bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonlinear Measures of Respiration: Respiratory Irregularity and Increased Chaos of Respiration in Patients with Panic Disorder
Authors: Yeragani Vikram Kumar , Radhakrishna Rao K.A. , Tancer Manuel , Uhde Thomas
Published: April 2003

Background: Respiratory irregularity has been previously reported in patients with panic disorder using time domain measures. However, the respiratory signal is not entirely linear and a few previous studies used approximate entropy (APEN), a measure of regularity of time series. We have been studying APEN and other nonlinear measures including a measure of chaos, the largest Lyapunov exponent (LLE) of heart rate time series, in some detail. In this study, we used these measures of respiration to compare normal controls (n = 18) and patients with panic disorder (n = 22) in addition to the traditional time domain measures of respiratory rate and tidal volume. Methods: Respiratory signal was obtained by the Respitrace system using a thoracic and an abdominal belt, which was digitized at 500 Hz. Later, the time series were constructed at 4 Hz, as the highest frequency in this signal is limited to 0.5 Hz. We used 256 s of data (1,024 points) during supine and standing postures under normal breathing and controlled breathing at 12 breaths/min. Results: APEN was significantly higher in patients in standing posture during normal as well as controlled breathing (p = 0.002 and 0.02, respectively). LLE was also significantly higher in standing posture during normal breathing (p = 0.009). Similarly, the time domain measures of standard deviations and the coefficient of variation (COV) of tidal volume (TV) were significantly higher in the patient group (p = 0.02 and 0.004, respectively). The frequency of sighs was also higher in the patient group in standing posture (p = 0.02). In standing posture, LLE (p < 0.05) as well as APEN (p < 0.01) contributed significantly toward the separation of the two groups over and beyond the linear measure, i.e. the COV of TV. Conclusion: These findings support the previously described respiratory irregularity in patients with panic disorder and also illustrate the utility of nonlinear measures such as APEN and LLE as additional measures toward a better understanding of the abnormalities of respiratory physiology in similar patient populations as the correlation between LLE, APEN and some of the time domain measures only explained up to 50–60% of the variation.
Handwashing Patterns in Two Dermatology Clinics
Authors: Cohen H.A. , Kitai E. , Levy I. , Ben-Amitai D.
Published: April 2003

Background: The hands of health care workers are a major source of nosocomial infection. Studies conducted mainly in intensive-care units and emergency departments have shown low compliance with hand hygiene recommendation. Objective: To study hand hygiene practices in outpatient dermatology clinics in Israel. Methods: The fingers of 13 dermatologist physicians were sampled for bacterial cultures and their hand hygiene practices were monitored by two observers. In addition, 51 dermatologists attending a professional conference completed a questionnaire on hand hygiene practice. Results: All the physicians’ hands were found to be contaminated. Staphylococcus aureus was isolated in 9 cases (69.2%), a methicillin-resistant S. aureus in 1 (7.7%). Monitoring revealed 555 opportunities for handwashing; the average compliance was 31.4%. In the questionnaire, the main reasons given for poor hand hygiene were excessive work schedule (58%), lack of awareness (35.3%), reaction to disinfectants (17.7%) and lack of readily available facilities (15.7%). Conclusion: The hands of dermatologists are frequently colonized with microbial pathogens, but compliance with hand hygiene practice recommendations is low, despite a fairly high awareness of the importance. An active educational infection control program should be introduced in dermatology clinics.
Repeat Lumpectomy for Patients with Ipsilateral Breast Tumor Recurrence after Breast-Conserving Surgery
Authors: Komoike Yoshifumi , Motomura Kazuyoshi , Inaji Hideo , Kasugai Tsutomu , Koyama Hiroki
Published: April 2003

In this study, we assessed the appropriateness of conducting repeat lumpectomy for ipsilateral breast tumor recurrence (IBTR) based on the characteristics of recurrence after primary breast conserving surgery (BCS). Of 41 patients who had developed IBTR from October 1986 to June 2000 at our institute, 11 underwent mastectomy of the remaining breast and 30 underwent repeat lumpectomy. The 5-year overall survival rate at a median follow-up of 43 months after salvage surgery was 90.9% for the mastectomy group and 90.0% for the lumpectomy group. The 5-year distant disease-free survival rate was 70.1% for the mastectomy group and 83.0% for the lumpectomy group. The survival rates were remarkably high in both treatment groups, with no significant difference between them. IBTRs in the majority of our patients were small lesions less than 1 cm in diameter. They did not feature lymphatic invasion and had low histological grade. Compared with that of primary lesions, the malignancy of recurrent tumors was not increased in many patients. In contrast to these preferable features, 9 of 30 patients who underwent repeat lumpectomy developed second local relapse within 3 years after salvage operation. Young age (≤35 years), positive family history and omission of adjuvant systemic therapy were found to exhibit trends as a discriminate for further local recurrences. In view of the relatively good prognosis of IBTRs and excellent results of repeat lumpectomy, we consider this method a treatment option that deserves serious consideration if we can select the patients who will not likely develop second local relapse.
The Effect of 6-Monthly Application of 40% Chlorhexidine Varnish on the Microflora and Dental Caries Incidence in a Population of Children in Surinam
Authors: de Soet J.J. , Gruythuysen R.J.M. , Bosch J.A. , van Amerongen W.E.
Published: April 2003

