bluuebunny/crossref_metadata_2025 huggingface dataset:
Kinetics of lactate metabolism after submaximal ergometric exercise in HIV‐infected patients
Authors: Bauer A‐M , Sternfeld T , Horster S , Schunk M , Goebel F‐D , Bogner JR
Published: September 2004

Objectives
It is unknown whether high levels of lactate result from enhanced production or decreased degradation. We therefore investigated differences in the kinetics of plasma lactic acid in HIV‐infected patients receiving or not receiving highly active antiretroviral therapy (HAART) and in uninfected controls after submaximal ergometric exercise.

Methods
Ten healthy controls, 11 HIV‐infected therapy‐naïve patients, 15 HIV‐infected patients on HAART with normal baseline lactate levels, and nine HIV‐infected patients on HAART with elevated baseline lactate levels >2 mmol/L performed 10 min of ergometric exercise, with a heart rate of 200 beats/min minus age. Lactate levels were measured at baseline, at the end of exercise and 15, 30, 45, 60 and 120 min thereafter.

Results
Mean baseline lactate levels were 1.4, 1.5, 1.5 and 2.8 mmol/L in the controls, the therapy‐naïve patients, the patients on HAART with normal lactate levels and the patients on HAART with elevated lactate levels, respectively. Maximum lactate levels after exercise were similar in all groups (9.7, 9.4, 9.0 and 10.1 mmol/L, respectively). Significant differences were found in the slope of lactate decline between controls and untreated individuals (P=0.038) and between patients on HAART with normal baseline lactate and patients on HAART with elevated baseline lactate (P=0.028).

Conclusions
Differences in lactate metabolism do exist between healthy controls and HIV‐infected therapy‐naïve individuals. Thus, HIV infection in itself may influence lactate levels. Elevated baseline lactate levels are associated with a delayed decline of lactate after exercise. These results could be explained by impaired lactate clearance. Lactate production upon exercise does not seem to be affected by baseline lactate levels.
Clinical features and predictors of survival of AIDS‐related non‐Hodgkin's lymphoma in a population‐based case series in Sydney, Australia
Authors: Robotin MC , Law MG , Milliken S , Goldstein D , Garsia RJ , Dolan GM , Kaldor JM , Grulich AE
Published: September 2004

Objectives

To analyse clinical features and predictors of survival for AIDS‐related non‐Hodgkin's lymphoma (NHL) in the era of highly active antiretroviral therapy (HAART), compared to earlier in the HIV epidemic.

Methods

All AIDS‐NHL cases diagnosed at three inner Sydney hospitals caring for people with AIDS during 1985–2001 were identified through medical record searches. Demographic, clinical, immunological and histopathological information was recorded. Year of NHL diagnosis was grouped into three periods, corresponding to whether monotherapy (1985–1991), dual therapy (1992–1995) or HAART (1996–2001) was the main treatment for HIV infection. Statistical comparisons were made between the pre‐HAART and post‐HAART eras.

Results

Three hundred cases of AIDS‐NHL were identified. Divergent trends were identified for systemic and primary central nervous system (CNS) NHL. For systemic NHL, the CD4 count at NHL diagnosis increased markedly to 208 cells/μL in the post‐HAART era (P=0.014) and there was a trend towards presentation as the first AIDS‐defining illness (69%, P=0.053), and as earlier stage NHL disease (42%, P=0.048). Median survival time increased from 4.2 months in 1985–1991 to 19 months in the post‐HAART era (P<0.001). In a multivariate model, predictors of poor survival from systemic NHL included: NHL diagnosis after another AIDS‐defining illness (P<0.001), stage 4 NHL (P<0.001), presentation at extra lymphatic sites (P=0.001), and nonreceipt of chemotherapy (P=0.002). After adjusting for the factors, those diagnosed in the era of HAART had a significant 56% reduction in rate of death (P<0.001). In contrast, for CNS NHL, clinical features were little changed and survival did not improve in the era of HAART.

Conclusions

Systemic NHL is presenting earlier in the course of HIV disease, and at a less advanced NHL stage. There has been a marked improvement in survival in the era of HAART even after adjustment for other prognostic variables. In contrast, primary CNS NHL remains a disease which presents late in the course of HIV infection and is associated with a very poor prognosis.
Significance of hepatitis C virus coinfection with persistently normal alanine aminotransferase levels in HIV‐1‐infected patients
Authors: Fonquernie L , Serfaty L , Charrois A , Wendum D , Lefebvre B , Girard PM , Meynard JL
Published: September 2004

Objectives

To assess the prevalence of chronic hepatitis C virus (HCV) infection with persistently normal alanine aminotransferase (ALT) levels in HIV‐1‐infected patients, together with its clinical, biological and histological characteristics and predictive factors.

Methods

We retrospectively studied all HCV/HIV‐coinfected patients treated in our Infectious Diseases Department, for whom data on both HIV and HCV infection were available. We compared the demographic characteristics and parameters of HIV and HCV infection between cases, defined by persistently normal ALT levels (<45 IU/L) and detectable serum HCV‐RNA (determined by PCR), and controls with high ALT levels and HCV PCR positivity during the previous 3 years.

Results

Among the 815 HIV‐infected patients assessed for this study, 179 (22%) were HCV‐coinfected, of whom 155 were eligible for this analysis. Of these 155 HCV‐coinfected patients, 137 (88%) were HCV‐PCR‐positive, of whom 39 (28.5%) had persistently normal ALT levels (cases) and 98 (71.5%) had high ALT levels (controls). Relative to controls, cases had a significantly lower fibrosis score and a lower fibrosis progression rate (2.2 vs. 1.3, P=0.004; 0.3 vs. 0.2, P=0.006, respectively). Three factors associated with persistently normal ALT levels were identified, namely: HBsAg negativity (P=0.003), HCV genotype 4 (P=0.01) and female sex (P=0.05).

Conclusion

Persistently normal ALT levels may be considered as a marker of slow HCV disease progression in HIV‐coinfected patients, with significantly less severe hepatic lesions.
Water drinking in the management of orthostatic intolerance due to orthostatic hypotension, vasovagal syncope and the postural tachycardia syndrome
Authors: Mathias C. J. , Young T. M.
Published: September 2004

Water drinking recently has been shown to raise blood pressure in normal subjects and in patients with autonomic failure who have orthostatic hypotension. However, in normal young subjects, ingestion of approximately 500 ml has no pressor effect; but in older subjects there is an increase in blood pressure. An even greater rise in blood pressure occurs in cases with autonomic failure. The possible mechanisms responsible for the pressor response to water include neural and humoral factors; fluid redistribution also needs to be considered. This review will concentrate on the water pressor response in normal subjects and different groups of patients with autonomic diseases who have orthostatic intolerance, on the mechanisms that could be involved, and on whether this pressor response may be used in the management of orthostatic hypotension, vasovagal syncope and the postural tachycardia syndrome.
Primary Sjogren's syndrome presenting with generalized autonomic failure
Authors: Sakakibara R. , Hirano S. , Asahina M. , Sawai S. , Nemoto Y. , Hiraga A. , Uchiyama T. , Hattori T.
Published: September 2004

A 64 year‐old woman developed Raynaud's phenomenon and dry eyes/mouth. Laboratory examination revealed positive Schirmer's test, rheumatoid factor and anti‐nuclear antibody, and lymphocytic sialoadenitis on salivary gland biopsy. These features strongly suggested the diagnosis of primary Sjogren's syndrome. Three years later, she gradually developed generalized autonomic failure without apparent sensory neuropathy on nerve conduction study. She had systolic pressure fall of 51 mmHg on head‐up tilt test, cardiovascular supersensitivity to diluted norepinephrine infusion, cardiac denervation in [123I]‐MIBG scintigraphy, impaired R‐R variability, decreased sweating and prolonged colonic transit time. Autoimmune autonomic ganglionopathy was mostly responsible for her autonomic failure.
Epidemiology of restless legs in the Netherlands
Authors: Rijsman Roselyne , Knuistingh Neven Arie , Graffelman Willy , Kemp Bob , De Weerd Al
Published: September 2004

The prevalence of restless legs syndrome (RLS) in various regions in the world has been estimated between 2.5 and 29%. For the Netherlands these figures are not known. Our observational and cross‐sectional study was performed to estimate the prevalence of RLS in the Netherlands. A cross‐sectional survey by postal questionnaire was carried out through a general practice in a small town in which one general practice serves 93% of the population. All men and women aged 50 years and older were invited to fill out the questionnaire on leg movements, quality of sleep and daytime symptoms. A total of 1485 (88.2%) persons returned their questionnaire and 1437 (85.4%) patients answered the questions on leg movements. A total of 102 (7.1%) inhabitants answered positively to the questions on leg movements and probably have RLS. The prevalence was higher in women and increased with age. People who complain of RLS have significantly more complaints of disturbances in initiating and maintaining sleep, sleepiness, tiredness during the day and less refreshing sleep. RLS is common in the Netherlands with an estimated prevalence of 7.1% in the population over 50 years of age.
Superior sensitivity of motor over somatosensory evoked potentials in the diagnosis of cervical spondylotic myelopathy
Authors: Simó M. , Szirmai I. , Arányi Z.
Published: September 2004

Myelopathy secondary to cervical spondylosis is often a difficult clinical diagnosis. Furthermore, with the introduction of magnetic resonance imaging (MRI) an increasing number of patients are identified with spondylotic cervical spinal cord compression. We analyzed the value of functional assessment of the spinal cord by motor and sensory evoked potentials (MEP and SEP) in the detection of myelopathy, with special emphasis on the correlation of clinical and electrophysiological findings. Fifty‐one patients with at least some degree of spinal cord compression because of cervical spondylosis, as shown by MRI, were included in the study, grouped according to clinical symptoms. We found that patients who had no clinical symptoms whatsoever indicating myelopathy (they were referred to MRI examination mostly because of cervical radiculopathy), had in the large majority normal MEP and SEP findings. Patients with slight, unspecific and non‐confirmative symptoms without pyramidal signs had mostly abnormal MEP but normal SEP findings. This points to the superior sensitivity of MEP over SEP in detecting myelopathy in its early stages. Patients with obvious clinical signs of myelopathy, including pyramidal signs had both abnormal MEP and SEP findings. Altogether these findings may help clinicians in interpreting MRI signs of cervical spinal cord compression.
Distinct clinical expressions of striatocapsular infarction according to cortical manifestations
Authors: Jung S. , Hwang S.‐H. , Lee B.‐C.
Published: September 2004

