bluuebunny/crossref_metadata_2025 huggingface dataset:
Early discharge and home rehabilitation after hip fracture achieves functional improvements: a randomized controlled trial
Authors: Crotty Maria , Whitehead Craig H , Gray Steven , Finucane Paul M
Published: October 2002

Objective: To compare hospital and home settings for the rehabilitation of patients following hip fracture.

Design: Randomized controlled trial comparing accelerated discharge and home-based rehabilitation ( n = 34) with conventional hospital care ( n = 32) for patients admitted to hospital with hip fracture.

Setting: Three metropolitan hospitals in Adelaide, Australia. Subjects: Sixty-six patients with fractured hip. Interventions: Patients assigned to the home-based rehabilitation group were discharged within 48 hours of randomization. The project team therapists made visits to the patient’s home and negotiated a set of realistic, short-term and measurable treatment goals with both the patient and carer. Those randomized to usual care remained in hospital for conventional rehabilitation.

Main outcome measures: Physical and social dependence, balance con”dence, quality of life, carer strain, patient and carer satisfaction, use of community services and incidence of adverse events such as re-admission and falls.

Results: While there was no difference between the groups for all measures of quality of life, patients in the accelerated discharge and home-based rehabilitation group recorded a greater improvement in MBI from randomization ( p < 0.05) and scored higher on the Falls Ef”cacy Scale ( p < 0.05) at four months. There was no difference in falls rates. Patients in the home-based rehabilitation group had a shorter stay in hospital ( p < 0.05) but a longer stay in rehabilitation overall ( p < 0.001). The groups were comparable on the rate and length of admissions after discharge, use of community services, need for carer input and contact with general practitioner (GP) after discharge.
Terminally ill cancer patients' wish to hasten death
Authors: Kelly B , Burnett P , Pelusi D , Badger S , Varghese F , Robertson M
Published: October 2002

This exploratory study investigated factors associated with the wish to hasten death among a sample of terminally ill cancer patients. Semi-structured interviews conducted on a total of 72 hospice and home palliative care patients were subjected to qualitative analysis using QSRNUDIST. The main themes to emerge suggested that patients with a high wish to hasten death had greater concerns with physical symptoms and psychological suffering, perceived themselves to be more of a burden to others, and experienced higher levels of demoralization, while also reporting less confidence in symptom control, fewer social supports, less satisfaction with life experiences and fewer religious beliefs when compared with patients who had a moderate or no wish to hasten death. The implications of these findings will be discussed.
Clinical nurse specialists in palliative care. Part 1. A description of the Macmillan Nurse caseload
Authors: Skilbeck Julie , Corner Jessica , Bath Peter , Beech Nicola , Clark David , Hughes Phillipa , Douglas Hannah-Rose , Halliday Deborah , Haviland Jo , Marples Rachael , Normand Charles , Seymour Jane , Webb Tom
Published: October 2002

Macmillan Nurses play a significant role in specialist palliative care services in the UK, providing direct and indirect services to patients with complex palliative care needs and to their families. Existing literature shows a developing understanding of the role; however, little detailed data exist regarding the clinical work that they undertake. This paper provides evidence from a major evaluation study, commissioned by Macmillan Cancer Relief. It reports the methods of data collection for the study and then goes on to use data from the evaluation to describe the caseload of Macmillan Nurses. Between September 1998 and October 1999, a team of researchers worked alongside 12 Macmillan teams for a period of 8 weeks with each team. Prospective data were gathered on all new referrals to the services within the 8-week period. This included demographic details, timing of referral, the nature and purpose of contacts, and interventions, recorded from case notes and Macmillan Nurse records. Where possible, a date of death was obtained for all patients. A total of 814 new patients were referred during the study period (range 45– 114 per site). The most common reasons for referral were emotional care for the patient (57%), pain control (27%), and other physical symptoms (33%). Thirteen per cent of the patients referred to the services died within 1 week of referral while 40% died within 6 weeks; thus, a significant proportion of patient work is focused on care at the end of life. It is also noteworthy that one-third of patients were still alive, indicating that some patients are being cared for earlier in the illness trajectory. On average, each new patient referral received two or more ‘face-to-face’ visits and two follow-up phone calls within the 8-week period. It would appear that Macmillan Nurse teams have been successful in getting access to relevant patients. As with any service that provides a complex set of interventions, the Macmillan teams have to adapt and develop the services in each setting. Whilst it is clearly important for the development of a Macmillan service to be tailored to the local conditions, the evidence on diversity suggests that in some cases, stronger guidance, in partnership with both Macmillan Cancer Relief and core providers, may be justified.
The prevalence of pancreatitis in organophosphate poisonings
Authors: Sahin IÇ , Onbasi K , Sahin H , Karakaya C , Ustun Y , Noyan T
Published: October 2002

