bluuebunny/crossref_metadata_2025 huggingface dataset:
Tumour Biology of Gastroenteropancreatic Neuroendocrine Tumours
Authors: Grötzinger Carsten
Published: October 2004

Neuroendocrine tumours of the gastroenteropancreatic tract (GEP NETs) represent a rare and heterogeneous group of tumours. Based on their ontogenetic origin, GEP NETs are classified into foregut, midgut and hindgut tumours. Although they have many features in common, their molecular backgrounds are obviously different. Elucidation of the key factors determining tumour biology has been hampered by the low incidence and high variability of these tumours in terms of origin, morphology and growth. However, recent years have shed some light on molecular genetics of these tumours, revealing important genetic factors as the RET proto-oncogene and the tumour suppressor menin as well as knowledge about the role of growth factors like IGF-1, TGF-β, VEGF and PDGF for the regulation of differentiation, growth and secretion. In the future, emerging molecular tools in rapid individual genome analysis and in proteomic and array technologies may help to delineate common patterns of NET disease.
Endocrine Tumors of the Gut and Pancreas Tumor Biology and Classification
Authors: Rindi G. , Klöppel G.
Published: October 2004

The endocrine tumors of the gut and pancreas tract are a group of neoplasms composed of cells with a neuroendocrine phenotype. Well-differentiated tumors, well-differentiated carcinomas and poorly differentiated carcinomas are the major categories identified. According to their localization (stomach, duodenum-jejunum, ileum, appendix and colorectum), they display distinct phenotypes, regarding their pathology, immunohistochemistry and hormonal syndromes. Their clinical behavior spans from benign, uncertain malignant potential, low-grade malignant to high-grade malignant. Currently, extensive work is performed to unravel the genetic background.
Gastric Neuroendocrine Tumors
Authors: Delle Fave Gianfranco , Capurso Gabriele , Annibale Bruno , Panzuto Francesco
Published: October 2004

Gastric carcinoids are rare neuroendocrine tumors, usually classified as type I, if associated with atrophic body gastritis; type II, if associated with Zollinger-Ellison syndrome and multiple endocrine neoplasia type I, and type III, in the absence of any gastric pathology (sporadic tumors). The pathological features, as well as the prognosis of the tumor and the patient’s survival strictly depend on this classification. The correct management of the patient with gastric carcinoid can only be proposed when the tumor has been classified by an accurate pathological and clinical evaluation of the patient. While the therapeutic approach in types I and II is based on a conservative strategy, including endoscopic resection, an adequate follow-up program, and the possible use of somatostatin analogues, an aggressive surgical approach is required in type III.
Insulinoma
Authors: de Herder W.W.
Published: October 2004

More than 90% of insulinomas are benign tumors. Insulinomas cause hypoglycemia and thereby symptoms of neuroglycopenia and catecholamine response. During symptoms, blood glucose levels should be less than 40 mg/dl (less than 2.2 mmol/l), concomitant insulin levels should be ≧6 IU/ml (≧43 pmol/l) and concomitant C-peptide levels ≧0.2 pmol/l. Most insulinomas can be identified intraoperatively by experienced surgeons. Initial therapy consists of administration of frequent meals and/or by glucose infusion. In patients with solitary insulinomas, complete surgical removal of the tumor should be the primary goal. In patients with metastatic insulinomas, symptoms of insulin hypersecretion will only completely disappear after complete resection of all metastases.
Gastrinomas: Advances in Diagnosis and Management
Authors: Jensen Robert T.
Published: October 2004

Gastrinomas causing Zollinger-Ellison syndrome (ZES) are the most common functional, malignant pancreatic endocrine tumors. In this paper, the diagnosis and treatment of these tumors are reviewed, incorporating recent advances in each area. Furthermore, recent advances in their pathology, molecular pathogenesis, and aspects of their localization using somatostatin receptor scintigraphy, as well as their treatment are discussed. Recent data from our NIH prospective studies on patients with ZES are included to illustrate many of these points.
Complications of Midgut Carcinoid Tumors and Carcinoid Syndrome
Authors: van der Horst-Schrivers Anouk N.A. , Wymenga A.N. Machteld , Links Thera P. , Willemse Pax H.B. , Kema Ido P. , de Vries Elisabeth G.E.
Published: October 2004

The carcinoid syndrome, associated with carcinoid tumors of the midgut, consists of symptoms such as diarrhea, flushing, wheezing and cardiovascular symptoms. This review focuses on these symptoms and discusses therapeutic options. The symptoms are caused by the secretion of biogenic amines, polypeptides and other factors of which serotonin is the most prominent. However, diarrhea is also due to factors such as malabsorption. Besides antitumor therapy, more specific interventions such as serotonin receptor blockers can be useful. The carcinoid heart disease involves the tricuspid and pulmonary valve. In the pathogenesis, serotonin plays a central role. The therapeutic approach is mostly symptomatic. Other cardiovascular complications include bowel ischemia and hypertension. Pellagra and psychiatric symptoms are due to a depletion of tryptophan, which is consumed by the carcinoid tumor for serotonin synthesis. Finally, follow-up and clinical practice of patients with carcinoid tumors are discussed.
Functional Activity of the Multiligand Analog SOM230 at Human Recombinant Somatostatin Receptor Subtypes Supports Its Usefulness in Neuroendocrine Tumors
Authors: Schmid Herbert A. , Schoeffter Philippe
Published: October 2004