This study is aimed at determining whether a commercially available varnish, containing 40% chlorhexidine, is able to reduce the numbers of mutans streptococci and lactobacilli in saliva, in a moderately caries-active population in Surinam. 238 children, ages 13–14 years, were selected from different schools in Paramaribo, Surinam. From these children, total dental status was recorded and saliva samples were taken. At baseline and every 6 months, a 40% chlorhexidine varnish (EC40®) was applied. The control group received a neutral gel that did not contain chlorhexidine. The numbers of salivary mutans streptococci and lactobacilli were calculated by standard methods, and the caries status was recorded every 12 months. The study lasted 30 months. The results indicate that chlorhexidine varnish did not decrease the numbers of cariogenic bacteria, nor did it decrease caries progression. Moreover, in this population with a low dental health care, children with lactobacilli present in the saliva above our detection level, the chlorhexidine varnish even tended to increase caries progression, possibly due to selection of aciduric and acidogenic oral bacterial species. We therefore conclude that 40% chlorhexidine varnish is not likely to decrease caries in children in a high-treatment-need population without treatment of the sources of infection.
In vitro Acid Resistance of CO2and Nd-YAG Laser-Treated Human Tooth Enamel
Authors: Tsai Chia-Ling , Lin Yng-Tzer , Huang Shun-Te , Chang Hseuh-Wen
Published: April 2003

The purposes of this study were to test the effectiveness of laser treatment (pulsed CO2 and pulsed Nd-YAG) on in vitro acid resistance of human enamel. Thirty enamel surfaces were prepared from 10 extracted permanent premolars (3 surfaces per tooth). Two experimental surfaces on each tooth were irradiated with either CO2 or Nd-YAG lasers. All specimens were demineralized in 10 ml lactate buffer for 24 or 72 h after laser treatment. After 24-hour acid treatment the mean concentration of calcium that dissolved into the lactate buffer in the CO2 laser group was significantly less than in the control group, while the dissolved calcium concentration in the Nd-YAG laser group did not differ from the control group (p > 0.05). The erosion depth in the CO2 laser group was significantly shallower than in the Nd-YAG laser group (p < 0.001). After 72-hour acid treatment, the acid resistances of neither group of laser-treated surfaces differed significantly from the controls. By scanning electron microscopy, the acid-eroded laser-treated enamel surfaces had type I and type II etching patterns, fissures, and disordered rough surfaces compared to control enamel, with a regular type II etching pattern. CO2 laser-treated tooth enamel was more resistant to acid challenge than was Nd-YAG laser-treated enamel, given the same fluence, but neither type of laser increased acid resistance of subsurface enamel.
Organisation of Bone Morphogenetic Proteins in Renal Development
Authors: Martinez Gemma , Bertram John F.
Published: April 2003

Bone morphogenetic proteins (BMPs) comprise the largest subfamily of the transforming growth factor-β (TGF-β) superfamily of secreted proteins. Evidence for the involvement of BMPs in metanephric development emerged recently when renal phenotypes were observed in BMP7 null mutant mice. Since then, several other BMPs, BMP receptor serine/threonine kinases and BMP signal transduction molecules (Smads) have been implicated in mammalian metanephric development. It appears that particular BMPs have pivotal roles in specific aspects of metanephric development. Current knowledge and evidence of specific roles of particular BMPs are presented in this review.
Effect of Sertraline Hydrochloride on Cardiac Autonomic Dysfunction in Patients with Hemodialysis-Induced Hypotension
Authors: Yalcin Ahmet Ugur , Kudaiberdieva Gulmira , Sahin Garip , Gorenek Bulent , Akcar Nevbahar , Kuskus Serhat , Bayrak Figen , Timuralp Bilgin
Published: April 2003

Background/Aims: It was previously shown that sertraline hydrochloride treatment improved hemodynamic parameters of patients with dialysis induced hypotension (DIH). The aim of this study was to examine the effect of sertraline on the autonomic functions of patients with DIH. Methods: Ten patients with DIH, 10 hemodialysis patients without DIH and 10 healthy control subjects were included into the study. All of the patients were treated with sertraline 50 mg per day for 4 weeks. Pre-treatment and post-treatment heart rate variability (HRV) in supine and tilt position was evaluated. In order to evaluate the autonomic response to tilt position, gap values were calculated by subtracting the HRV in supine position from the HRV in tilt position. Results: Analysis of the HRV response to tilt, demonstrated a paradoxical reduction in the indices of sympathetic modulation and sympathovagal balance in the patients with DIH while there was an increase in normalized powers of low frequency components (LFNU) and low frequency to high frequency components ratio (LFP/HFP) in the patients without DIH and control group. The number of therapeutic interventions for restoration of DIH decreased significantly in the sertraline period (p < 0.001). The gap values of the patients with DIH in LFNU (sympathetic modulation) (p < 0.05) and LFP/HFP (sympathovagal balance) increased in the sertraline period (p < 0.01). The decrease in gap value of normalized powers of high frequency components (parasympathetic modulation) was pronounced in the sertraline period in the patients with DIH (p < 0.05). Conclusion: The preventive effect of sertraline on DIH might be related to the improvement of regulation of autonomic response to hypovolemia.
An Economic Evaluation of Donepezil in Mild to Moderate Alzheimer’s Disease: Results of a 1-Year, Double-Blind, Randomized Trial
Authors: Wimo Anders , Winblad Bengt , Engedal Knut , Soininen Hilkka , Verhey Frans , Waldemar Gunhild , Wetterholm Anna-Lena , Mastey Vera , Haglund Anders , Zhang Richard , Miceli Robert , Chin Warren , Subbiah Ponni
Published: April 2003