Objective: The aim of this study was to evaluate the prevalence of pancreatitis in cases of organophosphate (OP) poisonings admitted to Yüzüncü Yõl University Teaching Hospital over an 18-month period. Materials and Methods: A total of 47 patients of acute poisoning with OP insecticides attended the Emergency Department of the Yüzüncü Yõl Medical School Hospital, from May 1999 to December 2000, and were prospectively studied. Serum amylase and lipase levels were studied with colorimetric assay. Serum SGOT, SGPT, LDH, CPK, K levels, leukocyte count and total hospitalization days were also evaluated. Results: Four of 47 patients had obviously elevated amylase and lipase levels (amylase >300 U/L, lipase >60 U/L). Only two of the patients with amylase levels between 100 and 300 U/L had also elevated levels of lipase. None of the patients with normal amylase levels had elevated levels of lipase. A total of 12.76% was diagnosed as acute pancreatitis. Conclusion: Acute pancreatitis as a complication of OP intoxication is not a rare condition. In order to improve the outcome of OP poisoning, early diagnosis of acute pancreatitis is important and serum levels of amylase and lipase should be routinely considered carefully. In acute pancreatitis, serum levels of SGOT, SGPT, LDH and leukocyte counts may also be found to be elevated. However, serum K levels are only slightly decreased.
Vascular endothelial growth factor plasma levels in patients with systemic lupus erythematosus and primary antiphospholipid syndrome
Authors: Navarro C , Candia-Zúñiga L , Silveira L H , Ruiz V , Gaxiola M , Avila M C , Amigo M C
Published: October 2002

The objective of this study was to assess the possible role of vascular endothelial growth factor (VEGF) in the pathogenesis of systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (PAPS).

We studied 28 patients with SLE, 10 patients with PAPS, and 24 healthy controls. VEGF plasma levels were measured by ELISA. Immunolocalization of VEGF was done in renal tissue from SLE patients and cadaveric controls.

Our results showed that VEGF plasma levels were increased in SLE patients compared with PAPS and controls. The correlation between clinical manifestations and VEGF levels revealed that SLE patients with renal failure had significantly increased plasma VEGF levels (134.1 + 91.0 pg= ml) compared with SLE patients with normal renal function (42.9 + 19.0 pg/ml), PAPS patients (41.9 + 26.6pg/ml), and controls (36.2+ 27.0 pg/ml; P 0.01). Immunostaining showed a strong expression of VEGF in SLE renal tissue samples. Our preliminary results indicate that VEGF is increased in plasma from patients with lupus nephritis and a moderate degree of renal failure and is overexpressed in renal tissue from these patients.
Human immunodeficiency virus infection and systemic lupus erythematosus. An unusual case and a review of the literature
Authors: Palacios R , Santos J , Valdivielso P , Márquez M
Published: October 2002

Systemic lupus erythematosus (SLE) and infection with the human immunodeficiency virus (HIV) are rarely seen in the same patient. Both diseases share clinical and serological features and the differential diagnosis is difficult, with renal manifestations being of special interest. To date, 29 cases of association between the two diseases have been reported, but the diagnosis was simultaneous in just two of these and only 18 fulfilled the ARA criteria for the diagnosis of SLE. Most patients experienced an improvement in their SLE after development of their HIV associated immunosuppression and a reactivation of lupus manifestations has also been noted after immunological recovery secondary to antiretroviral therapy. We present the case of a woman in whom HIV and SLE with renal involvement were diagnosed simultaneously.
Association of vitamin D receptor gene BsmI polymorphisms in Chinese patients with systemic lupus erythematosus
Authors: Huang C-M , Wu M-C , Wu J-Y , Tsai F-J
Published: October 2002

The purpose of this study was to evaluate whether vitamin D receptor (VDR) genes BsmI polymorphisms were markers for susceptibility to or severity of systemic lupus erythematosus (SLE) in Chinese patients in Taiwan.

The study included 47 Chinese patients with SLE. In addition, 90 unrelated, healthy individuals living in central Taiwan served as control subjects. Each polymorphism was detected as a result of polymerase chain reaction (PCR)-based restriction analysis. A PCR product length was determined to be 580 bp (BB) whereas two fragments of 405 and 175 bp were determined to be excisable lengths (bb) by BsmI endonuclease. The relationship between Bsm polymorphisms and clinical manifestations of SLE was evaluated.

We found that BB was significantly more common and bb less common in SLE than in control group (w2 54.2, P 0.0001). In addition, the frequency of B allele was also significantly more common in patients with SLE than in the healthy control subjects (w2 38.7, P 0.0001), giving an odds ratio of 7.14 (95% confidence interval 3.53–14.4). In the SLE patients, we did not detect any associations of VDR genotype with the clinical, laboratory profiles, or lupus nephritis (w2 2.34, P 0.3).

This study indicated an increased distribution of VDR BB genotype and B allelic frequencies in the Chinese SLE patients in Taiwan. However, there were no associationsbetween the frequency of VDR allelic variations and clinical manifestations, laboratory profiles, or lupus nephritis.
Antimalarials in cutaneous lupus erythematosus: mechanisms of therapeutic benefit
Authors: Wozniacka A , Carter A , Mccauliffe D P
Published: October 2002

Antimalarials are arguably the best modality currently available for treating patients with cutaneous lupus erythematosus (LE). Although antimalarials have been used for decades in treating cutaneous LE, the precise mechanisms by which they provide therapeutic benefit are not well defined. The putative mechanisms by which antimalarials might provide therapeutic benefit to patients with cutaneous LE include a number of interrelated anti-inflammatory and immunosuppressive effects that include photoprotection, lysosomal stabilization, suppression of antigen presentation, and inhibition of prostaglandin and cytokine synthesis. If we had a more precise understanding of how antimalarials provide therapeutic benefit in cutaneous LE we might gain better insight into the pathogenic mechanisms of LE and ways of developing better therapies for afflicted patients.
Systemic lupus erythematosus in three ethnic groups. XII. Risk factors for lupus nephritis after diagnosis
Authors: Bastian H M , Roseman J M , Mcgwin G , Alarcón G S , Friedman A W , Fessler B J , Baethge B A , Reveille J D ,   Lumina Study Group
Published: October 2002

