bluuebunny/crossref_metadata_2025 huggingface dataset:
Whites Excrete a Water Load More Rapidly Than Blacks
Authors: Weder Alan B. , Gleiberman Lillian , Sachdeva Amit
Published: February 2009

A recent report demonstrated a racial difference in response to furosemide compatible with increased ion reabsorption in the thick ascending limb of the loop of Henle in blacks. Urinary dilution is another function of the loop-diuretic–sensitive Na,K,2Cl cotransporter in the thick ascending limb, and racial differences in urinary diluting capacity have not been reported previously. We assessed diluting segment (cortical thick ascending limb and distal convoluted tubule) function in black and white normotensives in 2 studies using a water-loading approach. In both studies, we found that whites excreted a water load more rapidly than blacks. In the first study, the final free water clearance rates (mean±SD) were 7.3±4.7 mL/min in whites (n=17, 7 females and 10 males) and 3.8±3.6 mL/min in blacks (n=14, 9 females and 5 males;
P
<0.03). In the second study, final free water clearance rates were 8.3±2.6 mL/min in whites (n=17, 8 females and 9 males) and 6.4±1.8 mL/min in blacks (n=11, 8 females and 3 males;
P
<0.01). We found no evidence of a racial difference in renal proximal tubular fluid reabsorption as assessed by renal endogenous lithium clearance or in plasma vasopressin level that could explain the difference in free water excretion. We conclude that our observations are most consistent with a lower capacity of ion reabsorption in the renal diluting segment in blacks. Slower excretion of an acute water load may have been an advantage during natural selection of humans living in arid, hot climates.
How Does Maintenance of Network Activity Depend on Endogenous Dynamics of Isolated Neurons?
Authors: Olypher Andrey V. , Calabrese Ronald L.
Published: February 2009

Robust activity of some networks, such as central pattern generators, suggests the existence of physiological mechanisms that maintain the most important characteristics, for example, the period and spike frequency of the pattern. Whatever these mechanisms are, they change the appropriate model parameters to or along the isomanifolds on which the characteristics of the pattern are constant, while their sensitivities to parameters may be different. Setting synaptic connections to zero at the points of isomanifolds allows for dissecting the maintenance mechanisms into components involving synaptic transmission and components involving intrinsic currents. The physiological meaning of the intrinsic current changes might be revealed by analysis of their impact on endogenous neuronal dynamics. Here, we sought answers to two questions: (1) Do parameter variations in insensitive directions (along isomanifolds) change endogenous dynamics of the network neurons? (2) Do sensitive and insensitive directions for network pattern characteristics depend on endogenous dynamics of the network neurons?

We considered a leech heartbeat half-center oscillator model network and analyzed isomanifolds on which the burst period or spike frequency of the model, or both, are constant. Based on our analysis, we hypothesize that the dependence on endogenous dynamics of the isolated neurons is the stronger the more characteristics of the pattern have to be maintained. We also found that in general, the network was more flexible when it consisted of endogenously tonically spiking rather than bursting or silent neurons. Finally, we discuss the physiological implications of our findings.
Nonlinear Extraction of Independent Components of Natural Images Using Radial Gaussianization
Authors: Lyu Siwei , Simoncelli Eero P.
Published: February 2009

We consider the problem of efficiently encoding a signal by transforming it to a new representation whose components are statistically independent. A widely studied linear solution, known as independent component analysis (ICA), exists for the case when the signal is generated as a linear transformation of independent nongaussian sources. Here, we examine a complementary case, in which the source is nongaussian and elliptically symmetric. In this case, no invertible linear transform suffices to decompose the signal into independent components, but we show that a simple nonlinear transformation, which we call radial gaussianization (RG), is able to remove all dependencies. We then examine this methodology in the context of natural image statistics. We first show that distributions of spatially proximal bandpass filter responses are better described as elliptical than as linearly transformed independent sources. Consistent with this, we demonstrate that the reduction in dependency achieved by applying RG to either nearby pairs or blocks of bandpass filter responses is significantly greater than that achieved by ICA. Finally, we show that the RG transformation may be closely approximated by divisive normalization, which has been used to model the nonlinear response properties of visual neurons.
Renal Artery Dissection following Marathon Running
Authors: Iqbal Fahad M. , Goparaju Madhavi , Yemme Soumya , Lewis Bruce E.
Published: February 2009

A 38-year-old, previously healthy man presented with flank pain after competing in a marathon. Initial laboratory tests and urinalysis were essentially normal. Both contrast enhanced—computed tomography and magnetic resonance angiography showed an infarcted region of the left lower kidney without renal artery dissection. Thromboembolism was suspected, but further testing was negative. The diagnosis of renal artery dissection was established by angiogram, showing dissection of the segmental branch. The patient remained normotensive, maintained normal renal function, and had resolution of pain symptoms prior to discharge. On the basis of our experience and review of the literature, renal artery dissection occurs in otherwise healthy men and often goes undiagnosed. The management strategy tends to be conservative unless the patient develops progressive decline in renal function or worsening hypertension, with an excellent prognosis. This case also shows the importance of discussing the pros and cons of extreme physical exertion with all patients.
Testing Residential Solar Thermal Adoption
Authors: Schelly Chelsea
Published: February 2009