The costs and consequences of donepezil versus placebo treatment in patients with mild to moderate Alzheimer’s disease (AD) were evaluated as part of a 1-year prospective, double-blind, randomized, multinational clinical trial. Patients received either donepezil (n = 142; 5 mg/day for 28 days followed by 10 mg/day according to the clinician’s judgement) or placebo (n = 144). Unit costs were assessed in 1999 Swedish kronas (SEK) and converted to US dollars (USD). Donepezil-treated patients gained functional benefits relative to placebo on the Progressive Deterioration Scale (p = 0.042) and Instrumental Activities of Daily Living scale (p = 0.025) at week 52. Caregivers of donepezil-treated patients spent an average of 400 h less annually providing care than caregivers of placebo-treated patients. Mean annual healthcare costs were SEK 137,752 (USD 16,438) per patient for the donepezil group and SEK 135,314 (USD 16,147) in the placebo group. With the average annual cost of donepezil at SEK 10,723 (USD 1,280) per patient, the SEK 2,438 (USD 291) cost difference represented a 77% cost offset. When caregiver time and healthcare costs were included, mean annual costs were SEK 209,244 (USD 24,969) per patient in the donepezil group and SEK 218,434 (USD 26,066) in the placebo group, a total saving associated with donepezil treatment of SEK 9,190 (USD 1,097) per patient [95% CI of SEK –43,959 (USD –5,246), SEK 25,581 (USD 3,053); p = 0.6]. The positive effects on the efficacy outcome measures combined with no additional costs from a societal perspective indicate that donepezil is a cost-effective treatment, representing an improved strategy for the management of patients with AD.
Efficiency of Haplotype Frequency Estimation when Nuclear Familiy Information Is Included
Authors: Becker Tim , Knapp Michael
Published: April 2003

In genetic studies the haplotype structure of the regarded population is expected to carry important information. Experimental methods to derive haplotypes, however, are expensive and none of them has yet become standard methodology. On the other hand, maximum likelihood haplotype estimation from unphased individual genotypes may incur inaccuracies. We therefore investigated the relative efficiency of haplotype frequency estimation when nuclear family information is included compared to estimation from experimentally derived haplotypes. Efficiency was measured in terms of variance ratios of the estimates. The variances were derived from the binomial distribution for experimentally derived haplotypes, and from the Fisher information matrix corresponding to the general likelihood function of the haplotype frequency parameters, including family information. We subsequently compared these variance ratios to the variance ratios for the case of estimation from individual genotypes. We found that the information gained from a single child compensates missing phase information to a high degree, resulting in estimates almost as reliable as those derived from observed haplotypes. Thus, if children have already been genotyped for other reasons, it is highly recommendable to include them into the estimation. If child information is not already present, it depends on the number of loci and the haplotype diversity if it is useful to genotype a single child just to reduce phase ambiguity. In general, if the number of loci is less than or equal to three or if the number of haplotypes with a frequency >5% is less than or equal to four, haplotype estimation from individuals is quite good already and the improvement gained from a single child can not compensate the genotyping effort for it. On the other hand, under scenarios with many loci and high haplotype diversity, haplotype frequency estimation from trios can be more efficent than haplotype frequency estimation from individuals also on a per genotype base.
A Method for Incorporating Ages at Onset in Affected Sibpair Linkage Studies
Authors: Hsu L. , Li H. , Houwing-Duistermaat J.J.
Published: April 2003

Data with varying age at disease onset arise frequently in studies of mapping disease associated genes. Naively combining affected subjects with different ages at onset may result in a much reduced power in detecting the disease genes. In this paper we present a weighted score test statistic to detect the linkage between marker and latent disease loci using affected sibpairs, where the weight is used for assigning differential contribution due to the varying age at onset of each affected sibpair to the test statistic. We show that the weighted test has a correct type I error rate asymptotically. For an illustrative purpose, we analyze a data set from the 12th Genetic Analysis Workshop. The result shows that the weighted tests appear to be able to pinpoint the location of latent disease genes better than the mean IBD test with equal weight with respect to the age at onset. To avoid the potential power loss due to the improper weight, we propose to use a combined test statistic, taking the maximum of two tests, one that is weighted by the age-dependent penetrance function and the other that may be invariant to the age. We conduct an analytical study, comparing the combined test with weighted and equal weight with respect to age test. It shows that the combined test retains the most power of the better one of the two tests being combined.
White Matter Injury, Neural Connectivity and the Pathophysiology of Psychiatric Disorders
Authors: Kumar Anand , Cook Ian A.
Published: April 2003

Psychiatric disorders are characterized by diverse clinical manifestations that include deficits in cognition, perception, mood and arousal. These complex processes are not mediated by any specific brain region but require the coordinated activity of several areas that are anatomically connected. Impairments in these neural circuits may therefore be expected to result in an attenuation of the functions regulated by them. The white matter provides the structural and physiological substrate of neural circuits in the central nervous system. We propose that injury to the white matter, from diverse biological sources, may compromise neural connectivity by associated axonal injury or impaired conductivity. Either mechanism could result in clusters of signs and symptoms that are currently recognized as psychiatric disorders. The role of white matter impairment in the pathophysiology of psychiatric illness is under-appreciated in the neurosciences. Focused translational research aimed at identifying the links between white matter compromise and specific behaviors are necessary for a more thorough understanding of the etiology of mental illness to emerge.
Long-Term Follow-Up of Celiac Adults on Gluten-Free Diet: Prevalence and Correlates of Intestinal Damage
Authors: Ciacci Carolina , Cirillo Massimo , Cavallaro Raimondo , Mazzacca Gabriele
Published: April 2003