The purpose of this study was to determine the cumulative incidence of lupus nephritis (LN) and the factors predictive of its occurrencein a multiethnic systemic lupus erythematosus (SLE) cohort. We studied 353 SLE patients as de” ned by the American College of Rheumatology (ACR) criteria (65 Hispanics, 93 African-Americans and 91 Caucasians). First, we determined the cumulative incidence of LN in all patients. Next, we determined the predictors for LN in those with nephritis occurring after diagnosis. The dependent variable, LN, was de” ned by: (1) A renal biopsy demonstrating World Health Organization (WHO), class II–V histopathology; and/or (2) proteinuria≥ 0.5 g=24 h or 3 + proteinuria attributable to SLE; and/or (3) one of the following features also attributable to SLE and present on two or more visits, which were performed at least 6 months apart— proteinuria≥ 2 +, serum creatinine≥ 1.4 mg/dl, creatinine clearance ≤ 79 ml/min, 10 RBCs or WBCs per high power ” eld (hpf), oŗ 3 granular or cellular casts per hpf. Independent variables assessed at diagnosis, and if absent, at baseline, were from four domains: sociodemographic, clinical, immunologic and immunogenetic (including the complete antibody pro” le and MHC class II alleles), and health habits. Variables with P < 0.05 by chi square analyses were entered into domain-speci”c stepwise logistic regression analyses controlling for disease duration, with LN as the dependent variable. Signi” cant domain-speci”c regression variables (P ≤ 0.1) were then entered into an overall model. The cumulative incidence of LN was 54.3% in all patients, and 35.3% for those developing LN after diagnosis. LN after diagnosis occurred in 43.1% of 65 Hispanics, 50.5% of 93 African-Americans, and 14.3% of 91 Caucasians, P < 0.0001. The duration of follow-up for those with LN after diagnosis was 5.5§ 2.4 vs 4.0§ 2.9 years for those without LN. Hispanic (odds ratio (OR) = 2.71, 95% con” dence limits (CL) = 1.07–6.87, P < 0.04) and African-American ethnicities (OR = 3.13, 95% CL = 1.21–8.09, P < 0.02), not married or living together (OR = 3.45, 95% CL = 1.69–7.69, P < 0.0003), higher SLAM score (OR = 1.11, 95% CL = 1.02–1.19, P < 0.007), anti-dsDNA (OR = 3.14, 95% CL = 1.50–6.57, P < 0.0001) and anti-RNP (OR = 4.24, CL = 1.98–9.07, P < 0.0001) antibodies were shown to be signi” cant predictors of the occurrence of LN. Repeated analyses excluding the patients with missing HLA data showed that absence of HLA-DQB1*0201 was also a signi” cant predictor for the occurrence of LN (OR = 2.34, CL = 1.13–5.26, P < 0.04).

In conclusion, LN occurred signi” cantly more often in Hispanics and African-Americans with SLE. Sociodemographic,clinical and immunologic/immunogenetic factors seem to be predictive of LN occurring after the diagnosis of SLE has been made.
Differences by race, sex and age in the clinical and immunologic features of recently diagnosed systemic lupus erythematosus patients in the southeastern United States
Authors: Cooper G S , Parks C G , Treadwell E L , St Clair E W , Gilkeson G S , Cohen P L , Roubey R A S , Dooley M A
Published: October 2002

We examined the prevalence of clinical and immunologic features of systemic lupus erythematosus (SLE) by race, sex and age in a population-based study of 265 SLE patients. Patients ful” lled the American College of Rheumatology classi” cation criteria. The median time between diagnosis and study enrollment was 13 months. The clinical and hematologic data were limited to occurrences up to 6 months after the diagnosis date, as documented in medical records. We used sera collected at study enrollment from 244 (92%) patients for serologic testing of autoantibodies. The associations between clinical and immunological features of SLE and age, sex and race were examined using logistic regression. The effect of each of these variables was examined adjusting for the other two demographic factors. Mean age at diagnosis was 6 years younger among African-Americans and other minorities compared with white patients (P < 0.01). Discoid lupus, proteinuria, anti-Sm and anti-RNP autoantibodieswere more commonly seen in African-American patients, with odds ratios higher than 3.0. Photosensitivity and mucosal ulcers were noted less often in African-American patients. Proteinuria, leukopenia, lymphopenia and thrombocytopenia were approximately three times more common in men compared with women. The prevalence of oral or nasal ulcers and antiDNA autoantibodies declined with age. The extent to which the differences we observed re‘ ect genetic or environmental in‘ uences on the disease process should be investigated.
Anti-adenosine deaminase antibodies in lupus erythematosus
Authors: Lee J Y-Y , Hempel J , Deng J-S
Published: October 2002