Functional gastroenteropancreatic tumors express all 5 somatostatin receptor subtypes (sst) in different quantities. Octreotide and lanreotide treat patients with these tumors by binding preferentially to sst2 and, to a lesser extent, to sst3 and sst5 receptors, thereby controlling prominent symptoms caused by hormone hypersecretion (diarrhea and flushing). Although symptoms initially improve in most patients, a loss of response occurs in about 50% during continuous treatment. The functional activity at sst receptors of SOM230, a new multiligand somatostatin analog, has been described and compared with that of somatostatin (SRIF-14) and octreotide. These data show that SOM230 is a full agonist with nanomolar potency at sst1,2,3 and sst5 receptors. The multiligand activity profile of SOM230, together with its nondesensitizing inhibitory effect on growth hormone and insulin-like growth factor-I secretion in rats, may underlie its successful use in clinical trials and its potential for use in refractory patients with carcinoid tumors.
Somatostatin and Other Peptide Receptors as Tools for Tumor Diagnosis and Treatment
Authors: Reubi Jean Claude
Published: October 2004

Somatostatin receptors are expressed in selected human cancers. They are particularly frequently expressed in gastroenteropancreatic neuroendocrine tumors (GEP NET), including both primaries and metastases. The density is often high, the distribution is usually homogeneous. While various somatostatin receptor subtypes can be expressed in these tumors, sst2 is clearly predominant. These receptors represent the molecular basis for a number of clinical applications, including symptomatic therapy with cold octreotide in hormone-secreting GEP NET, in vivo diagnostic with Octreoscan to evaluate the extend of the disease, and 90Y-DOTATOC radiotherapy. GEP NET can, however, express peptide receptors other than somatostatin receptors: insulinomas have more glucagon-like peptide 1 receptors than somatostatin receptors, gut NET (carcinoids) may also express cholecystokinin 2, bombesin or vasoactive intestinal peptide receptors. Often, several of these peptide receptors are expressed simultaneously in GEP NET, providing a molecular basis for in vivo multireceptor targeting of those tumors.
Future Aspects of Somatostatin- Receptor-Mediated Therapy
Authors: Öberg Kjell
Published: October 2004

More than 30 years have passed since somatostatin was discovered and its hormonal function defined. The wide range of anatomical distribution and actions of somatostatin and its receptors have stimulated intense scientific and clinical interest. The development of somatostatin analogues helped define its usefulness in the treatment of endocrine diseases and cancer. The molecular cloning of five distinct subtypes of somatostatin receptors in the 1980s has significantly increased our insight into the biology of somatostatin and its receptor subtypes and has led to the design and development of subtype-selective peptides and nonpeptide agonists and antagonists. In the future, the development of somatostatin-receptor-mediated treatment will go along different lines. Tumor-targeted radioactive treatment based on somatostatin analogues will be further developed and improved. New somatostatin analogues will come into clinical practice, both receptor subtype-specific analogues, but also pan-receptor analogues. One is currently in clinical trial – SOM230 – which is a cyclo-hexapeptide binding with high affinity to receptor type 1, 2, 3 and 5, but not 4. It has already shown activity both in acromegaly and in neuroendocrine gastrointestinal tumors. Preclinical studies on somatostatin analogues, coupled to cytotoxic agents, have shown rather promising results and will hopefully be further developed in clinical trials. Another interesting area is treatment of neuroendocrine gut tumors with ultra-high doses of somatostatin analogues, which has demonstrated significant clinical effects in patients resistant to standard-dose treatment with the same somatostatin analogue.
Surgical Treatment of Endocrine Pancreatic Tumours
Authors: Åkerström Göran , Hellman Per , Hessman Ola , Osmak Liliana
Published: October 2004

Endocrine pancreatic tumours (EPTs) are uncommon, with a major challenge to alert physicians to their recognition and requirements of treatment. Functioning EPTs cause well-known clinical syndromes of hormone excess. Insulinomas, gastrinomas and glucagonomas are most common; vipomas and somatostatinomas are rare. EPTs also occur as non-functioning lesions without symptoms of hormone excess occasionally with ectopic hormone, such as ACTH and Cushing syndrome as a late complication. The majority of EPTs are sporadic, but they may also be part of a multiple endocrine neoplasia type 1 syndrome or rarely the von Hippel-Lindau syndrome. EPTs have been of great interest to endocrine surgeons and we have, during recent years, witnessed continuing advances in diagnosis, imaging and treatment of the different tumour entities. It has become obvious that surgical treatment of these tumours is of increased concern and can have a marked impact on symptoms and survival.
Ablative Therapies for Liver Metastases of Gastroenteropancreatic Endocrine Tumors
Authors: Ruszniewski Philippe , O’Toole Dermot
Published: October 2004