Background and Aims: Celiac disease is the most common severe food intolerance in the Western world and is due to gluten ingestion in genetically susceptible children and adults. Intestinal biopsy is the golden standard for evaluation of mucosal damage associated with celiac disease. Gluten-free diet is the key treatment for celiac disease. Data on the long-term control of celiac disease are few and limited to small series of patients. The study reports data on the control of celiac disease and on its correlates in a large cohort of celiac adults during long-term treatment with gluten-free diet. Methods: The study cohort comprises 91 men and 299 women having undergone treatment with a gluten-free diet for at least 2 years and with complete records for visits at the time of diagnosis of celiac disease (baseline). Data collection included gender, age, education, weight, bowel habit, blood hemoglobin, plasma albumin and cholesterol, serum antiendomysium antibodies (EMA), dietary compliance to gluten-free diet (coded as good, low, or very low), and intestinal damage at biopsy (coded as absent, mild, or severe). Results: The duration of follow-up was 6.9 ± 7.5 years (mean ± SD, range 2–22 years). At follow-up visit, intestinal damage was absent in 170 patients (43.6%), mild in 127 (32.6%), and severe in 93 (23.8%). At follow-up, intestinal damage was significantly associated with dietary compliance, EMA, and plasma albumin (follow-up value and change value from baseline to follow-up). Baseline education significantly predicted dietary compliance and intestinal damage at follow-up. Conclusions: Celiac disease is often poorly controlled in the majority of patients on long-term treatment with a gluten-free diet as demonstrated by intestinal biopsy. Lack of adherence to strict gluten-free diet is the main reason of poorly controlled disease in adults. Laboratory and clinical information have a high positive predictive value and low negative predictive value for intestinal damage on long-term treatment. Dietary compliance as assessed by interview is the best marker of celiac disease control due to low cost, noninvasivity, and strong correlation with intestinal damage.
Anti-Saccharomyces cerevisiae Antibodies in Patients with Inflammatory Bowel Disease and Their First-Degree Relatives: Potential Clinical Value
Authors: Glas J. , Török H.-P. , Vilsmaier F. , Herbinger K.-H. , Hoelscher M. , Folwaczny C.
Published: April 2003

Anti-Saccharomyces cerevisiae antibodies (ASCA) have been described as specific markers in Crohn’s disease and their healthy first-degree relatives. 171 patients with Crohn’s disease, their 105 first-degree relatives, 145 patients with ulcerative colitis and 101 first-degree relatives of patients with ulcerative colitis, 50 patients with infectious enterocolitis and 100 healthy controls were tested for ASCA employing the ELISA technique. When compared with the healthy controls (p < 0.0001) and patients with infectious enterocolitis (p < 0.0001) the prevalence of ASCA was significantly increased in patients with Crohn’s disease and their first-degree relatives (p < 0.01). Further significant differences concerning the frequency of ASCA within the different groups of our study population were not observed. In particular, ASCA were not found in increased prevalence in infectious enterocolitis. These observations are compatible with a role of ASCA as a marker of genetic predisposition to Crohn’s disease.
Mechanism of the Antihypertensive Effect of Stevioside in Anesthetized Dogs
Authors: Liu Ju-Chi , Kao Pai-Keng , Chan Paul , Hsu Yung-Ho , Hou Chun-Cheng , Lien Gi-Shih , Hsieh Min-Hsiung , Chen Yi-Jen , Cheng Juei-Tang
Published: April 2003

Stevioside is a sweet-tasting glycoside isolated from the leaves of Stevia rebaudiana. It has been used as a noncaloric sugar substitute in Japan and Brazil for decades. Previous studies have shown that it lowered blood pressure in spontaneously hypertensive rats by intravenous injection. This study was designed to evaluate the hypotensive effect of stevioside in dogs and to define the underlying mechanism. After nasogastric administration of stevioside powder (200 mg/kg), the blood pressure of healthy mongrel dogs began to significantly decrease at 60 min and returned to baseline level at 180 min. The reduction of blood pressure was more rapid (at 5–10 min) and effective after intravenous injection. However, no significant change of blood pressure was noted after injection through left vertebral artery, implicating that the hypotensive effect is not related to the central nervous system. Stevioside also showed significant hypotensive effects in renal hypertensive dogs, in a dose-dependent manner. In cultured rat aortic smooth muscle cells (A7r5 cell line), stevioside can dose-dependently inhibit the stimulatory effects of vasopressin and phenylephrine on intracellular Ca2+ in a calcium-containing medium. However, no intracellular Ca2+ inhibitory effect was observed in calcium-free medium, implicating that stevioside may inhibit the Ca2+ influx from extracellular fluid. Our present data show that stevioside did not influence the calcium ionophore (A23187) induced Ca2+ influx, indicating that the antagonistic effect was through Ca2+ channels. This study confirmed that stevioside is an effective antihypertensive natural product, and its hypotensive mechanism may be probably due to inhibition of the Ca2+ influx.
Dexamethasone-Induced Increase in Lymphocyte β-Adrenergic Receptor Density and cAMP Formation in vivo
Authors: Abraham G. , Schusser G.F. , Ungemach F.R.
Published: April 2003