Adenosine deaminase (ADA) is an enzyme involved in purine metabolism and has a major role in the development and function of lymphoid cells. Congenital de” ciency of ADA results in severe immunode”ciency. Patients with congenital ADA de” ciency treated with polyethylene glycolconjugated bovine ADA develop antibodies to ADA. This leads us to investigate the role of antiADA antibodies in patients with systemic rheumatic diseases. Commercially available ADA was used in ELISA and immunoblots for detection of anti-ADA antibodies. Four out of 100 patients examined were positive for anti-ADA antibodies. Two of them had peripheral blood lymphopenia but the antibody levels did not appear to correlate with the lymphocyte counts. Immunoblotting revealed that the antibodies recognized a 40 kDa peptide of ADA, corresponding to ADA1, the major component of ADA. Af” nity-puri”ed antibodies were used to locate the distribution of ADA on Hep-2 cells and lymphocytes by indirect immuno‘ uorescence. Anti-ADA antibodies gave a distinct nuclear speckled pattern on acetone-”xed cells. With viable cell immuno‘ uorescence, antiADA antibodies also stained the cell surface of HEp-2 cells and lymphocytes, indicating surface expression of ADA. The anti-ADA antibodies failed to gain access into the cytoplasm or nuclei when added to the cultures of HEp-2 cells. In summary, this is the ” rst report of detection of antiADA1 autoantibody which is a new type of ANA with discrete, speckled nuclear staining, but which may not be associated with lymphopenia.
Fcgamma and complement receptors: expression, role and co-operation in mediating the oxidative burst and degranulation of neutrophils of Brazilian systemic lupus erythematosus patients
Authors: Marzocchi-Machado C M , Alves C M O S , Azzolini A E C S , Polizello A M N , Carvalho I F , Lucisano-Valim Y M
Published: October 2002

We have investigated the individual role of FcgR and CR, as well as their cooperation, in mediating the oxidative burst and degranulation of neutrophils of Brazilian systemic lupus erythematosus (SLE) patients. Neutrophils were stimulated with the immune complexes (IC)-IgG or-F(ab')2, opsonized or not with normal or SLE human serum. The oxidative burst was decreased in neutrophils of active SLE patients compared to healthy controls when this response was mediated by FcgR and/or CR, while the degranulation was unaffected. The SLE hypocomplementemia did not affect the oxidative burst mediated only by CR. FcgRII and CR1 expression on neutrophils of active SLE patients was reduced, while the expression of FcgRIII and CR3 was unaffected. These results suggest that the different FcgR and CR may be involved or cooperate in different ways in the mediation of the oxidative burst and the degranulation. Moreover, the decreased oxidative burst of neutrophils of active SLE patients may not depend only on SLE hypocomplementemia for IC opsonization. These observations are directed at the understanding of how each of these immune system components (FcgR, CR and complement) influences the precise biological neutrophil responses both in physiological and pathological conditions. Since the Brazilian population comprises many races, these results are important because they are directed at a specific population of SLE patients.
Mycobacterium haemophilum infection in an SLE patient on mycophenolate mofetil
Authors: Teh C L , Kong K O , Chong A Py , Badsha H
Published: October 2002

We describe a case of Mycobacterium haemophilum in an immunocompromised patient with systemic lupus erythematosus (SLE). Mycobacterium haemophilum is a recently described pathogen which has not been previously described either in SLE patients or patients on Mycophenolate Mofetil. Mycobacterium haemophilum can be difficult to diagnose, as it may not have the granulomas characteristic of atypical mycobacterial infections. Combination therapy with at least two drugs for several months is required and the outcome depends on the patient's underlying immunocompromised state. Our report highlights the need for early diagnosis and treatment of Mycobacterium haemophilum in immunocompromised patients with SLE.
SLE/myositis overlap: are the manifestations of SLE different in overlap disease?
Authors: Dayal N A , Isenberg D A
Published: October 2002

Myositis is a rare but recognized complication of systemic lupus erythematosus (SLE). This study compares clinical and laboratory features in patients with SLE complicated by myositis with patients with SLE who do not have myositis. Thus we reviewed the notes of 10 patients with an overlap of biopsy-proven myositis and SLE and compared their clinical, serological and immunogenetic features with 290 patients with SLE without myositis. Our data suggests that patients with SLE associated with myositis are more likely to have alopecia, oral ulcers, erosive joint disease and pulmonary disease but less likely to have renal disease. Our SLE/myositis patients were likely to die at a younger age. The overall disease process seems to be influenced by the presence of antiRNP autoantibodies.
Dysphagia in a patient with lupus and review of the literature
Authors: Chua S , Dodd H , Saeed I T , Chakravarty K
Published: October 2002

Dysphagia is not infrequent in patients with connective tissue diseases such as scleroderma, polymyositis or systemic lupus erythematosus (SLE). It is usually the result of gastro-oesophageal reflux but dysmotility can equally be responsible. A case of dysphagia is described in a patient with SLE, who had developed a rare variety of bullous mucous disease affecting the whole length of oesophagus with spontaneous extrusion of an oesophageal cast. Histological features were suggestive of a variant of rare form of bullous disease in SLE called epidermolysis bullosa acquisita (EBA). This rare association of SLE and EBA involving the oesophagus has not been described in the literature.
Serum IL-12 in systemic lupus erythematosus: absence of p70 heterodimers but presence of p40 monomers correlating with disease activity
Authors: Lauwerys B R , Van Snick J , Houssiau F A
Published: October 2002

