bluuebunny/crossref_metadata_2025 huggingface dataset:
The Mortgage Arrears Pre‐Action Protocol: An Opportunity Lost
Authors: Whitehouse Lisa
Published: August 2009

In February 2008, the Civil Justice Council circulated for consultation a mortgage arrears pre‐action protocol that proposed some of the most radical and significant reforms of the repossession process for a century. Hinting at a return to the equitable tradition, the draft protocol required a minimum level of equitable dealing within the mortgage relationship coupled with the restriction and, at times, exclusion of the lender's inherent right to possession. The version which emerged following the period of consultation, however, bore little if any resemblance to its predecessor. The Pre‐Action Protocol for Possession Claims Based on Mortgage or Home Purchase Plan Arrears in Respect of Residential Property attempts no alteration of the parties' existing rights and obligations and seeks merely to encourage rather than compel lenders to view repossession as a last resort. To this extent, therefore, it represents an opportunity lost to afford borrowers greater protection within the repossession process.
N v UK: No Duty to Rescue the Nearby Needy?
Authors: Mantouvalou Virginia
Published: August 2009

This article discusses the deportation of a seriously ill foreign national to her country of origin, where she would face a high risk of extreme deterioration of her health due to the inadequate medical treatment. It criticises the reasoning of the judgment N v UK of the European Court of Human Rights, and explores the circumstances under which removal of a severely ill non‐national constitutes a breach of the prohibition against inhuman and degrading treatment under the European Convention on Human Rights.
Three‐dimensional volume rendering of the ankle based on magnetic resonance images enables the generation of images comparable to real anatomy
Authors: Anastasi Giuseppe , Cutroneo Giuseppina , Bruschetta Daniele , Trimarchi Fabio , Ielitro Giuseppe , Cammaroto Simona , Duca Antonio , Bramanti Placido , Favaloro Angelo , Vaccarino Gianluigi , Milardi Demetrio
Published: August 2009

We have applied high‐quality medical imaging techniques to study the structure of the human ankle. Direct volume rendering, using specific algorithms, transforms conventional two‐dimensional (2D) magnetic resonance image (MRI) series into 3D volume datasets. This tool allows high‐definition visualization of single or multiple structures for diagnostic, research, and teaching purposes. No other image reformatting technique so accurately highlights each anatomic relationship and preserves soft tissue definition. Here, we used this method to study the structure of the human ankle to analyze tendon–bone–muscle relationships. We compared ankle MRI and computerized tomography (CT) images from 17 healthy volunteers, aged 18–30 years (mean 23 years). An additional subject had a partial rupture of the Achilles tendon. The MRI images demonstrated superiority in overall quality of detail compared to the CT images. The MRI series accurately rendered soft tissue and bone in simultaneous image acquisition, whereas CT required several window‐reformatting algorithms, with loss of image data quality. We obtained high‐quality digital images of the human ankle that were sufficiently accurate for surgical and clinical intervention planning, as well as for teaching human anatomy. Our approach demonstrates that complex anatomical structures such as the ankle, which is rich in articular facets and ligaments, can be easily studied non‐invasively using MRI data.
Medical and non‐medical direct costs of chronic low back pain in patients consulting primary care physicians in France
Authors: Depont Fanny , Hunsche Elke , Abouelfath Abdelilah , Diatta Thierno , Addra Isabelle , Grelaud Angela , Lagnaoui Rajaa , Molimard Mathieu , Moore Nicholas
Published: August 2009

A retrospective, observational, cohort study in primary care. To determine the total direct medical and non‐medical cost of chronic low back pain (LBP) in France and its associated factors. Chronic LBP affects 5–10% of the population its burden in France is unknown. Ninety‐eight randomly selected general practitioners included 796 adult patients with chronic LBP between October 2001 and December 2002. Direct costs due to physician visits, investigations, medications, hospitalizations, and other medical and non‐medical resource use were collected for the 6 months prior to study visit. Costs both reimbursed and not by the French health insurance system were considered. Quality of life (QoL) and disease severity were measured using Short Form (SF)‐8 and Roland‐Morris disability questionnaire (RMDQ), respectively. Costs were updated to represent 2007 prices. Men represented 50.6% of the 796 patients, mean age was 53 ± 11.3 years, and the duration of LBP was more than 1 year in 80.9% of patients. The total mean cost per patient over six months was 715.6€ (95% CI: 644.2–797.8). Of these costs, 22.9% related to care provided by physiotherapists and allied specialists, 19.5% to medications, 17.4% to hospitalizations, 9.6% to investigations, and 12.5% to physician fees. In multivariate analysis, the factors associated with the cost of chronic LBP were disease severity (RMDQ score) and age of the patients. LBP is a disease that is both common and costly.
The comparison of the effects of anesthetic doses of ketamine, propofol, and etomidate on ischemia–reperfusion injury in skeletal muscle
Authors: Ergün Yusuf , Darendeli Sacide , İmrek Seçil , Kilinç Metin , Öksüz Hafize
Published: August 2009