The influence of dexamethasone on the density of β2-adrenergic receptors (β2-adrenergic receptors (β2AR) and on the intracellular adenosine 3′,5′-cyclic monophosphate (cAMP) response was studied in equine lymphocytes in vivo. Dexamethasone (0.1 mg/kg/day, 1–5 days) raised the number of β2AR – Bmax as assessed by (–)-[125I]iodocyanopindolol binding (ICYP) – to 2.5- to 3.5-fold as compared with control values. The increase in β2AR number was fast (342 ± 49 vs. 960 ± 103 binding sites/lymphocyte after 24 h), reaching a maximum between 48 and 96 h (342 ± 49 vs. 1,289 ± 150 and 1,106 ± 68 binding sites/lymphocyte, respectively). The isoprenaline-induced cAMP accumulation (measured by a [3H]-cAMP radioimmunoassay system) was concomitantly enhanced by dexamethasone (1.5- to 2.4-fold). Both parameters were reversible to a similar rate at dexamethasone withdrawal. The changes in the functional responsiveness of lymphocytes were not reflected by changes in the binding affinity for ICYP of β2AR. These results demonstrate the in vivo glucocorticoid-mediated regulation of β2AR in equine lymphocytes which has already been suggested on the basis of in vitro observations in other tissues.
Effect of Angiotensin II on ANP-Dependent Guanylyl Cyclase Activity in Cultured Mouse and Rat Podocytes
Authors: Golos Magdalena , Lewko Barbara , Bryl Ewa , Witkowski Jacek M. , Dubaniewicz Anna , Olszewska Agnieszka , Latawiec Elżbieta , Angielski Stefan , Stepinski Jan
Published: April 2003

The presence of a well-developed contractile apparatus is the feature determining major roles of podocytes in the renal glomeruli. Receptors for a variety of vasoactive hormones are expressed in these cells; however, most of the signaling pathways are still unknown and remain to be elucidated. Angiotensin II (Ang II) and atrial natriuretic peptide (ANP), due to their opposite action, are the major modulators of glomerular filtration. In podocytes, Ang II induces rise in intracellular calcium concentration, whereas ANP stimulates generation of cGMP. The present study was designed to check whether ANP-stimulated cGMP synthesis in podocytes might be affected by Ang II. Cultured rat (RP) and mouse (MP) podocytes were stimulated with ANP, in the absence or presence of Ang II and cyclic GMP was determined by RIA method. Co-incubation of podocytes with ANP and Ang II caused significant (p < 0.01) suppression of ANP-dependent cGMP generation. The effect was prevented by saralasin, an inhibitor of angiotensin receptors. Phorbol-12-myristate-13-acetate (PMA) mimicked, whereas chelerythrine reversed inhibitory effect of Ang II. In conclusion, angiotensin II counteracts ANP-stimulated cGMP synthesis in cultured podocytes. It seems likely that the protein kinase C pathway is involved in this effect.
Intravenous Iron: The Iatrogenic Kick to Lose Control over Oxygen?
Authors: Deicher R. , Hörl W.H.
Published: April 2003

Effective erythropoiesis requires both erythropoietin and iron. Regular, intravenous iron supplements represent a standard adjuvant therapy for the treatment of anemia of chronic kidney disease. In this paper, the authors speculate upon potential deleterious effects of intravenous iron on cellular physiology in the setting of the increased oxidant burden of hemodialysis patients.
Exposure to Di(2-ethylhexyl)phthalate in Humans during Pregnancy
Authors: Latini G. , De Felice C. , Presta G. , Del Vecchio A. , Paris I. , Ruggieri F. , Mazzeo P.
Published: April 2003

Background: Di(2-ethylhexyl)phthalate (DEHP), the most commonly used plasticizer, is a widespread ubiquitous environmental contaminant. The potential health hazards from exposure to DEHP and its main metabolite, mono(2-ethylhexyl)phthalate (MEHP), have been well documented. Exposure to DEHP and MEHP in humans at risk, such as pregnant women and human fetuses, has not been tested. Methods: Plasma DEHP and MEHP concentrations were measured in a total of 24 consecutive mother-infant pairs by high performance liquid chromatography. Associations between DEHP/MEHP and infant characteristics were tested using Fisher’s exact test, unpaired t tests and univariate linear regression analysis. Results: Measurable DEHP and MEHP concentrations were found in 17/24 (70.8%) and 18/24 (75%) maternal plasmas, respectively, and in 11/25 (44%) and 18/25 (72.0%) cord samples, respectively. Either DEHP or MEHP were detectable in 21/24 (87.5%) maternal plasmas and 19/25 (76%) cord samples. The mean DEHP concentrations in maternal and cord plasmas were 1.15 ± 0.81 and 2.05 ± 1.47 µg/ml, respectively. The mean MEHP concentrations were 0.68 ± 0.85 and 0.68 ± 1.03 µg/ml, respectively. No significant correlations were found between maternal and cord blood DEHP, maternal and cord blood MEHP, maternal DEHP and cord blood MEHP, or maternal MEHP and cord blood DEHP plasma concentrations. Conclusion: Although the effects of perinatal exposure to phthalates need further research, our findings: (i) confirm the high frequency of DEHP and/or MEHP exposure in human pregnancies; (ii) indicate that the exposure to these environmental contaminants begins during intrauterine life, and (iii) suggest that fetal exposure is closely related to the maternal exposure.
Evaluation of a Netilmicin-Loading Dose in Very Low Birthweight Infants
Authors: Berger A. , Kretzer V. , Gludovatz P. , Rohrmeister K. , Prusa A.R. , Kohlhauser C.
Published: April 2003