Hepatic metastases are frequent in patients with gastroenteropancreatic (GEP) endocrine tumors. The presence of hepatic metastases affects overall prognosis and quality of life especially in the presence of debilitating functional syndromes. Surgery, although the method of choice for hepatic metastases, is usually impossible due to disease extent. Results of systemic chemotherapy are also disappointing especially in patients with metastases from midgut GEP tumors. These latter patients usually have carcinoid syndrome which can be controlled by somatostatin analogues. Other therapeutic options in the treatment of highly vascular liver metastases from GEP tumors are locoregional strategies by inducing vascular occlusion resulting in ischemia and necrosis of tumoral tissue. Surgical ligation of the hepatic artery or transient hepatic ischemia has been replaced by transcatheter arterial chemoembolization (TACE). TACE has proven effective in controlling symptoms and gives objective tumor response in about half of patients. Other regional destructive methods, used either alone or in combination with surgery, include radiofrequency ablation and cryotherapy. The latter strategies are poorly evaluated to date and are usually adjuncts to surgery and reserved for limited disease.
Chemotherapy for Gastro-Enteropancreatic Endocrine Tumours
Authors: O’Toole Dermot , Hentic Olivia , Corcos Olivier , Ruszniewski Philippe
Published: October 2004

Despite similar histological and morphological aspects, gastro-enteropancreatic (GEP) endocrine tumours represent a heterogeneous group of tumours with varying clinical expression depending on tumour type (functional or not), origin and extension, but also on histological differentiation and proliferative capacity. The natural history of well-differentiated tumours is often favourable without treatment and GEP endocrine tumours may remain indolent for many years. Chemotherapy may however be indicated in the presence of symptomatic non-progressive disease (progression evaluated over 3–6 months). In contrast, poorly differentiated GEP endocrine tumours are frequently aggressive and early treatment is required. Accurate staging is mandatory and where surgery is possible (even in the event of limited metastatic disease), this option should be re-evaluated in a multidisciplinary approach. Approximately 2/3 of malignant GEP tumours are metastatic at discovery and surgery is possible in a minority of patients; therefore, chemotherapy, with/without other strategies (e.g. local ablation), is frequently indicated in patients with symptomatic, bulky or progressive disease. For well-differentiated pancreatic tumours, the reference association is Adriamycin with streptozotocin yielding objective responses (OR) in 40–60% of patients. Prolonged treatment is limited due to potential cardiotoxicity of Adriamycin and standard 2nd-line regimens are not of proven efficacy; thus, other treatment modalities are usually additionally required (e.g. chemo-embolisation). A significant OR may render a small number of patients secondarily amenable to surgery. Published series evaluating chemotherapy for midgut endocrine tumours are outdated and disappointing. Objective response rates with combined associations (including either 5-fluorouracil and/or streptozotocin) rarely exceed 20% and where possible, chemo-embolisation for hepatic metastases combined with somatostatin analogues (± interferon) should be preferred. Poorly differentiated GEP tumours are generally aggressive tumours with metastases at diagnosis and tend to progress rapidly. Surgery is rarely possible and ineffective even in locally advanced disease due to a high risk of recurrence. Chemotherapy, using cisplatin and etoposide, is the reference treatment and frequently yields OR rates >50%. However, despite being chemosensitive, disease control is limited (8–10 months). Overall, advances in therapeutic chemotherapeutic options are required in the management of all types of advanced GEP endocrine tumours and evaluation of new drugs (e.g. irinotecan) and combination strategies (chemotherapy with local ablative therapies) are required in the future.
Improved Arteriogenesis with Simultaneous Skeletal Muscle Repair in Ischemic Tissue by SCL+ Multipotent Adult Progenitor Cell Clones from Peripheral Blood
Authors: Huss Ralf , Heil Matthias , Moosmann Sabine , Ziegelhoeffer Tibor , Sagebiel Sabine , Seliger Christian , Kinston Sarah , Gottgens Berthold
Published: October 2004

Background: The CD34– murine stem cell line RM26 cloned from peripheral blood mononuclear cells has been shown to generate hematopoietic progeny in lethally irradiated animals. The peripheral blood-derived cell clones expresses a variety of mesodermal and erythroid/myeloid transcription factors suggesting a multipotent differentiation potential like the bone marrow-derived ‘multipotent adult progenitor cells’ (MAP-C). Methods: SCL+ CD34– RM26 cells were transfused intravenously into mice suffering from chronic hind-limb ischemia, evaluating the effect of stem cells on collateral artery growth and simultaneous skeletal muscle repair. Results: RM26 cells are capable of differentiating in vitro into endothelial cells when cultured on the appropriate collagen matrix. Activation of the SCL stem cell enhancer (SCL+) is mediated through the binding to two Ets and one GATA site and cells start to express milieu- and growth condition-dependent levels of the endothelial markers CD31 (PECAM) and Flt-1 (VEGF-R1). Intravenously infused RM26 cells significantly improved the collateral blood flow (arteriogenesis) and neo-angiogenesis formation in a murine hind-limb ischemia transplant model. Although transplanted RM26 cells did not integrate into the growing collateral arteries, cells were found adjacent to local arteriogenesis, but instead integrated into the ischemic skeletal muscle exclusively in the affected limb for simultaneous tissue repair. Conclusion: These data suggest that molecularly primed hem-/mesangioblast-type adult progenitor cells can circulate in the peripheral blood improving perfusion of tissues with chronic ischemia and extending beyond the vascular compartment.
Antibody-Induced Failure of Botulinum Toxin Type B Therapy in de novo Patients
Authors: Dressler Dirk , Bigalke Hans
Published: October 2004

