bluuebunny/crossref_metadata_2025 huggingface dataset:
Multicentric liposarcoma
Authors: SATO HIROTAKA , MINEI SADATSUGU , SUGIMOTO SHUJI , KISHIMOTO YUICHI , YOSHIDA TOSHIO , TAKIMOTO YUKIE
Published: December 2004

Abstract  A 72‐year‐old man complaining of upper abdominal discomfort was diagnosed as having retroperitoneal liposarcoma by means of diagnostic imaging. He then underwent an operation. One mass existed on the curvatura ventriculi major, extending to the hilum splenicum and pressing back the pancreal head and body. There was another mass to the left of the first, situated on the ventral side of the left kidney. Also, another mass was intramurally found adjacent to the curvatura ventriculi major. Histologically, the mass on the curvatura ventriculi major ranged from the peritoneal cavity to the retroperitoneum Its intraperitoneal portion was classified as a differentiated lipoma‐like type and the retroperitoneal mass was of mucous type. The mass on the left kidney was of a differentiated fibrosing type. The intramural mass in the gastric curvature was found to be a differentiated lipoma‐like type. The patient has been under observation for 12 months and has shown no recurrence.
Effect of intraurethral Mitomycin‐C on healing and fibrosis in rats with experimentally induced urethral stricture
Authors: AYYILDIZ ALI , NUHOGLU BARIS , GÜLERKAYA BÜLENT , ÇAYDERE MUZAFFER , ÜSTÜN HÜSEYIN , GERMIYANOGLU CANKON , EROL DEMOKAN
Published: December 2004

Abstract  Background:  In the pathogenesis of urethral stricture, fibrosis is associated with an excessive collagen increase. After the recognition that topical application of Mitomycin‐C (MMC) inhibits fibroblast proliferation and is effective in preventing scar formation, many studies have been carried out on this subject outside the scope of urology. The aim of the present study is to observe the intraurethral impact of the employment of low doses of MMC on scar formation and fibrosis in experimental rat model.

Methods:  Urethral injuries were made by internal urethrotomy knife. The study was carried out with 35 adult male Wistar albino rats. Five rats were allocated to the control group (group 1), 10 to a group that was administered 2 mg/L MMC (group 2) and 20 to a group that was administered 10 mg/L MMC (group 3). Mitomycin‐C was administered to the injured urethra in the form of irrigation for 5 min. The rats were sacrificed 14 days later in order to evaluate chronic inflammation and fibrosis and their penises were histopathologically examined under light microscopy with hematoxilen eosin and trichrom stains.

Results:  When group 2 was compared with control group, the differences in hemosiderin‐laden macrophages (HLM), mononuclear cell infiltration (MCI) and fibrosis were found to be statistically significant (P < 0.01, P < 0.05, P < 0.005, respectively). When group 3 was compared with control group, the differences in HLM, MCI and fibrosis were also found to be statistically significant (P < 0.05, P < 0.05, P < 0.005, respectively). In the comparison of group 2 with group 3, no statistically significant differences were found in terms of the these parameters.

Conclusions:  Although MMC is toxic at high doses, the antifibrotic effect of the intraurethral low dose MMC may be useful in combination therapy for internal urethrotomy.
Comparison of two in vivo models for prostate cancer: Orthotopic and intratesticular inoculation of LNCaP or PC‐3 cells
Authors: KOSHIDA KIYOSHI , KONAKA HIROYUKI , IMAO TETSUYA , EGAWA MASAYUKI , MIZOKAMI ATSUSHI , NAMIKI MIKIO
Published: December 2004

Abstract  Background:  The critical events in the clinical course of prostate cancer are the occurrence of metastasis and the induction of the hormone‐refractory status of the disease. In order to investigate the factors responsible for these events, we need appropriate in vivo models.

Materials and methods:  Orthotopic and intratesticular models were created by the injection of LNCaP cells or PC‐3 cells into the prostate or testis of severe combined immunodeficient mice.

Results:  LNCaP cells in the intratesticular model showed a higher incidence of tumor formation and lymph node metastasis when compared with those in the orthotopic model, while PC‐3 cells were highly tumorigenic and metastastic in both models. A high concentration of androgens might play a role in tumor aggressiveness of LNCaP cells, given that enhanced mRNA expressions of integrin αV and vascular endothelial growth factor was induced by dehydrotestosterone administration in vitro. The high expression of metastasis‐related genes, including the urokinase plasminogen activator system, metalloproteinases and vascular endothelial growth factor‐C, might be attributed to the high metastatic potential in both models. Interestingly, testicular xenografts of LNCaP cells were able to survive on the subcutis back of castrated male mice as well female mice.