Striatocapsular infarction is known to have various neurologic manifestations including cortical symptoms. However, striatocapsular infarction patients without cortical dysfunctions can be easily found. Therefore, we tried to evaluate the properties and pathogenesis of two distinct expressions of striatocapsular infarction, striatocapsular infarction with and without cortical dysfunctions respectively. Forty‐eight patients were divided into two groups according to their initial manifestations. Forty‐eight patients with striatocapsular infarction were divided into cortical type of striatocapsular infarction (CSCI) and non‐cortical type (NCSCI) according to their initial manifestations. We compared the properties such as stroke risk factors, laboratory data, and clinical features and assessed magnetic resonance imaging (MRI) and MR angiography for possible mechanisms in each type of striatocapsular infarction. Patients with CSCI and those with NCSCI had similar characteristics, laboratory data and morphologic findings in MRI. CSCI patients had more profound initial neurologic manifestations [Both National Institutes of Health Stroke Scale (NIHSS) score and Barthel index]. In MR angiography, patients with CSCI showed more frequent single middle cerebral artery (MCA) stenosis, whereas NCSCI patients had findings that were more heterogeneous. In conclusion, we found that not all the patients with striatocapsular infarction had cortical dysfunctions. It is possible for lesions with similar size and location to have different manifestations (cortical or non‐cortical) according to their vascular integrity.
Guidance for the preparation of neurological management guidelines by EFNS scientific task forces – revised recommendations 2004*
Authors: Brainin M. , Barnes M. , Baron J.‐C. , Gilhus N. E. , Hughes R. , Selmaj K. , Waldemar G.
Published: September 2004

Since the publication of the first EFNS task force reports in 1997, a total of 20 evidence‐based guidelines for the treatment and management of neurological diseases have been published by the EFNS (http://www.efns.org/guidelines). In 2001, recommendations for the preparation of neurological guidelines were issued by the EFNS Scientific Committee (Eur J Neurol 2001; 8: 549–550). These have now been updated and revised. More unified criteria for standards of reporting are set up which include classes of scientific evidence and predefined levels of recommendation. These criteria as well as others listed below should be used for all working groups that aim at recommending treatment, diagnostic procedures or other interventions within the framework of the EFNS.
Full recovered meningoencephalomyelitis caused by mumps virus
Authors: Savaş L. , Arlıer Z. , Akçalı A. , Karataş M. , Önlen Y.
Published: September 2004

Meningitis is the most common central nervous system complication of mumps virus, whereas encephalitis, cranial nerve palsies, poliradiculoneuritis are less common and myelitis caused by mumps virus is very rare [Nussinovitch et al., Acta Pediatrica (1992) 81, 183]. Lesions in young age as a result of severe acute transverse myelitis [shown on a magnetic resonance imaging (MRI) procedure] often has a viral cause. The case of a young male afflicted by meningoencephalomyelitis because of mumps virus is discussed.
A patient with Marfan's syndrome and neurofibromatosis type 1 with polyneuropathy
Authors: Hartlapp I. , Bühring U. , Dichgans J. , Isenmann S.
Published: September 2004

Both Marfan's syndrome and neurofibromatosis type 1 are hereditary, autosomal dominant conditions. Here, we report the rare case of a patient fulfilling the clinical criteria for both diseases. In the absence of a family history of either of the two conditions, two independent de novo mutations are the most likely cause.
Packaging demands in the food service industry
Authors: Olsson Annika , Petterson Maria , Jönson Gunilla
Published: September 2004

The European food service market was estimated, in 1999, to be worth US$293 billion with high profit margins and a growth rate of 2.75%. Future demand for value‐added products and high levels of customization will stress the issue of keeping profit margins in the food service industry. Packaging is a critical issue, because it adheres to the product throughout the entire food service supply chain. Package design influences the efficiency of the entire chain in terms of functions, features, information and cost aspects. The purpose of this study was to explore the demands of value‐added packaging in the food service sector and was carried out in the UK. The study shows that there are opportunities to improve packaging solutions to fit better with food service needs. The study also indicates a lack of understanding in the food service sector and that packages can actually add value to the products. Suggested opportunities in package development are presented.
The formulation and evaluation of culinary success factors (CSFs) that determine the palatability of food
Authors: Klosse P. R. , Riga J. , Cramwinckel A. B. , Saris W. H. M.
Published: September 2004

The aim of the research reported here was to analyse palatability. In the first part of the study, renowned chefs in the Netherlands were interviewed about their most successful dishes to search for ‘common denominators’. In total 18 chefs were interviewed and 63 dishes were analysed. Six product characteristics were found that were present in at least 80% of the described dishes: (i) name and presentation fit the expectation; (ii) appetizing smell that fits the food; (iii) good balance of flavour components in relation to the food; (iv) presence of umami, also called the fifth basic taste; (v) in mouthfeel a mix of hard and soft textures; and (vi) high flavour richness. It was hypothesized that palatability is determined by the presence of each of these culinary success factors (CSFs). In a second study, a Michelin‐star chef was asked to develop three series of dishes each with a specified main ingredient. Every series consisted of one dish based on the CSFs and two variants, in which systematically one of the CSFs was left out, under the condition that the dish was still restaurant‐worthy. In a tasting these nine dishes were served to a group of 26 experienced restaurant guests. In the tasting, the dishes in which most CSFs were united were preferred to the variants. It is concluded that the formulated CSFs can help chefs in the development of new dishes and improvement of existing ones.
Uncovering aspects of franchisees’ incentives: an explorative investigation
Authors: Marnburg Einar , Larsen Svein , Ogaard Torvald
Published: September 2004