Biologically active IL-12 is a 70 kDa heterodimeric cytokine (IL-12 p70) mainly produced by antigen-presenting cells (APC) and made of disulfide-linked a (p35) and b (p40) chains. Since the production of the p40 subunit is independently regulated from that of IL-12 p70, we compared levels of p40 and IL-12 p70 in the sera of patients with systemic lupus erythematosus (SLE). Sera obtained from rheumatoid arthritis (RA) patients and healthy subjects were used as controls. Serum p40 titers were significantly higher in SLE patients (mean§ s.e.m.: 348§ 40 pg/ml) compared with patients with rheumatoid arthiritis (mean§ s.e.m.: 116§ 18 pg/ml, P < 0.0001). or controls (mean § s.e.m.: 0 § 0 pg/ml, By contrast, IL-12 p70 was not detected in any serum. In SLE patients, serum p40 levels were positively correlated with the SLEDAI (r=‡ 0.56, P=0.02) and negatively with serum C3 levels (r=7 0.42, P=0.03). Follow-up measurements indicated that serum p40 dropped significantly after immunosuppressive therapy. Finally, size exclusion chromatography with p40 immunoprecipitates obtained from SLE sera demonstrated that p40 was present as a monomer, and not as a homodimer, nor as a p19=p40 (IL-23) heterodimer. In conclusion, serum p40 monomers (but not IL-12 p70 titers) are elevated in the sera of SLE patients commensurate with disease activity. While the relevance of these observations needs to be further investigated, our results are consistent with the APC dysfunction described in SLE.
Steady-state pharmacokinetic comparison of a new, once-daily, extended-release morphine formulation (Morphelan™) and OxyContin® twice daily
Authors: Eliot Lise , Geiser Rita , Loewen Gordon
Published: October 2002

Context. Morphelan2 (morphine sulfate extended release), a new, once-daily, oral morphine sulfate formulation, releases morphine in a dual-release manner, providing an initial rapid delivery while maintaining therapeutic morphine concentrations throughout a 24-hour period with minimal fluctuation.

Objective. The primary objective of this study was to compare steady-state pharmacokinetic (PK) profiles of morphine and oxycodone following administration of 60 mg of Morphelan, once daily and 20 mg of OxyContin1 (oxycodone hydrochloride controlled release) twice daily, respectively.

Design, Setting, Participants, Intervention. Thirty-five healthy subjects were randomized to receive Morphelan once daily, or OxyContin twice daily for 7 days in this multiple-dose, open-label, parallel design study.

Measures. Blood samples were obtained on day 7 to determine differences, if any, in the PK parameters that characterize the ability of the formulations to control the release of drug. Safety data were collected throughout the study.

Results. Thirty-two subjects completed the study; 31 subjects were eligible for PK evaluation. The time to reach and maintain threshold concentrations of 50% or 75% of maximum was comparable for Morphelan and OxyContin. However, in comparison to OxyContin twice daily, once-daily Morphelan provided a statistically significantly reduced peak-to-trough fluctuation (%FI = 91% vs 77%, respectively, P= 0.05) and a lower number of fluctuations (2 vs 1, respectively) over a 24-hour period.

Conclusions. Once-daily Morphelan provided an initial rapid release of opioid reaching and maintaining threshold concentrations of 50% and 75% of maximum comparable to OxyContin twice daily. However, Morphelan provided more consistent opioid concentrations throughout a 24-hour period, with less frequent dosing.
Trastuzumab in the treatment of HER2 positive breast cancer
Authors: Summerhayes Maxwell
Published: October 2002

Objective. To provide a comprehensive review of the preclinical and clinical pharmacology and toxicology of the monoclonal antibody trastuzumab, with particular reference to its use in its approved indication, HER2/neu-overexpressing breast cancer.

Data sources. A MEDLINE search was conducted using the terms ‘trastuzumab’ and ‘Herceptin’ for the period 1995-2001. The reference lists from retrieved articles were reviewed and other relevant papers identified. The abstract books from the annual meetings of the American Society of Clinical and Oncology and the European Society of Medical Oncology were also reviewed.

Data extraction. The aim of the review was to be comprehensive and descriptive. All studies containing information deemed to be of interest were reviewed by the author; none were excluded on grounds of quality.