Conclusions:  Intratesticular models of prostate cancer appear to be suitable for studying the mechanisms of metastasis and for evaluating various treatment strategies.
Long‐term survival after bilateral adrenalectomy for metachronous adrenocortical cancer
Authors: HARA ISAO , SAKAMOTO YUICHI , KANOMATA NAOKI , MURAMAKI MOTOTSUGU , YAMADA YUJI , KAWABATA GAKU , KAMIDONO SADAO
Published: December 2004

Abstract  We report the case of a female patient with bilateral metachronous adrenocortical cancer who survived long‐term after adrenalectomy. In 1991, the patient underwent left adrenalectomy to remove a huge adrenal mass (10 × 9 cm) displaying no hormonal abnormality. Histological diagnosis was adrenocortical cancer. A right adrenal mass (7 × 6 cm) was found 4 years after left adrenalectomy. Right adrenalectomy was performed, and histological diagnosis was again adrenocortical cancer. The patient remains alive with no evidence of disease 8 years after last surgery.
Efficacy, dose–response relationship and safety of once‐daily extended‐release metformin (Glucophage® XR) in type 2 diabetic patients with inadequate glycaemic control despite prior treatment with diet and exercise: results from two double‐blind, placebo‐controlled studies
Authors: Fujioka K. , Brazg R. L. , Raz I. , Bruce S. , Joyal S. , Swanink R. , Pans M.
Published: December 2004

Aim:  The efficacy, dose–response relationships and safety of an extended‐release formulation of metformin (Glucophage® XR) were evaluated in two double‐blind, randomized, placebo‐controlled studies of 24 and 16 weeks' duration, in patients with inadequate glycaemic control despite diet and exercise. Protocol 1 provided an evaluation of metformin XR at a commonly used dosage. Protocol 2 evaluated different dosages of metformin XR.

Methods:  In Protocol 1, 240 patients were randomized to receive metformin XR 1000 mg once daily. or placebo in a 2 : 1 ratio for 12 weeks (patients could receive metformin XR 1500 mg during weeks 12–24 if required). In Protocol 2, 742 patients were randomized to receive metformin XR 500 mg once daily, 1000 mg once daily, 1500 mg once daily, 2000 mg once daily, 1000 mg twice daily or placebo for 16 weeks. The primary endpoint in each study was the change from baseline in HbA1C at 12 weeks (Protocol 1) or 16 weeks (Protocol 2).

Results:  Metformin XR reduced HbA1C in Protocol 1, with mean treatment differences for 1000 mg once daily vs. placebo of −0.7% at 12 weeks and −0.8% at 24 weeks (p < 0.001 for each). In Protocol 2, a clear dose–response relationship was evident at doses up to 1500 mg, with treatment differences vs. placebo of −0.6% (500 mg once daily), −0.7% (1000 mg once daily), −1.0% (1500 mg once daily) and −1.0% (2000 mg once daily). The efficacy of metformin XR 2000 mg once daily and 1000 mg twice daily were similar (mean treatment differences vs. placebo in HbA1C were −1.0% and −1.2%, respectively). More patients achieved HbA1C < 7.0% with metformin XR vs. placebo in Protocol 1 (29% vs. 14% at 12 weeks) and with once‐daily metformin XR in Protocol 2 (up to 36% vs. 10% at 16 weeks). No significant changes in fasting insulin or body weight occurred. Total and low‐density lipoprotein (LDL)‐cholesterol improved (p < 0.05–p < 0.001) in metformin XR groups in Protocol 2. Metformin XR was well tolerated; gastrointestinal side effects were more common with metformin XR vs. placebo, but few patients withdrew for this reason (1.3% vs. 1.3% in Protocol 1 and 1.6% vs. 0.9% in Protocol 2).

Conclusions:  Once‐daily metformin XR presents an effective and well‐tolerated therapeutic option for delivering metformin in a convenient manner, which supports good compliance with therapy.
The anti‐obesity effect of rimonabant is associated with an improved serum lipid profile
Authors: Poirier B. , Bidouard J.‐P. , Cadrouvele C. , Marniquet X. , Staels B. , O'Connor S. E. , Janiak P. , Herbert J.‐M.
Published: December 2004

We investigated the effects of chronic treatment with the CB1 receptor antagonist rimonabant (10 mg/kg/day p.o. for 10 weeks) in mice with established obesity (5‐month high‐fat diet). Untreated obese mice showed a weight gain of 46% (45.0 ± 0.6 g vs. 30.8 ± 0.5 g) compared with age‐matched animals fed a standard diet. Rimonabant treatment, commencing after 5‐month high‐fat diet, produced a marked and sustained decrease in body weight (34.5 ± 0.8 g vs. 47.2 ± 0.5 g in the high‐fat vehicle group, p < 0.001). The anti‐obesity effect of rimonabant was similar to that obtained by switching obese mice from high‐fat diet to standard laboratory diet during 10 weeks (final weight 33.7 ± 0.6 g) and was associated with only transient (14 days) reduction in energy intake. Serum leptin, insulin and glucose levels were markedly elevated in obese animals. Rimonabant treatment significantly reduced these elevations (leptin −81%, insulin −78%, glucose −67%, p < 0.001 in all cases vs. high‐fat vehicle group). In addition, rimonabant treatment modestly but significantly increased serum adiponectin levels (+18%, p < 0.05 vs. high‐fat vehicle group). Obese mice demonstrated abnormal serum lipid profiles. Although rimonabant did not modify high‐density lipoprotein cholesterol (HDLc) and had modest effects on total cholesterol, it significantly reduced triglycerides and low‐density lipoprotein cholesterol (LDLc) and, notably, increased the HDLc/LDLc ratio (12.4 ± 0.8 vs. 7.9 ± 0.2 in high‐fat vehicle group, p < 0.001). Therefore, in a model of established obesity, chronic rimonabant treatment produces a marked and sustained decrease in body weight (equivalent to that achieved by dietary change) which is associated with favourable modifications in serum biochemical and lipid profiles.
Combination treatment of vitamin C and desferrioxamine suppresses glomerular superoxide and prostaglandin E2 production in diabetic rats
Authors: Iino K. , Iwase M. , Sonoki K. , Yoshinari M. , Iida M.
Published: December 2004

Aims:  Increased oxidative stress may contribute to the development of diabetic nephropathy. Conversely, it has been proposed that enhanced glomerular production of prostaglandin E2 (PGE2) may be the cause of glomerular hyperfiltration in streptozotocin (STZ)‐induced diabetic rats. As the role of superoxide anion (O2–) production in early diabetic nephropathy is not fully understood, we investigated the effect of vitamin C and desferrioxamine treatment on glomerular O2– and PGE2 production in diabetic rats.