Background: The bactericidal efficacy of aminoglycosides is directly related to maximum serum concentrations, particularly the initial one. Therefore, several groups have recommended an aminoglycoside loading dose. Our goal was to develop a simplified dosage regimen for preterm infants which would result in therapeutic maximum serum concentrations early in the course of therapy. Methods: Open, noncomparative study during November 2000 to April 2001. The modified netilmicin-dosing protocol included a loading dose of 5 mg/kg in the first week of life, followed by a maintenance regimen of 3.5 mg/kg every 24 h. After the first week of life the corresponding doses were 6 (loading) and 5 mg/kg (maintenance). A peak level was measured 30 min after the second dose, and a trough level immediately before the third dose. Results: Thirty-five very low birthweight infants (mean birthweight 876 ± 170, range 536–1,385 g; mean gestational age 26 ± 1.8, range 23–30 weeks) who had 46 episodes of netilmicin treatment were included in the analysis. Mean netilmicin peak and trough values were 15.9 ± 3.7 (range 8.9–28.9) and 3.4 ± 1.3 (range 1.0–7.8) µmol/l, respectively. Ninety-one percent of all peak levels were within the targeted range of ≧10 µmol/l. Eleven trough values (24%) were ≧4 µmol/l: in 7 instances netilmicin was administered within the first week of life, 5 of these patients had concomitant indomethacin treatment. Only 1 of the 35 neonates had a rise in serum creatinine of ≧0.5 mg/dl during netilmicin therapy. Hearing evaluations were performed in 25 of the 29 surviving infants at discharge home, all of which gave normal results. Conclusions: The new netilmicin-dosing protocol yielded therapeutic maximum serum concentrations in 91% of cases after the second dose. However, a significant number of very low birthweight infants had elevated trough levels, particularly when netilmicin was administered in the first week of life with concomitant indomethacin treatment. We speculate that a longer interval between the loading dose and the first maintenance dose would result in fewer elevated trough levels with a similarly high number of therapeutic peak levels.
The Three-Item Clock-Drawing Test: A Simplified Screening Test for Alzheimer’s Disease
Authors: Lin Ker-Neng , Wang Pei-Ning , Chen Chien , Chiu Yu-Hong , Kuo Chi-Chung , Chuang Ya-Yun , Liu Hsiu-Chih
Published: April 2003

The Clock-Drawing Test (CDT) has been used to screen for Alzheimer’s disease (AD) as a supplement to cognitive tests that focus on memory impairment. We examined a comprehensive scoring system of the CDT in screening of AD in a Chinese population and derived a simplified scoring system. All 403 (144 AD and 259 nondemented) subjects were administered the CDT, including both the drawing part (CDT-D) and the copying part (CDT-C). The Cognitive Abilities Screening Instrument and the Clinical Dementia Rating were also administered. Stepwise discriminant analysis was used to develop a simplified CDT scoring system. The optimal CDT cutoff scores (CDT-D: 10/11; CDT-C: 12/13) show intermediate sensitivity (CDT-D: 66.7%; CDT-C: 51.4%) and specificity (CDT-D: 74.5%; CDT-C: 74.1%). The simplified 3-item CDT scoring system, with a cutoff score of 2/3, has a sensitivity of 72.9% and a specificity of 65.6%; it can be used as a quick test for AD screening.
Apraxia of Tool Use: An Autopsy Case of Biparietal Infarction
Authors: Fukutake Toshio
Published: April 2003

Although disorders in the use of single objects have been reported, there have been few detailed analyses. We describe the autopsy case of a 65-year-old, right-handed male patient with severe impairment of actual tool use which was caused by biparietal infarctions. He persistently and stably showed a severely defective use of actual objects, single or multiple, and relatively well-preserved pantomimes of object use and intransitive gestures. He did not have aphasia or dementia, and his ability for tool naming and function description was completely preserved. The author identified similar patterns of errors about a tool-action(-target) relationship both in single-object use and multiple-object use. Lesion analysis showed cortical infarcts mainly located in the bilateral inferior parietal lobules, extending into the temporal lobe on the right side.
A Multivariate Exploration of Basic Symptoms
Authors: Rubino I. Alex , Ciani Nicola
Published: April 2003

Little is known about the relationship between the different categories of basic symptoms (BS). Researchers of the Bonn School have accurately described the progression from second-level BS (relatively characteristic BS) to first-rank Schneiderian symptoms. Using a multiple regression model, the present study tried to investigate which kind of dynamic deficiencies (DDs; uncharacteristic first-level BS) mostly lead to each type of second-level BS. A group of 108 patients with a DSM-III-R diagnosis of schizophrenia completed an inventory on BS, with all items in strict accordance with those of the Bonn Scale. Five dependent variables (cognitive thought disorders, cognitive perception disorders, cognitive action disorders, increased impressionability, cenesthesias) and four independent variables (DDs with direct negative symptoms, DDs with indirect negative symptoms, affective DDs, relational DDs) were considered. Among the significant findings, a widespread contribution of DDs with indirect negative symptoms to most of the dependent variables, and the special role of DDs with direct negative symptoms as a predictor of cognitive thought disorders, must be emphasized. Suggestions for further multivariate studies in the field of BS are presented.
Cannabis and Neurological Soft Signs in Schizophrenia: Absence of Relationship and Influence on Psychopathology
Authors: Bersani G. , Orlandi V. , Gherardelli S. , Pancheri P.
Published: April 2003