Botulinum toxin type B (BT-B) therapy failure due to formation of botulinum toxin type B antibodies (BT-B-AB) has only been reported in patients with botulinum toxin type A antibodies (BT-A-AB). We are reporting BT-B-AB-induced therapy failure in 2 patients with no previous exposure to botulinum toxin. In patient 1 complete therapy failure occurred after a single exposure to 14,400 mouse units (MU) BT-B (NeuroBloc™). The mouse diaphragm assay (MDA) revealed a BT-B-AB titre in excess of 10 mU/ml. Doubling the BT-B dose did not elicit any effects. Application of 360 MU BT-A (Botox®) produced the original therapeutic effect, but the second BT-A application was followed by partial and the third by complete therapy failure. Doubling the BT-A dose did not elicit any effects. MDA testing showed a BT-A-AB titre in excess of 10 mU/ml. In patient 2 a single exposure to 7,200 MU BT-B lead to a complete therapy failure. MDA testing revealed a BT-B-AB titre in excess of 10 mU/ml. Doubling the BT-B dose did not elicit any effects. Application of 180 MU BT-A (Botox) produced the original response on 3 consecutive applications. Antibody formation can occur after a single exposure to botulinum toxin. However, this is highly unusual. Since therapy failure occurred after the first-ever botulinum toxin exposure, short intervals between injections and use of booster injections can be excluded as causes for BT-B-AB formation in both patients. A more likely cause may be the substantially higher amount of antigenic protein administered in BT-B therapy compared to BT-A therapy. Further studies are necessary to compare the incidence of antibody formation in BT-B and BT-A therapy.
Evaluation of Maximal Respiratory Pressures in Myasthenia gravis
Authors: Muñoz Fernández Carmen , Díez Tejedor Exuperio , Frank Garcia Ana , Pino Jose María , Pérez Conde Concepción , Barreiro Tella Pablo
Published: October 2004

We assess the prognosis of mild forms of myasthenia gravis (MG) by maximal respiratory pressures (MRP) and single fiber electromyography (SFEMG). Fifty MG patients (12 form I, 21 form IIa and 17 form IIb) are valued by MRP [maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP)] and SFEMG, and are followed-up clinically. We have found in form I patients developing form IIa and form IIa worsening to form IIb, MEP and MIP mean relative values significantly lower than the rest. Inversely, IIb form patients improving to IIa form display MIP mean relative values higher than the rest; no difference appears with MEP. A reduction under 50% of fifth-percentile implies clinical deterioration in forms I and IIa, while its surpassing in IIb form suggests a tendency to improvement. No evident differences are found by SFEMG. MRP allow the follow-up of MG patients and could warn us of a clinical prognosis.
Thromboembolic Complications of Intravenous Immunoglobulin Treatment
Authors: Vucic S. , Chong P. Siao Tick , Dawson K.T. , Cudkowicz M. , Cros D.
Published: October 2004

Intravenous immunoglobulin (IVIg) preparations are increasingly being used in the treatment of neuroautoimmune diseases. Although for most part this treatment is safe, serious side effects such as thromboembolic events have been reported. We report on 7 patients who suffered a thromboembolic event while being treated with IVIg. Four patients suffered a stroke or transient ischemic attack, 1 an inferior wall myocardial infarction, 1 a deep venous thrombosis, and 1 a retinal artery infarct. The age range of the patients was 57–81 and most had underlying risk factors, such as hypertension, hypercholesterolemia, atrial fibrillation, history of vascular disease and stroke, and deep venous thrombosis. Three patients received multiple IVIg infusions before suffering a thromboembolic complication. Therefore, the clinicians should be vigilant about the possibility of thromboembolic complications with each IVIg infusion and be especially judicious with the use of IVIg in patients with underlying risk factors.
Ligation of the Uterine Artery and Early Postnatal Food Restriction – Animal Models for Growth Retardation
Authors: Huizinga C.T. , Engelbregt M.J.T. , Rekers-Mombarg L.T.M. , Vaessen S.F.C. , Delemarre-van de Waal H.A. , Fodor M.
Published: October 2004

Intrauterine growth restriction (IUGR) is one of the major causes of short stature in child- and adulthood. The cause of IUGR is unknown, however, an impaired uteroplacental function during the second half of human pregnancy might be an important factor, by affecting the programming of somatotropic axis and leading to postnatal growth failure into adulthood. Two rat models with perinatally induced growth retardation were used to examine the long-term effects of perinatal insults on growth. IUGR rats were prepared from pregnant dams, with a bilateral uterine artery ligation at day 17 of their pregnancy. Since the rat is relatively immature at birth, an early postnatal food restriction model was included as another model to broaden the time window of sensitive period of organogenesis. An individual growth curve was calculated of each animal (n = 813). From these individual growth curves the predicted growth curve for each experimental group was calculated by multilevel analysis. The proposed mathematical model allows us to estimate the growth potentials of these rat models with precision and could provide basic information to investigate the relationships among a number of other variables in future studies. Furthermore, we concluded that both pre- and early postnatal malnutrition leads to irreversible slowing down of postnatal growth.
Adenoid Cystic Carcinoma of Bartholin’s Gland
Authors: Nasu Kaei , Kawano Yukie , Takai Noriyuki , Kashima Kenji , Miyakawa Isao
Published: October 2004