Methods:  STZ‐induced diabetic rats were given drinking water containing 1 g/l of vitamin C and desferrioxamine for 10 days, and glomerular O2– production, glomerular PGE2 synthesis and creatinine clearance were examined.

Results:  Glomerular O2– production increased in untreated diabetic rats compared to non‐diabetic controls (142.2 ± 12.4 vs. 65.4 ± 3.6 counts/mg protein/min). Treatment with vitamin C and desferrioxamine significantly decreased glomerular O2– production (93.7 ± 6.7 counts/mg protein/min). Glomerular PGE2 synthesis and creatinine clearance were significantly increased in untreated diabetic rats compared to controls and PGE2 synthesis was reduced and creatinine clearance tended to decrease by the treatment.

Conclusions:  Our results demonstrated that vitamin C and desferrioxamine suppressed the enhanced glomerular O2– production with subsequent decrease in PGE2 production. Antioxidant therapy may be beneficial in preventing the development of diabetic nephropathy.
The post‐prandial state in Type 2 diabetes and endothelial dysfunction: effects of insulin aspart
Authors: Ceriello A. , Cavarape A. , Martinelli L. , Da Ros R. , Marra G. , Quagliaro L. , Piconi L. , Assaloni R. , Motz E.
Published: December 2004

Objective  Recently, much attention has been focused on the possibility that the post‐prandial state may be a cardiovascular risk factor in diabetes. The aim of the present study was to evaluate whether the post‐prandial state is associated with endothelial dysfunction in patients with diabetes and to explore the effect on this aspect of managing post‐prandial hyperglycaemia by insulin aspart.

Research design and methods  Twenty‐three patients with Type 2 diabetes and 10 normal controls were recruited. In the diabetic patients two different tests were performed in each subject: a standard meal preceded by subcutaneous injection of soluble insulin (0.15 U/kg body weight) or of short‐acting insulin aspart (0.15 U/kg body weight). These tests were designed to achieve different levels of post‐prandial hyperglycaemia. Controls received a single standard meal test. Immediately before, and 1, 2, 4 and 6 h after each meal, blood glucose, triglycerides, free fatty acids and flow‐mediated vasodilation were measured.

Results  Compared with regular insulin, insulin aspart significantly reduced the area under the curve for post‐prandial hyperglycaemia (58.3 ± 17.6 vs. 68.1 ± 17.7; P < 0.04), and preserved flow‐mediated vasodilation, which was decreased in the post‐prandial state (39.4 ± 2.9 vs. 34.1 ± 2.2; P < 0.01). Triglyceride and free fatty acid levels were not differentially affected by the treatment. In normal controls the meal did not affect flow‐mediated vasodilation.

Conclusion  This study shows that the post‐prandial state is accompanied by endothelial dysfunction in Type 2 diabetic patients and that insulin aspart improved endothelial function.

Diabet. Med. 21, 171–175 (2004)
Effects of acute hyperglycaemia on anorectal motor and sensory function in diabetes mellitus
Authors: Russo A. , Botten R. , Kong M.‐F. , Chapman I. M. , Fraser R. J. L. , Horowitz M. , Sun W.‐M.
Published: December 2004

Aims  To determine the effects of acute hyperglycaemia on anorectal motor and sensory function in patients with diabetes mellitus.

Methods  In eight patients with Type 1, and 10 patients with Type 2 diabetes anorectal motility and sensation were evaluated on separate days while the blood glucose concentration was stabilized at either 5 mmol/l or 12 mmol/l using a glucose clamp technique. Eight healthy subjects were studied under euglycaemic conditions. Anorectal motor and sensory function was evaluated using a sleeve/sidehole catheter, incorporating a barostat bag.

Results  In diabetic subjects hyperglycaemia was associated with reductions in maximal (P < 0.05) and plateau (P < 0.05) anal squeeze pressures and the rectal pressure/volume relationship (compliance) during barostat distension (P < 0.01). Hyperglycaemia had no effect on the perception of rectal distension. Apart from a reduction in rectal compliance (P < 0.01) and a trend (P = 0.06) for an increased number of spontaneous anal sphincter relaxations, there were no differences between the patients studied during euglycaemia when compared with healthy subjects.

Conclusions  In patients with diabetes, acute hyperglycaemia inhibits external anal sphincter function and decreases rectal compliance, potentially increasing the risk of faecal incontinence.