Background: Cannabis is a possible risk factor for the onset of schizophrenia and can induce neurocognitive, behavioural and motor co-ordination alterations. The aim of this study was to evaluate the role of cannabis in the occurrence of neurological soft signs (NSS) and, considering that this drug has been related to positive symptoms, whereas NSS have been linked to negative symptoms, we also examined the role of clinical features. Methods: The study investigated NSS in 25 male cannabis-consuming and 25 male non-consuming schizophrenic patients, using the Neurological Evaluation Scale. Clinical features were studied using SANS and SAPS. Results: Significant differences emerged after comparison analysis, with more NSS in non-consuming patients. The SANS subscales Alogia and Anhedonia-asociality were also statistically significant in this group of patients. Discussion: If non-consuming patients show a higher incidence of both NSS and negative symptoms, which, according to the literature, seem to be associated, then these findings suggest that NSS are relatively independent from cannabis, but not from clinical features.
Grief Hallucinations: True or Pseudo? Serious or Not?
Authors: Baethge Christopher
Published: April 2003

An inquiry into the psychopathology and the clinical significance of grief hallucinations is presented and two cases with severe grief hallucinations are described. Unlike many cases in the literature, the two female patients were young (aged 43 and 45, respectively) and both suffered from the loss of a daughter. The heterogeneous concept of grief hallucinations is described and discussed, focusing particularly on the difficulties of reaching a differentiation between hallucination and pseudohallucination. Basic theses of the article are: (1) Contrary to a widely held view, grief hallucinations can display all the characteristics of ‘true’ hallucinations. (2) The concept of grief hallucinations probably comprises a heterogeneous group of disturbances of perception and of thought processes. They can be experienced as comforting but can also cause considerable distress. (3) There are essentially two definitions of pseudohallucinations and they contradict each other. The extremely vague concept of pseudohallucinations appears to be of questionable value and should be abandoned.
Stalking Behavior – An Overview of the Problem and a Case Report of Male-to-Male Stalking during Delusional Disorder
Authors: Dressing Harald , Henn Fritz A. , Gass Peter
Published: April 2003

Stalking is a widespread phenomenon describing a pattern of intrusive and threatening behavior leading to the victim’s perception of being harassed and rendered fearful. This paper outlines relevant aspects of the stalking concept and reviews the historical development of this categorization, different typologies of stalking behavior, associated psychiatric diagnoses, frequency and demographic data, psychomedical impact on the victims and therapeutic approaches. Special gender aspects are discussed by presenting a case history of male-to-male stalking.
Two-Peak Temporal Distribution of Stroke Onset in Greek Patients
Authors: Spengos Konstantinos , Vemmos Kostas N. , Tsivgoulis Georgios , Synetos Andreas , Zakopoulos Nikolaos A. , Zis Vassilios P. , Vassilopoulos Demitris
Published: April 2003

A circadian distribution with a single peak of stroke onset in the morning hours has been described in various countries. Analysis of the temporal pattern of symptom onset in a series of 1,253 Greek first-ever stroke patients revealed a circadian distribution with two incidence peaks between 08.00 and 10.00 h, and between 16.00 and 18.00 h. Considering the different etiopathogenic types of stroke, the same two-peak time pattern was evaluated in all stroke subgroups with the only exception of lacunar stroke, which seems to predominantly occur during night and sleep. A secondary stroke onset peak in the late afternoon has not been previously described in such detail. A relation between the second, however lower, frequency peak and the traditional Greek habit of afternoon sleep (siesta) could be assumed and deserves further investigation.
Lateralization and Catecholaminergic Neuroimmunomodulation: Prazosin, an α1/α2-Adrenergic Receptor Antagonist, Suppresses Interleukin-1 and Increases Interleukin-10 Production Induced by Lipopolysaccharides
Authors: Dong Jing , Mrabet Oulaya , Moze Elisabeth , Li KangSheng , Neveu Pierre J.
Published: April 2003

Objective: The brain has previously been shown to asymmetrically modulate neurochemical, neuroendocrine and immune responses to lipopolysaccharides (LPS). As these responses are reversed by a chemical sympathectomy, it can be hypothesized that the asymmetry in the functioning of the sympathetic nervous system may be one of the mechanisms by which the brain hemispheres asymmetrically modulate immune reactivity. Methods: The effects of prazosin, an α1/α2-adrenergic receptor antagonist, on the production of interleukin (IL)-1β and IL-10 induced by LPS was studied in mice selected for their paw preference. Results: Two hours after intraperitoneal injection of 5 µg of LPS, plasma levels of IL-1β were higher in right-pawed mice as compared to left-pawed or ambidextrous animals. No lateralization effect was observed for LPS-induced plasma IL-10 levels. Prazosin, 10 mg/kg, injected intraperitoneally half an hour before LPS, reduced plasma levels of IL-1β and abolished the effect of lateralization. By contrast, prazosin drastically increased plasma levels of IL-10 in response to LPS and the production of corticosterone in untreated controls. Conclusions: These results suggest that the catecholaminergic modulation of immune reactivity depends on lateralization. This work further demonstrates that prazosin is endowed with anti-inflammatory properties that may be considered side effects of this drug, which is widely prescribed in the treatment of hypertension.
Suicidal Tendencies and Body Image and Experience in Anorexia nervosa and Suicidal Female Adolescent Inpatients
Authors: Stein Daniel , Orbach Israel , Shani-Sela Mirit , Har-Even Dov , Yaruslasky Amit , Roth Dina , Meged Sorin , Apter Alan
Published: April 2003