Data summary. Trastuzumab is a chimeric monoclonal antibody with a hypervariable region of murine origin inserted into a human IgG1 skeleton. Trastuzumab recognizes p185HER2/neu, the 185-kDa product of the HER2/neu protooncogene. This gene is overexpressed in around 20% of breast cancers and encodes for a trans-membrane protein that has extensive structural homology with the EGFR. HER2/neu overexpression is prognostic of short relapse-free and overall survival and, possibly, of poor response to certain hormonal and cytotoxic treatments. Trastuzumab inhibits the growth of HER2/neu-overexpressing tumour cells grown in tissue culture or as xeno-grafts in mice. It also potentiates the action of certain cytotoxic drugs against such cells. These properties stimulated clinical trials of trastuzumab in women with HER2/neu-positive breast cancer. Used alone, in women with heavily pretreated HER2/neu-positive breast cancer, trastuzumab stabilized disease in 35% of cases and induced regression in a further 22%. Its use was associated with prolonged stabilization of quality of life. When used in combination with paclitaxel, or anthracycline-based chemotherapy, as a first-line treatment for metastatic breast cancer, it increased response rates, time to disease progression and survival. Unfortunately, when used in conjunction with anthracyclines, trastuzumab has been associated with an unacceptable incidence of cardiotoxicity. For this reason, it is currently approved for use alone or in combination with paclitaxel. When added to paclitaxel as a first-line treatment, it increased the median time to disease progression from 3.0 to 6.9 months (P= 0.0001) and the 1-year survival rate from 62% to 73%, with little toxicity except occasional and, generally, mild infusion reactions.
Chemotherapy-induced moderate tolife-threatening anemia in early-stage breast cancer
Authors: Caggiano Vincent , Gupta Sanjay , Tannous Rima E , Fridman Moshe , Carter William B
Published: October 2002

Purpose. We evaluated the incidence and severity of anemia experienced by women treated with doxorubicin and cyclophosphamide (AC) therapy for early-stage breast cancer are described. We also explored the possibility of identifying clinical characteristics that will allow early identification of women more likely to develop anemia and may require anemia treatment.

Methods. This study used a historic case series from 13 oncology practices that participated in the Oncology Practice Pattern Study. The analysis focused on 411 patients who received AC chemotherapy from 1993 through 1999. Seventeen percent of the study population was excluded from the analysis due to missing data. Anemia was defined as a hemoglobin (Hb) value of < 12 g/dL. Hb ≤10 g/dL was considered the threshold value for treatment.

Results. Among patients receiving AC, 18.0% was anemic prior to chemotherapy. Overall, 14.9 -16.9% of women with early-stage breast cancer who started AC chemotherapy with a normal Hb (≥12 g/dL) developed anemia. Nearly 11% developed severe to life-threatening anemia (Hb < 8 g/dL). Data on blood transfusions and erythropoietic therapy were unavailable. Multivariate logistic regression analysis showed that patients who started with a normal prechemotherapy Hb and dropped to ≤10 g/dL at some point during chemotherapy were more likely to be ≥65 years of age, have a low body surface area (< 1.78), and have four or more positive nodes.

Conclusion. The incidence of anemia increased substantially from baseline to post-chemotherapy. The data suggested the importance of monitoring and managing Hb levels of patients at increased risk for developing chemotherapy-induced anemia.
Autonomic instability, as measured by pupillary unrest, is not associated with multiple sclerosis fatigue severity
Authors: Egg R , Högl B , Glatzl S , Beer R , Berger T
Published: October 2002

Multiple sclerosis (MS) fatigue is one of the most common symptoms in MS, but its pathophysiology is still not understood. Sympathovagal imbalance was suggested as a reason for fatigue in chronic fatigue syndrome. We examined the role of an imbalance in the central autonomic nervous system (ANS) as a cause of MS fatigue in 51 MS patients and a control group of 22 healthy volunteers. Fatigue was assessed with the revised MS Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS). Depression was evaluated with the Beck Depression Inventory (BDI). Disintegration of the central ANS expressed by pupillary fatigue waves was measured with pupillography and documented in the pupillary unrest index (PUI). All subjects had less than five points on the seven-point Stanford Sleepiness Scale and were therefore not sleepy. MS patients had significant higher mean FSS scores (p =0.001) and mean MFIS scores (p =0.003) than our control group. Mean BDI scores were significant higher (p=0.001) in the MS group, but were in the lowest score range (0 -10 points) in both groups. Surprisingly, we found a statistically significant inverse correlation between PUI values and either FSS scores (p=0.001; r = −0.521) or MFIS scores (p =0.002; r = −0.423) in the MS group, but not in healthy participants. We therefore conclude that autonomic instability, as measured by pupillary unrest, is not associated with MS fatigue severity.
Quantitative 1H MRS imaging 14 years after presenting with a clinically isolated syndrome suggestive of multiple sclerosis
Authors: Kapeller P , Brex P A , Chard D , Dalton C , Griffin C M , McLean M A , Parker G JM , Thompson A J , Miller D H
Published: October 2002

Clinically isolated syndromes (CIS) are events suggestive for emerging multiple sclerosis (MS). A majority of patients develop MS within months or years whilst others remain clinically isolated. The goal of this study was to investigate whether biochemical metabolites detectable by 1H magnetic resonance spectroscopy (MRS) may serve to distinguish between these two groups. We investigated 41 patients 14 years after presentation with a CIS and 21 controls with combined quantitative short echo 1H MRS and magnetic resonance imaging (MRI) and assessed disability according to the Expanded Disability Status Scale (EDSS). At follow-up, 32 had developed MS, and 9 still had CIS. Compared with controls, MS patients demonstrated significantly higher concentrations of myo-inositol (Ins) in normal appearing white matter (NAWM) and lesions. Lesions also demonstrated a reduced N-acetyl-aspartate (NAA) level and an increase in choline-containing compounds (Cho). The NAWM Ins concentration was correlated with EDSS (r = 0.48, p = 0.005). MS normal appearing cortical grey matter (CGM) exhibited a decreased NAA. Patients who remained CIS did not differ significantly from controls in any MRS measure. Metabolite changes in normal appearing white and grey matter in MS indicate diffuse involvement of the entire MS brain, which was not seen in the persisting CIS patients. Elevated Ins in MS NAWM appeared functionally relevant. It may indicate glial cell proliferation or gliosis.
Patterns of self-inflicted injury
Authors: Matthews W , Wallis DN
Published: October 2002