Adenoid cystic carcinoma of Bartholin’s gland is characterized by slow growth, local invasion, and sometimes distant metastasis. There is no consensus regarding the optimal treatment. We report herein a rare case of stage II adenoid cystic carcinoma of Bartholin’s gland that was successfully treated by wide local excision of the tumor and ipsilateral inguinal and pelvic lymphadenectomy. A 54-year-old Japanese woman was admitted complaining of painless, gradually increasing vulvar mass existing from ten years before. Local examination revealed a 3 × 2-cm hard mass in the left labium major. Pathological examination of subsequent excisional biopsy revealed adenoid cystic carcinoma originating in the Bartholin’s gland. A wide local resection of the tumor with inguinal and pelvic lymphadenectomy was performed. The tumor was completely excised with free margins. There was no metastasis in the resected lymph nodes. The patient was diagnosed as having stage II vulvar cancer according to the International Federation of Gynecologists and Obstetricians classification (1988). The patient is now healthy without evidence of recurrence at 5 years after surgery. Adenoid cystic carcinoma of Bartholin’s cyst at early stage can be treated by wide local excision as a primary surgery.
CT Air-Contrast Enema as a Preoperative Examination for Colorectal Cancer
Authors: Nagata Koichi , Endo Shungo , Kudo Shin-ei , Kitanosono Takashi , Kushihashi Tamio
Published: October 2004

Background/Aims: We conducted a study on three-dimensional computed tomography (CT) images, in particular CT air-contrast enema (CT enema), using multidetector-row CT (MDCT), to see whether CT enema is useful as a preoperative examination for colorectal cancer. We aimed to evaluate the detectability of lesions and the depth of cancer invasion using CT enema. Methods: 292 patients (328 lesions) with colorectal cancer were enrolled. After an adequate insufflation of the large intestine, MDCT scans were performed. With the data obtained by MDCT, we reconstructed CT enema images. CT enema images were assessed for the detectability of lesions. The depth of invasion was evaluated by the deformity of the lesion on profile images. The deformities were divided into five groups: no deformity, slight deformity, mild deformity, moderate deformity and severe deformity. Results: The detectability of lesions was 97.3%. The reasons for undetectability were due to residual fluid in 8 cases and insufficient colonic distention in 1 case. As the depth of invasion increased, the grade of the deformity became severer (p < 0.0001). Conclusions: CT enema proved to be an excellent examination tool to detect lesions. The deformity demonstrated by CT enema could be an additional source of information to predict the depth of invasion.
Development of Outward Potassium Currents in Inner and Outer Hair Cells from the Embryonic Mouse Cochlea
Authors: Helyer Richard J. , Kennedy Helen J. , Davies Dawn , Holley Matthew C. , Kros Corné J.
Published: October 2004

We recorded K+ currents in inner (IHCs) and outer (OHCs) hair cells from mice at embryonic days 16 and 18 and on the day of birth (PO) to characterize their early physiological differentiation. In both cell types, outward currents increased in size during late embryonic development, in cells situated in both the apical and basal coils of the cochlea. Currents increased up to six-fold, with current density increasing four-fold. Currents in basal cells were generally larger than in the apex, and currents in IHCs were larger than in OHCs at any given stage. In OHCs, they were initially non-inactivating but gained the partial inactivation characteristic of the K+ current of neonatal mouse cochlear hair cells, IK,neo, by day 18 in the base and by P0 in the apex. In IHCs, there was little change, other than in amplitude, with partial inactivation already evident in the base by embryonic day 16. These results suggest that changes in the channel complement of OHCs occur within a few days of terminal mitosis, whereas in IHCs any such development would occur earlier. The progressive development of K+ currents correlates with a developmental delay of around 2 days from the base to the apex of the cochlea.
Diagnostic Hysteroscopy in Endometrial Hyperplasia
Authors: Butureanu Stefan A. , Socolov Razvan M. , Pricop Florentina , Gafitanu Dumitru M.
Published: October 2004

Objectives: To assess the reproducibility of hysteroscopic diagnosis in the various types of endometrial hyperplasias and to compare different classifications of endometrial hyperplasia from this point of view. Study Design: 109 endometrial hyperplasias, diagnosed in the last 5 years with hysteroscopy, were all biopsied and had a pathological examination. We tried to estimate the accuracy of hysteroscopy comparing the various classifications of endometrial hyperplasia to the final pathologic diagnosis. Results: Using older endometrial hyperplasia classification, the overall diagnostic accuracy of hysteroscopy was 76% as for the correct type of hyperplasia. Classifying them at hysteroscopy into two categories only, i.e. hyperplasias and neoplasias, gave a more accurate result (90.26%). Conclusions: The newer classification is better from the hysteroscopist’s point of view.
Tachycardia-Related Channel in the Scar Tissue in Patients With Sustained Monomorphic Ventricular Tachycardias
Authors: Arenal Angel , del Castillo Silvia , Gonzalez-Torrecilla Esteban , Atienza Felipe , Ortiz Mercedes , Jimenez Javier , Puchol Alberto , García Javier , Almendral Jesús
Published: October 2004

Background—

Endocardial mapping before sustained monomorphic ventricular tachycardia (SMVT) induction may reduce mapping time during tachycardia and facilitate the ablation of unmappable VT.

