental fluctuations, suggesting that different types of denitrifying strategies win in different environments. In a single environment, biodiversity of denitrifiers is higher in biofilms than chemostats, higher with than without costs and higher at intermediate frequency of change. The highly modular nature of the new computational model made this case study straightforward to implement, and reflects the sort of novel studies that can easily be executed with the new model.
Diversity of extremophilic purple phototrophic bacteria in Soap Lake, a Central Washington (USA) Soda Lake
Authors: Asao Marie , Pinkart Holly C. , Madigan Michael T.
Published: March 2011

Culture‐based and culture‐independent methods were used to explore the diversity of phototrophic purple bacteria in Soap Lake, a small meromictic soda lake in the western USA. Among soda lakes, Soap Lake is unusual because it consists of distinct upper and lower water bodies of vastly different salinities, and its deep waters contain up to 175 mM sulfide. From Soap Lake water new alkaliphilic purple sulfur bacteria of the families Chromatiaceae and Ectothiorhodospiraceae were cultured, and one purple non‐sulfur bacterium was isolated. Comparative sequence analysis of pufM, a gene that encodes a key photosynthetic reaction centre protein universally found in purple bacteria, was used to measure the diversity of purple bacteria in Soap Lake. Denaturing gradient gel electrophoresis and subsequent phylogenetic analyses of pufMs amplified from Soap Lake water revealed that a significant diversity of purple bacteria inhabit this soda lake. Although close relatives of several of the pufM phylotypes obtained from cultured species could also be detected in Soap Lake water, several other more divergent pufM phylotypes were also detected. It is possible that Soap Lake purple bacteria are major contributors of organic matter into the ecosystem of this lake, especially in its extensive anoxic and sulfidic deep waters.
The logicome of environmental bacteria: merging catabolic and regulatory events with Boolean formalisms
Authors: Silva‐Rocha Rafael , Tamames Javier , dos Santos Vitor Martins , de Lorenzo Víctor
Published: March 2011

The regulatory and metabolic networks that rule biodegradation of pollutants by environmental bacteria are wired to the rest of the cellular physiology through both transcriptional factors and intermediary signal molecules. In this review, we examine some formalisms for describing catalytic/regulatory circuits of this sort and advocate the adoption of Boolean logic for combining transcriptional and enzymatic occurrences in the same biological system. As an example, we show how known regulatory and metabolic actions that bring about biodegradation of m‐xylene by Pseudomonas putida mt‐2 can be represented as clusters of binary operations and then reconstructed as a digital network. Despite the many simplifications, Boolean tools still capture the gross behaviour of the system even in the absence of kinetic constants determined experimentally. On this basis, we argue that still with a limited volume of data binary formalisms allow us to penetrate the raison d'être of extant regulatory and metabolic architectures.
Comparison of intraoperative outcomes using the new and old generation da Vinci® robot for robot‐assisted laparoscopic prostatectomy
Authors: Shah Ketul , Abaza Ronney
Published: March 2011

Study Type – Therapy (case series)

Level of Evidence 4

OBJECTIVE

To review and compare intraoperative outcomes for robotic prostatectomy procedures performed on two generations of the da Vinci robotic surgery platform.

MATERIAL AND METHODS

We reviewed 100 consecutive robotic prostatectomy cases and compared intraoperative outcomes for procedures randomly performed on either the da Vinci S robot or first‐generation standard robot.

Baseline demographic data and intra‐operative variables potentially impacting outcomes were reviewed and compared between the two groups.

RESULTS

Mean total operative time was 191 min using the standard da Vinci robot (range 132–266) versus 169 min with S robot (range 98–230), representing a mean difference of 22 min (P = 0.002).

This difference was statistically significant despite no difference in mean patient BMI of 30.6 (range 19–51) for standard versus 29.3 (range 21–37) for S (P = 0.31), no difference in mean prostate size of 54.6 g (range 26–101) for standard versus 57.3 g (range 32–151) for S (P = 0.55), and no difference in frequency of nerve‐sparing (P = 0.99).

There was also no difference in the portions of procedues performed by residents, which in some cases was none and some the entire procedure, but the standard was more often used for the surgeon’s first case of the day (P = 0.006).

There was no difference in blood loss (P = 0.08), positive margins (P = 0.87), or mean number of lymph nodes removed (10.7 vs 10.6).

CONCLUSIONS

Both generations of da Vinci robotic technology are equally effective for PALP, but the S robot appears to allow shorter procedure times.