Patterns of self-inflicted injury vary widely depending on the mechanism of injury and intent of the individual. Life threatening injuries are usually inflicted with suicidal intent. Non-life threatening injuries can be divided into three groups distinguished by distinct patterns of injury and underlying psychopathology. Recognition of these patterns facilitates optimal treatment of the injury and psychological morbidity.
Becoming-icy: Scott and Amundsen’s South Polar voyages, 1910-1913
Authors: Wylie John
Published: October 2002

This paper presents a critical narration of the South Polar voyages of Roald Amundsen and Robert Falcon Scott. The argument which guides this narration is that it is through embodied, material practices - through relations of becoming anterior to a duality of discourse and world - that distinctive subjectivities and landscapes are produced. Within this conceptual frame, the paper focuses upon the differences between the expeditions led by Scott and Amundsen, and especially upon differences as regards styles of dwelling within and strategies for moving through the Antarctic landscape. Such differences, I argue, may be witnessed and narrated within the varying materialities, mobilities and corporealities enacted by the two expeditions. In analysing these via the format of a critical narrative, the aim is to foreground a sense of Scott and Amundsen’s voyages as concrete, sensuous contexts of practice and performance, and in this way the paper seeks to abet and inflect the interpretative strategies of current critical histories of European exploration.
Faking it? The multiple meanings of environmental restoration near Twyford Down
Authors: Eden Sally
Published: October 2002

Resistance to the construction of a new motorway link through Twyford Down in the 1990s made the name of this small part of Hampshire, England, symbolic of contemporary environmental protest in Britain. But a little-known part of the story concerns the use of environmental restoration by proponents and opponents of the new road. This paper investigates how the ‘restoration rhetoric’ was used in the Twyford Down case and also how it was translated into practice on the ground. It shows that environmental restoration is neither necessarily good nor bad for environmental protection, but that its very plasticity can be moulded by different hands and contexts.
Behavioral Risk Factor and Preventive Health Care Practice Survey of Immigrants in the Emergency Department
Authors: Jacobs David H. , Tovar Juan M. , Hung Oliver L. , Kim Mimi , Ye Philip , Chiang William K. , Goldfrank Lewis R.
Published: October 2002

Objective: To compare the demographic profiles, behavioral risk factors, and preventive health care practices of adult immigrant and non‐immigrant patients while considering the effects of various socioeconomic variables. Methods: This was a prospective survey administered at a large urban emergency department in New York City. Study subjects were adult immigrant patients presenting in an eight‐week period in 1998. One non‐immigrant control patient was recruited concurrently with every two immigrant patients. Differences between immigrants and non‐immigrants were evaluated using the chi‐square test. Multivariate logistic regression models were used to adjust for confounding variables. Results: Eight hundred sixty‐nine immigrant patients from 80 countries and 354 non‐immigrant patients completed surveys. Immigrants were more likely not to have reached high school (28.9% vs 8.5%; p < 0.001), to have annual family incomes less than $20,000 (73.8% vs 64.5%; p < 0.01), and to have no health coverage (51.7% vs 30.8%; p < 0.001). Immigrant women were more likely never to have had a Papanicolaou test (16.1% vs 1.4%; OR 11.24, 95% CI = 2.70 to 46.8) and never to have performed a self‐breast examination (20.8% vs 7.5%; OR 2.03, 95% CI = 1.29 to 3.20). Immigrants were more likely not to use condoms (63.4% vs 42.8%; OR 1.61, 95% CI = 1.20 to 2.15) and never to have visited a dentist (21.2% vs 7.8; OR 2.54, 95% CI = 1.60 to 4.04). Immigrants were more likely never to have received a purified protein derivative (PPD) skin test (30.3% vs 9.1%; OR 3.85, 95% CI = 2.56 to 5.80) and never to have received a tetanus immunization (48.1% vs 13.5%; OR 3.09, 95% CI = 2.17 to 4.42). These differences were independent of age, gender, marital status, employment, education, income, and health insurance status. When analyzing the immigrant group alone, region of origin, length of time in the United States, and English ability were significant independent predictors of higher‐risk behavioral profiles and poor preventive health care practices. Conclusions: Differences exist between the socioeconomic profiles, behavioral risk profiles, and preventive health care practices of immigrant and non‐immigrant patients presenting to a large inner‐city municipal emergency department. Different populations within a heterogeneous group of immigrants have distinct health risks and public health needs.
Scientific Priorities and Strategic Planning for Resuscitation Research and Life Saving Therapy Following Traumatic Injury: Report of the PULSE Trauma Work Group
Authors: Carrico C. James , Holcomb John B. , Chaudry Irshad H.
Published: October 2002