Methods and Results—

Left ventricular electroanatomic voltage maps obtained during right ventricular apex pacing in 26 patients with chronic myocardial infarction referred for VT ablation were analyzed to identify conducting channels (CCs) inside the scar tissue. A CC was defined by the presence of a corridor of consecutive electrograms differentiated by higher voltage amplitude than the surrounding area. The effect of different levels of voltage scar definition, from 0.5 to 0.1 mV, was analyzed. Twenty-three channels were identified in 20 patients. The majority of CCs were identified when the voltage scar definition was ≤0.2 mV. Electrograms with ≥2 components were recorded more frequently at the inner than at the entrance of CCs (100% versus 75%,
P
≤0.01). The activation time of the latest component was longer at the inner than at the entrance of CCs (200±40 versus 164±53 ms,
P
≤0.001). Pacing from these CCs gave rise to a long-stimulus QRS interval (110±49 ms). Radiofrequency lesion applied to CCs suppressed the inducibility in 88% of CC-related tachycardias. During a follow-up of 17±11 months, 23% of the patients experienced a VT recurrence.

Conclusions—

CCs represent areas of slow conduction that can be identified in 75% of patients with SMVT. A tiered decreasing-voltage definition of the scar is critical for CC identification.
Predictive Value of 16-Slice Multidetector Spiral Computed Tomography to Detect Significant Obstructive Coronary Artery Disease in Patients at High Risk for Coronary Artery Disease
Authors: Hoffmann Udo , Moselewski Fabian , Cury Ricardo C. , Ferencik Maros , Jang Ik-kyung , Diaz Larry J. , Abbara Suhny , Brady Thomas J. , Achenbach Stephan
Published: October 2004

Background—

In this study, we investigated the diagnostic value and limitations of multidetector computed tomography (MDCT)–based noninvasive detection of significant obstructive coronary artery disease (CAD) in a consecutive high-risk patient population with inclusion of all coronary segments.

Methods and Results—

In a prospective, blinded, standard cross-sectional technology assessment, a cohort of 33 consecutive patients with a positive stress test result underwent 16-slice MDCT and selective coronary angiography for the detection of significant obstructive CAD. We assessed the diagnostic accuracy of MDCT in a segment-based and a patient-based model and determined the impact of stenosis location and the presence of calcification on diagnostic accuracy in both models. Analysis of all 530 coronary segments demonstrated moderate sensitivity (63%) and excellent specificity (96%) with a moderate positive predictive value of 64% and an excellent negative predictive value (NPV) of 96% for the detection of significant coronary stenoses. Assessment restricted to either proximal coronary segments or segments with excellent image quality (83% of all segments) led to an increase in sensitivity (70% and 82%, respectively), and high specificities were maintained (94% and 93%, respectively). In a patient-based model, the NPV of MDCT for significant CAD was limited to 75%. Coronary calcification was the major cause of false-positive findings (94%).

Conclusions—

For all coronary segments included, 16-slice MDCT has moderate diagnostic value for the detection of significant obstructive coronary artery stenosis in a population with a high prevalence of CAD. The moderate NPV of patient-based detection of CAD suggests a limited impact on clinical decision-making in high-risk populations.
Comparison of the Associations of Apolipoprotein B and Non-High-Density Lipoprotein Cholesterol With Other Cardiovascular Risk Factors in Patients With the Metabolic Syndrome in the Insulin Resistance Atherosclerosis Study
Authors: Sattar Naveed , Williams Ken , Sniderman Allan D. , D’Agostino Ralph , Haffner Steven M.
Published: October 2004

Background—

The metabolic syndrome (MetS) as defined by the National Cholesterol Education Panel definition has been proposed as an indicator of cardiovascular disease risk. Both apolipoprotein (apo)B and non-HDL cholesterol (NHDLC) have been proposed as an additional indicator to identify patients at higher risk in MetS patients.

Methods and Results—

We studied 1522 individuals in the Insulin Resistance Atherosclerosis Study (IRAS) who were 40 to 69 years of age and from 3 ethnic groups. Their anthropometric measures, lipids, apoB, C-reactive protein, fibrinogen, plasminogen activator inhibitor-1, fasting and post-glucose load glucose, and insulin concentrations were measured, and insulin sensitivity was determined by intravenous glucose tolerance test. Differences in risk parameters in individuals with hyper-apoB/normo-NHDLC, and normo-apoB/hyper-NHDLC were compared in all IRAS subjects and again in those with MetS. In both cases, despite anticipated lower LDL cholesterol, the hyper-apoB/normo-NHDLC group had elevated risk indicated by greater waist circumference (both
P
<0.05) and fasting insulin (
P
<0.01) and lower insulin sensitivity (
P
<0.001). They also had higher C-reactive protein (
P
<0.05). Moreover, the Spearman correlation of apoB was significantly stronger (
P
<0.05) in the direction of greater associated risk than that of NHDLC with body mass index, waist circumference, systolic blood pressure, 2-hour glucose, fasting glucose, fasting insulin, 2-hour insulin, insulin sensitivity, C-reactive protein, fibrinogen, and plasminogen activator inhibitor-1.