Diabet. Med. 21, 176–182 (2004)
What does postprandial hyperglycaemia mean?
Authors: Heine R. J. , Balkau B. , Ceriello A. , Del Prato S. , Horton E. S. , Taskinen M‐R.
Published: December 2004

Aims  The potential importance of postprandial glucose (PPG) control in the development of complications in Type 2 diabetes is much debated. The recent American Diabetes Association (ADA) consensus statement discussed the role of postprandial hyperglycaemia in the pathogenesis of diabetic complications and concluded that the relationship between PPG excursions and the well‐established risk factors for cardiovascular disease (CVD) should be further examined. Using the ADA statement as a starting point and including the more recent American College of Endocrinology guidelines on glycaemic control, a panel of experts in diabetes met to review the role of PPG within the context of the overall metabolic syndrome, in the development of complications in Type 2 diabetes.

Results  Post‐prandial hyperglycaemia is a risk indicator for micro‐ and macrovascular complications, not only in patients with Type 2 diabetes but also in those with impaired glucose tolerance. In addition, the metabolic syndrome confers an increased risk of CVD morbidity and mortality. The debate focused on the relative contributions of postprandial hyperglycaemia, the metabolic syndrome and, in particular, raised triglyceride levels in the postprandial state, to the development of cardiovascular complications of diabetes.

Conclusions  The panel recommended that in the prevention and management of microvascular complications of Type 2 diabetes, targeting both chronic and acute glucose fluctuations is necessary. Lowering the macrovascular risk also requires control of (postprandial) triglyceride levels and other components of the metabolic syndrome.
Twelve‐month‐olds point to share attention and interest
Authors: Liszkowski Ulf , Carpenter Malinda , Henning Anne , Striano Tricia , Tomasello Michael
Published: December 2004

Infants point for various motives. Classically, one such motive is declarative, to share attention and interest with adults to events. Recently, some researchers have questioned whether infants have this motivation. In the current study, an adult reacted to 12‐month‐olds’ pointing in different ways, and infants’ responses were observed. Results showed that when the adult shared attention and interest (i.e. alternated gaze and emoted), infants pointed more frequently across trials and tended to prolong each point – presumably to prolong the satisfying interaction. However, when the adult emoted to the infant alone or looked only to the event, infants pointed less across trials and repeated points more within trials – presumably in an attempt to establish joint attention. Results suggest that 12‐month‐olds point declaratively and understand that others have psychological states that can be directed and shared.
Culture and children's cosmology
Authors: Siegal Michael , Butterworth George , Newcombe Peter A.
Published: December 2004

In this investigation, we examined children's knowledge of cosmology in relation to the shape of the earth and the day‐night cycle. Using explicit questioning involving a choice of alternative answers and 3D models, we carried out a comparison of children aged 4–9 years living in Australia and England. Though Australia and England have a close cultural affinity, there are differences in children's early exposure to cosmological concepts. Australian children who have early instruction in this domain were nearly always significantly in advance of their English counterparts. In general, they most often produced responses compatible with a conception of a round earth on which people can live all over without falling off. We consider coherence and fragmentation in children's knowledge in terms of the timing of culturally transmitted information, and in relation to questioning methods used in previous research that may have underestimated children's competence.
Toward “Epistemic Reflexivity” in Educational Research: A Response to Scientific Research in Education
Authors: Moss Pamela A.
Published: December 2004

In this response to Scientific Research in Education (National Research Council, 2002), I argue that the report has provided us with a carefully considered but partial vision of social science that limits the capacity of our field to engage in critical self-reflection. As one counterexample to the vision of social science portrayed in the report, I draw on the work of French sociologist Pierre Bourdieu. Bourdieu's work not only offers an alternative vision of social science, but it also treats academic fields, including social sciences, as objects of study, illuminating the social forces that shape categories of thought and action. As such, it invites a rigorous form of self-reflection that is not promoted within SRE's vision of social science.
After Methods, Then What? A Researcher's Response to the Report of the National Research Council
Authors: Walker Vanessa Siddle
Published: December 2004

This commentary commends the authors of Scientific Research in Education for addressing important questions for the field of education research and identifies six areas that might profit from further attention: 1) explicit factors that compromise the building of scholarly community, 2) introspective conversation on the role of the researcher in the research process, 3) privileged and silenced research, 4) over reliance on the scientific model as the most important way to influence policy, 5) integration of “stages” of research with research quality, and 6) innocence of purpose.
Theorizing and Describing Preservice Teachers’ Images of Families and Schooling
Authors: Graue Elizabeth
Published: December 2004

This article examines how prospective teachers just beginning a professional education program think about working with parents. Through interviews with students in an elementary teacher education program, I explore how biography shapes dispositions toward families by setting expectations for the roles and the activities of participants. Merging cognitive, cultural, and narrative frameworks for teacher development, I suggest that prospective teachers must cross-traditionally consider cultural boundaries of race/class/gender but are also challenged as they move from being a child and student in family and school to the professional position of teacher. I argue that the role of teacher education is to manage the identity work necessary to integrate the tools of biography and the process of learning to relate to others in a new role.
UNDERSTANDING INNOVATION AS A COMPLEX ADAPTIVE SYSTEM: CASE STUDIES FROM SHIMADZU AND NEC
Authors: Ishimatsu Hirokazu , Sugasawa Yoshio , Sakurai Keizo
Published: December 2004

Abstract.  This paper describes innovation from the viewpoint of biologic evolution, a complex adaptive system. First, three characteristics of complex adaptive systems – variation, interaction and selection – are explained. Second, we propose that variation in R&D activities is brought about by innovation seeds, which can be subdivided into reproduction and mutation types. Third, taking into account the concept of an innovation seed, we propose our innovation creation process model. Finally, our proposed concept is validated through case studies of (i) a mass analyser business by Shimadzu and (ii) a carbon nanotube business by NEC.
Neurophysiological tests and neuroimaging procedures in non‐acute headache: guidelines and recommendations
Authors: Sandrini G. , Friberg L. , Jänig W. , Jensen R. , Russell D. , Sanchez del Rìo M. , Sand T. , Schoenen J. , van Buchem M. , Van Dijk J. G.
Published: December 2004

The use of instrumental examinations in headache patients varies widely. In order to evaluate their usefulness, the most common instrumental procedures were evaluated, on the basis of evidence from the literature, by an EFNS Task Force (TF) on neurophysiological tests and imaging procedures in non‐acute headache patients. The conclusions of the TF regarding each technique are expressed in the following guidelines for clinical use.