The success of franchise systems is usually explained by referring to franchisees’ incentives, that is, residual claims to profit and empowerment through delegation. This paper focuses on possible psychological and social dimensions of franchisees’ incentives by investigating franchisees’ and employed managers’ self‐efficacy, system commitment, and system conformity performance. In the explorative study, we found that franchisees were significantly more committed than employed managers, but we were not able to discover any differences between operational managers employed by franchisors and franchisees. This paper discusses various theoretical understandings of franchisees’ incentives and discusses possible explanations of how and why franchisees’ incentives affect their employed managers.
Granule‐assisted dishwashing improves cleanliness
Authors: Ståhl Wernersson Eva , Johansson Erik , Håkanson Håkan
Published: September 2004

The cleanliness of plates and dishes washed in two different types of machines was investigated. Both machines were one‐tank dishwashers; one of them used water and detergent, the other used plastic granules, water and detergent as the cleaning medium. The mechanical effect of plastic granules, water and detergent cleaned the dishes better than water and detergent alone. For easily removed soil, as characterized in the international standards ANSI/NSF 3 and DIN 10512, both dishwashing machines resulted in clean dishes. Dishes covered with a more adhesive soil were clean only after washing in the granule‐assisted washer. The importance of cleaning plates and dishes, in order to avoid cross‐contamination and the spread of infection, is discussed.
Development and optimization of microsatellite DNA primers for boreal owls (Aegolius funereus)
Authors: KOOPMAN MARNI E. , SCHABLE NANCY A. , GLENN TRAVIS C.
Published: September 2004

We developed 22 microsatellite loci for boreal owls (Aegolius funereus). We genotyped 275 unrelated boreal owls (Aegolius f. richardsoni) and 36 unrelated Tengmalm's owls (Aegolius f. funereus) using seven loci that were polymorphic and did not have detectable null alleles. Among North American and Scandinavian boreal owls, respectively, allelic diversity ranged from three to 11 alleles and from one to 11 alleles, observed heterozygosity ranged from 0.31 to 0.80 and from 0.00 to 0.81, and expected heterozygosity ranged from 0.28 to 0.81 and from 0.00 to 0.81. These markers appeared to amplify DNA in six other Strigidae species.
Characterization of microsatellites located within the genes of goldfish (Carassius auratus auratus)
Authors: YUE GEN HUA , ORBAN LASZLO
Published: September 2004

The goldfish (Carassius auratus auratus; Cyprinidae) is not only an important ornamental fish species, but also a useful model for biological studies. The sequence of goldfish genes present in the public database was searched for short tandem repeats, and 11 polymorphic microsatellites were detected within eight important genes. Two microsatellites were located in coding regions of the c‐myc and GAP‐43 genes, respectively, whereas the others were mainly located in 5′ and 3′ untranscribed regions of other genes, such as gonadotropin and activin. The average allele number of these microsatellites was 5.5 per locus with a range between 3 and 9. These microsatellites will be useful for ecological and population genetic studies of this species, as well as for the ornamental fish industry.
Isolation and characterization of microsatellite loci in Amazonian red‐handed howlers Alouatta belzebul (Primates, Plathyrrini)
Authors: GONÇALVES E. C. , SILVA A. , BARBOSA M. S. R. , SCHNEIDER M. P. C.
Published: September 2004

Ten highly polymorphic microsatellite loci are described for Amazonian red‐handed howlers (Alouatta belzebul), an endemic Brazilian primate species subject to intense hunting pressure. The number of alleles observed in 30 individuals ranged from nine to 20, and observed heterozygosity varied from 0.35 to 0.93. No linkage associations were evident from pairwise comparisons of loci. These microsatellites offer a powerful tool for fine‐scale studies of genetic structure in both captive colonies and wild populations of red‐handed howlers.
Characterization of novel microsatellites and development of multiplex PCR for large‐scale population studies in wild cherry, Prunus avium
Authors: VAUGHAN S. P. , RUSSELL K.
Published: September 2004

Primers were developed for 14 microsatellite or simple sequence repeat (SSR) loci identified from a Prunus avium‘Charger’ genomic DNA library. In a survey of 16 wild cherry accessions 10 of the loci revealed polymorphisms of between two and six alleles. The remaining loci were found to be monomorphic. Seven polymorphic loci identified in this study and four polymorphic loci previously reported in sweet cherry were mapped and found to be unlinked. Two multiplex polymerase chain reactions (PCR) were optimized to enable the characterization of all 11 unlinked, polymorphic SSR loci.
Characterization of 17 microsatellite loci in the Japanese land snail genera Mandarina, Ainohelix, and Euhadra (Mollusca, Gastropoda, Pulmonata)
Authors: DAVISON ANGUS , CHIBA SATOSHI , KAWATA MASAKADO
Published: September 2004