Conclusions—

In conclusion, apoB is more closely associated with central adiposity, insulin resistance, thrombosis, and inflammation than NHDLC. Our data suggest that apoB is a better candidate risk parameter than NHDLC for identifying a subgroup of individuals with or without MetS with elevated cardiovascular risk.
Brood Parasitism in a Population of Common Eider (somateria Mollissima)
Authors: Kilpi Mikael , Waldeck Peter , Andersson Malte , Öst Markus
Published: October 2004

The common eider differs from many other ducks in being a colonial 'capital' breeder, producing eggs from stored resources. These traits are expected to influence the occurrence of conspecific brood parasitism (CBP), which is particularly common in waterfowl. We analysed CBP in an eider population in the central Baltic Sea 2001-2002, using non-destructive egg albumen sampling combined with protein fingerprinting. This technique greatly increases the detection of parasitic eggs compared to more traditional methods. Parasitic eggs occurred in 20-22% of 164 nests studied, 6% of 754 eggs being laid by other than the host female. Parasitism increased with nest density, was rather evenly distributed over the laying season, and occurred both early and late in the laying sequence of the host. Protein fingerprinting showed that host females laid up to seven eggs, more than previously reported. Among 33 parasitised nests 22 had one parasitic egg, nine had two and two had three. In all but one case all parasitic eggs within a nest were laid by the same female. Although colonial breeding facilitates CBP, it is less frequent in this eider population than in several other diving ducks. Possible contributing reasons are the relatively small clutch size and start of incubation after egg 2 or 3, limiting the time window for successful parasitism.
Sexual Conflict Over Remating in House Crickets: No Evidence of an Anti-aphrodisiac in Males' Ejaculates
Authors: Fleischman Rebecca , Sakaluk Scott
Published: October 2004

We tested the hypothesis that male house crickets (Acheta domesticus L.) transfer substances in their ejaculates that inhibit female receptivity by experimentally manipulating the amount of ejaculate that females received and recording their propensity to remate. In both virgin and non-virgin females, the length of time over which the spermatophore remained attached after an initial mating had no discernable effect on female latency to remating. This was true regardless of whether females were given the opportunity to remate immediately after an initial mating or prevented from remating until 24-h later. We conclude, therefore, that male A. domesticus do not transfer substances in their ejaculates that inhibit the sexual receptivity of females, at least over the short term. However, there was a marked difference in the remating propensity of once-mated and multiply-mated females, with multiply-mated females taking significantly longer to remate. These results suggest that female sexual receptivity changes in response to the gradual accumulation of sperm or ejaculatory products in the female's spermatheca over multiple matings.
Is Male Unpredictability a Paternity Assurance Strategy?
Authors: Danchin Etienne , Helfenstein Fabrice , Wagner Richard
Published: October 2004

In socially monogamous birds, levels of extra-pair paternity vary widely across species. A possible explanation for this variation is that the costs to both sexes of pursuing extra-pair copulations (EPCs) varies widely, which may substantially depend upon the effectiveness of the paternity assurance tactics employed by pair males. Given the prevalence of extra-pair paternity, an enigma exists in non-mate-guarding species in which males have no apparent means of assuring their paternity and yet rarely or never lose paternity. We propose that males in some species may pursue a subtle but effective paternity assurance tactic consisting of unpredictable behaviour. By departing and returning to and from their mates at unpredictable intervals males may be able to deter other males and their mates from attempting EPCs. Consistent with this idea, we found in the monogamous kittiwake Rissa tridactyla that the absences of males became decreasingly predictable in duration as their mates' fertile periods approached. Moreover, the durations of 80% of male absences were shorter than the minimum duration of copulations, creating a high probability of pair males returning in time to prevent EPCs. Factors other than male unredictability may explain the lack of extra-pair paternity in kittiwakes. Nevertheless, the unpredictable male hypothesis is testable in the many species with variable levels of EPP. Furthermore, we suggest that unpredictability may comprise a general strategy by which animals of both sexes protect various reproductive assets such as food, mates and territories.
The Demographic and Reproductive Context of Male Replacements in Cebus Capucinus
Authors: Jack Katharine , Fedigan Linda Marie
Published: October 2004

Male primates may immigrate into groups by peacefully joining the residents and taking up low-ranking positions in the hierarchy, or they may enter by force, challenging the resident males and attempting to drive them from high rank or from the group. Here we address the questions of how, when, and why immigrating male white-faced capuchins (C. capucinus) at Santa Rosa replace the former resident males of our groups, rather than simply joining them. We present data on 15 male replacements in 6 study groups tracked from 1984 through March 2004. During 11 aggressive takeovers, resident males were nearly always outnumbered by coalitions of invading males; lone resident males were particularly vulnerable. Both residents and invaders were wounded and infants often perished during or soon after takeovers. Male replacements also occur when resident males abandon their groups and males from neighboring groups 'waltz in' to become resident. Three such 'waltz in' replacements occurred during the study period. If we combine takeovers with 'waltz in' cases, replacements occur about every 4 years in our study groups, almost invariably during the dry season months of January to April, about 3-6 months before the annual peak in conceptions. In the years that groups are subject to takeovers, group composition includes significantly lower proportions of adult males than in no-takeover years. We conclude that: (1) the mechanism of male replacement is usually aggressive takeover, but sometimes abandonment of the group by prior resident males occurs; and (2) aggressive takeovers are more likely to happen when the group is vulnerable because it has a lower proportion of adult males, particularly when all co-resident males have emigrated, leaving only the alpha male in residence. Our long-term study shows that adult males need coalition partners not only to gain entry to a group but also to maintain their membership within it.
Thresholds or Comparisons: Mate Choice Criteria And Sexual Selection in a Periodical Cicada, Magicicada Septendecim (Hemiptera: Cicadidae)
Authors: Marshall David , Cooley John
Published: October 2004

Many insects possess life history characteristics that make them unlikely to use the kinds of relative mate choice criteria implicit in theoretical discussions of leks; thus, many insect mating aggregations are treated differently, as 'swarms' or 'choruses.' Yet periodical cicadas (Magicicada spp.) seem strong candidates for participating in lek mating systems. We present a series of observations and experiments designed to reveal whether there are mating biases in periodical cicadas and whether any biases are most consistent with flexible ('best-of-N 'choice) or fixed (threshold choice) mating criteria. We rule out postcopulatory choice by demonstrating that most females mate once, after which they become sexually unreceptive. In our study, patterns of mating success among actively chorusing males are indistinguishable from random mating, and we uncover no consistent differences between unmated and mated males on the basis of size and song pitch, two criteria that have been associated with Magicicada mating biases in other contexts. Because our results are most consistent with a fixed-threshold choice mechanism, we suggest that Magicicada mating aggregations do not function in a manner similar to vertebrate leks even though they fulfill Bradbury's (1981) lek criteria. Instead, features of Magicicada behavior suggesting female selectivity may arise incidentally from males' and females' unequal tendencies to mate multiply, the resulting superabundance of sexually receptive males, and the high frequency at which females are courted at the onset of mating readiness.
Subordinate Male Black Howler Monkey (Alouatta Pigra) Responses to Loud Calls: Experimental Evidence for the Effects of Intra-group Male Relationships and Age
Authors: Horwich Robert , James Roxie , Kitchen Dawn
Published: October 2004

When assessing a group's overall fighting ability, functional group size (i. e. the number of cooperative members willing to confront opponents) may be more important than actual group size. Despite obvious benefits, group members do not always act in a collective manner. For example, participation by subordinate male black howler monkeys (Alouatta pigra) in natural group-level contests is highly variable. Using playback experiments, we examined whether alpha-subordinate relationships, number of intruders, or age affected subordinate contest participation. Long-term census data were used to estimate the nature and duration of intra-group male associations. Some subordinate males had long-term relationships with the alpha that existed prior to residence in the current group or they were the alpha male's grown sons. Other subordinate males were in more recent associations with the alpha that formed under seemingly antagonistic circumstances (e. g. the deposed alpha or his grown sons). We found that subordinate males in long-term alpha-subordinate associations had stronger howling and approach responses than males in short-term associations. Younger long-term associates had the strongest reactions to simulated intruders, similarly aged shortterm associates rarely responded, and older males in both association categories responded at intermediate levels. We discuss the variable strategies of subordinate male black howlers and suggest that males who were more likely to participate in group-defence might be gaining direct or indirect fitness benefits by group living.
Community informal care and welfare systems in Asia-Pacific countries
Authors: Pawar Manohar
Published: October 2004

The significance, objectives and process of implementing the project in Asia-Pacific countries are discussed. The evaluation looks at successful and unsuccessful aspects, lessons learned and the expected impact of the target groups for the project. It examines strategies to implement follow-up plans, draws implications for developing professional networks and offers insights for replicating similar exercises elsewhere.
Empowerment in difficulty
Authors: Dickens Jonathan , Groza Victor
Published: October 2004

This article examines the successes and shortcomings of international intervention in child welfare in Romania, highlighting the importance of an empowerment approach. Implementing such an approach brings its own challenges, and the authors debate the possibilities and potential pitfalls. They identify key principles and essential personal qualities for putting empowerment into practice in situations of economic, political and social difficulty.
The impact of peer, family and school on delinquency
Authors: Davis Cindy , Tang Catherine , Ko Janet
Published: October 2004

This study explored the relationship among family, peer and school factors on delinquency among Chinese adolescents. Interviews were conducted with 718 Chinese adolescents in Hong Kong. At-risk adolescents had more family problems, negative peer relations and a poorer school environment. Negative peer influence was the most salient predictor of delinquency.
Social workers’ conceptions of the relationship between theory and practice in an organizational context
Authors: Chan Ko Ling , Chan Cecilia L.W.
Published: October 2004

The research studies the relationship between theory and practice in the context of an agency. Eight social workers from an agency were recruited for in-depth interviews. Results showed that the conception of theory and practice was influenced by the self, the client and the agency.
Modeling of Cell Structure in Polyurethane Foam
Authors: Goto Akihiko , Yamashita Katsuhisa , Nonomura Chisato , Yamaguchi Kazumi
Published: October 2004

We suggested that the cell structure of polyurethane foam could be approximated to be oval by the use of the finite element method. Three kinds of parameters for cell modeling were employed, which are the ratio of radius, the area, and the thickness of the cell wall.
Modeling of Friction and Shear in Thermostamping of Composites - Part I
Authors: Gorczyca Jennifer L. , Sherwood James A. , Liu Lu , Chen Julie
Published: October 2004

The effects of processing parameters on the friction coefficient between commingled glass-polypropylene plain-weave fabric composites (Twintex) and the steel tool during thermostamping processes are under investigation. This work focuses on the effect of fiber orientation, fabric velocity, normal force, and resin viscosity (through variations in tool and fabric temperatures) under conditions similar to those in the thermostamping processes. In comparison to the experiments conducted to date, velocity, normal force, and tool temperature have the greatest effect on the friction coefficient. The effect of tool temperature on the friction coefficient dominated the effect of initial fabric temperature on the friction coefficient. Based on the effect of these parameters, a phenomenological model has been incorporated into ABAQUS/Standard as a user-supplied friction subroutine. This model was first used in a finite element model of the friction test. A good agreement was found between the experimentally measured friction force and the numerically calculated one.