Interictal electroencephalography (EEG) is not routinely indicated in the diagnostic evaluation of headache patients. Interictal EEG is, however, indicated if the clinical history suggests a possible diagnosis of epilepsy (differential diagnosis). Ictal EEG could be useful in certain patients suffering from hemiplegic and basilar migraine.

Recording of evoked potentials is not recommended for the diagnosis of headache disorders.

There is no evidence to justify the recommendation of autonomic tests for the routine clinical examination of headache patients.

Manual palpation of pericranial muscles, with standardized palpation pressure, can be recommended for subdividing patient groups but not for diagnosis. Pressure algometry and electromyography (EMG) cannot be recommended as clinical diagnostic tests.

In adult and paediatric patients with migraine, with no recent change in attack pattern, no history of seizures, and no other focal neurological signs or symptoms, the routine use of neuroimaging is not warranted. In patients with atypical headache patterns, a history of seizures and/or focal neurological signs or symptoms, magnetic resonance imaging (MRI) may be indicated.

If attacks can be fully accounted for by the standard headache classification [International Headache Society (IHS)], a positron emission tomography (PET) or single‐photon emission computerized tomography (SPECT) and scan will generally be of no further diagnostic value.

Nuclear medicine examinations of the cerebral circulation and metabolism can be carried out in subgroups of headache patients for diagnosis and evaluation of complications, when patients experience unusually severe attacks, or when the quality or severity of attacks has changed.

Transcranial Doppler examination is not helpful in headache diagnosis.

Although many of the examinations described are of little or no value in the clinical setting, most of the tools have a vast potential for further exploring the pathophysiology of headaches and the effects of pharmacological treatment.
EFNS guidelines on neuropathic pain assessment
Authors: Cruccu G. , Anand P. , Attal N. , Garcia‐Larrea L. , Haanpää M. , Jørum E. , Serra J. , Jensen T. S.
Published: December 2004

In September 2001, a Task Force was set up under the auspices of the European Federation of Neurological Societies with the aim of evaluating the existing evidence about the methods of assessing neuropathic pain and its treatments. This review led to the development of guidelines to be used in the management of patients with neuropathic pain. In the clinical setting a neurological examination that includes an accurate sensory examination is often sufficient to reach a diagnosis. Nerve conduction studies and somatosensory‐evoked potentials, which do not assess small fibre function, may demonstrate and localize a peripheral or central nervous lesion. A quantitative assessment of the nociceptive pathways is provided by quantitative sensory testing and laser‐evoked potentials. To evaluate treatment efficacy in a patient and in controlled trials, the simplest psychometric scales and quality of life measures are probably the best methods. A laboratory measure of pain that by‐passes the subjective report, and thus cognitive influences, is a hopeful aim for the future.
Predictive factors for spondylotic cervical myelopathy treated conservatively or surgically
Authors: Kadaňka Z. , Mareš M. , Bednařík J. , Smrčka V. , Krbec M. , Chaloupka R. , Dušek L.
Published: December 2004

A prospective 3‐year randomized study comparing conservative and surgical treatment of spondylotic cervical myelopathy to establish predictive factors for outcome after conservative treatment and surgery. The clinical, electrophysiological and imaging parameters were examined to reveal how they characterized the clinical outcome. The patients with a good outcome in the conservatively treated group were of older age before treatment, had normal central motor conduction time (CMCT), and possessed a larger transverse area of the spinal cord. The patients with a good outcome in the surgically treated group had a more serious clinical picture (expressed in mJOA score and slower walk). Patients should rather be treated conservatively if they have a spinal transverse area larger than 70 mm2, are of older age and have normal CMCT. Surgery is more suitable for patients with clinically worse status and a lesser transverse area of spinal cord.
MTHFR C677T gene mutation as a risk factor for arterial stroke: a hospital based study
Authors: Alluri R. V. , Mohan V. , Komandur S. , Chawda K. , Chaudhuri J. R. , Hasan Qurratulain
Published: December 2004