Background: The aim of this study was to assess the relationship between body image and suicidal tendencies in anorexia nervosa (AN). Methods: Three groups of hospitalized female adolescents – nonsuicidal AN, suicidal psychiatric and nonsuicidal psychiatric patients, as well as a community control group with no psychiatric disturbances were compared with regard to suicidal tendencies (in the form of attitudes to life and death), body image and experience, depression and anxiety. Results: The AN and suicidal patients showed less attraction to but more repulsion by life, and more attraction to and less repulsion by death compared with the other two groups. The AN and suicidal patients were also different from either one or both control groups in showing more negative attitudes and feelings towards their bodies, lower sensitivity to body clues, less body control, and elevated depression and anxiety. These between-group differences in suicidal tendencies were retained after controlling for age, body mass index, the different body image dimensions, anxiety and depression. Conclusions: Our findings suggest that female AN inpatients with no evidence of overt suicidal behavior demonstrate elevated suicidal tendencies that are similar to those of suicidal psychiatric inpatients. These self-destructive tendencies are highly associated with a pervasive sense of disturbance of body image and experience.
Increased Probability of Remaining in Remission from Panic Disorder with Agoraphobia after Drug Treatment in Patients Who Received Concurrent Cognitive-Behavioural Therapy: A Follow-Up Study
Authors: Biondi Massimo , Picardi Angelo
Published: April 2003

Background: Many short-term trials suggested that the combination of psychotherapy with medication might be more effective than either treatment alone. However, only few studies examined the long-term effectiveness of this combination. Methods: A private practice sample of consecutive patients with DSM-III-R panic disorder with agoraphobia who achieved remission after drug treatment with or without concurrent cognitive-behavioural psychotherapy were followed up. Patients were assessed before treatment, after treatment and at each follow-up contact with the Marks-Sheehan Phobia Scale, the Hamilton Anxiety Rating Scale, and the Hamilton Depression Rating Scale. Kaplan-Meier survival analysis was performed on the time to panic disorder relapse. Cox regression analysis was used to control for the possible confounding effect of factors other than treatment. Results: Of patients who received medication alone (n = 32), 25 (78.1%) relapsed, prevalently (65.6%) during the first year. The estimated mean survival time was 12 months (95% CI 7–17). Of patients who received integrated treatment (n = 21), only 3 (14.3%) relapsed. The estimated mean survival time was 65 months (95% CI 44–86). Treatment was the only variable associated with the occurrence of relapse, with a hazard ratio of 12.6 (95% CI 2.5–63.3) for patients who received only medication. Conclusions: Some methodological limitations, such as treatment allocation by preference, suggest caution in the interpretation of our results. However, the long-term therapeutic advantage of integrated treatment over medication alone was large and independent from known prognostic factors. The long-term effectiveness of integrated treatment should be tested with a randomised controlled trial.
Treating Medication-Resistant Panic Disorder: Predictors and Outcome of Cognitive-Behavior Therapy in a Brazilian Public Hospital
Authors: Heldt Elizeth , Manfro Gisele Gus , Kipper Leticia , Blaya Carolina , Maltz Sandra , Isolan Luciano , Hirakata Vânia Naomi , Otto Michael W.
Published: April 2003

Background: In Brazil, treatment of panic disorder is most frequently initiated with pharmacotherapy, but only half of the patients can be expected to be panic free after medication. Studies have suggested that individual or group cognitive-behavior therapy (CBT) is an effective treatment strategy for panic patients who have failed to respond to pharmacotherapy. Methods: Thirty-two patients diagnosed with panic disorder with agoraphobia having residual symptoms despite being on an adequate dose of medication were treated with 12 weeks of group CBT. The outcome was evaluated for panic frequency and severity, generalized anxiety, and global severity. Comorbid conditions, a childhood history of anxiety, and defense mechanism styles were assessed as potential predictors of treatment response. Results: Twenty-nine patients completed the 12-week protocol. Treatment was associated with significant reductions in symptom severity on all outcome measures (p < 0.001). Patients with depression had a poorer outcome of the treatment (p = 0.01) as did patients using more neurotic (p = 0.002) and immature defenses (p = 0.05). Conclusion: Consistent with previous reports, we found that CBT was effective for our sample of treatment-resistant patients. Among these patients, depression as well as neurotic defense style was associated with a poorer outcome. The use of CBT in Brazil for treatment-resistant and other panic patients is encouraged.
Ultrastructural Identification of P2Y2 Receptor mRNA in the Rat Thymus
Authors: Loesch A. , Glass R. , Burnstock G.
Published: April 2003

In situ hybridisation to identify P2Y2 receptor mRNA was performed for the first time at the ultrastructural level on the thymus of adult male rats. These studies revealed transcripts for P2Y2 receptors in cortical T cells and endothelial cells of thymic blood vessels. These transcripts are likely to be linked with the production of functional P2Y2 receptors in these cells. In the T cells, transcripts for the P2Y2 receptor were localised in the cytoplasm as well as on the smooth endoplasmic reticulum and cell membrane. Dividing T cells also expressed P2Y2 receptor mRNA, mostly in the cytoplasm around chromosomal material. Endothelial cells displaying labels for P2Y2 receptor transcripts were of cortical arteries/arterioles and capillaries and of postcapillary venules in the corticomedullary junction. P2Y2 mRNA transcripts were localised in the cytoplasm of endothelial cells, although they did not appear to be specifically associated with subcellular organelles or structures. In postcapillary venules, T cells displaying labelling for the P2Y2 receptor were seen migrating across the P2Y2 receptor mRNA-positive endothelium. Our findings are discussed in terms of the relationship between thymic immune cells and the endothelium. This includes the issue of immune cell trafficking into the circulation, and the ATP-related regulatory role and involvement of P2Y2 receptors in the rat thymus.