The fact that a considerable amount of clinical conditions suffering from ischemia–reperfusion injury (IRI) occur under general anesthesia has triggered researchers to focus on the effects of anesthetic drugs on IRI. Hence, the aim of this study was to compare the use of different anesthetic drugs in a skeletal IRI model. Tourniquet IRI method was performed and two experimental groups were established as sham‐control and IRI group. Rats in each group were anesthetized either with thiopental, ketamine, propofol or etomidate. Malondialdehyde, superoxide dismutase, catalase, and glutathione peroxidase were measured in skeletal muscle via a spectrophotometer. Zinc, iron, copper, and selenium were evaluated by atomic absorption spectrophotometer. In rats anesthetized with thiopental (40 mg/kg, i.p.), malondialdehyde values in IRI group were higher and glutathion peroxidase levels were lower compared to sham‐control group. However, superoxide dismutase and catalase activities were identical. On the other hand, while the level of zinc in IRI group attenuated, no differences in iron and copper values were determined. Rats anesthetized with ketamine (60 mg/kg), propofol (100 mg/kg), or etomidate (20 mg/kg) did not show increased malondialdehyde levels in comparison with control levels. While the drugs did not cause a distinction in the levels of superoxide dismutase, catalase, glutathion peroxidase, iron, and copper, zinc was in a lower level in IRI group compared to sham‐control. In conclusion, ketamine, propofol, and etomidate, with anesthetic doses, denoted efficacious effects on IRI; hence the drugs might be preferred in certain operations with the risk of IRI.
Protective effect of p‐methoxyl‐diphenyl diselenide in lethal acute liver failure induced by lipopolysaccharide and d‐galactosamine in mice
Authors: Wilhelm E.A. , Jesse C.R. , Nogueira C.W.
Published: August 2009

Organoselenium compounds display important antioxidant activity and many biological activities interesting from pharmacological point of view. The aim of this study was to evaluate the hepatoprotective effect of p‐methoxyl‐diphenyl diselenide, a disubstituted diaryl diselenide, on acute liver injury induced by d‐galactosamine (d‐GalN) and lipopolysaccharide (LPS) in mice. The animals received p‐methoxyl‐diphenyl diselenide (10, 50 and 100 mg/kg; per oral, p.o.) and 1 h after d‐GalN (500 mg/kg) and LPS (50 μg/kg) were administered by intraperitoneal route (i.p.). Twenty‐four hours after LPS/d‐GalN exposure the animals were euthanized to the biochemical and histological analysis. Pretreatment with p‐methoxyl‐diphenyl diselenide (50 and 100 mg/kg; p.o.) protected against the increase in aspartate aminotransferase (AST) activity induced by LPS/d‐GalN exposure in mice. p‐Methoxyl‐diphenyl diselenide at the doses of 50 and 100 mg/kg protected against the increase in alanine aminotransferase (ALT) activity induced by LPS/d‐GalN exposure. In this study, no alteration in ascorbic acid levels was observed in livers of mice exposed to LPS/d‐GalN. Glutathione‐S‐transferase (GST) activity was stimulated by LPS/d‐GalN exposure and p‐methoxyl‐diphenyl diselenide, at all doses, protected against this alteration. p‐Methoxyl‐diphenyl diselenide was effective in ameliorating inhibition of catalase activity induced by LPS/d‐GalN exposure. Histological data showed that sections of livers from LPS/d‐GalN‐treated mice presented massive hemorrhage, inflammatory cells and necrosis. p‐Methoxyl‐diphenyl diselenide significantly attenuated LPS/d‐GalN‐induced hepatic histopathological alterations. Based on the results, we suggest the hepatoprotective effect of p‐methoxyl‐diphenyl diselenide on acute liver injury induced by LPS/d‐GalN exposure in mice.
Aspirin in the secondary prevention of cardiovascular disease: an update of the APTC meta‐analysis
Authors: Lièvre Michel , Cucherat Michel
Published: August 2009