Land snails of the genera Mandarina, Euhadra and Ainohelix are useful for understanding the ecology and evolution of speciation and adaptation, so we have developed 17 microsatellite loci for these species. As in other land snails, most of the loci are highly polymorphic compound repeats, with a great size range between alleles. The loci should be useful in understanding gene‐flow, genetic structure and speciation in these species.
Twelve variable microsatellite loci for the North American medicinal leech, Macrobdella decora
Authors: BUDINOFF REBECCA B. , SIDDALL AIMEE M. , SIDDALL MARK E.
Published: September 2004

We isolated and characterized 12 microsatellite loci for the North American medicinal leech, Macrobdella decora. Macrobdella decora is abundant in central and northern North American freshwater systems. The resulting microsatellite library, the first for any species of leech or any clitellate annelid, demonstrates the efficacy of this type of analysis on unexploited leech populations and should serve as a baseline for comparison with other species, notably the commercially important and threatened European medicinal leech, Hirudo medicinalis.
Ethics Guidelines for International, Multicenter Research Involving People with Intellectual Disabilities1,2,3,4
Authors: Dalton Arthur J. , McVilly Keith R.
Published: September 2004

Abstract  This position statement endorsed by the International Association for the Scientific Study of Intellectual Disabilities is designed to promote and facilitate research projects affecting and involving people with intellectual disabilities. The paucity of dedicated research infrastructure and expert ethical review processes to oversee research in this field, especially in developing countries, is asserted as a major issue to be addressed by both the scientific community and governments. International multicenter collaboration has been proposed as a means of addressing these problems. The statement draws on internationally recognized documents outlining the ethical considerations involved in human research activities. It interprets these documents in light of the particular needs and interests of people with intellectual disabilities and incorporates international consultation involving researchers from a variety of disciplines. It affirms the importance of ethical decision making in local communities. Specific recommendations are made concerning ethical review processes, research design considerations, consent processes and the conduct of research involving and affecting people with intellectual disabilities, their families and communities. Research proposals, especially those for international, multicenter projects, need to take into account cultural diversity among participants and differing legal requirements across jurisdictions, while at the same time maintaining the scientific rigor of the research protocol. Promoting partnerships between researchers and people with intellectual disability, together with their families, advocates and local communities are important considerations when developing research projects. Similarly, the development of strategies to both communicate findings to participants and their communities, and to promote their community's access to the benefits of these findings are all important ethical considerations.
Contributions of IASSID to the Scientific Study of Intellectual Disability: The Past, the Present, and the Future1
Authors: Parmenter Trevor R.
Published: September 2004

Abstract  Since its inception in the early 1960s, the International Association for the Scientific Study of Intellectual Disabilities (IASSID) has played an important role in advancing the scientific study of intellectual disabilities, primarily in the developed world. Through its regular world congresses, and its nongovernmental organization status with the World Health Organization, IASSID has served as a forum for bringing together scientists and professionals working the multiple fields of interest related to intellectual disabilities. Highlighted are IASSID's achievements throughout the past 40 years, with special reference to the trends of presentation content made at its regular congresses, and discussed are the challenges facing the Association, which include reaching out to developing countries and involving more researchers from the non‐English speaking world, maintaining its networking and informative role in acting as an information clearing house, and promoting the dissemination of research.
Effective Teamwork in Special Schools for Children with Intellectual Disabilities in India
Authors: Rao L. G. , Suryaprakasam B.
Published: September 2004

Abstract  Special educational services for children with intellectual disabilities in India are mostly provided by nongovernmental organizations. Described is a study designed to assess the impact of professional “teamwork” in special schools run by such nongovernmental organizations in India. The sample consisted of 112 rehabilitation professionals who attended a short‐term training program at the National Institute for the Mentally Handicapped, and who were randomly selected from a range of nongovernmental organizations running such schools representing various parts of the country. Comparison of the teamwork scores in relation to the functional area of work using a F‐test for unequal “n” revealed greater teamwork present among regular (line function) professionals (such as the educators and therapists) than among support staff (such as administrators), supporting the hypothesis that the application of professional teamwork is a useful device in special school settings. The results were interpreted against the background of organizational effectiveness in the context of special education services and it was suggested that additional research needs to be directed at the dynamics of the teamwork process and to better understanding why support staff reflect low involvement in teamwork in India.
Using Focus Groups to Elicit Views Across Disciplines and National Experiences with Intellectual Disabilities
Authors: McCallion Philip , McCarron Mary
Published: September 2004

Abstract  This article reports upon the usefulness of a focus group strategy to develop a consensus on key health and aging research recommendations for persons with intellectual disabilities (ID). This strategy was employed at an opportunistic situation, a consensus meeting (the Tampa Scientific Conference on Intellectual Disability, Aging and Health) which involved 75 diverse background participants from the United States and other countries who came together to evolve recommendations for aging health policy. The meeting's participants included basic and applied researchers with a range of professional interests (physicians, psychologists, sociologists, social workers, and nurses), public policy workers and administrators, and family members and persons with ID. A working group process, a focus group strategy, was used successfully to develop recommendations in the areas of medical and epidemiological issues, syndrome‐specific concerns, and the promotion of healthy aging. The approach used was found to be particularly helpful in reconciling diverse researcher and consumer perspectives, considering both basic and applied research issues, and yielding both national‐specific and internationally relevant recommendations.
Goals, Outcomes, and Future Challenges for People with Intellectual Disabilities in a Noninstitutional Society: The Norwegian Experience
Authors: Meyer Jan
Published: September 2004

Abstract  The Norwegian Welfare System and how its programs support Norwegians with intellectual and developmental disabilities is described and proffered as a case example of how one nation's public policy shifted to provide community‐invested services for people with lifelong disabilities. The foundation of Norway's shift to complete reliance on home and community supports for its citizens with intellectual disabilities lies in the health and welfare system that is in place for all Norwegians. Social change began in the mid‐1970s when a governmental commission examined Norwegian social policy for people with developmental disabilities using four factors: (1) the ideological tenets of the principle of normalization, (2) the government's commitment to decentralization of services, (3) the goal of the integration of persons with disabilities, and (4) moving toward a broader definition of developmental disabilities as a target group for services. The commission's recommendations of closure of institutions and the devolution of services led to a reliance on local townships and municipalities. However, this process was not without its problems, such as competing demands for public services and local economies, and dealing with barriers posed by resistance to social integration and inclusion. The author explores the Norwegian experience and the dilemmas faced by local communities in attempting to meet the national goals of a “noninstitutional society.”
Delayed Substantial Increase in Older Age Cohorts in Austria – Challenges for Service Providers and Policy Planners
Authors: Weber Germain
Published: September 2004

Abstract  In Germany and Austria, cohorts of older people with an intellectual disability (ID) are missing due to their liquidation during the Third Reich period. This report presents the finding of a survey of all ID service providers in Austria. The survey found a total of 2866 persons aged 40 years and older with ID, but over one‐third (n = 1036) did not live within the accommodation settings of a service provider, meaning that they are still living with their aging parents or relatives. Contrasting this with earlier findings, the data provided by this survey indicate an urgent need in Austria for quality management, planning, financing and realizing additional accommodation provisions for adults and older people with ID.
Morbidity and Health‐Care Use in People with Intellectual Disabilities in General Practice: First Results of a Survey in the Netherlands
Authors: Van Schrojenstein Lantman‐de Valk H. M. J , Te Wierik M. J. M. , Van Den Akker M. , Wullink M. , Schellevis F. G. , Dinant G. J. , Metsemakers J. F. M.
Published: September 2004

Abstract  Reported here are the preliminary results of the second Dutch National Survey of General Practice in which data were collected on all contacts with general practitioners (GPs) during a 12‐month period to determine characteristics of patients with intellectual disabilities (ID). Sociodemographic characteristics differed significantly between people with ID and controls, indicating significant differences in morbidity between the two groups (people with ID were found to have more psychological problems, more digestive problems, more ear problems, more neurological problems, and more general and unspecified problems).
Early diagnosis is vital in the management of squamous cell carcinomas associated with chronic non healing ulcers: a case series and review of the literature
Authors: Enoch Stuart , Miller David R , Price Patricia E , Harding Keith G
Published: September 2004

The association between chronic ulcers and squamous cell carcinomas (SCCs) is well established. Their clinical presentations, however, are varied, ranging from innocuously appearing lesions to overtly exophytic growths. We present a series of cases with heterogeneous clinical presentations and different treatment outcomes. Case series – patient 1 was a 69‐year‐old man with an 18‐month history of static non healing venous leg ulcer, but no sinister features, biopsy was performed to rule out Marjolin's transformation, histology revealed SCC and treatment was simple excision and skin grafting; patient 2 was a 73‐year‐old lady with an 18‐month history of non healing ulcer (innocuous appearance) over distal interphalangeal joint of index finger, histology revealed SCC with deeper extension and treatment was amputation of distal half of finger; patient 3 was a 73‐year‐old lady with a 12‐month history of non healing fungating leg ulcer with irregular borders and everted edges, histology revealed SCC (tumour eroding tibia and distant metastasis) and treatment was above‐knee amputation, radiotherapy and palliation. Whilst SCC is amenable to simple excision in the early stages, delay in diagnosis could result in loss of the affected digit or limb; an SCC which has metastasised is also life threatening. Therefore, a low threshold to biopsy static non healing ulcers or ulcers in unusual sites should be adopted even in those not manifesting any evidence of malignancy.
Gamma‐irradiated human skin allograft: a potential treatment modality for lower extremity ulcers
Authors: Rosales M Anthony , Bruntz Merri , Armstrong David G
Published: September 2004

Gamma‐irradiated human skin allograft consists of epidermis and dermis. Unlike bioengineered tissues which require cold storage and timely use once received from the manufacturer, gamma‐irradiated human skin allograft can be stored for as long as 24 months at room temperature. This modality is applied in a fashion similar to that of bioengineered skin grafts. In this article, we present case studies with concise reviews of the available evidence to discuss the potential use of gamma‐irradiated human skin allograft on wounds in the lower extremity.
Comparison of bacteria‐retaining ability of absorbent wound dressings
Authors: Tachi Masahiro , Hirabayashi Shinichi , Yonehara Yoshiyuki , Suzuki Yasutoshi , Bowler Philip
Published: September 2004

Fibrous materials in some modern absorbent wound dressings have the ability to sequester and retain bacteria; however, this ability varies according to the nature of the fibres. We studied the bacterial retention capacity of alginate and carboxymethylcellulose dressings, using an infected skin ulcer model on the backs of rats. Wound surfaces were inoculated with either Staphylococcus aureus or Pseudomonas aeruginosa at a concentration of 1·5 × 106 colony‐forming units per wound. AQUACEL®; Hydrofiber®;, Kaltostat®; or Sorbsan®; were applied to the contaminated wounds for 12 h. Each dressing was then divided into two pieces. Total viable bacterial count within the dressing was calculated using one piece, and bacterial count released from the dressing into physiological saline was determined using the other piece, enabling bacterial retention rate to be calculated. Bacterial counts in tissue were also determined. Each dressing was tested on each of 10 wounds contaminated with each bacterium. Statistical analyses were performed using one‐way analysis of variance (ANOVA) for replicated measures combined with Duncan's multiple comparison test. AQUACEL®; Hydrofiber®; dressing was most effective in its ability to retain both Staphylococcus aureus and Pseudomonas aeruginosa (p < 0·05). Bacterial counts in tissue showed no significant change with respect to pathogen or the type of dressing used. It can be concluded that the bacterial retaining ability of AQUACEL®; Hydrofiber®; dressing was found to be significantly higher than that of alginate dressings in an infected animal wound model.
Pyoderma gangrenosum: a challenging complication of bilateral mastopexy
Authors: Poucke Sven Van , Jorens Philippe G , Peeters Raymond , Jacobs Werner , De Beeck Bart Op , Lambert Julien , Beaucourt Luc
Published: September 2004

A case of pyoderma gangrenosum progressively developing after bilateral mastopexy at the surgical site is described. The described case was successfully treated with corticosteroids, the application of the dermal regeneration template Integra® and autologous skin grafts. This approach was able to save the patient's life and to generate a high‐quality aesthetical outcome. The article reported the case, reviewed the literature of pyoderma gangrenosum related to mastopexy or augmentation mammoplasty and discussed the use of a dermal regeneration template to optimise aesthetical results after reconstructive surgery.
Cardiac hypertrophy in vitamin D receptor knockout mice: role of the systemic and cardiac renin-angiotensin systems
Authors: Xiang Wei , Kong Juan , Chen Songcang , Cao Li-Ping , Qiao Guilin , Zheng Wei , Liu Wenhua , Li Xinmin , Gardner David G. , Li Yan Chun
Published: September 2004

Our recent studies suggest that 1,25-dihydroxyvitamin D3functions as an endocrine suppressor of renin biosynthesis. Genetic disruption of the vitamin D receptor (VDR) results in overstimulation of the renin-angiotensin system (RAS), leading to high blood pressure and cardiac hypertrophy. Consistent with the higher heart-to-body weight ratio, the size of left ventricular cardiomyocytes in VDR knockout (KO) mice was markedly increased compared with wild-type (WT) mice. As expected, levels of atrial natriuretic peptide (ANP) mRNA and circulating ANP were also increased in VDRKO mice. Treatment of VDRKO mice with captopril reduced cardiac hypertrophy and normalized ANP expression. To investigate the role of the cardiac RAS in the development of cardiac hypertrophy, the expression of renin, angiotensinogen, and AT-1a receptor in the heart was examined by real-time RT-PCR and immunostaining. In VDRKO mice, the cardiac renin mRNA level was significantly increased, and this increase was further amplified by captopril treatment. Consistently, intense immunostaining was detected in the left ventricle of captopril-treated WT and VDRKO mice by use of an anti-renin antibody. Levels of cardiac angiotensinogen and AT-1a receptor mRNAs were unchanged in the mutant mice. These data suggest that the cardiac hypertrophy seen in VDRKO mice is a consequence of activation of both the systemic and cardiac RAS and support the notion that 1,25-dihydroxyvitamin D3regulates cardiac functions, at least in part, through the RAS.
Amino acid metabolism in leg muscle after an endotoxin injection in healthy volunteers
Authors: Vesali Rokhsareh F. , Klaude Maria , Rooyackers Olav , Wernerman Jan
Published: September 2004

Decreased plasma amino acid concentrations and increased net release of amino acids from skeletal muscle, especially for glutamine, are common features in critically ill patients. A low dose of endotoxin administered to healthy volunteers was used as a human model for the initial phase of sepsis to study the early metabolic response to sepsis. Six healthy male volunteers were studied in the postabsorptive state. Blood samples from the forearm artery and femoral vein were taken during 4 h before and 4 h after an intravenous endotoxin injection (4 ng/kg body wt). In addition, muscle biopsies from the leg muscle were taken. Plasma concentration of the total sum of amino acids decreased by 19% ( P = 0.001) and of glutamine by 25% ( P = 0.004) the 3rd h after endotoxin administration. At the same time, muscle concentrations of the sum of amino acids and glutamine decreased by 11% ( P = 0.05) and 9% ( P = 0.09), respectively. In parallel, the efflux from the leg increased by 35% ( P = 0.004) for the total sum of amino acids and by 43% ( P = 0.05) for glutamine. In conclusion, intravenous endotoxin administration to healthy volunteers, used as a model for the initial phase of sepsis, resulted in a decrease in plasma amino acid concentrations. At the same time, amino acid concentrations in muscle tissue decreased, whereas the efflux of amino acids from leg skeletal muscle increased.
Investigation of in vivo fatty acid metabolism in AFABP/aP2−/−mice
Authors: Baar Rachel A. , Dingfelder Carlus S. , Smith Lisa A. , Bernlohr David A. , Wu Chaodong , Lange Alex J. , Parks Elizabeth J.
Published: September 2004