Further such evaluations are necessary to guide institutions and public policy decision‐makers on investments in newer generations of robotic technology as incremental advances continue.
Establishing moral bearings: ethics and expatriate health care professionals in humanitarian work
Authors: Hunt Matthew R.
Published: March 2011

Expatriate health care professionals frequently participate in international responses to natural disasters and humanitarian emergencies. This field of practice presents important clinical, logistical and ethical challenges for clinicians. This paper considers the ethics of health care practice in humanitarian contexts. It examines features that contribute to forming the moral landscape of humanitarian work, and discusses normative guidelines and approaches that are relevant for this work. These tools and frameworks provide important ethics resources for humanitarian settings. Finally, it elaborates a set of questions that can aid health care professionals as they analyse ethical issues that they experience in the field. The proposed process can assist clinicians as they seek to establish their moral bearings in situations of ethical complexity and uncertainty. Identifying and developing ethics resources and vocabulary for clinical practice in humanitarian work will help health care professionals provide ethically sound care to patients and communities.
Reverse Island Effects and the Backward Search for a Licensor in Multiple Wh‐Questions
Authors: Sprouse Jon , Fukuda Shin , Ono Hajime , Kluender Robert
Published: March 2011

Abstract.  This paper reports a series of formal acceptability‐judgment experiments designed to investigate the syntactic properties of a relatively understudied type of wh‐dependency: multiple wh‐questions in English. By using a factorial definition of island effects made available only by formal experiments, we report an unpredicted pattern of acceptability that suggests the existence of reverse island effects for whether and adjunct islands inside of multiple wh‐questions, but not for subject and CNPC islands. We argue that this unpredicted effect can best be analyzed by taking into account the parsing processes that are necessary for real‐time comprehension of multiple wh‐questions in English. We propose that multiple wh‐questions require a backward search for an antecedent that is in many ways similar to the forward search for a gap site that occurs in single wh‐questions in English (Frazier & Clifton 1989). We then present additional acceptability‐judgment experiments in both English and Japanese to test the predictions of the backward‐search analysis.
‘The Changelessness of God’ as Kierkegaard's Final Theodicy: God and the Gift of Suffering
Authors: MARTENS PAUL , MILLAY TOM
Published: March 2011

In the midst of his final ‘attack on Christendom’, Kierkegaard published a short discourse devoted to James 1:17–21 entitled ‘The Changelessness of God’. Aside from providing a pleasant rhetorical anomaly at this juncture in his corpus, Kierkegaard's final discourse also introduces another surprise: a defense of the God who sits silently by and watches true Christianity disappear from Denmark. Kierkegaard's defense of God also accounts for Christian suffering – Christ's, the apostles' and perhaps his own – and it does so by creating a sharp division of reality between temporality and eternity, a division that echoes through from the earliest discourses on the same biblical passage. This article contextualizes ‘The Changelessness of God’ by tracing these developments and then continues to press the logic of Kierkegaard's construal of the relationship between temporality and eternity which ultimately leads to a rather problematic description of suffering as a necessary good and perfect gift from God.
Moral Taint: On the Transfer of the Implications of Moral Culpability
Authors: ØVERLAND GERHARD
Published: March 2011

abstract

Suppose two people are about to drown. We are in a position to save only one, so the other will have to die. One of the two has just culpably killed an innocent person, but has no intention of killing anybody else and there is no reason to expect that he will. Everything else being equal, should we give them an equal chance of being saved by flipping a coin? In this paper I argue that we should not. I argue that the implications of a person's moral culpability for (recent or prospective) harm to a particular victim should transfer to other conflict situations in which the wrongdoer might find him or herself. This requires establishing the extent to which a person's contributing to harming another person — and his moral culpability for that harm — impinges on our decision making in situations where it is possible only to assist either the wrongdoer or some other person that is not his victim.
Population recovery of black rhinoceros in north‐west Namibia following poaching
Authors: Brodie J. F. , Muntifering J. , Hearn M. , Loutit B. , Loutit R. , Brell B. , Uri‐Khob S. , Leader‐Williams N. , du Preez P.
Published: March 2011

Curtailing overharvest, whether illegal or legal, is often a critical conservation objective. Yet even if overexploitation can be stopped, subsequent rates of population recovery can be highly variable due to Allee effects, alterations to age and sex structure and disruptions of animal social systems. Moreover, understanding the influence of density dependence can be difficult but important for long‐term management. Here, we investigate the dynamics of black rhinoceros Diceros bicornis in the Kunene region of Namibia as they recover from illegal hunting. We use multi‐strata mark–recapture models to examine survival and stage‐transition rates from 1992 to 2005. Survivorship estimates ranged from 0.793 for calves to 0.910 for adult males and 0.944 for adult females. The annual reproductive rate in adult females was estimated at 0.315. Model selection showed that these vital rates were time invariant, suggesting that Allee effects and transient dynamics did not have an important effect upon population dynamics, even in the early stages of recovery. Relative population density increased significantly from 1992 to 2005 once illegal hunting had ceased in Kunene. However, the best‐fit models did not include relative density in the estimation of survival or stage‐transition rates. We then used the vital rates generated from our mark–recapture analysis to build matrix projection models that assessed overall population dynamics. The female‐only model gave a population growth rate estimate of λ=1.011. Two‐sex models suggest that the growth rate of the population could range from 0.990 to 1.012. The relatively slow growth rate of this population, even without hunting or density dependence, could stem from the low productivity of the region. Adult females had the highest reproductive value and their survival had the highest elasticity among vital rates. Translocating adult females would lead to the fastest initial population growth rate in founder populations but would have the most impact on the source population.
Myopia, posture and the visual environment
Authors: Neil Charman W
Published: March 2011

Citation information:Charman WN. Myopia, posture and the visual environment.Ophthalmic Physiol Opt2011,31, 494–501. doi: 10.1111/j.1475‐1313.2011.00825.x

Evidence for a possible role for the peripheral retina in the control of refractive development is discussed, together with Howland’s suggestion (Paper presented at the 13th International Myopia Conference, Tubingen, Germany, July 26–29, 2010) that signals to generate appropriate growth might be derived from ocular oblique astigmatism. The dependence of this, or similar peripheral mechanisms, on exposure to a uniform field of near‐zero dioptric vergence is emphasized: this is required to ensure a consistent relationship between the astigmatic image fields and the retina. This condition is satisfied by typical outdoor environments. In contrast, indoor environments are likely to be unfavourable to peripherally‐based emmetropization, since dioptric stimuli may vary widely across the visual field. This is particularly the case when short working distances or markedly asymmetric head postures with respect to the visual task are adopted.
Television, computer and portable display device use by people with central vision impairment
Authors: Woods Russell L , Satgunam PremNandhini
Published: March 2011

Citation information: Woods RL & Satgunam P. Television, computer and portable display device use by people with central vision impairment. Ophthalmic Physiol Opt 2011, 31, 258–274. doi: 10.1111/j.1475‐1313.2011.00833.x

Purpose:  To survey the viewing experience (e.g. hours watched, difficulty) and viewing metrics (e.g. distance viewed, display size) for television (TV), computers and portable visual display devices for normally‐sighted (NS) and visually impaired participants. This information may guide visual rehabilitation.

Methods:  Survey was administered either in person or in a telephone interview on 223 participants of whom 104 had low vision (LV, worse than 6/18, age 22–90 years, 54 males), and 94 were NS (visual acuity 6/9 or better, age 20–86 years, 50 males). Depending on their situation, NS participants answered up to 38 questions and LV participants answered up to a further 10 questions.

Results:  Many LV participants reported at least ‘some’ difficulty watching TV (71/103), reported at least ‘often’ having difficulty with computer displays (40/76) and extreme difficulty watching videos on handheld devices (11/16). The average daily TV viewing was slightly, but not significantly, higher for the LV participants (3.6 h) than the NS (3.0 h). Only 18% of LV participants used visual aids (all optical) to watch TV. Most LV participants obtained effective magnification from a reduced viewing distance for both TV and computer display. Younger LV participants also used a larger display when compared to older LV participants to obtain increased magnification. About half of the TV viewing time occurred in the absence of a companion for both the LV and the NS participants. The mean number of TVs at home reported by LV participants (2.2) was slightly but not significantly (p = 0.09) higher than NS participants (2.0). LV participants were equally likely to have a computer but were significantly (p = 0.004) less likely to access the internet (73/104) compared to NS participants (82/94). Most LV participants expressed an interest in image enhancing technology for TV viewing (67/104) and for computer use (50/74), if they used a computer.

Conclusions:  In this study, both NS and LV participants had comparable video viewing habits. Most LV participants in our sample reported difficulty watching TV, and indicated an interest in assistive technology, such as image enhancement. As our participants reported that at least half their video viewing hours are spent alone and that there is usually more than one TV per household, this suggests that there are opportunities to use image enhancement on the TVs of LV viewers without interfering with the viewing experience of NS viewers.
Changes in Vertisol properties as affected by organic amendments application rates
Authors: Ghosh S. , Lockwood P. , Daniel H. , Hulugalle N. , King K. , Kristiansen P.
Published: March 2011

There is considerable global interest in using recycled organic materials because of perceived benefits to soil health and environment. However, information on the effects of organic waste products and their optimal application rates on the quality of heavy clay soils such as Vertisols is sparse. An incubation experiment was therefore conducted using five organic amendments at various rates to identify their optimal application rates, which could improve the quality of the Vertisol. Cotton gin trash, cattle manure, biosolids (dry weight basis 7.5–120 t/ha), chicken manure (dry weight basis 2.25–36 t/ha) and a liquefied vermicast (60–960 L/ha, volumetric basis) changed the soil chemical, physical and microbiological properties compared with a control where no amendments were applied, viz. higher light fraction of organic matter, nutrient content (N and P) and soil microbial activity. Higher application of chicken manure resulted in an increase in dry‐sieved mean weight diameter. Increasing rates of cattle manure increased exchangeable Na concentration and ESP. Although vermicast itself did not contribute a significant amount of N into the soil, when applied at higher rates (60–960 L/ha), its application resulted in increased concentration of NO3‐N in soil by amounts ranging from 43 to 429%. Optimal application rates for cattle manure and cotton gin trash were 30 t/ha, whereas for biosolids and chicken manure, the optimum rate was 60–18 t/ha, respectively.
Near‐surface macropore flow and saturated hydraulic conductivity in drained and restored blanket peatlands
Authors: Wallage Z. E. , Holden J.
Published: March 2011

The impacts of blanket peatland management on water tables, near‐surface macropore flow and saturated hydraulic conductivity were investigated using automated dipwells and mini‐disc tension infiltrometers. Three neighbouring hillslopes which were undisturbed, drained and restored by drain blocking were studied. Mean water table depths at the undisturbed sites were slightly shallower than at the restored site and water tables at both sites were significantly shallower relative to the drained treatment. Through time, however, the water table at the restored treatment behaved in a markedly different way to that at the undisturbed site. Water tables reached the peat surface for only 2% of the time for the drained and restored treatments compared to 18% for the undisturbed treatment. The proportion of runoff flowing through macropores in the near‐surface layers of the peat was found to be large (≥60%) across all three treatments, yet functional macroporosity was found to be significantly greater in the undisturbed peat relative to the two other treatments. Meanwhile, saturated hydraulic conductivity was found to be significantly higher at the restored treatment relative to the two other treatments, with mean conductivities ca. 1.5 times greater, suggesting a form of heightened soil–water interaction. Combined, the results indicate that although restoration by ditch blocking may result in a relatively successful water table recovery, there may not be the full reinstatement of peatland hydrological processes.
Hepatitis C virus infection in USA: an estimate of true prevalence
Authors: Chak Eric , Talal Andrew H. , Sherman Kenneth E. , Schiff Eugene R. , Saab Sammy
Published: March 2011

The recent National Health and Nutrition Examination Survey (NHANES) sampled only the civilian, non‐institutionalized population of USA and may have underestimated the prevalence of hepatitis C virus (HCV) in this country. We searched the database MEDLINE, the Bureau of Justice Statistics, Center for Medicare and Medicaid and individual states Department of Corrections for all epidemiological studies regarding the prevalence of HCV in populations not sampled by the NHANES survey namely the incarcerated, homeless, nursing home residents, hospitalized and those on active military duty. Because of their relatively low frequency in the NHANES sample, we also expanded our search to include healthcare workers and long‐term dialysis patients. Although included in the NHANES sample, we also performed searches on drug users (injection and non‐injection) and veterans to confirm the findings of the NHANES study. Based on the prevalence of studies identified meeting our inclusion criteria, our most conservative estimates state that there at least 142 761 homeless persons, 372 754 incarcerated persons and 6805 persons on active military duty unaccounted for in the NHANES survey. While the NHANES estimates of drug users (both injection and non‐injection) appear to be reasonable, the survey seems to have underestimated the number of HCV‐positive veterans. Our most conservative estimates suggest that there are at least 5.2 million persons living with HCV in USA today, approximately 1.9 million of whom were unaccounted for in the NHANES survey.
An Alternative, Sensitive Method to Detect Helicobacter pylori DNA in Feces
Authors: Horemans Tessa , Deschacht Maartje , Clais Sofie , Van Camp John , de Rijk Pim , Holvoet Jan , Van Assche Tim , Maes Louis , Cos Paul
Published: March 2011

Background:  Despite the high sensitivity and specificity of PCR, detection of Helicobacter pylori DNA in feces is still challenging. Fecal samples contain inhibitory molecules that can prevent amplification of the target DNA. Even by using specific DNA extraction kits for stools, monitoring of infection by analyzing stool samples remains problematic and endorses the need for improved diagnostic methods.

Materials and Methods:  The newly proposed method uses selective hybridization of target DNA with biotin‐labeled probes, followed by DNA isolation with streptavidin‐coated magnetic beads. After three washing steps, the purified DNA can be amplified immediately using conventional or quantitative PCR. In order to test this technique on biological samples, Mongolian gerbils were infected with H. pylori ATCC 43504 and fecal samples were analyzed on days 1, 4, and 10 post infection.

Results:  A detection limit of one bacterial cell per 100 mg stool sample was established, but only after removal of the magnetic beads from the target DNA by heating. This resulted in a 10‐fold increase of sensitivity compared to a commercially available stool DNA extraction kit. Analysis of fecal samples from infected gerbils demonstrated the presence of H. pylori DNA on each time point, while the uninfected animal remained negative.

Conclusions:  The proposed technique allows detection of very low quantities of H. pylori DNA in biological samples. In laboratory animal models, detailed monitoring of infection and complete clearance of infection can be demonstrated thanks to the low detection limit.
Modified Sequential Helicobacter pylori Therapy: Proton Pump Inhibitor and Amoxicillin for 14 Days with Clarithromycin and Metronidazole added as a Quadruple (Hybrid) Therapy for the Final 7 Days
Authors: Hsu Ping‐I. , Wu Deng‐Chyang , Wu Jeng‐Yih , Graham David Y.
Published: March 2011

Background:  Ten‐day sequential therapy with a proton pump inhibitor (PPI) and amoxicillin followed by a PPI, clarithromycin, and an imidazole typically achieves Helicobacter pylori eradication rates of 90–94% (Grade B success).

Aims:  We tested whether prolonging treatment and continuing amoxicillin throughout the 14‐day treatment period would produce a ≥95% result.

Methods:  This was a multicenter pilot study in which H. pylori‐infected patients received a 14‐day sequential–concomitant hybrid therapy (esomeprazole and amoxicillin for 7 days followed by esomeprazole, amoxicillin clarithromycin, and metronidazole for 7 days). H. pylori status was examined 8 weeks after therapy. Success was defined as achieving ≥95% eradication by per‐protocol analysis.

Results:  One hundred and seventeen subjects received hybrid therapy. The eradication rate was 99.1% (95% confidence interval (CI), 97.3–100.0%) by per‐protocol analysis and 97.4% by intention‐to‐treat analysis (95% CI, 94.5–100.0%). Adverse events were seen in 14.5%; drug compliance was 94.9%.

Conclusions:  Fourteen‐day hybrid sequential–concomitant therapy achieved >95%H. pylori eradication (Grade A result). Further studies are needed 1, in regions with different patterns and frequencies of resistance to confirm these findings, and 2, to examine whether Grade A success is maintained with hybrid therapy shorter than 14 days.
A Case of Sclerodermatous Graft‐versus‐Host Disease Responsive to Imatinib Therapy
Authors: Lazar Jozef , Poonawalla Tasneem , Teng Joyce M.C.
Published: March 2011

Abstract:  Sclerodermatous graft‐versus‐host disease (sGVHD) is a rare, late complication of hematopoietic cell transplantation. Classified as a variant of chronic graft‐versus‐host disease, sGVHD is thought to be predominantly an immune‐mediated response characterized by aberrant T‐cell function and dysregulation of tyrosine kinase cascades. Recently, the profibrotic cytokine transforming growth factor B and stimulatory autoantibodies against the platelet‐derived growth factor receptor have been implicated in the pathogenesis of sGVHD. Treatment of sGVHD remains disappointing and largely limited by systemic side effects. Imatinib mesylate is a small molecule tyrosine kinase inhibitor that has been shown to selectively inhibit both the platelet‐derived growth factor receptor and transforming growth factor‐β signaling pathways. We report a case of sGVHD in a pediatric patient that was resistant to traditional therapy but showed improvement in cutaneous symptoms following daily treatment with 400 mg of imatinib mesylate. Due to its favorable side‐effect profile, specificity for molecular pathways deranged in sGVHD and proven efficacy in other sclerodermoid diseases, imatinib mesylate is a promising new tool in the management of this challenging disease.
24. Chronic Refractory Angina Pectoris
Authors: van Kleef Maarten , Staats Peter , Mekhail Nagy , Huygen Frank
Published: March 2011

Angina pectoris, cardiac pain associated with ischemia, is considered refractory when optimal anti‐anginal therapy fails to resolve symptoms. It is associated with a decreased life expectancy and diminishes the quality of life. Spinal cord stimulation (SCS) may be considered for patients who have also undergone comprehensive interventions, such as coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA) procedures.

The mechanism of action of SCS is not entirely clear. Pain reduction is related to the increased release of inhibitory neuropeptides as well as normalization of the intrinsic nerve system of the heart muscle, and may have a protective myocardial effect.

SCS in patients with refractory angina pectoris results in reduced anginal attacks as well as improved rate pressure product prior to the occurrence of ischemic events. This may be the result of reduced Myocardial Volume Oxygen (MVO2) and possibly the redistribution of the coronary blood flow to ischemic areas. There are a number of studies that demonstrate that SCS does not mask acute myocardial infarction.

The efficacy of the treatment has been investigated in two prospective, randomized studies.

The long‐term results showed an improvement of the symptoms and of the quality of life. SCS can be an alternative to surgical intervention in a selected patient population. In addition, SCS is a viable option in patients in whom surgery is not possible.

SCS is recommended in patients with chronic refractory angina pectoris that does not respond to conventional treatment and in whom revascularization procedures have been attempted or not possible, and who are optimized from a medical perspective.
Opioids: How to Improve Compliance and Adherence
Authors: Graziottin Alessandra , Gardner‐Nix Jacqueline , Stumpf Maik , Berliner Michael N.
Published: March 2011

Abstract:  Chronic pain has been recognized as a major worldwide health care problem. Today, medical experts and health agencies agree that chronic pain should be treated with the same priority as the disease that caused it, and patients should receive adequate pain relief. To achieve good analgesia, patient adherence to a prescribed pain treatment is of high importance. Patients with chronic pain often do not use their medication as prescribed, but change the frequency of intake. This can result in poor treatment outcomes and may necessitate additional emergency treatment, which increases the overall costs.

Factors that influence adherence include knowledge of the disease, realistic treatment expectations, perceived benefit from treatment, side effects, depression, dosing frequency, and attitudes of relatives/significant others toward opioids. Addressing all these factors should ensure a good treatment outcome. Good adherence to pain therapy is associated with improved efficacy in pain relief and quality of life.

Opioids have become an integral part of the treatment of moderate to severe chronic noncancer pain. They may cause unpleasant side effects such as nausea, vomiting, and constipation. Patients should be informed adequately about side effects, which should be treated pro‐actively to foster adherence to treatment. Signs of tolerance, hyperalgesia, and drug abuse should be monitored as these may occur in some patients.

An individualized treatment algorithm with a clear treatment goal and regular treatment reassessment is key for successful treatment. Long‐acting opioids offer sustained pain relief over 24 hours with manageable side effects—they simplify treatment thereby supporting treatment adherence.
Do Victims of War Need International Law? Human Rights Education Programs in Authoritarian Sudan
Authors: Massoud Mark Fathi
Published: March 2011

Drawing on ethnographic fieldwork in Sudan, this article illuminates the consequences of human rights educational workshops as a form of humanitarian assistance in war-ravaged areas. These projects are built on flawed assumptions about Sudanese politics and about the likelihood that human rights education empowers the war-ravaged poor. The beneficial impacts of human rights discourse stem from its side effects, which fulfill urgent and symbolic needs, and not from the core content of human rights. The case of an authoritarian regime exposes an alternative site of rights promotion, outside the established or struggling democracies where most literature on rights resides. Bridging the literature on rights in Western, democratic contexts and on human rights in Africa, this article argues that law is not enough—and is potentially dangerous—in the insecure and impoverished areas where the international aid community has been encouraging it to flourish.
Mapping the Racial Bias of the White Male Capital Juror: Jury Composition and the “Empathic Divide”
Authors: Lynch Mona , Haney Craig
Published: March 2011

This article examines the nature of racial bias in the death sentencing process. After reviewing the various general explanations for the continued significance of race in capital cases, we report the results of an empirical study in which some aspects of racially biased death sentencing are examined in depth. Specifically, in a simulated capital penalty-phase trial setting where participants were assigned to small group “juries” and given an opportunity to deliberate, white male jurors were significantly more likely to sentence black defendants to death than were women and nonwhite jurors. This racialized pattern was explained in part by the differential evaluation of the case facts and the perceptions of the defendant that were made by the white male jurors. We discuss these findings in light of social psychological theories of contemporary racism, and we conclude that the demonstrated bias in capital jury settings should be understood as an interaction of several factors, including individual juror characteristics, group-level demographic composition, and group deliberation processes.
Comparing Circuits: Are Some U.S. Courts of Appeals More Liberal or Conservative Than Others?
Authors: Broscheid Andreas
Published: March 2011

This article investigates possible ideological differences between circuits of the U.S. Courts of Appeals. It looks at the distribution of three-judge panel ideologies on the circuits and at differences in decisionmaking patterns, testing several theoretical approaches to circuit differences: the attitudinalist approach, arguing that different judicial ideologies account for intercircuit differences; historical-institutionalist approaches that argue that circuit norms lead to differences in the proportion of conservative decisions and in the effects of judicial ideologies; and the rational-choice institutionalist argument that overall circuit preferences constrain three-judge panel decisions through the en banc process. Using a multilevel logit model, the study finds some support for the attitudinalist and historical-institutionalist accounts of circuit differences. It also finds that intercircuit ideological differences contribute comparatively little to the prediction of appeals court outcomes.
Has Legal Realism Damaged the Legitimacy of the U.S. Supreme Court?
Authors: Gibson James L. , Caldeira Gregory A.
Published: March 2011

Does understanding how U.S. Supreme Court justices actually decide cases undermine the institutional legitimacy of the nation's highest court? To the extent that ordinary people recognize that the justices are deciding legal disputes on the basis of their own ideological biases and preferences (legal realism and the attitudinal model), the belief that the justices merely “apply” the law (mechanical jurisprudence and the myth of legality) is difficult to sustain. Although it is easy to see how the legitimacy of the Supreme Court, the most unaccountable of all American political institutions, is nurtured by the view that judicial decisionmaking is discretionless and mechanical, the sources of institutional legitimacy under legal realism are less obvious. Here, we demonstrate, using a nationally representative sample, that the American people understand judicial decisionmaking in realistic terms, that they extend legitimacy to the Supreme Court, and they do so under the belief that judges exercise their discretion in a principled and sincere fashion. Belief in mechanical jurisprudence is therefore not a necessary underpinning of judicial legitimacy; belief in legal realism is not incompatible with legitimacy.
Spontaneously Alternating Forms of the Atrioventricular Node Reentrant Tachycardia
Authors: LIU XIUSHI , LIU TONG , SHEHATA MICHAEL , NAHAPETIAN ARBY , AMORN ALLEN , CHUGH SUMEET S. , WANG XUNZHANG
Published: March 2011

We present a case of atrioventricular node reentrant tachycardia that displays spontaneously alternating antegrade and retrograde conduction via 1:2 manners. (PACE 2011; 34:e43–e46)
Quality of Life Outcomes in Chinese Patients with Implantable Cardioverter Defibrillators
Authors: CHAIR SEK Y. , LEE CHUI K. , CHOI KAI C. , SEARS SAMUEL F.
Published: March 2011

Background:
 Patient‐centered outcomes for Chinese implantable cardioverter defibrillator (ICD) patients have not been previously studied. This study examined health‐related quality of life (HRQL) and its relation with ICD shock‐related anxiety, ICD shock, patient acceptance of the ICD, and demographic and clinical characteristics among a sample of Chinese ICD patients.

Methods:
 Eighty‐five ICD recipients completed the Chinese versions of the Short Form (SF‐12) Health Survey, Florida Patient Acceptance Survey (FPAS), and Florida Shock Anxiety Scale (FSAS), and a demographic sheet during their follow‐up visit.

Results:
 The mean scores of physical component summary and mental component summary (MCS) of ICD patients (41.7 and 46.6, respectively) were lower than the Hong Kong Chinese normative data. As expected, MCS was negatively correlated with shock anxiety (r =−0.38, P < 0.01) and positively correlated with patient acceptance (r = 0.50, P < 0.01). Shock anxiety was negatively correlated with patient acceptance of the ICD (r =−0.58, P < 0.01). Age was positively associated with FPAS (r = 0.55, P = 0.014) while negatively related with FSAS (r =−0.28, P = 0.003). The experience of ICD shock (yes/no) was not associated with any differences but shock frequency groups (no shocks, 1–2 shocks, and ≥3) and gender were significantly different on shock anxiety but not on general mental functioning.

Conclusion:
 Higher ICD shock anxiety was associated with lower HRQL and lower ICD acceptance. Age, female, and clinical characteristics such as diabetes, coronary heart disease, and ICD shock experience can influence patient‐centric outcomes of HRQL, FPAS, and FSAS. These results extend the evidence for increased clinical attention in Chinese patients to specific outcomes such as shock anxiety and its impact on HRQL. (PACE 2011; 34:858–867)
A Wide Complex Tachycardia with Changing Atrial Activation Sequence
Authors: AYOU ROMEO , AGARWAL SHARAD , TANG ANTHONY , STERNS LAURENCE D.
Published: March 2011

Change of the retrograde atrial activation sequence during radiofrequency (RF) ablation of left‐side accessory pathway can be due to another accessory pathway, another mechanism for the tachycardia, or due to intraatrial conduction block, partial or complete, caused by RF delivery to a site proximal to the site of insertion of the accessory pathway. In this case report, a temporary complete intraatrial conduction block was created by RF delivery proximal to the site of accessory pathway insertion, causing a change in the retrograde atrial activation sequence during ongoing tachycardia that was terminated by ablation at the insertion site of accessory pathway.

(PACE 2013; 36:e23–e26)
Retrograde Buddy Wire Technique for Coronary Sinus Lead Placement—An Approach to Overcome Coronary Vein Angulation
Authors: DOBESH DAVID P. , COSTEAS CONSTANTINOS A. , PAMIDI MANDHAVI , ROELKE MARC , RUBENSTEIN DONALD G.
Published: March 2011

Implantation of a left ventricular pacing lead via the coronary sinus to deliver cardiac resynchronization therapy has become standard therapy for patients with New York Heart Association (NYHA) Class III or IV heart failure and significant intraventricular conduction delay. Biventricular pacing has been shown to provide both symptomatic and mortality benefit in appropriately selected patients. There is significant variability in the anatomy of the coronary sinus and the epicardial coronary venous system. Although a suitable candidate vein may be identified during coronary venography, efforts toward successful guidewire placement or lead placement may be hampered by anatomic obstacles. In this case report, we provide a solution to overcome severe tortuosity encountered at the vein—coronary sinus junction and angulation of the proximal vein. The use of a second coronary sinus sheath and a retrogradely placed guidewire may overcome this anatomic obstacle of vessel tortuosity, when placement by other means has proven unsuccessful. (PACE 2013; 36:e41–e44)
Complete Atrioventricular Block As the First Manifestation of Noncompaction of the Ventricular Myocardium
Authors: NASCIMENTO BRUNO RAMOS , VIDIGAL DANIEL FURTADO , DE CARVALHO BICALHO CARNEIRO RENATA , DE SOUZA WARLEY CRISTIANO , LOPES WALKIRIA MONTEIRO , RIBEIRO ANTONIO LUIZ PINHO , NUNES E MARIA DO CARMO PEREIRA
Published: March 2011

Noncompaction of ventricular myocardium (NVM) is a rare cardiomyopathy, most probably caused by disturbances in embryonic morphogenesis of the myocytes, resulting in prominent trabeculations in the ventricular myocardium. Several diagnostic criteria have been proposed by echocardiography, and its association with other heart diseases is common. Its mortality is closely related to ventricular dysfunction, cardiac arrhythmias, and cardioembolic events.

We report here a case of occurrence of atrioventricular block with syncope as the clinical manifestation of NVM. A brief review of the literature on morphological features, diagnosis, prognosis, and treatment will also be discussed.
FLAIR Vascular Hyperintensity Preceding Stroke in Cryptococcal Meningitis
Authors: Sanossian Nerses , Shatzmiller Ron A. , Djabiras Christina , Liebeskind David S.
Published: March 2011

BACKGROUND AND PURPOSE

Ischemic stroke is a common complication of cryptococcal meningitis. Fluid attenuated inversion recovery vascular hyperintensity (FVH) is a neuroimaging marker of sluggish blood flow usually seen in the setting of acute stroke. FVH have never been described in the setting of meningitis.

METHODS

Case report.

RESULTS

A 20‐year‐old man with cryptococcal meningitis and a magnetic resonance imaging demonstrating FVH had subsequent neurological deterioration and was found to have bilateral ischemic stroke.

CONCLUSIONS

In conditions with high risk of stroke, such as meningitis, the presence of FVH should alert the clinician to the possibility of impending infarction.
A heel cup improves the function of the heel pad in Sever's injury: effects on heel pad thickness, peak pressure and pain
Authors: Perhamre S. , Lundin F. , Klässbo M. , Norlin R.
Published: March 2011

Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children between 8 and 15 years. Treating Sever's injury with insoles is often proposed as a part of a traditional mix of recommendations. Using a custom‐molded rigid heel cup with a brim enclosing the heel pad resulted in effective pain relief without reducing the physical activity level in our previous two studies. The purpose of this study was to assess the effect of the heel cup on heel pad thickness and heel peak pressure (n=50). The difference in heel pad thickness and in heel peak pressure using a sports shoe without and with a heel cup was compared. With the heel cup the heel pad thickness improved significantly and the heel peak pressure was significantly reduced. These effects correlated with a significant reduction in pain when using the heel cup in a sports shoe, compared with using a sports shoe without the heel cup. A heel cup, providing an effective heel pad support in the sports shoe, improved the heel pad thickness and reduced heel peak pressure in Sever's injury with corresponding pain relief.
Longevity of soccer players: an investigation of all German internationals from 1908 to 2006
Authors: Kuss O. , Kluttig A. , Greiser K. H.
Published: March 2011

Leisure‐time physical activity is associated with better health and a reduced risk of all‐cause mortality. It is unclear if this association is also present with a high level of physical activity as it is found in professional athletes. In a population‐based retrospective cohort study, we compared the survival experience of all soccer players participating for Germany in international matches between 1908 and 2006 to that of the general population. To summarize survival experience, we calculated cumulative relative survival ratios (RSRs) from a life table. We included data of 812 international players, of which 428 (=52.7%) died during follow‐up. In all 13 intervals, cumulative observed survival was smaller than cumulative expected survival, resulting in cumulative RSRs being <1. The cumulative RSRs are statistically significantly different from 1 in all but the last interval. This impaired survival experience of the internationals translates into a loss of median residual lifetime of 1.9 years [95% confidence interval: 0.6, 3.2] years at the entry time into the cohort. This loss is mainly driven by the mortality of internationals from the earlier half of the observation period. Reasons for this might be poorer medical care in former times, internationals being killed in action during World War II, and a changing distribution of causes of death during the 20th century.