We updated the 2002 Antiplatelet Trialists’ Collaboration meta‐analysis of antiplatelet therapy to assess the effects of aspirin alone in the secondary prevention of different types of thrombotic arterial disease. Results of randomized, placebo‐controlled trials of aspirin in patients with confirmed cardiovascular disease were abstracted and synthesized by the Mantel–Haenszel method. We defined three cardiovascular disease groups according to the qualifying disease at entry: coronary artery disease (CAD), cerebrovascular disease (CRVD), and peripheral arterial disease (PAD). Results are given as odds ratios (OR) and 95% confidence intervals (95% CI). Compared with placebo, aspirin decreased significantly the risk of all‐cause death in CAD and CRVD (OR = 0.80, 95% CI 0.75–0.86 and 0.91, 95% CI 0.85–0.98, respectively), and of vascular events in CAD, CRVD, and PAD (OR = 0.71, 95% CI 0.67–0.76, 0.87, 95% CI 0.82–0.93, and 0.50, 95% CI 0.29–0.88, respectively). The risk of non‐fatal stroke was decreased in the CAD, CRVD, and PAD (OR = 0.64, 95% CI 0.50–0.83, 0.81, 95% CI 0.74–0.89, and 0.26, 95% CI 0.07–0.94, respectively). The risk of non‐fatal myocardial infarction was decreased significantly in the CAD and CRVD (OR = 0.59, 95% CI 0.53–0.67, and 0.63, 95% CI 0.48–0.84, respectively), but not in the PAD (OR = 0.43, 95% CI 0.15–1.25). Aspirin nearly doubled the risk of major bleeds (OR = 1.87, 95% CI 1.51–2.32 for all clinical conditions). This meta‐analysis confirms that aspirin decreases the risk of thrombotic events in patients with confirmed disease of the coronary, cerebrovascular, or peripheral artery beds.
Increasing longevity through caloric restriction or rapamycin feeding in mammals: common mechanisms for common outcomes?
Authors: Cox Lynne S. , Mattison Julie A.
Published: August 2009

Significant extension of lifespan in important mammalian species is bound to attract the attention not only of the aging research community, but also the media and the wider public. Two recent papers published by Harrison et al. (2009) in Nature and by Colman et al. (2009) in Science report increased longevity of mice fed with rapamycin and of rhesus monkeys undergoing caloric restriction, respectively. These papers have generated considerable debate in the aging community. Here we assess what is new about these findings, how they fit with our knowledge of lifespan extension from other studies and what prospects this new work holds out for improvements in human longevity and human health span.
EVALUATION OF THE APPLICABILITY OF CONVENTIONAL METHODS FOR THE CHEMICAL CHARACTERIZATION OF WATERLOGGED ARCHAEOLOGICAL WOOD
Authors: PIZZO BENEDETTO , GIACHI GIANNA , FIORENTINO LUIGI
Published: August 2009

A series of 112 waterlogged archaeological wood samples of different provenances, wood species, burial times and states of preservation were analysed with the aim of assessing the validity (in terms of limits and reliability) of procedures conventionally used in the pulp and paper industry, to evaluate the state of preservation of decayed wood. In particular, the extent of any damage wrought on decayed wood tissue by the repetitive cycles that characterize these procedures was evaluated as a function of the degradation of the samples. The results indicated that standard methodologies give reliable measurements regardless of the extent of wood decay. However, it is essential to compare these data with those of non‐decayed wood that has been measured using the same procedures to take account of the errors that are inherent in these methodologies and that affect measurements.
African Americans show increased risk for pressure ulcers: A retrospective analysis of acute care hospitals in America
Authors: Fogerty Mary , Guy Jeffrey , Barbul Adrian , Nanney Lillian B. , Abumrad Naji N.
Published: August 2009

In an earlier study, we reported a significantly increased risk of pressure ulcer hospital discharge diagnoses in African Americans, higher age groups, and those with certain medical conditions. The objectives of the present study were to: (a) investigate the demographics associated with a higher odds ratio (OR) in African Americans and (b) determine whether African Americans have different rates of medical risk factors. The 2003 Nationwide Inpatient Sample database was queried. Patients with pressure ulcers were identified by discharge diagnoses using ICD‐9 codes 707.0–707.09. Discharge diagnosis was examined using the agency for healthcare research and quality clinical classifications software (CCS). The present study used identified CCS discharge diagnoses present in at least 5% of all patients, with an OR>2. African Americans exhibited a higher incidence of an OR>2 for 28 identified CCS risk factors for pressure ulcers. The pressure ulcer diagnoses tended to occur at younger ages in African Americans. No significant differences were noted in African Americans with pressure ulcers when a subanalysis was conducted by zip code income quartile, region of the country, or teaching status of the hospital. Hospitalized African Americans exhibit an age‐dependent, higher prevalence of pressure ulcers compared with Caucasians. Socioeconomic factors tracked within the Nationwide Inpatient Sample do not provide an explanation for this phenomenon.
Loss of viability and induction of apoptosis in human keratinocytes exposed to Staphylococcus aureus biofilms in vitro
Authors: Kirker Kelly R. , Secor Patrick R. , James Garth A. , Fleckman Philip , Olerud John E. , Stewart Philip S.
Published: August 2009

Bacteria colonizing chronic wounds are believed to exist as polymicrobial, biofilm communities; however, there are few studies demonstrating the role of biofilms in chronic wound pathogenesis. This study establishes a novel method for studying the effect of biofilms on the cell types involved in wound healing. Cocultures of Staphylococcus aureus biofilms and human keratinocytes (HK) were created by initially growing S. aureus biofilms on tissue culture inserts then transferring the inserts to existing HK cultures. Biofilm‐conditioned medium (BCM) was prepared by culturing the insert‐supported biofilm in cell culture medium. As a control planktonic‐conditioned medium (PCM) was also prepared. Biofilm, BCM, and PCM were used in migration, cell viability, and apoptosis assays. