bluuebunny/crossref_metadata_2025 huggingface dataset:
THE SYMBIOTIC BIRTH AND SPREAD OF PLASTIDS: HOW MANY TIMES AND WHODUNIT?
Authors: Palmer Jeffrey D.
Published: March 2003

I discuss the evidence for a single origin of primary plastids in the context of a paper in this issue challenging this view, and I review recent evidence concerning the number of secondary plastid endosymbioses and the controversy over whether the relic plastid of apicomplexans is of red or green algal origin. A broad consensus has developed that the plastids of green algae, red algae, and glaucophytes arose from the same primary, cyanobacterial endosymbiosis. Although the analyses in this issue by Stiller and colleagues firmly undermine one of many sources of data, gene content similarities among plastid genomes used to argue for a monophyletic origin of primary plastids, the overall evidence still clearly favors monophyly. Nonetheless, this issue should not be considered settled and new data should be sought from better sampling of cyanobacteria and glaucophytes, from sequenced nuclear genomes, and from careful analysis of such key features as the plastid import apparatus. With respect to the number of secondary plastid symbioses, it is completely unclear as to whether the secondary plastids of euglenophytes and chlorarachniophytes arose by the same or two different algal endosymbioses. Recent analyses of certain plastid and nuclear genes support the chromalveolate hypothesis of Cavalier‐Smith, namely, that the plastids of heterokonts, haptophytes, cryptophytes, dinoflagellates, and apicomplexans all arose from a common endosymbiosis involving a red alga. However, another recent paper presents intriguing conflicting data on this score for one of these groups—apicomplexans—arguing instead that they acquired their plastids from green algae.
Characterization and Position of the Genus Stenogramme in the Phyllophoraceae (Gigartinales, Rhodophyta)
Authors: Lopez‐Bautista J. M. , Fredericq S. , Lindstrom S. C. , Nelson W. A. , Ramirez M. E.
Published: March 2003

The red algal genus Stenogramme was described by Harvey (1840) for entities having flattened, dichotomously branched thalli with cystocarps borne in narrow, linear sori resembling an interrupted midrib on blades, and with isomorphic tetrasporophytes with scattered circular to irregular tetrasporangial nemathecia. In the current literature, the most common species listed is Stenogramme interrupta (C. agardh) Montagne ex Harvey 1848, said to have a worldwide distribution in temperate seas. DNA sequences from three molecular datasets (chloroplast‐encoded rbcL, and nuclear‐encoded ITS and LSU rDNA) instead reveal that the genus is more species‐rich than is currently appreciated, and that several species go under the name S. interrupta. The latter species, described from Cadiz, Spain, is found to be restricted to the Eastern Atlantic. The name Stenogramme californica Harvey 1840, the type species described from the Pacific coast of North America, is reinstated for members from California and Oregon. S. rhodymenioides Joly et Alveal 1969 is reinstated for the entity from Chile. The range of S. phyllophoroides (J. Agardh) Millar 1990 described from northern NSW, Australia, is expanded to accommodate the taxon from South Australia referred to as S. interrupta. S. leptophylla J. Agardh 1885 is a distinct South Australian species. A new name needs to be provided for the New Zealand taxon. The genus also comprises a new entity (sterile) from Alaska, and a new (sterile) species from offshore Louisiana. Stenogramme is a well‐defined monophyletic genus, but its position within the Phylophoraceae remains equivocal.
Protist Origin of the Ulvophyceae (Chlorophyta) Revealed by SSU rDNA Analyses of Marine Coccoid Green Algae
Authors: Pröschold T. , Surek B. , Marin B. , Melkonian M.
Published: March 2003

Traditionally, brackish and marine coccoid green algae are placed as isolated species of common trebouxiophycean or chlorophycean genera (e.g. Chlorella, Chlorococcum); exclusively the marine genera Chlorocystis and Halochlorococcum are characterized by quadriflagellated zoospores and a ‘Codiolum‐stage’ (characteristic for the Ulvophyceae) in their life histories. In Chlorocystis cohnii, sexual reproduction could only be induced by presence of the tube‐dwelling diatom Berkeleya rutilans. Phylogenetic analyses of the SSU rDNA sequences of 32, mostly marine, coccoid or sarcinoid strains confirmed the monophyly of the Ulvophyceae. The class contain 11 independent well‐supported lineages; of which eight contain coccoid species. (1) The basal branch of the ulvophytes is the Oltmannsiellopsis clade (in agreement with the order Oltmannsiellopsidales emend.) which contains the quadriflagellated monads (O. viridis and O. unicellularis) and the type species of the coccoid genus Halochlorococcum (H. marinum). (2) The other species of Halochlorococcum (except H. saccatum) formed together with Chlorocystis and Chlorella salina a significant clade corresponding to the order Chlorocystidales in emended form. (3) Gomontia polyrhiza is closely related to Urospora penicelliformis within the Acrosiphonia group (Acrosiphoniales). (4) The sarcinoid Trichosarcina polymorpha and T. mucosa, and the freshwater planctonic Helicodictyon planctonicum are member of the Ulothrix clade together with filamenteous taxa. (5) The type species of Pseudoneochloris (P. marina) form together with three unidentified marine coccoid strains an independent lineage within the Ulvophyceae (called Pseudoneochloris clade). (6–8) Ignatius tetrasporus (isolated from soil), the strain CCMP 250 originating from desert soil and the marine strain CCMP 1293 isolated from Palau Islands represent three single lineages within the ulvophytes. From our results, the class Ulvophyceae can be subdivided taxonomically into at least 11 orders (including the Ulvales, Cladophorales and Dasycladales) with the largest biodiversity at the coccoid level.

†Present address: Department of Molecular and Cell Biology, Brown University, Providence, RI 02912, USA.
Toward Individualized Evidence‐Based Medicine: Five “N of 1” Trials of Methylphenidate in Geriatric Patients
Authors: Jansen Inge H.M. , Rikkert Marcel G.M. Olde , Hulsbos Hans A.J. , Hoefnagels Willibrord H.L.
Published: March 2003

OBJECTIVES: To investigate the efficacy of methylphenidate in depressed or apathetic geriatric patients.

DESIGN: Five “N of 1” trials (individual cross‐over, double‐blinded, randomized trials).

SETTING: Department of Geriatrics, University Medical Center, Nijmegen, and two nursing homes in Nijmegen, the Netherlands.

PARTICIPANTS: Patients suffered from depression due to a general medical condition (n = 2); depression resistant to antidepressive drugs (n = 1), chronic apathy due to mild and moderate severe dementia (n = 2).

INTERVENTION: Methylphenidate (5 mg bid) and placebo (both for two subsequent days) in 5 weeks of randomized treatment blocks.

MEASUREMENTS: Montgomery Åsberg Depression Rating Scale (MADRS), Apathy Evaluation Scale (AES)‐clinician, the AES‐informant, Barthel index and a semiquantitative checklist of adverse effects.

RESULTS: Among the three depressed patients, two showed significant improvement on the MADRS (P = .089 and P = .001; α = 0.10), one patient's apathy showed significant improvement on AES‐clinician and ‐informant (P = .077 and P = .086). One apathetic patient's trial was stopped because AES could not be completed. None of the patients showed significant changes in the Barthel index. No side effects developed.

CONCLUSION: “N of 1” trials are useful in evaluating efficacy of methylphenidate in depressed or apathetic geriatric patients. Single‐patient trials can be a useful tool in pharmacotherapeutic decision‐making in frail older subjects.
A Nurse‐Led Interdisciplinary Intervention Program for Delirium in Elderly Hip‐Fracture Patients
Authors: Milisen Koen , Foreman Marquis D. , Abraham Ivo L. , De Geest Sabina , Godderis Jan , Vandermeulen Erik , Fischler Benjamin , Delooz Herman H. , Spiessens Bart , Broos Paul L. O.
Published: March 2003

OBJECTIVES: To develop and test the effect of a nurse‐led interdisciplinary intervention program for delirium on the incidence and course (severity and duration) of delirium, cognitive functioning, functional rehabilitation, mortality, and length of stay in older hip‐fracture patients.

DESIGN: Longitudinal prospective before/after design (sequential design).

SETTING: The emergency room and two traumatological units of an academic medical center located in an urban area in Belgium.

PARTICIPANTS: 60 patients in an intervention cohort (81.7% females, median age = 82, interquartile range (IQR) = 13) and another 60 patients in a usual care/nonintervention cohort (80% females, median age = 80, IQR = 12).

INTERVENTION: (1) Education of nursing staff, (2) systematic cognitive screening, (3) consultative services by a delirium resource nurse, a geriatric nurse specialist, or a psychogeriatrician, and (4) use of a scheduled pain protocol.

MEASUREMENTS: All patients were monitored for signs of delirium, as measured by the Confusion Assessment Method (CAM). Severity of delirium was assessed using a variant of the CAM. Cognitive and functional status were measured by the Mini‐Mental State Examination (MMSE) (including subscales of memory, linguistic ability, concentration, and psychomotor executive skills) and the Katz Index of activities of daily living (ADLs), respectively.

RESULTS: Although there was no significant effect on the incidence of delirium (23.3% in the control vs 20.0% in the intervention cohort; P = .82), duration of delirium was shorter (P = .03) and severity of delirium was less (P = .0049) in the intervention cohort. Further, clinically higher cognitive functioning was observed for the delirious patients in the intervention cohort compared with the nonintervention cohort. Additionally, a trend toward decreased length of stay postoperatively was noted for the delirious patients in the intervention cohort. Despite these positive intervention effects, no effect on ADL rehabilitation was found. Results for risk of mortality were inconclusive.

CONCLUSIONS: This study demonstrated the beneficial effects of an intervention program focusing on early recognition and treatment of delirium in older hip‐fracture patients and confirms the reversibility of the syndrome in view of the delirium's duration and severity.
How EverCare Nurse Practitioners Spend Their Time
Authors: Kane Robert L. , Flood Shannon , Keckhafer Gail , Rockwood Todd
Published: March 2003

OBJECTIVES: To describe how nurse practitioners (NPs) employed by EverCare, a Medicare HMO serving exclusively nursing home residents, spend their working days.

DESIGN:

A descriptive study based on structured self‐reports.

SETTING:

Nursing homes.

PARTICIPANTS:

Seventeen NPs employed by EverCare in five sites.

MEASUREMENTS:

Self‐reports of time spent over a 2‐week period and specific reports of how time was spent on selected cases.

RESULTS:

NPs spend about 35% of their working day on direct patient care and another 26% in indirect care activities. Of the latter, 46% of the time was spent interacting with nursing home staff, 26% with family, and 15% with the physicians. The mean time spent on a given patient per day was 42 minutes (median 30); of this time 20 minutes was direct care (median 15).

CONCLUSIONS:

NPs' activities are varied. Much of their time is spent communicating with vital parties, an important function that supports the physicians' primary care role and should enhance families' satisfaction with care. J Am Geriatr Soc 49:1530–1534, 2001.
Recovery from Poststroke Urinary Incontinence: Associated Factors and Impact on Outcome
Authors: Patel Mehool , Coshall Catherine , Lawrence Enas , G Rudd Anthony , Wolfe Charles DA
Published: March 2003

OBJECTIVES: To determine factors associated with recovery from poststroke urinary incontinence and to estimate the impact of this recovery on stroke outcome at 3 months.

DESIGN: Prospective, observational study.

SETTING: Population‐based stroke register.

PARTICIPANTS: Three hundred twenty‐four incident cases of stroke with incontinence 1 week poststroke were identified from the register between January 1, 1995, and December 31, 1998.

MEASUREMENTS: At 3 months, 105 patients were dead and 12 were lost to follow‐up. The remaining patients were classified by continence status; those who had regained continence (n = 127) were compared with those who remained incontinent (n = 80) in terms of demographic details, stroke risk factors, premorbid disability, neurological impairments, and Oxfordshire Community Stroke Project stroke subtypes. Data at 3 months included disability using the modified Barthel Index (BI) (without its urinary continence component) and the Frenchay Activity Index (FAI), and institutionalization.

RESULTS: Multivariate analysis showed being age 75 and older (odds ratio (OR) = 0.38; 95% confidence interval (CI) = 0.17–0.83) was associated with poor recovery from incontinence. Compared with subjects with total anterior circulatory infarctions, those with lacunar infarctions were more likely to regain continence (OR = 3.66; 95% CI =1.10–12.2), and compared with subjects with a BI between 0 and 14, those with a BI between 15 and 18 were also more likely to regain continence (OR = 21.8; 95% CI = 5.95–79.7). At 3 months, the incontinent group had greater institutionalization rates (27 (34%) vs 9 (7%), P < .001) and worse disability, measured with BI and FAI (BI: P < .001, FAI: P = .002).

CONCLUSIONS: Age 75 and older is independently associated with poor recovery from poststroke urinary incontinence. Further clinical trials are required to explore underlying mechanisms and efficacy of possible interventions for this group of stroke survivors. Recovery from poststroke urinary incontinence should be a major goal of stroke professionals because it is associated with lower institutionalization rates and less disability at 3 months.
Outbreak of Campylobacteriosis at a Senior Center
Authors: Winquist Andrea G. , Roome Aaron , Mshar Roger , Fiorentino Terry , Mshar Patricia , Hadler James
Published: March 2003

OBJECTIVES: In August 1997, campylobacteriosis was diagnosed in four older persons in one Connecticut town. We investigated this outbreak to determine its cause and to identify appropriate preventive measures. We also analyzed surveillance data to assess the impact of campylobacteriosis among persons are 65 years and older in Connecticut.

DESIGN: The outbreak was investigated through a case‐control study and an environmental investigation. Surveillance data were from population‐based, active foodborne disease surveillance.

SETTING: The outbreak and environmental studies were conducted at a senior center identified as the one eating place common to all four patients. Active surveillance data were from three Connecticut counties during 1996/1997.

PARTICIPANTS: We administered a questionnaire to senior center attendees. A case was defined as onset of diarrhea with fever or abdominal cramps during August 20–25 in a person who ate at the senior center during August 18–20. Respondents without illness meeting the case definition who ate at the senior center during August 18–20 were controls.

MEASUREMENTS: Case‐control study participants were asked about symptoms of gastrointestinal illness and meals and foods eaten at the center. The environmental investigation gathered information about food preparation procedures and facilities. Active surveillance data were analyzed to determine age‐specific annual campylobacteriosis incidence rates and proportions of cases involving hospitalization.

RESULTS: For the case‐control study, there were 66 respondents (16 case patients, 50 controls), representing approximately 52% of August 18–20 attendees. Case patients were more likely than controls to have eaten at a Hawaiian luau at the center. The most strongly implicated food was sweet potatoes. Review of food preparation procedures identified multiple opportunities for cross‐contamination from raw meats to other foods. In Connecticut's active surveillance area during 1996/1997, the annual campylobacteriosis incidence rate was highest among young adults, but the proportion of hospitalized cases was highest among persons age 70 years and older.

CONCLUSION:
Campylobacter transmission occurred at the luau, likely because of cross‐contamination in the kitchen. This investigation emphasizes the importance of strict separation of raw meats from other foods during preparation. Careful attention to these measures is particularly important when an older population is served.
New Glaucoma Medications in the Geriatric Population: Efficacy and Safety
Authors: Novack Gary D. , O'Donnell Martin J. , Molloy D. William
Published: March 2003

Glaucoma can be considered a disease of the aging eye. Most medications used to treat glaucoma are in topical eyedrop form and may cause numerous untoward systemic effects in older persons. In recent years, several new ocular hypotensive medications have become available. These medications are being used more commonly because there is a growing trend by ophthalmologists to aggressively lower intraocular pressure. Therefore, geriatricians require a comprehensive knowledge of medications used to treat glaucoma, in addition to an understanding of their mechanism of action profiles of untoward effects and possible interactions with other diseases or medications. Therefore, we performed a review of the medications recently introduced into clinical practice.

We selected drugs approved by the U.S. Food and Drug Administration between 1996 and September 2001. The safety profiles of these agents and their untoward side effects were reviewed by class: topical carbonic anhydrase inhibitors (brinzolamide: ocular tolerance, taste perversion), β‐adrenoceptor antagonists (timolol: bradycardia and bronchospasm), α‐adrenergic agonists (brimonidine: oral dryness, headache, and fatigue), and prostaglandin analogs (latanoprost, bimatoprost, travoprost, and unoprostone isopropyl: ocular hyperemia, iris color changes).

The function of this review is to make geriatricians more aware of the efficacy and untoward effects of medications recently introduced into clinical practice. We recommend that geriatricians perform a medication review on all medications their patients use, including eye drops.
Cognitive Impairment, Depressive Symptoms, and Functional Decline in Older People
Authors: Mehta Kala M. , Yaffe Kristine , Covinsky Kenneth E.
Published: March 2003

OBJECTIVES: Although cognitive impairment and depressive symptoms are associated with functional decline, it is not understood how these risk factors act together to affect the risk of functional decline. The purpose of this study is to determine the relative contributions of cognitive impairment and depressive symptoms on decline in activity of daily living (ADL) function over 2 years in an older cohort.

DESIGN: Prospective cohort study.

SETTING: A U.S. national prospective cohort study of older people, Asset and Health Dynamics in the Oldest Old.

PARTICIPANTS: Five thousand six hundred ninety‐seven participants (mean age 77, 64% women, 86% white) followed from 1993 to 1995

MEASUREMENTS: Cognitive impairment and depressive symptoms were defined as the poorest scores: 1.5 standard deviations below the mean on a cognitive scale or 1.5 standard deviations above the mean on validated depression scales. Risk of functional decline in participants with depressive symptoms, cognitive impairment, and both, compared with neither risk factor, were calculated and stratified by baseline dependence. Analyses were adjusted for demographics and comorbidity.

RESULTS: Eight percent (n = 450) of subjects declined in ADL function. In participants who were independent in all ADLs at baseline, the relative risk (RR) of 2‐year functional decline was 2.3 (95% confidence interval (CI) = 1.7–3.1) for participants with cognitive impairment, 1.9 (95% CI = 1.3–2.6) for participants with depressive symptoms, and 2.4 (95% CI = 1.4–3.7) for participants with cognitive impairment and depressive symptoms. In participants who were dependent in one or more ADLs at baseline, RR of 2‐year functional decline was 1.9 (95% CI = 1.2–2.8) for participants with cognitive impairment, 0.6 (95% CI = 0.3–1.3) for participants with depressive symptoms, and 1.5 (95% CI = 0.8–2.6) for participants with cognitive impairment and depressive symptoms.

CONCLUSIONS: In participants with no ADL dependence at baseline, cognitive impairment and depressive symptoms are risk factors for decline, but that, in participants with dependence in ADL at baseline, cognitive impairment, but not depressive symptoms, is a risk factor for additional decline.
Androgen Supplementation in Older Women: Too Much Hype, Not Enough Data
Authors: Padero Ma Clara M. , Bhasin Shalender , Friedman Theodore C.
Published: March 2003

Androgen supplementation in women has received enormous attention in the scientific and lay communities. That it enhances some aspects of cognitive function, sexual function, muscle mass, strength, and sense of well‐being is not in question. What is not known is whether physiological testosterone replacement can improve health‐related outcome in older women without its virilizing side effects. Although it is assumed that the testosterone dose‐response relationship is different in women than in men and that clinically relevant outcomes on the above‐mentioned effects can be achieved at lower testosterone doses, these assumptions have not been tested rigorously. Androgen deficiency has no clear‐cut definition. Clinical features may include impaired sexual function, low energy, depression, and a total testosterone level of less than 15 ng/dL, the lower end of the normal range. Measurement of free testosterone is ideal, because it provides a better estimate of the biologically relevant fraction. It is not widely used in clinical practice, because some methods of measuring free testosterone assay are hampered by methodological difficulties. In marked contrast to the abrupt decline in estrogen and progesterone production at menopause, serum testosterone is lower in older women than in menstruating women, with the decline becoming apparent a decade before menopause. This article reviews testosterone's effects on sexual function, cognitive function, muscle mass, body composition, and immune function in postmenopausal women.
Prevalence of Dementia in Older Latinos: The Influence of Type 2 Diabetes Mellitus, Stroke and Genetic Factors
Authors: Haan Mary N. , Mungas Dan M. , Gonzalez Hector M. , Ortiz Teresa A. , Acharya Ananth , Jagust William J.
Published: March 2003

OBJECTIVES: To estimate dementia prevalence in older Mexican Americans, determine the distribution of dementia by etiology, and evaluate the contribution of type 2 diabetes mellitus, stroke, and apolipoprotein E (ApoE) genotype to dementia.

DESIGN: Analysis of baseline data from an epidemiological cohort study.

SETTING: Sacramento Valley, California.

PARTICIPANTS: One thousand seven hundred eighty‐nine Latinos aged 60 and older residing in targeted census tracts during 1998–99.

MEASUREMENTS: Each subject was interviewed and screened for dementia and cardiovascular risk factors and diseases. Fasting blood samples were drawn for glucose, insulin, and lipids. Buccal cells were obtained for genetic analysis of ApoE. A three‐stage process of screening was used to diagnose dementia, including cognitive testing, a clinical examination, and imaging to determine etiology. Presence of dementia was established according to National Institute of Neurological Disorders and Stroke/Alzheimers and Related Disorders Association criteria and California Alzheimer's Disease Diagnostic and Treatment Criteria.

RESULTS: Overall dementia prevalence was 4.8%. Prevalence in those aged 85 and older was 31%. Education and Anglo cultural orientation was negatively associated with dementia risk. Risk of dementia was nearly eight times higher in those with both type 2 diabetes mellitus and stroke. Forty‐three percent of dementia was attributable to type 2 diabetes mellitus, stroke, or a combination of the two. ApoE allele frequency was E2 5.9%, E3 90.1%, and E4 4%. Those with any E4 and 4–4 combinations had a higher risk for dementia than those with the E3–3 combination.

CONCLUSIONS: Dementia prevalence in this ethnic group is similar to that reported in Canadian and European studies but lower than in Caribbean‐Hispanics residing in the United States. The etiological fraction of dementia attributable to type 2 diabetes mellitus and stroke is substantial and points toward the need for intervention research and treatment with the goal of reducing neurological sequelae in groups with high prevalence of type 2 diabetes mellitus. The allele frequency of ApoE was similar to that in other published studies on Mexican Americans. The low frequency of the E4 allele may contribute to the difference in etiology of dementia in older Mexican Americans and older people of European background. Dementia in this ethnic group may be related to preventable causes, with a smaller genetic component than in Europeans.
Cognitive Impairment and Mortality in Older Mexican Americans
Authors: Nguyen Ha T. , Black Sandra A. , Ray Laura A. , Espino David V. , Markides Kyriakos S.
Published: March 2003

OBJECTIVES: To examine the extent to which cognitive status and decline in cognitive status predict mortality in older Mexican Americans.

DESIGN: Longitudinal cohort.

SETTING: Older Mexican Americans residing in five southwestern states in the United States.

PARTICIPANTS: Two thousand six hundred twenty‐five persons aged 65 and older living in Texas, New Mexico, Colorado, Arizona, and California.

MEASUREMENTS: The cognitive function of participants was assessed using the Mini‐Mental State Examination (MMSE) in 1993–94 and again in 1995–96. Cognitive decline was defined using two sets of criteria: a drop to 17 or less (moderate‐severe cognitive impairment) on the MMSE at 2‐year follow‐up and a decrease of at least four points, a threshold change in scores that was used to predict mortality in this sample. Cox proportional hazards models were conducted to examine the association between the MMSE and increased risk for mortality, after controlling for sociodemographic characteristics, medical conditions, and depressive symptoms.

RESULTS: Five‐year mortality risk was significantly associated with persons in the moderately‐severely cognitively impaired category (hazard ratio (HR) = 2.35, P < .001). Moreover, mild cognitive impairment was also predictive of mortality in older Mexicans (HR = 1.45, P < .001). Two‐year declines in cognitive functioning, particularly in persons who had declined to the moderate‐severe impairment category (HR = 2.23, P < .001) and those who dropped at least four points on the MMSE (HR = 1.30, P < .001), were predictive of mortality 3 years later, after controlling for important variables.

CONCLUSIONS: Baseline moderate‐severe and mild cognitive status and 2‐year decline in cognitive functioning independently predict mortality in older Mexican Americans. Although age and selected medical conditions have been reported as the more salient predictors of mortality, cognitive functioning should be considered part of identifying older persons at high risk for underlying medical conditions and mortality.
Resistant Pathogens in Urinary Tract Infections
Authors: Nicolle Lindsay E.
Published: March 2003

Antimicrobial susceptibility of bacteria causing urinary tract infection (UTI) has evolved over several decades as antimicrobial exposure has repeatedly been followed by emergence of resistance. Older populations in the community, long‐term care facilities, or acute care facilities have an increased prevalence of resistant bacteria isolated from UTI. Resistant isolates are more frequent in long‐term care populations than the community. Resistant isolates include common uropathogens, such as Escherichia coli or Proteus mirabilis, and organisms with higher levels of intrinsic resistance, such as Pseudomonas aeruginosa or Providencia stuartii. Isolation of resistant organisms is consistently associated with prior antimicrobial exposure and higher functional impairment. The increased likelihood of resistant bacteria makes it essential that a urine specimen for culture and susceptibility testing be obtained before instituting antimicrobial therapy. Therapy for the individual patient must be balanced with the possibility that antimicrobial use will promote further resistance. Antimicrobial therapy should be avoided unless there is a clear clinical indication. In particular, asymptomatic bacteriuria should not be treated with antimicrobials. Where symptoms are mild or equivocal, urine culture results should be obtained before initiating therapy. This permits selection of specific therapy for the infecting organism and avoids empiric, usually broad‐spectrum, therapy. Where empirical therapy is necessary, prior infecting organisms should be isolated, and recent antimicrobial therapy, as well as regional or facility susceptibility patterns, should be considered in antimicrobial choice. Where empirical therapy is used, it should be reassessed 48 to 72 hours after initiation, once pretherapy cultures are available.
Topical lidocaine patch relieves a variety of neuropathic pain conditions: an open‐label study. (Department of Pain Medicine and Palliative Care, Beth Lsrael Medical Center, New York, NY) Clin J Pain 2000;16:205–208.
Authors: Devers Allison , Galer: Bradley S.
Published: March 2003

Our goal was to perform a pilot, open‐label, prospective study to access the effectiveness and tolerability of a topical lidocaine patch (Lidoderm) for the treatment of peripheral neuropathic pain conditions other than postherpetic neuralgia. Sixteen patients with refractory peripheral neruopathic pain conditions who had reported intolerable side effects or inadequate pain relief with antidepressant, anticonvulsant, antiarrhythmic, and opioid medications participated in this study. Diagnoses included postthoracotomy pain, stump neuroma pain, intercostal neuralgia, diabetic polyneuropathy, meralgia paresthetica, complex regional pain syndrome, radiculopathy, and postmastectomy pain. A 6‐item Pain Relief Scale was used. Moderate or better pain relief was reported by 13 of the 16 participants (81%). One patient stopped treatment after 4 days due to lack of relief. The remaining 15 patients had a mean duration of patch use of 6.2 weeks with continued relief. Only 1 patient reported a side effect, a mild skin irritation. Conclude the Lidoderm patch provides clinically meaningful pain relief in most of these refractory neuropathic pain patients without side effects. Controlled trials need to be performed to confirm these preliminary findings.

Comment by Tat‐Leang Lee, M.D. This is an interesting study that highlighted a simple, efficacious method for the treatment of resistant neuropathic pain. As this was a pilot study using an open‐label method, and treating a heterogenous group of neuropathic pain conditions, caution should be adopted in the interpretation of the results. What remains unanswered is the reason for the success of the lidocaine patch, particularly when previous studies have documented the failure of EMLA in the treatment of neuropathic pain. Indeed, several patients who participated in this study had used EMLA unsuccessfully before, although no details on its administration was reported. Both the lidocaine patch and EMLA contain 5% lidocaine, which presumably would result in greater penetration by the EMLA cream. Therefore, a placebo‐controlled randomized trial is needed to confirm the findings of this pilot study. Nevertheless, this is a promising treatment that is convenient, lacks systemic effect, easily added‐on to existing treatment, and with only minor side effects, that is worth considering for our patients.
Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims. (University of Toronto, Ontario, Canada) Can J Anaeth 2000;47:105–112.
Authors: Peng Philip W. H. , Smedstad: Kari G.
Published: March 2003

This review discussed the pattern of malpractice litigation related to regional anesthesia in Canada. Source information for this review came from the Canadian Medical Protective Association (CMPA). From 1990 to 1997 there were 7,909 closed legal actions involving all CMPA members. Of these, there were 310 cases involving anesthesiologists, of which 61 cases (approximately 20%) were related to regional anesthesia. Forty‐two of the cases involved neuraxial blocks and the legal outcome was favorable in 37 claims. There were 19 claims that involved peripheral nerve blocks; all of these had favorable outcomes. Overall, 10% of the regional anesthesia claims had unfavorable outcomes, compared with 28% of all anesthesia‐related claims and 30% of all CMPA members' claims. The degree of disability in the regional anesthesia claims were: none 10%; minor 49%; major 36%; and catastrophic 5%. There were no deaths in the malpractice claims involving regional anesthesia, compared with 17% in the all anesthesia group and 11% in all members' claims. Conclude that 20% of all anesthesia claims in Canada are related to regional anesthesia. The legal outcome of these claims is favorable 90% of the time. There were no deaths in the regional anesthesia claims.
Acute brachial plexus neuritis: an uncommon cause of shoulder pain. (North Mississippi Neurosurgical Services, Tupelo, MS) Am Fam Physician 2000;62:2067–2072.
Authors: Miller Jimmy D. , Pruitt Stephanie , McDonald: Thomas J.
Published: March 2003

This article discussed the importance of a proper diagnosis with regard to acute brachial plexus neuritis. A 66‐year‐old man who presented with severe, left‐sided neck pain that radiated to the left shoulder without associated numbness was provided as an illustrative case. Diagnosis suggestions and treatment options were provided. Conclude that differentiating acute brachial plexus neuritis from other diagnoses is important so that surgical treatment is not performed for small osteophytes that may be observed on magnetic resonance imaging, but are not causing neurologic deficits.
Pain mechanisms and management: a central perspective. (Massachusetts General Hospital, Charlestown, MA) Clin J Pain 2000;16:S144–S156.
Authors: Mannion Richard J. , Woolf: Clifford J.
Published: March 2003

This article reviews the specific role of the dorsal horn of the spinal cord in the mechanisms of nociceptive protective pain and the spinal plasticity that occurs after nerve and tissue injury. Spinal neuronal plasticity is shown to be a key contributor to pathologic pain hypersensitivity. The potential for the molecular mechanisms responsible for the spinal plasticity in revealing new targets for future treatment is also discussed.
Fentanyl improves analgesia but prolongs the onset of axillary brachial plexus block by peripheral mechanism. (Sapporo Medical University, School of Medicine, Sapporo, Japan) Anesth Analg 2000;91:384–387.
Authors: Nishikawa Kohki , Kanaya Noriaki , Nakayama Masayasu , Igarashi Motohiko , Tsunoda Kazumasa , Namiki: Akiyoshi
Published: March 2003

This double‐blinded study evaluated the effects of fentanyl added to lidocaine for axillary brachial plexus block in 66 adult patients scheduled for elective hand and forearm surgery. All patients received 40 mL of 1.5% lidocaine with 1:200,000 epinephrine, injected into the brachial plexus sheath using the axillary perivascular technique, and they were randomized into 3 groups. Group 1 was given lidocaine containing 2 mL of normal saline plus 2 mL of normal saline IV. Patients in Group 2 received lidocaine containing 100 μg fentanyl plus 2 mL of normal saline IV. Group 3 patients received lidocaine containing 2 mL of normal saline plus 100 μg fentanyl IV. Sensory and motor blockade were evaluated by using a pinprick technique and by measuring the gripping force, respectively. The success rate of sensory blockade for radial and musculocutaneous nerves and the duration of the sensory blockade significantly increased in Group 2 (323 ± 96 min) as compared with Group 1 (250 ± 79 min). However, the onset time of analgesia was prolonged in every nerve distribution by adding fentanyl to the brachial plexus block. IV fentanyl had no effect on the success rate, onset, or duration of the blockade. Conclude that the addition of fentanyl to lidocaine causes an improved success rate of the sensory blockade, but a delayed onset of analgesia, although this may be accounted for by the decreased pH caused by the fentanyl.

Comment by Alan Kaye, M.D. The addition of opioids to regional blocks is controversial. This is due in part to the potential uptake and distribution centrally of the opioid agent. In 66 patients undergoing axillary block, all had 40 mL of 1.5% lidocaine with epinephrine. One group had normal saline, another group has fentanyl plus saline, and a third had just fentanyl. The authors found that the addition of fentanyl caused an improved success rate with regard to sensory blockade. However, onset of the blockade was delayed with fentanyl and this was theorized by a decreased pH caused by the fentanyl. More studies are needed to better elucidate mechanistic effects of opioids and other agents in enhancing or modulating local anesthetics in regional blockade.
Primary sensory neurons with dichotomizing axons projecting to the facet joint and sciatic nerve in rats. (School of Medicine, Chiba University, Chiba, Japan) Spine. 2001;26:1105–1109.
Authors: Sameda Hiroaki , Takahashi Yuzuru , Takahashi Kazuhisa , Chiba Tanemichi , Ohtori Seiji , Moriya Hideshige
Published: March 2003

The object of this study was to clarify the existence of dorsal root ganglion (DRG) neurons with dichotomizing axons projecting to the lumbar facet joint and to the sciatic nerve in rats. Two kinds of neurotracers (Dil and FG) were used in the study. Dil crystals were placed in the left F5‐F6 facet joint, and FG was applied to the ipsilateral sciatic nerve or along the midline of the F% dermatome. Bilateral DRGs T13‐S1 were observed by fluorescence microscope. DRG neurons double labeled with Dil and FG were recognized only in the ipsilateral DRGs from L3‐L6 levels. Approximately 3% of DRG neurons innervating the L5‐L6 facet joint had other axons to the sciatic nerve. By contrast, no double‐labeled neurons were observed after FG was applied to the L5 dermatome. Conclude that in rats approximately 3% of DRG neurons innervating the lumbar facet joints have dichotomized axons projecting to the sciatic nerve.
Spinal endoscopy in chronic low back pain with radiculopathy. (Bradford Royal Infirmary, Bradford, United Kingdom) Anaesthesia 2001;56:454–460.
Authors: Richardson J. , McGurgan P. , Cheema S. , Prasad R. , Gupta S.
Published: March 2003

All 38 patients listed for day‐case spinal endoscopy over a 12‐month period, who had chronic severe low back pain with a radiculopathic element, were studied. The mean pain duration before treatment was 10.9 years and 50% had failed back surgery syndrome. In all patients in whom treatment was completed (n = 34), the pain‐generating nerve roots were located through symptom interaction with the patient. All had epidural scar tissue, 14 (41%) having dense adhesion. Mobilization of adhesions around the nerve root was performed so that a pocket was formed for the subsequent placement of bupivacaine, Depomedrone, and clonidine. No intra‐operative complications occurred and side effects were minimal. Follow‐up over a 12‐month period showed statistically significant reductions in pain scores and disability. Spinal endoscopy may be the diagnostic method of choice for epidural fibrosis. It has substantial therapeutic and research potential. Prospective randomized studies are required.
Quantitative sensory studies in complex regional pain syndrome type 1/RSD. (MCP Hahnemann University, Philadelphia, PA) Clin J Pain. 2000;16:340–344.
Authors: Tahmoush Albert J. , Schwartzman R. J. , Hopp J. L. , Grothusen J. R.
Published: March 2003

This study measured the warm, cold, heat‐evoked pain threshold and the cold‐evoked pain threshold in the affected area of 16 control patients and patients with complex regional pain syndrome type 1/RSD (CRPSD1) to test the hypothesis that allodynia results from an abnormality in sensory physiology. The cold‐evoked pain threshold in patients with CRPSD1/RSD was significantly decreased when compared with the thresholds in control patients (ie, a smaller decrease in temperature was necessary to elicit cold‐pain in patients with CRPSD1/RSD than in control patients). The heat‐evoked pain threshold in patients with CRPSD1/RSD was decreased significantly when compared with thresholds in control patients. The warm‐detection and cold‐detection thresholds in patients with CRPS1/RSD were similar to the thresholds in control patients. Conclude that the study suggests that thermal allodynia in patients with CRPS1/RSD resulted from decreased cold‐evoked and heat‐evoked pain thresholds. The thermal pain thresholds are reset so that non‐noxious thermal stimuli are perceived to be pain (allodynia).
Electromyographic reflex responses to mechanical force, manually assisted spinal manipulative therapy. (Logan College of Chiropractic, St. Louis, MO) Spine. 2001;26:1117–1124.
Authors: Colloca Christopher J. , Keller Tony S.
Published: March 2003

This is the first study demonstrating neuromuscular reflex responses associated with mechanical force, manually assisted (MFMA) spinal manipulative therapy in patients with low back pain. Noteworthy was the finding that such mechanical stimulation of both the paraspinal musculature stimulation and spinous processes produced consistent generalized sEMG responses. Identification of neuromuscular characteristics, together with a comprehensive assessment of patient clinical status, may provide for clarification of the significance of spinal manipulative therapy in eliciting putative conservative therapeutic benefits in patients with pain of musculoskeletal origin.
Continuous peripheral nerve block for ambulatory surgery. (Duke University, Durham, NC) Reg Anesth Pain Med 2001;26:209–214.
Authors: Grant Stuart A. , Nielsen Karen C. , Greengrass Roy A. , Steele Susan M. , Klein Stephen M.
Published: March 2003

In this study data was prospectively gathered for 1 year from 228 patients in an ambulatory surgery center. All continuous peripheral nerve blocks (CPNB) were performed using the Contiplex system to provide anesthesia and postoperative analgesia. CPNB were performed using 5 upper and lower extremity techniques. Postsurgery local anesthetic was infused and at 24 hours, a rebolus of local anesthetic was performed. The CPNB catheter was removed and patients were examined for a loss of sensation. Patients were then discharged. The initial peripheral block was successful in 94% of the patients. Failed nerve block requiring general anesthesia occurred in 6%. The catheter was patent and functional in 90% of the patients at 24 hours, and 8% of the patients required more than 10 mg of intravenous morphine by 24 hours postsurgery. In the postanesthesia care unit, only 4 patients (1.7%) required treatment for nausea. At 24 hours and 7 days postsurgery, no patient reported a dysesthesia. Conclude that CPNB using the insulated Tuohy catheter system offered acceptable anesthesia and prolonged pain relief postsurgery. There were few side effects.

Comment by Alan David Kaye, M.D., Ph.D., Erin Bayer, M.D. This study demonstrates the efficacy of the Contiplex system (CPNB) in providing surgical anesthesia and postoperative analgesia through CPNB. Despite the efficacy of CPNB, which could provide longer duration of postoperative analgesia than single injection block, it is not widely used due to lack of available equipment. Contiplex system utilizes a connector for a nerve stimulator attached to a 18‐gauge Tuohy needle. It allows for aspiration of blood, injection of local anesthesia and passage of a peripheral nerve catheter. This study demonstrated in an ambulatory surgery center with 228 patients, CPNB was used for 27 different types of surgical procedures which involved 5 different block sites. Success rates were 94% for initial peripheral block while 6% required general anesthesia. Patients required less postoperative analgesia. The incidence of postoperative side effects such as nausea and vomiting were minimal. Not a single patient reported dissatisfied with a 7‐day telephone follow‐up. A disadvantage of this technique is the use of an 18‐gauge needle and potential for vascular and/or nerve injuries, which did not occur in this study. Though previous studies have demonstrated the efficacy of the CPNB in inpatients, this is an important study focused on outpatients. A larger study group will be valuable in future studies.
Percutaneous Radiofrequency Lesion Adjacent to the Dorsal Root Ganglion in the Treatment of Spasticity and Pain in Children With Cerebral Palsy
Authors: De Louw A. J. A. , Van Kleef M. , Vles J. S. H.
Published: March 2003

Abstract: The use of percutaneous radiofrequency (RF) lesion adjacent to the dorsal root ganglion (RF‐DRG) in the treatment of pain has been established for years. A relatively novel indication for RF‐DRG treatment is spasticity in children with cerebral palsy. In this article the pathophysiology and management of spasticity is discussed with an emphasis on the role of RF‐DRG. In the management of spasticity, RF‐DRG could prove to be a little invasive treatment option with little adverse effects.
Optimal protocol for preparation of leukocyte‐poor red cells with a blood cell processor
Authors: Uda M. , Naito S. , Yamamoto K. , Ishii A. , Nishizaki T.
Published: March 2003

The optimal red cell override (RCO) protocol for preparation of leukocyte‐poor red cells (LPRCs) with a blood cell processor (IBM 2991) was studied. By a four‐step process, including determining leukocyte (WBC) and red cell (RBC) distributions in the processing bag after centrifugation, the optimal RCO sequence was determined. The “effectiveness index” of WBC removal also was used for comparison of the efficiencies of various RCO protocols. In this way, a four‐cycle RCO sequence of 1.5/1.5/1.5/1.5 was found to be optimal for washing 130‐ ml units of concentrated red cells (CRCs). This protocol yielded LPRCs with means of 5.4 percent of WBCs remaining and an 84.2 percent recovery of RBCs. The optimal RCO sequence of 2.0/2.0/2.0/2.0 for washing 260‐ml units of CRC gave LPRCs with means of 6.2 percent of WBCs remaining and an 87.8 percent recovery of RBCs.
Spontaneous agglutination of red cells with a positive direct antiglobulin test in various media
Authors: Garratty G. , Postoway N. , Nance S.J. , Brunt D.J.
Published: March 2003

Red cells from 475 individuals (donors and patients) with a positive direct antiglobulin test (DAT) (66% were 1/2+ to 1+, 19% were 1 1/2+ to 2+, and 15% were 2 1/2+ or greater) were examined for spontaneous agglutination following incubation in various media. Twenty‐three percent of the samples showed spontaneous agglutination in commercial Rh control solutions, 6 percent in 30 percent albumin, 3 percent in 10 percent albumin, 2 percent in 6 percent albumin, and 1 percent in saline. Cells suspended in serum were more prone to spontaneous agglutination. The strength of spontaneous agglutination varied; more than 50 percent of the samples reacted only 1+ or less, approximately 10 percent reacted 2+ or stronger. There was not a complete correlation with spontaneous agglutination and quantity of IgG on the cells, as determined by the antiglobulin test. Of those samples showing spontaneous agglutination, 50 percent were associated with a DAT strength of more than 2+, 27 percent with a DAT of 1 1/2+ to 2+, and 23 percent with a DAT of 1/2+ to 1+. Spontaneous agglutination occurred with the same frequency whether the cells were sensitized with both IgG and C3 or with IgG alone. Surprisingly, 7 percent of the samples sensitized with C3 but no detectable IgG also demonstrated spontaneous agglutination. Marked differences in reaction strength were seen with Rh control solutions from different manufacturers, and the degree of spontaneous agglutination was inconsistent with individual products.