The metabolic impact of the murine adipocyte fatty acid-binding protein (AFABP/aP2) on lipid metabolism was investigated in the AFABP/aP2−/−mouse and compared with wild-type C57BL/6J littermates. Mice were weaned on a high-fat diet (59% of energy from fat) and acclimated to meal feeding. Stable isotopes were administered, and indirect calorimetry was performed to quantitate fatty acid flux, dietary fatty acid utilization, and substrate oxidation. Consistent with previous in situ and in vitro studies, fasting serum nonesterified fatty acid (NEFA) release was significantly reduced in AFABP/aP2−/−(17.1 ± 9.0 vs. 51.9 ± 22.9 mg·kg−1·min−1). AFABP/aP2−/−exhibited higher serum NEFA (1.4 ± 0.6 vs. 0.8 ± 0.4 mmol/l, AFABP/aP2−/−vs. C57BL/6J, respectively) and triacylglycerol (TAG; 0.23 ± 0.09 vs. 0.13 ± 0.10 mmol/l) and accumulated more TAG in liver tissue (2.9 ± 2.3 vs. 1.1 ± 0.8% wet wt) in the fasted state. For the liver-TAG pool, 16.4 ± 7.3% of TAG-fatty acids were derived from serum NEFA in AFABP/aP2−/−. In contrast, a significantly greater portion of C57BL/6J liver-TAG was derived from serum NEFA (42.3 ± 25.5%) during tracer infusion. For adipose-TAG stores, only 0.29 ± 0.04% was derived from serum NEFA in AFABP/aP2−/−, and, in C57BL/6J, 1.85 ± 0.97% of adipose-TAG was derived from NEFA. In addition, AFABP/aP2−/−preferentially oxidized glucose relative to fatty acids in the fed state. These data demonstrate that in vivo disruption of AFABP/aP2−/−leads to changes in the following two major metabolic processes: 1) decreased adipose NEFA efflux and 2) preferential utilization of glucose relative to fatty acids.
Sex differences in the myocardial inflammatory response to ischemia-reperfusion injury
Authors: Wang Meijing , Baker Lauren , Tsai Ben M. , Meldrum Kirstan K. , Meldrum Daniel R.
Published: September 2004

The myocardium generates inflammatory mediators during ischemia-reperfusion (I/R), and these mediators contribute to cardiac functional depression and apoptosis. The great majority of these data have been derived from male animals and humans. Sex has a profound effect over many inflammatory responses; however, it is unknown whether sex affects the cardiac inflammatory response to acute myocardial I/R. We hypothesized the existence of inherent sex differences in myocardial function, expression of inflammatory cytokines, and activation of the p38 mitogen-activated protein kinase (MAPK) signaling pathway after I/R. Isolated rat hearts from age-matched adult males and females were perfused (Langendorff), and myocardial contractile function was continuously recorded. After I/R, myocardium was assessed for expression of TNF-α, IL-1β, and IL-6 (RT-PCR, ELISA); IL-1α and IL-10 mRNA (RT-PCR); and activation of p38 MAPK (Western blot). All indexes of postischemic myocardial function [left ventricular developed pressure, left ventricular end-diastolic pressure, and maximal positive (+dP/d t) and negative (−dP/d t) values of the first derivative of pressure] were significantly improved in females compared with males. Compared with males, females had decreased myocardial TNF-α, IL-1β, and IL-6 (mRNA, protein) and decreased activation of p38 MAPK pathway. These data demonstrate that hearts from age-matched adult females are relatively protected against I/R injury, possibly due to a diminished inflammatory response.
Inhibition of 5α-reductase blocks prostate effects of testosterone without blocking anabolic effects
Authors: Borst Stephen E. , Lee Jun Hak , Conover Christine F.
Published: September 2004

We studied the effect of the 5α-reductase inhibitor MK-434 on responses to testosterone (T) in orchiectomized (ORX) male Brown Norway (BN) rats aged 13 mo. At 4 wk after ORX or sham surgery, a second surgery was performed to implant pellets delivering 1 mg T/day or placebo pellets. During the second 4 wk of the study, rats received injections of MK-434 (0.75 mg/day) or vehicle injections. Treatment with T elevated serum T to 75% above that for sham animals ( P = 0.002) and did not affect serum dihydrotestosterone (DHT) or serum estradiol. T treatment also caused an elevation of prostate T and a marked elevation of prostate DHT. During the second half of the study, ORX rats lost an average of 18.86 ± 4.62 g body wt. T completely prevented weight loss, and the effect was not inhibited by MK-434 ( P < 0.001). ORX produced a nonsignificant trend toward a small (5%) decrease in the mass of the gastrocnemius muscle ( P = 0.0819). This trend was also reversed by T, and the effect of T was not blocked by MK-434. T caused a significant 16% decrease in subcutaneous fat that was not blocked by MK-434 ( P < 0.05). Finally, T caused a 65% decrease in urine excretion of deoxypyridinoline, a marker of bone resorption, and again the effect was not blocked by MK-434 ( P < 0.0001). In contrast, T caused a greater than fivefold increase in prostate mass, and the effect was almost completely blocked by MK-434 ( P < 0.0001). This study demonstrates that 5α-reductase inhibitors may block the undesirable effects of T on the prostate, without blocking the desirable anabolic effects of T on muscle, bone, and fat.