Elevated homocysteine level is an independent risk factor for ischemic stroke, thrombotic and cardiovascular diseases. The enzyme methylenetetrahydrofolate reductase (MTHFR) plays a crucial role in regulating the levels of homocysteine. A C677T mutation in this gene results in reduced activity. Sixty‐nine patients with arterial stroke, six patients with venous stroke (confirmed by computed tomography and/or magnetic resonance imaging) with hyperhomocysteinemia were selected for the study. Forty‐nine subjects with no past history of stroke served as controls. MTHFR genotypes were determined by PCR using specific primers, followed by restriction digestion and gel analysis. The prevalence of the mutated homozygous and heterozygous C677T MTHFR genotype in the patients with arterial stroke was 1.4% (one of 69) and 31.88% (21 of 69), respectively. There frequency was 16.6% (one of six) and 33.3% (two of six) in venous stroke. The genotyping results from controls showed that there was only one heterozygote out of the 49 studied (2.08%). There was a significant difference between the control and the patient groups. Odds ratio for the probability of the C677T MTHFR gene mutation in the patients versus control group was 22.29 (95% CI 4.89–98.8). This indicates that C677T MTHFR mutation is strongly associated with arterial stroke especially in young adults. MTHFR allele evaluation will help in preventing/reducing morbidity caused by stroke.
Predictive factors for mild forms of spondylotic cervical myelopathy treated conservatively or surgically
Authors: Kadaňka Z. , Mareš M. , Bednařík J. , Smrčka V. , Krbec M. , Chaloupka R. , Dušek L.
Published: December 2004

A prospective 3‐year randomized study comparing conservative and surgical treatment of spondylotic cervical myelopathy to establish predictive factors for outcome after conservative treatment and surgery. The clinical, electrophysiological and imaging parameters were examined to reveal how they characterized the clinical outcome. Statistically, pair‐wise and multiple comparisons of different were used with the independent t‐test and on one‐way anova models followed by Tukey multiple‐range tests. The patients with a good outcome in the conservatively treated group were of older age before treatment, had normal central motor conduction time (CMCT), and possessed a larger transverse area of the spinal cord. The patients with a good outcome in the surgically treated group had a more serious clinical picture (expressed in mJOA score and slower walk). Patients should rather be treated conservatively if they a spinal transverse area larger than 70 mm2, are of older age, and have normal CMCT. Surgery is more suitable for patients with clinically worse status and a lesser transverse area of spinal cord.
Zolmitriptan Nasal Spray Exhibits Good Long‐Term Safety and Tolerability in Migraine: Results of the INDEX Trial
Authors: Dowson Andrew J. , Charlesworth Bruce R. , Green Judy , Färkkilä Markus , Diener Hans‐Christoph , Boes Hansen Steen , Gawel Marek ,   INDEX Study Group
Published: December 2004

Background.—Previous studies have shown that zolmitriptan 5 mg nasal spray has a fast onset of action, high efficacy, and good tolerability in the acute treatment of migraine.

Objective.—This open‐label, noncomparative, multicenter, multinational phase III study was designed to further evaluate the long‐term safety and tolerability of zolmitriptan 5 mg nasal spray in a population of migraineurs largely naïve to triptan nasal sprays who treated multiple migraine attacks over a 1‐year period.

Methods.—Patients were required to have an established diagnosis of migraine with or without aura (based on International Headache Society criteria), a high frequency of migraine attacks, and were allowed to treat migraine with any baseline headache intensity. A secondary objective of the study was to assess the long‐term efficacy of zolmitriptan nasal spray. A subgroup analysis aimed to determine whether rhinitis had any influence on outcomes of treatment.

Results.—The safety population consisted of 538 patients who treated 20 717 migraine attacks with zolmitriptan 5 mg nasal spray. Overall, adverse events occurred in 32.8% of attacks, and led to treatment withdrawal in 4.5% of patients. The most common adverse events were unusual taste (19.0%) and paresthesia (6.8%). Adverse events were generally of mild intensity, transient, and well tolerated, showing a decline in incidence over time. Serious adverse events were rare. The presence of rhinitis and use of a second dose of trial medication had no effect on the incidence of adverse events. At 2 hours, 53.8% of attacks treated with zolmitriptan nasal spray 5 mg were rendered pain free. The highest 2‐hour pain free rates were seen for headaches of mild baseline intensity (83.3%), followed by headaches of moderate (56.5%), and severe (32.2%) baseline intensity. The 2‐hour pain‐free rate remained consistent throughout the study period. The presence of rhinitis had no effect on efficacy.

Conclusions.—Zolmitriptan 5 mg nasal spray demonstrated a well‐tolerated and efficacious profile in the acute treatment of multiple migraine attacks over a 1‐year period.
Chronic Post‐Traumatic Neck and Head Pain
Authors: Solomon Seymour
Published: December 2004

Objective.—This is a review of current concepts of chronic post‐traumatic neck and head pain. In this article, I will emphasize the physiological and sociological aspects of these disorders.

Background.—The pathophysiology of chronic post‐traumatic neck and head pain has not been well understood. Some have emphasized the organic factors and others the psychogenic aspects of these conditions. Only in recent years have this dichotomy been integrated with sociocultural concepts.

Methods.—The history of chronic post‐traumatic head and neck pain is reviewed. Paradoxes are discussed, ie, the great differences in prevalence around the world, the inconsistent relationship of symptoms to degree of trauma, the curious phenomena of structural disease without symptoms, and symptoms without structural disease. The organic and pathophysiologic factors are reviewed, then those factors that modulate pain in these conditions are discussed.