Solar thermal is a viable technology that uses clean, renewable energy (the sun) to provide a primary heat source in homes. A combination of structural constraints and value-oriented motivators potentially influences solar thermal technology adoption. This study examines the extent to which solar thermal adoption correlates with structural or value-related factors through logistic regression modeling. Variables measuring socioeconomic circumstances, environmental concern, and ecological conditions are used to predict residential solar thermal technology adoption at the county level throughout the United States. This project provides insight regarding the role of structural and value-related factors, thus highlighting the significance of both structure and agency in explaining social change.
Race, Place, and Neighboring: Social Ties among Neighbors in Urban, Suburban, and Rural Contexts
Authors: Nation Maury , Fortney Timothy , Wandersman Abraham
Published: February 2009

This study examined the relations between community type, race, and the types of neighboring behaviors in which residents engage, with a random sample of 1,367 participants from urban, suburban, and rural areas of a southeastern state. Analyses controlled for several variables that are believed to influence neighboring. The multivariate analyses indicated a main effect for the type of community. However, the effect was contingent on the type of neighboring and disappeared once the covariates were included in the model. Similarly, main effects of race were found with African Americans engaging in more surveillance and Caucasians engaging in more social neighboring. The implications of these findings framing additional research on race and community type are discussed.
Stigma, Culture, and HIV and AIDS in the Western Cape, South Africa: An Application of the PEN-3 Cultural Model for Community-Based Research
Authors: Airhihenbuwa Collins , Okoror Titilayo , Shefer Tammy , Brown Darigg , Iwelunmor Juliet , Smith Ed , Adam Mohamed , Simbayi Leickness , Zungu Nompumelelo , Dlakulu Regina , Shisana Olive
Published: February 2009

HIV- and AIDS-related stigma has been reported to be a major factor contributing to the spread of HIV. In this study, the authors explore the meaning of stigma and its impact on HIV and AIDS in South African families and health care centers. They conducted focus group and key informant interviews among African and Colored populations in Khayelitsha, Gugulethu, and Mitchell’s Plain in the Western Cape province. The audio-recorded interviews were transcribed and coded using NVivo. Using the PEN-3 cultural model, the authors analyzed results showing that participants’ shared experiences ranged from positive/nonstigmatizing, to existential/ unique to the contexts, to negative/stigmatizing. Families and health care centers were found to have both positive nonstigmatizing values and negative stigmatizing characteristics in addressing HIV/AIDS-related stigma. The authors conclude that a culture-centered analysis, relative to identity, is central to understanding the nature and contexts of HIV/AIDS-related stigma in South Africa.
Working around ERPs in Technological Universities
Authors: Kitto Simon , Higgins Vaughan
Published: February 2009

This article explores the work-arounds through which an Enterprise Resource Planning (ERP) software system is implemented within an Australian University. We argue that while resistance is significant, the process of working around a technology can have ambiguous effects in terms of how users—in this case academics—are governed and govern themselves. Drawing upon Andrew Barry’s Foucauldian-inspired work on ‘‘technological zones,’’ we show how attempts to work-around the ERP contributed to the creation of an alternative technological zone based on cultural discourses of academic freedom aimed at resisting the standardized programs of action inscribed within the university-wide ERP. However, we demonstrate also that these work-arounds resulted in a partial convergence with the university’s advanced liberal objectives of going online to become a globally competitive university. We conclude that more research needs to be conducted into the multiple and ambiguous effects of work-arounds in the practice of governing.
Preretirement Planning and Well-Being in Later Life
Authors: Noone Jack H. , Stephens Christine , Alpass Fiona M.
Published: February 2009

Cross-sectional and retrospective research has identified a reliable relationship between preretirement planning and later-life well-being. Although it seems intuitive that retirement planning leads to more positive retirement outcomes, limited longitudinal analysis has confirmed the directionality of this relationship or clarified its complexities. The Health and Retirement Study, a prospective survey of American workers and retirees from 1992 to the present, can help illuminate this relationship. Data signifying the preretirement activities of employed individuals from the 1992 wave were compared with their postretirement ratings of retirement satisfaction and subjective physical and emotional health in 2004. An ordinal regression analysis indicated that those who had discussed retirement with their spouses and had retirement superannuation or savings plans in 1992 reported greater well-being in 2004 (controlling for health status, the reason for retirement, and income in 1992). These results confirm the importance of preretirement preparation and provide a rationale for developing more comprehensive, theory-driven measures of retirement planning.
Intimal Hyperplasia in Rats after Subcutaneous Injection of a Somatostatin Analog
Authors: Wells Monique Y. , Voute Hélène , Lonchampt Marie-Odile , Fisch Cécile , Boulifard Virginie , Picaut Philippe
Published: February 2009

The somatostatin analog octreotide was administered to male and female Sprague-Dawley rats by subcutaneous injection for thirteen weeks at 0 (saline control), 0 (placebo control [mannitol and lactic acid; pH 4.2]), 1.25 mg/kg/day and 2.5 mg/kg/day to explore its potential effect on cutaneous vascular morphology. The placebo caused an increase in the incidence of intimal hyperplasia compared to saline controls in female rats; octreotide increased the incidence and severity of intimal hyperplasia in males and females. Intimal hyperplasia consisted of increased numbers of cells located between the endothelial cell layer and the internal elastic lamina. Severity was based on the degree of compromise of the vascular lumen (regardless of vessel size and number), with severely affected vessels having no visible lumen. Intimal hyperplasia in rats treated with octreotide was considered to be an unexpected and adverse finding, given that this compound and other somatostatin analogs have been investigated as reducers of intimal proliferation or restenosis after angioplasty in humans and that no such lesion has been reported in the literature for this class of compound to date. The induction of intimal hyperplasia by the placebo is also a notable finding; this may be because of the low pH of the formulation.
Phytol-induced Hepatotoxicity in Mice
Authors: Mackie John T. , Atshaves Barbara P. , Payne H. Ross , McIntosh Avery L. , Schroeder Friedhelm , Kier Ann B.
Published: February 2009

Phytanic acid is a branched-chain, saturated fatty acid present in high concentrations in dairy products and ruminant fat. Some other dietary fats contain lower levels of phytol, which is readily converted to phytanic acid after absorption. Phytanic acid is a peroxisome proliferator binding the nuclear transcription factor peroxisome proliferator-activated receptor α (PPARα) to induce expression of genes encoding enzymes of fatty acid oxidation in peroxisomes and mitochondria. Administration of dietary phytol (0.5% or 1%) to normal mice for twelve to eighteen days caused consistent PPARα-mediated responses, such as lower body weights, higher liver weights, peroxisome proliferation, increased catalase expression, and hepatocellular hypertrophy and hyperplasia. Female mice fed 0.5% phytol and male and female mice fed 1% phytol exhibited midzonal hepatocellular necrosis, periportal hepatocellular fatty vacuolation, and corresponding increases in liver levels of the phytol metabolites phytanic acid and pristanic acid. Hepatic expression of sterol carrier protein-x (SCP-x) was five- to twelve-fold lower in female mice than in male mice. These results suggest that phytol may cause selective midzonal hepatocellular necrosis in mice, an uncommon pattern of hepatotoxic injury, and that the greater susceptibility of female mice may reflect a lower capacity to oxidize phytanic acid because of their intrinsically lower hepatic expression of SCP-x.
Management of Tendinopathy
Authors: Rees Jonathan D. , Maffulli Nicola , Cook Jill
Published: February 2009

Overuse disorders of tendons, or tendinopathies, present a challenge to sports physicians, surgeons, and other health care professionals dealing with athletes. The Achilles, patellar, and supraspinatus tendons are particularly vulnerable to injury and often difficult to manage successfully. Inflammation was believed central to the pathologic process, but histopathologic evidence has confirmed the failed healing response nature of these conditions. Excessive or inappropriate loading of the musculotendinous unit is believed to be central to the disease process, although the exact mechanism by which this occurs remains uncertain. Additionally, the location of the lesion (for example, the midtendon or osteotendinous junction) has become increasingly recognized as influencing both the pathologic process and subsequent management.

The mechanical, vascular, neural, and other theories that seek to explain the pathologic process are explored in this article. Recent developments in the nonoperative management of chronic tendon disorders are reviewed, as is the rationale for surgical intervention. Recent surgical advances, including minimally invasive tendon surgery, are reviewed. Potential future management strategies, such as stem cell therapy, growth factor treatment, and gene transfer, are also discussed.
A Commentary on Age Segregation for Older Prisoners
Authors: Kerbs John J. , Jolley Jennifer M.
Published: February 2009

The growing number of older prisoners in state and federal prisons has fostered an important discussion in literature regarding the potential benefits of age-segregated living arrangements for older inmates. This article begins with a brief review of the reasons for America's aging prison population. Thereafter, it uses a multidisciplinary literature review to clarify a 4-point rationale for age-segregated prisons: (a) cost savings via centralized health care for older prisoners; (b) the reduction of civil liabilities for correctional systems that centralize disability services as per requirements of the Americans with Disabilities Act of 1990; (c) the advancement of prisoner safety for older inmates; and (d) the promotion of rehabilitation by advancing treatment opportunities with a group that is most likely to desist from future criminal activity (in part) due to age-related desistance from crime. Conclusions focus on age segregation within the historical context of segregation in prison based on sociodemographic characteristics.
Phenotypic Variations in 3 Children With POLG1 Mutations
Authors: Burusnukul Prinyarat , de los Reyes Emily C.
Published: February 2009

Autosomal inherited mitochondrial diseases have been of increasing interest among clinicians and mitochondrial research groups because these diseases are caused through a secondary effect on the mitochondrial DNA. It was thought that the genetic stability of mitochondrial DNA relies on the accuracy of DNA polymerase gamma. Mutations of DNA polymerase gamma 1 gene (MIM# 174763) have been shown to be a cause of mitochondrial disorders associated with Mendelian disorders characterized by multiple mitochondrial DNA deletions or depletions. To date, several clinical phenotypes associated with polymerase gamma mutation have been reported presenting in both adults and children. We present 3 children in whom were found to have reported pathogenic DNA polymerase gamma 1 mutations: heterozygous p.G517V in 2 half siblings and heterozygous p.T251I and p.P587L in the other. The aim of this communication is to report 3 pediatric cases associated with DNA polymerase gamma 1 mutations to augment the expanding clinical phenotype that has been previously reported.
The Ketogenic Diet: Additional Information From a Crossover Study
Authors: Freeman John M.
Published: February 2009

The purpose of this blinded, crossover study of the ketogenic diet in children with the Lennox-Gastaut syndrome was to confirm, by the addition of 60 g of glucose per day to negate the ketosis, that the effectiveness of the ketogenic diet was neither the result of a placebo effect nor due to parental expectations and commitment. We found that the additional glucose did not significantly alter the frequency of electroencephalography-assessed events, but did decrease the frequency of parent-reported ``drop'' seizures (P = .07). Fasting had substantial effects on both seizures and electroencephalography-assessed events. The diet remained effective in decreasing seizures of the Lennox-Gastaut syndrome at 12 days, 6 months, and 12 months. In conclusion, the ketogenic diet is effective in decreasing the drop seizures of the Lennox-Gastaut syndrome.
Co-Occurrence of Intracerebral Tuberculoma With Lumbar Intramedullary Tuberculoma
Authors: Chitre Prachi S. , Tullu Milind S. , Sawant H.V. , Ghildiyal Radha G.
Published: February 2009

Tuberculosis is common in India, but the co-occurrence of intracranial and intramedullary tuberculomas as a manifestation of central nervous system tuberculosis is extremely rare in children. We report a case of concurrent intracranial and lumbar intramedullary tuberculomas in a 6-year-old girl. The child developed the intracranial and intramedullary tuberculomas while on antituberculous therapy for previously diagnosed tuberculous meningitis. The child improved well on antituberculous drugs and neurosurgical excision of the lumbar lesion. Histopathology confirmed tuberculous etiology of the intramedullary lesion.
Essential Tremor After Ipsilateral Cerebellar Hemispherectomy: Support for the Thalamus as the Central Oscillator
Authors: Chahine Lama M. , Ghosh Debabrata
Published: February 2009

Essential tremor is a long-recognized and common movement disorder, yet controversy still surrounds its pathophysiology. The olivo-cerebello-thalamo-cortical pathway has been implicated in the genesis of essential tremor, and the inferior olive has been considered the central oscillator driving the peripheral tremor. We present the case of a patient who developed essential tremor ipsilateral to cerebellar hemispherectomy and propose that the central oscillator in patients with essential tremor may not be the inferior olive in all cases, but rather the nucleus ventralis intermedius of the thalamus.
The Underrecognized Epilepsy Spectrum: The Effects of Levetiracetam on Neuropsychological Functioning in Relation to Subclinical Spike Production
Authors: Mintz Mark , LeGoff Daniel , Scornaienchi Jean , Brown Micah , Levin-Allen Sarah , Mintz Pnina , Smith Cathy
Published: February 2009

The purpose of this prospective, open-label pilot study was to determine whether treatment with levetiracetam improves neuropsychological functioning in children and adolescents who have evidence of subclinical spike production associated with attention and learning difficulties. Six participants (mean age 9.8 years) were treated with levetiracetam up to 40 mg/kg per day and evaluated using neuropsychological (Wide Range Assessment of Memory and Learning, Second Edition), academic (Wechsler Individual Achievement Test, Second Edition, Abbreviated), and electroencephalographic assessments at baseline and after 10 weeks of treatment. Statistically significant improvements on indexes of the Wide Range Assessment of Memory and Learning, Second Edition were observed in 4 participants after 10 weeks. No statistically significant differences were observed for the Wechsler Individual Achievement Test, Second Edition, Abbreviated. Concomitant spike suppression was observed. Levetiracetam was generally well tolerated. A subset of patients exists with attention and learning problems that have associated aberrant cortical electrical activity without clinical seizures and associated neuropsychological deficits that may improve after treatment with levetiracetam.
The Effects of Ventilatory Mode on Lung Aeration Assessed With Computer Tomography: A Randomized Controlled Study
Authors: Varpula Tero , Valta Paivi , Markkola Antti , Pohjanen Katriina , Halavaara Juha , Hynynen Markku , Pettila Ville
Published: February 2009

Maintenance of spontaneous breathing superimposed on mechanical ventilation is suggested to improve gas exchange in patients with acute lung injury. The aim of this study was to evaluate the long-term effects of airway pressure release ventilation with maintained unsupported spontaneous breathing (APRV) and synchronized intermittent mandatory ventilation with pressure support (SIMV) on the amount of lung collapse in acute lung injury patients. Thirty-seven patients with acute lung injury were studied in a trial comparing APRV or SIMV. Computer-assisted tomography scannings (CT) were performed before randomization and at day 7. The change in the amount of nonaerated lung was comparable between groups; 14.7% (3.8-17.4) in APRV group (n = 13) and 9.6% (—1.4 to 18.62) in the SIMV group (n = 10), (P = .65, difference in mean 4.9%, 95% confidence interval —9.0% to 19.0%). The effects of APRV and SIMV on lung aeration are similar after 7 days of mechanical ventilation.
Mycobacterium avium Septicemia With ARDS in a Patient With Diabetes Mellitus and No Other Known Immune-compromising Condition
Authors: Baylor Peter , Larson Roger
Published: February 2009

A 39-year-old diabetic male sustained 4 culture-proven episodes of disseminated Mycobacterium avium complex infection over a span of 6 years. The first, second, and fourth episodes were manifested clinically by osteomyelitis. The third episode was characterized by Mycobacterium avium complex septicemia (positive blood cultures for Mycobacterium avium complex) and acute respiratory failure with features of acute respiratory distress syndrome requiring mechanical ventilation and positive end-expiratory pressure for up to 30 days. Studies for impaired immunity including human immunodeficiency virus infection, idiopathic CD4+ T lymphocytopenia syndrome, and interferon γ deficiency were negative. Intensive treatment of the fourth episode with amikacin, clarithromycin, rifampin, isoniazide, ethambutol, and pyrazinamide for 2 months followed by 2 years of treatment with the same regimen without amikacin resulted in apparent cure. The patient has remained free of clinical infection for 13 years. The possible role of diabetes in pathogenesis is discussed.
Brain Injury and Fever: Hospital Length of Stay and Cost Outcomes
Authors: Reaven Nancy L. , Lovett Joseph E. , Funk Susan E.
Published: February 2009

Fever has been shown to be related to extended hospital stays in neurologically injured patients. We performed meta-analyses of the impact of fever on length of stay (LOS) in the Intensive Care Unit (ICU) and for total hospital length of stay, including all recent scholarship published since 1/1/1995 pertaining to thermoregulation of neurogenic fever and length of hospital stay. We also developed estimates of the financial impact on hospital costs. Fever was shown to have a large, statistically significant impact on both ICU and hospital LOS. For ICU LOS, combined effect size g = .88, Z = 4.24, P < .0001. For hospital LOS, g = .79, Z = 2.2, P = .0278. Mean additional ICU days = 5.7 days; mean additional hospital days = 8.5 days. We estimate that fever added an average of $17,414 in hospital cost to total hospital stays; mean $13,672 (95% Confidence Interval [CI]: $10,074, $17,270) in additional ICU costs and mean $3,742 (CI: —$1,203, $8,820) in additional routine costs.
Drug-Induced Liver Disease and Drug Use Considerations in Liver Disease
Authors: Kim Jiwon W. , Phongsamran Paula V.
Published: February 2009

Chronic liver disease encompasses a large number of hepatic disorders. One of the most important etiologies of liver disease is drug-induced liver disease, which is the leading cause of liver failure in patients referred for liver transplantation in the United States. Drug-induced liver disease can present in all forms of acute and chronic liver disease with highly variable clinical presentations. There is no effective treatment for most drug-induced liver disease and the recognition and prevention of drug-induced liver disease remain the most important management strategy. Drug dosing in patients with liver disease represents an even more challenging task to clinicians, as there is only scant information on biomarkers that can be used to predict the pharmacokinetic changes of drugs in patients with underlying liver disease. Several factors contribute to alterations in drugs metabolism and clearance in cirrhotic patients, including the severity of the liver disease and the metabolic pathways of each individual drug. Only general guidelines on dosage adjustment in patients with hepatic impairment are available. When drugs with extensive hepatic metabolism are required in patients with preexisting liver disease, benefit of therapeutic effect must be evaluated against the risk of toxicity, and the drugs must be initiated with extreme caution with appropriate dosage reduction.
Recent Advances in Pharmacotherapy
Authors: Kemp Debra W. , Brown Jamie N. , Tofade Toyin S.
Published: February 2009

Many unique and clinically important medications were approved by the Food and Drug Administration from December 2007 through May 2008 for various conditions encountered in an internal medicine setting. These new treatments dramatically vary in their targeted body system and include agents for the cardiovascular system (nebivolol), central nervous system (desvenlafaxine), gastrointestinal tract (certolizumab, methylnaltrexone, and alvimopan), immunological function (etravirine), and metabolic function (sapropterin). This article discusses medications by their respective body system. Each review is comprised of an overview of the Food and Drug Administration–approved indication and the drug’s role in treatment of that disease state. Current dosing guidance, clinical efficacy and clinically relevant adverse drug reactions, drug interactions, contraindications, and precautions are also presented. This review is designed to focus on the new molecular entities and biological approvals clinicians may potentially encounter in an internal medicine practice.
Caring for the Elderly in an Inpatient Setting: Managing Insomnia and Polypharmacy
Authors: Kim Jenny , Tofade Toyin S. , Peckman Howard , Tofade Toyin S.
Published: February 2009

Caring for the elderly in an inpatient setting can be difficult because of the lack of literature to provide clinical guidelines addressing issues in this population. Insomnia and polypharmacy are common concerns. This article addresses these concerns by highlighting key points from the available literature. Insomnia may be a problem in the elderly because of their increased sensitivity to changes in environment among other factors. First, obtain a sleep history and a comprehensive medical and medication history to identify the cause. Next, treat the underlying cause with nonpharmacological interventions to restore restful and qualitative sleep. When nonpharmacological interventions are not successful, pharmacological means are indicated. Remember to start low, go slow, and treat for a short duration of time (less than 4 weeks) to avoid withdrawal or rebound insomnia. First-line agents are trazodone, triazolam, temazepam, and lorazepam followed by zaleplon and zolpidem. As people age, it is common for them to have multiple chronic comorbidities, which may result in polypharmacy and an increased risk of adverse events. Clinical practitioners should identify and prevent potential complications of polypharmacy. This should prevent further hospitalizations, decrease health care costs, and ultimately improve the quality of care in the elderly.
The Past, Present, and Future of Internationalization in Japan
Authors: Ninomiya Akira , Knight Jane , Watanabe Aya
Published: February 2009

The purpose of this special volume containing five articles dedicated to the internationalization of higher education in Japan is to provide information, analysis, and insight on the current goals, rationales, policies, and challenges facing internationalization's role as way to increase research excellence, profile, and competitiveness within Asia and the world beyond. Collectively, they paint a picture of a country that is supporting the higher education sector to be a key actor in helping Japan become the “Asian Gateway” to the rest of the world. To understand the nature of internationalization of higher education in Japan, it is important to review the changes in the international dimension of higher education during the past decades. Given the pivotal role that foreign students have played in the history of Japan's international academic relations, this topic is at the centre of a review of what could be called the “three primary phases” of internationalization from 1950 to the present day.
Lake Victoria Fish Stocks and the Effects of Water Hyacinth
Authors: Kateregga Eseza , Sterner Thomas
Published: February 2009

This article analyzes the effects of the invasion of water hyacinth on fishing in Lake Victoria. The authors built two fairly standard Schaefer-type models that have one innovation: They allow the water hyacinth abundance to affect catchability. The authors estimated static and dynamic catch per unit of effort functions for Lake Victoria fisheries, investigating the trend in the lake's stocks during the period 1983 to 2000 and focusing particularly on the effect of the water hyacinth on fish stocks and on catchability coefficients. The results show that although fish stocks have fallen since 1990, this decline appears to have been at least temporarily halted by the declining catchability of fish because of the growing abundance of water hyacinth. The impact of the hyacinth on the catchability of fish was greatest in the Kenyan section of Lake Victoria. Although hyacinth has many negative effects, it effectively hinders fishing and thereby paradoxically stops or at least postpones serious overfishing.
Motor Training of Upper Extremity With Functional Electrical Stimulation in Early Stroke Rehabilitation
Authors: Mangold Sabine , Schuster Corina , Keller Thierry , Zimmermann-Schlatter Andrea , Ettlin Thierry
Published: February 2009

Background. Functional electrical stimulation (FES) allows active exercises in stroke patients with upper extremity paralysis. Objective. To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and/or hand paralysis. Methods. For this pilot study, 23 acute and subacute stroke patients were randomly assigned to the intervention (n = 12) and control group (n = 11). Distributed over 4 weeks, FES training replaced 12 conventional training sessions in the intervention group. An Extended Barthel Index (EBI) subscore assessed the performance of activities of daily living (ADL). The Chedoke McMaster Stroke Assessment (CMSA) measured hand and arm function and shoulder pain. The Modified Ashworth Scale (MAS) assessed resistance to passive movement. Unblinded assessments were performed prior to and following the end of the training period. Results. The EBI subscore and CMSA arm score improved significantly in both groups. The CMSA hand function improved significantly in the FES group. Resistance to passive movement of finger and wrist flexors increased significantly in the FES group. Shoulder pain did not change significantly. None of the outcome measures, however, demonstrated significant gain differences between the groups. Conclusions. We did not find clear evidence for superiority or inferiority of FES. Our findings, and those of similar trials, suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences.
The Frequency of Osteoporosis Screening in Men With Inflammatory Bowel Disease
Authors: Nguyen Huy D. , Bakshi Anita K. , Borum Marie L.
Published: February 2009

Osteoporosis is underdiagnosed in men, and osteoporosis-related fractures carry high morbidity and mortality. Recent recommendations on osteoporosis screening in men from the American College of Physicians state that screening and risk factor assessment need to occur earlier in men at high risk. Men with inflammatory bowel disease are at high risk for osteoporosis and fragility fractures due to corticosteroid use, malabsorption from intestinal resection, potential vitamin D deficiency, and fluctuations in weight. This study examines the rate of corticosteroid use, vitamin D screening, and bone mineral density screening of men with inflammatory bowel disease in a gastroenterology practice. The vast majority of men with inflammatory bowel disease are at high risk for osteoporosis. Screening and risk factor assessment should be emphasized.
Health Insurance and Diabetes Among Multiracial Men: The Mediation Effects of Usual Source of Care
Authors: Hastings Julia F. , Hawkins Jaclynn
Published: February 2009

Background. Health insurance and having a usual source of care is important in diabetes management for multiethnic men. Few studies focus on determining whether usual source of care mediates the association between health insurance and diabetes among men. Methods. Using data from the 2005 California Health Interview Survey, responses from 17,472 men were analyzed to examine the extent to which a usual source of health care mediates the relationship between health insurance and diabetes. Results. Sobel—Goodman tests for mediation indicated the largest effects between Latino and White men. For African American and Asian men, usual source of care did not serve as a significant mediation factor between health insurance and diabetes. Discussion. Findings highlight a need for more research on the importance of having a usual source of care along with consistent health insurance type for multiracial men.
Sexual Coercion and Mental Health Symptoms Among Heterosexual Men: The Pressure to Say “Yes”
Authors: Próspero Moisés , Fawson Peter
Published: February 2009

The present study investigated the prevalence of female-to-male intimate partner violence (IPV) and mental health symptoms among 370 male university students. Participants completed surveys that measured three types of IPV victimization (sexual, physical, and psychological) and four types of mental health symptoms (anxiety, depression, hostility, and somatic symptoms). Correlations revealed strong positive associations between sexual, physical, and psychological IPV among male victims. Multiple regressions identified that males who reported psychological and sexual IPV from their female partner were more likely to report higher hostility, anxiety, and somatic symptoms. Further analyses identified that male victims experienced much higher levels of “insisted” sexual coercion rather than “forced” sexual coercion. Mental health practitioners should be aware of the possible mental health symptoms among male IPV victims, specifically from sexual coercion. The study posits that gender socialization does not allow men to refuse sex from an intimate partner and therefore elicit mental health symptoms.
Unique secretion mode of human protein Z: its Gla domain is responsible for inefficient, vitamin K–dependent and warfarin-sensitive secretion
Authors: Souri Masayoshi , Iwata Hiroki , Zhang Wei Guang , Ichinose Akitada
Published: February 2009

Protein Z is a vitamin K–dependent plasma glycoprotein that is involved in the regulation of blood coagulation. Plasma concentrations of protein Z vary widely between subjects and are greatly reduced during warfarin therapy. We developed a sensitive and quantitative assay for protein secretion using a secretory luciferase to explore the mode of secretion of protein Z compared with that of factor X. Protein Z secretion was much less efficient than factor X and was totally dependent upon added vitamin K, while factor X secretion was not. Protein Z secretion was highly sensitive to warfarin treatment of the synthesizing cells. In contrast, although factor X secretion was not precluded by warfarin, its γ-carboxylation was completely blocked. An exchange of the propeptide and/or γ-carboxyglutamic acid domain between protein Z and factor X reproduced the inefficient and warfarin-sensitive secretion pattern of protein Z, and vice versa. Joining of the propeptide and γ-carboxyglutamic acid domain to luciferase also demonstrated that the γ-carboxyglutamic acid domain of protein Z was responsible for its warfarin-sensitive secretion. Thus, it was concluded that the difference observed in secretion patterns of protein Z and factor X was mainly based on the structure of their γ-carboxyglutamic acid domains.
FLT3 receptor and ligand are dispensable for maintenance and posttransplantation expansion of mouse hematopoietic stem cells
Authors: Buza-Vidas Natalija , Cheng Min , Duarte Sara , Nozad Charoudeh Hojjatollah , Jacobsen Sten Eirik W. , Sitnicka Ewa
Published: February 2009

Originally cloned from hematopoietic stem cell (HSC) populations and its ligand being extensively used to promote ex vivo HSC expansion, the FMS-like tyrosine kinase 3 (FLT3; also called FLK2) receptor and its ligand (FL) were expected to emerge as an important physiologic regulator of HSC maintenance and expansion. However, the role of FLT3 receptor and ligand in HSC regulation remains unclear and disputed. Herein, using Fl-deficient mice, we establish for the first time that HSC expansion in fetal liver and after transplantation is FL independent. Because previous findings in Flk2−/− mice were compatible with an important role of FLT3 receptor in HSC regulation and because alternative ligands might potentially interact directly or indirectly with FLT3 receptor, we here also characterized HSCs in Flk2−/− mice. Advanced phenotypic as well as functional evaluation of Flk2−/− HSCs showed that the FLT3 receptor is dispensable for HSC steady-state maintenance and expansion after transplantation. Taken together, these studies show that the FLT3 receptor and ligand are not critical regulators of mouse HSCs, neither in steady state nor during fetal or posttransplantation expansion.
EpCAM, a human tumor-associated antigen promotes Th2 development and tumor immune evasion
Authors: Ziegler Alexandra , Heidenreich Regina , Braumüller Heidi , Wolburg Hartwig , Weidemann Susanne , Mocikat Ralph , Röcken Martin
Published: February 2009

Experimental tumor vaccination and adoptive T-cell therapies show that interferon-γ (IFN-γ)–producing CD4+ T helper cells (Th1) can be highly effective in tumor prevention and therapy. Unexpectedly, first vaccine trials in humans revealed that tumor immune therapy may not only be protective, but, on the contrary, even promote tumor progression. Here, we analyzed T-cell immune responses to the epithelial cell adhesion molecule (EpCAM), one of the most common tumor-associated antigens (TAA) serving as immune target in colon cancer patients. Th-cell priming against EpCAM inevitably resulted in interleukin-4 (IL-4)–dominated Th2 responses, even under most stringent Th1-inducing conditions. These EpCAM-reactive Th2 cells rather promoted growth of EpCAM-expressing tumors. To analyze the role of IL-4 in tumor immune evasion, we generated EpCAM-reactive Th1 cells from IL-4.ko mice. These Th1 cells provided tumor-specific protection and established highly protective Th1 memory responses, even in naive BALB/c mice. Inhibition of tumor growth by Th1 cells resulted in intra-tumoral expression of cytokines of the IL-12 family and of IFN-γ. Preventing activation-associated death of Th1 cells further increased intratumoral IFN-γ expression and improved therapeutic efficacy. Thus, human TAA may promote tumor immune evasion by strongly favoring Th2 development.
MCRS2 represses the transactivation activities of Nrf1
Authors: Wu Jia-Long , Lin Young-Sun , Yang Chi-Chiang , Lin Yu-Jen , Wu Shan-Fu , Lin Ying-Ting , Huang Chien-Fu
Published: February 2009

Background

Nrf1 [p45 nuclear factor-erythroid 2 (p45 NF-E2)-related factor 1], a member of the CNC-bZIP (CNC basic region leucine zipper) family, is known to be a transcriptional activator by dimerization with distinct partners, such as Maf, FosB, c-Jun, JunD, etc. The transcriptional roles of CNC-bZIP family are demonstrated to be involved in globin gene expression as well as the antioxidant response. For example, CNC-bZIP factors can regulate the expression of detoxification proteins through AREs, such as expression of human gamma-glutamylcysteine synthetases (GCS), glutathione S-transferases (GST), UDP-glucuronosyl transferase (UDP-GT), NADP (H) quinone oxidoreductase (NQOs), etc. To further explore other factor(s) in cells related to the function of Nrf1, we performed a yeast two-hybrid screening assay to identify any Nrf1-interacting proteins. In this study, we isolated a cDNA encoding residues 126–475 of MCRS2 from the HeLa cell cDNA library. Some functions of MCRS1 and its splice variant-MSP58 and MCRS2 have been previously identified, such as transforming, nucleolar sequestration, ribosomal gene regulation, telomerase inhibition activities, etc. Here, we demonstrated MCRS2 can function as a repressor on the Nrf1-mediated transactivation using both in vitro and in vivo systems.

Results

To find other proteins interacting with the CNC bZIP domain of Nrf1, the CNC-bZIP region of Nrf1 was used as a bait in a yeast two-hybrid screening assay. MCRS2, a splicing variant of p78/MCRS1, was isolated as the Nrf1-interacting partner from the screenings. The interaction between Nrf1 and MCRS2 was confirmed in vitro by GST pull-down assays and in vivo by co-immunoprecipitation. Further, the Nrf1-MCRS2 interaction domains were mapped to the residues 354–447 of Nrf1 as well as the residues 314–475 of MCRS2 respectively, by yeast two-hybrid and GST pull-down assays. By immunofluorescence, MCRS2-FLAG was shown to colocalize with HA-Nrf1 in the nucleus and didn't result in the redistribution of Nrf1. This suggested the existence of Nrf1-MCRS2 complex in vivo. To further confirm the biological function, a reporter driven by CNC-bZIP protein binding sites was also shown to be repressed by MCRS2 in a transient transfection assay. An artificial reporter gene activated by LexA-Nrf1 was also specifically repressed by MCRS2.

Conclusion

From the results, we showed MCRS2, a new Nrf1-interacting protein, has a repression effect on Nrf1-mediated transcriptional activation. This was the first ever identified repressor protein related to Nrf1 transactivation.
CDC2/SPDY transiently associates with endoplasmic reticulum exit sites during oocyte maturation
Authors: Hölzenspies Jurriaan J , Stoorvogel Willem , Colenbrander Ben , Roelen Bernard AJ , Gutknecht Dagmar R , van Haeften Theo
Published: February 2009

Background

Mammalian oocytes acquire competence to be fertilized during meiotic maturation. The protein kinase CDC2 plays a pivotal role in several key maturation events, in part through controlled changes in CDC2 localization. Although CDC2 is involved in initiation of maturation, a detailed analysis of CDC2 localization at the onset of maturation is lacking. In this study, the subcellular distribution of CDC2 and its regulatory proteins cyclin B and SPDY in combination with several organelle markers at the onset of pig oocyte maturation has been investigated.

Results

Our results demonstrate that CDC2 transiently associates with a single domain, identified as a cluster of endoplasmic reticulum (ER) exit sites (ERES) by the presence of SEC23, in the cortex of maturing porcine oocytes prior to germinal vesicle break down. Inhibition of meiosis resumption by forskolin treatment prevented translocation of CDC2 to this ERES cluster. Phosphorylated GM130 (P-GM130), which is a marker for fragmented Golgi, localized to ERES in almost all immature oocytes and was not affected by forskolin treatment. After removal of forskolin from the culture media, the transient translocation of CDC2 to ERES was accompanied by a transient dispersion of P-GM130 into the ER suggesting a role for CDC2 in redistributing Golgi components that have collapsed into ERES further into the ER during meiosis. Finally, we show that SPDY, rather than cyclin B, colocalizes with CDC2 at ERES, suggesting a role for the CDC2/SPDY complex in regulating the secretory pathway during oocyte maturation.

Conclusion

Our data demonstrate the presence of a novel structure in the cortex of porcine oocytes that comprises ERES and transiently accumulates CDC2 prior to germinal vesicle breakdown. In addition, we show that SPDY, but not cyclin B, localizes to this ERES cluster together with CDC2.