Traumatic injury and its sequelae remain a major, unrecognized public health problem in North America. Traumatic injury is the principal cause of death in patients aged 1‐44 years and the overall leading cause of life‐years lost in the United States. Recognizing this, the National Heart, Lung, and Blood Institute (NHLBI), in conjunction with other federal agencies, organized a conference in June 2000 to discuss the basic and clinical research needs that could lead to improved outcomes following cardiopulmonary or post injury resuscitation. The Post Resuscitative and Initial Utility of Life Saving Efforts (PULSE) Workshop resulted and eight work groups were established to focus on various aspects, including organ systems, pharmacology, epidemiology, and trauma. The Trauma Work Group recommendations are presented in this article. Despite the recognition of improved survival and outcome through advancements in trauma systems and trauma care, the National Institutes of Health (NIH) support ratio for trauma research is only 0.10, compared with 1.65 for cancer research and a remarkable 3.51 for AIDS and HIV infection research. The successful federal HIV research program has significantly decreased the morbidity and mortality over the last ten years at a cost of $1.4 billion per year. A coordinated trauma research program should aim to replicate the success achieved by such programs; however, a centralized federal “home” for trauma research does not exist. Consequently, the existing limited research support is derived from NIH institutes in addition to other federal and state agencies. This report serves to describe some of the obstacles and outline various strategies and priorities for basic science, clinical, and translational trauma resuscitation research.
Influence of International Emergency Medicine Opportunities on Residency Program Selection
Authors: Dey Chayan C. , Grabowski Jurek G. , Gebreyes Kulleni , Hsu Edbert , VanRooyen Michael J.
Published: October 2002

Objectives: In the last several years, there has been increasing interest in international emergency medicine (IEM) programs. A number of residency programs offer or encourage international opportunities during residency. The purpose of this study was twofold: 1) to determine whether the availability of international opportunities during residency affected the ranking of emergency medicine (EM) residency programs by graduating medical students and 2) to determine whether prior international health experience among medical students influences interviewing and ranking of residency programs with international opportunities. Methods: An eight‐question survey measuring interest in IEM and its effect on ranking of programs was mailed to all 1,205 first‐year EM residents from 122 accredited allopathic EM residency programs in the United States. International opportunities were defined as any program that offered an international elective during residency or had an IEM fellowship. Data were analyzed using descriptive statistics and chi‐square tests. Results: Of the 1,205 mailed surveys, 34% were returned by the first‐year residents. Of all respondents, 281/408 (69%) interviewed at programs with international opportunities. Study findings revealed 62% (164/264) of the students who interviewed at programs with international opportunities considered the availability of international opportunities a positive factor in ranking residency programs. Analysis revealed that applicants with previous international health experience, 68% (104/152), were more likely to rank EM residency programs with international opportunities higher than those that did not. Conclusions: This study suggests that the availability of international opportunities during residency positively affected residency ranking. This relationship was stronger in medical students with prior international health experience.
Preventive Care in the Emergency Department: Diagnosis and Management of Smoking and Smoking‐related Illness in the Emergency Department: A Systematic Review
Authors: Bernstein Steven L. , Becker Bruce M.
Published: October 2002

Smoking remains the leading preventable cause of morbidity and mortality in the United States. The efficacy of emergency department (ED)‐based patient screening and counseling for smoking cessation is not currently known. Objectives: To perform a structured, systematic review of the medical literature to assess the efficacy of limited screening and counseling for tobacco use cessation among adults in the primary care and ED settings, and develop recommendations for emergency physicians based on these data. Methods: A two‐person template‐driven review of all English‐language articles from Medline, the Cochrane Database, and two recent smoking cessation guidelines, with evidence graded according to the scheme of the U.S. Preventive Services Task Force (USPSTF), was performed. Recommendations were developed, and strength graded, based on this evidence. Results: Of 2,078 citations reviewed, 16 were selected for inclusion, based on their methodologic strength and relevance to emergency medicine. Routine physician screening and counseling may increase quit rates at 6‐12 months from 3% (usual care) to 8‐11%. Interventions include brief counseling (<3 minutes), possibly supplemented with self‐help literature, nicotine replacement therapy (NRT), and follow‐up telephone calls. Conclusions: Strong evidence exists, in the primary care setting, that smoking cessation screening and counseling are effective. Limited data exist for ED‐based practice, but, based on the burden of disease, relative ease of intervention, and likely efficacy, routine screening of all patients for tobacco use and referral of smokers to primary care and cessation programs are recommended.
Microarrays as Cancer Keys: An Array of Possibilities
Authors: Mohr Steve , Leikauf George D. , Keith Gérard , Rihn Bertrand H.
Published: October 2002

ABSTRACT: Malignant transformation results from accumulation of genetic and epigenetic events. Functional studies of cancer will be crucial to our understanding of its complexity and polymorphism. There is no doubt that emerging genomic and proteomic technologies will facilitate such investigations. Microarray technology is a new and efficient approach to extract data of biomedical relevance for a wide range of applications. In cancer research, it will provide high-throughput and valuable insights into differences in an individual’s tumor as compared with constitutional DNA, mRNA expression, and protein expression and activity. Across individuals, comparisons could provide tissue-specific disease signatures that provide diagnosis based on hundreds of informative genes. The resulting product should be a wealth of tumor-associated and tumor-specific biomarkers, which may help in cancer etiology, diagnosis, and therapy and ultimately lead to “molecular nosology” of cancers. This review highlights the recent developments in microarray technologies in cancer research, focuses on the results obtained so far, and describes the eventual use of microarray technology for clinical applications.