Conclusion.—Chronic post‐traumatic neck and head pain is rarely either organic or psychogenic. Rather physiological, social, and cultural factors play major roles in modulating pain and either perpetuate or ameliorate these chronic pain conditions.
Spontaneous Intracranial Hypotension Presenting as Mental Deterioration
Authors: Tsai Ping‐Huang , Wang Shuu‐Jiun , Lirng Jiing‐Feng , Fuh Jong‐Ling
Published: December 2004

A 55‐year‐old woman had new onset of postural headache followed by change of mental status 3 weeks later. Magnetic resonance imaging (MRI) of the brain and whole spine showed typical spontaneous intracranial hypotension (SIH) findings, bilateral subdural hematoma, and cerebrospinal fluid leakage over the T7–T9. Her headache and mentality improved after epidural blood patches. Early recognition and correct diagnosis are crucial for successful treatment in patients with SIH presenting with mental confusion.
Cluster Headache With Obstructive Sleep Apnea and Periodic Limb Movements During Sleep: A Case Report
Authors: Pelin Zerrin , Bozluolcay Melda
Published: December 2004

We report the case of a man with episodic cluster headache who suffered from severe obstructive sleep apnea (OSA) as well as periodic limb movements during sleep (PLMS). His attacks of headache occurred primarily during sleep being timely to REM sleep as 90 to 120 minutes interval. OSAs were more frequent and prolonged during REM sleep and oxygen saturation decreased to 81% during this sleep period. Periodic limb movements were also observed in our patient that were more frequent during the first half of the polysomnographic recordings. This case is one of the few reporting cases with CH who had both OSA and PLMS.
Severe Headaches Following Smallpox Vaccination
Authors: Sejvar James , Boneva Roumiana , Lane J. Michael , Iskander John
Published: December 2004

Headaches are common following smallpox vaccination; the re‐introduction of civilian vaccination necessitates better understanding of the clinical features and outcome of postvaccination headache. We identified patients reporting headache following vaccination from among those reported to the U.S. Vaccine Adverse Events Reporting System to characterize demographic and clinical features. One‐hundred and eight reports were obtained from among 627 smallpox vaccine‐related reports, including 15 hospitalized persons. None had neurologic dysfunction or acute laboratory abnormalities; headache resolved in all except 2 hospitalized patients within 3 months. Severe headache following smallpox vaccination is generally transient, but debilitating headache may occur and further characterization is needed.
Functional‐Task Exercise Versus Resistance Strength Exercise to Improve Daily Function in Older Women: A Randomized, Controlled Trial
Authors: De Vreede Paul L. , Samson Monique M. , Van Meeteren Nico L. U. , Duursma Sijmen A. , Verhaar Harald J. J.
Published: December 2004

Objectives: To determine whether a functional‐task exercise program and a resistance exercise program have different effects on the ability of community‐living older people to perform daily tasks.

Design: A randomized, controlled, single‐blind trial.

Setting: Community leisure center in Utrecht, the Netherlands.

Participants: Ninety‐eight healthy women aged 70 and older were randomly assigned to the functional‐task exercise program (function group, n=33), a resistance exercise program (resistance group, n=34), or a control group (n=31). Participants attended exercise classes three times a week for 12 weeks.

Measurements: Functional task performance (Assessment of Daily Activity Performance (ADAP)), isometric knee extensor strength (IKES), handgrip strength, isometric elbow flexor strength (IEFS), and leg extension power were measured at baseline, at the end of training (at 3 months), and 6 months after the end of training (at 9 months).

Results: The ADAP total score of the function group (mean change 6.8, 95% confidence interval (CI)=5.2–8.4) increased significantly more than that of the resistance group (3.2, 95% CI=1.3–5.0; P=.007) or the control group (0.3, 95% CI=−1.3–1.9; P<.001). Moreover, the ADAP total score of the resistance group did not change significantly compared with that of the control group. In contrast, IKES and IEFS increased significantly in the resistance group (12.5%, 95% CI=3.8–21.3 and 8.6%, 95% CI=3.1–14.1, respectively) compared with the function group (−2.1%, 95% CI=−5.4–1.3; P=.003 and 0.3%, 95% CI=−3.6–4.2; P=.03, respectively) and the control group (−2.7%, 95% CI=−8.6–3.2, P=.003 and 0.6%, 95% CI=−3.4–4.6; P=.04, respectively). Six months after the end of training, the increase in ADAP scores was sustained in the function group (P=.002).

Conclusion: Functional‐task exercises are more effective than resistance exercises at improving functional task performance in healthy elderly women and may have an important role in helping them maintain an independent lifestyle.
Effects of a Nap on Nighttime Sleep and Waking Function in Older Subjects
Authors: Campbell Scott S. , Murphy Patricia J. , Stauble Thomas N.
Published: December 2004

Objectives: To examine, in older subjects, the effect on waking function of increasing 24‐hour sleep amounts by providing a nap opportunity; to assess what effects an afternoon nap may have on subsequent nighttime sleep quality and composition.

Design: Two‐session, within‐subject laboratory design.

Setting: The study was conducted in the Laboratory of Human Chronobiology at Weill Cornell Medical College.

Participants: Thirty‐two healthy men and women aged 55 to 85.

Measurements: Polysomnography (sleep electroencephalogram), cognitive and psychomotor performance, body core temperature.

Results: Napping had little effect on subsequent nighttime sleep quality or duration, resulting in a significant increase in 24‐hour sleep amounts. Such increased sleep resulted in enhanced cognitive and psychomotor performance immediately after the nap and throughout the next day.

Conclusion: A behavioral approach that adds daytime sleep to the 24‐hour sleep quota seems worthy of consideration when presented with a situation in which physiological changes associated with aging may limit the duration of nighttime sleep.
Genetic Variant of Lactase‐Persistent C/T‐13910 Is Associated with Bone Fractures in Very Old Age
Authors: Enattah Nabil S. , Sulkava Raimo , Halonen Pirjo , Kontula Kimmo , Järvelä Irma
Published: December 2004

Objectives: To determine the relation between the C/T‐13910 single‐nucleotide polymorphism residing 13,910 base pairs from the 5′ end of the lactase gene associated with lactase persistence and the occurrence of bone fractures in elderly people.

Design: Population‐based study.

Setting: Vantaa 85+ population‐based study, including all 601 subjects born before April 1, 1906, who were living in the city of Vantaa, Finland, on April 1, 1991.

Participants: Four hundred eighty‐three people aged 85 and older (106 men and 377 women).

Measurements: Genotype determination was made using a polymerase chain reaction minisequencing technique.

Results: The frequency of the genotype C/C‐13910 associated with adult‐type hypolactasia (low lactase enzyme activity or primary lactose malabsorption (LM)) was significantly greater in individuals with hip fractures, with an adjusted odds ratio (OR) of 3.7 (95% confidence interval (CI)=1.8–7.8), wrist fractures with an adjusted OR of 2.5 (95% CI=1.2–5.2), and hip and wrist fractures combined with an adjusted OR of 4.1 (95% CI=2.0–8.3).

Conclusion: The C/C‐13910 genotype associated with primary LM could represent a genetic risk factor for bone fractures for elderly people.
Health‐Related Quality of Life, Functional Impairment, and Healthcare Utilization by Veterans: Veterans' Quality of Life Study
Authors: Singh Jasvinder A. , Borowsky Steven J. , Nugent Sean , Murdoch Maureen , Zhao Yanli , Nelson David B. , Petzel Robert , Nichol Kristin L.
Published: December 2004

Objectives: To describe the health status of veterans receiving care in a veterans integrated service network (VISN).

Design: Cross‐sectional survey with prospective follow‐up.

Setting: Former Upper Midwest VISN 13 (now a part of VISN 23), a regional Veterans Affairs (VA) network comprising five inpatient facilities and associated outpatient clinics.

Participants: All veterans in VISN 13 who had at least one inpatient or outpatient encounter between October 1, 1997, and March 31, 1998.

Measurements: Health‐related quality of life (HRQOL) assessed using subscales and component summaries from the 36‐item short form for veterans (SF36‐V), functional status assessed according to limitations in activities of daily living (ADLs), healthcare utilization assessed according to outpatient visits and hospitalizations, and death.

Results: Of 70,334 eligible veterans, 40,508 responded and reported baseline HRQOL significantly lower than that of the general U.S. population for the physical (35.6, P<.001) and mental (46.4, P<.001) component summary scores (PCS and MCS, respectively) of the SF36‐V. Many reported complete inability or some difficulty in completing ADLs such as getting in and out of a chair (35.1%) and walking (45.3%). More than 58% indicated some degree of difficulty with at least one of the ADLs. In multivariate analysis, PCS and MCS were significantly associated with subsequent use of inpatient and outpatient care and with mortality.

Conclusion: The low quality of life and associated high rates of health services utilization in VA patients imply a need for innovative strategies to improve the HRQOL and functional status of this population.
From Aspiration to Achievement: Assessment and Noninvasive Treatment of Erectile Dysfunction in Aging Men
Authors: Seftel Allen D.
Published: December 2004

More than 70% of elderly men (≥65) remain sexually active, and more than 40%, according to one estimate, are dissatisfied with their sex lives. Declining sexual function and a reluctance to seek medical attention with advancing age are cross‐cultural observations. Normal erection is largely dependent on intact function of the central and peripheral nervous systems and the penile vascular endothelium. Consequently, chronic conditions (e.g., cardiovascular disease, diabetes mellitus) and lifestyle factors (e.g., smoking) that have adverse effects on the vascular endothelium and central and peripheral nervous systems, as well as on endocrine function or connective tissues within the corpus cavernosum of the penis, can attenuate erectile function. Because of these associations, assessment of sexual function in elderly men often reveals not only erectile dysfunction (ED) but also other reversible conditions. An expanding array of noninvasive options is available to assist the clinician in individualizing ED therapy to the unique health and lifestyle needs of each elderly ED patient and his partner. These treatment alternatives include the phosphodiesterase type 5 inhibitors sildenafil, vardenafil, and tadalafil, as well as other oral medications, such as α‐adrenoceptor antagonists and topical vasoactive or testosterone therapy.
Geriatric Content in Medical School Curricula: Results of a National Survey
Authors: Eleazer G. Paul , Doshi Rupal , Wieland Darryl , Boland Rebecca , Hirth Victor A.
Published: December 2004

Despite recent gains in establishing academic sections, divisions, and departments of geriatrics in medical schools, much remains to be done to meet the medical needs of an aging population. To better understand how medical schools are educating students in geriatric‐related topics, all U.S. allopathic and osteopathic medical schools were surveyed in two waves, in 1999 and 2000, using a questionnaire based on recommendations from the Education Committee of the American Geriatrics Society. Responding schools were more likely to address diseases and conditions of aging, psychosocial issues, and ethical issues and less likely to cover anatomic changes, nutrition, knowledge of healthcare financing, outcome measurement, and cultural aspects of aging. Although limited, the results indicate that medical schools have increased coverage of aging‐related material, although further expansion of geriatric content will be necessary to meet the needs of an aging society.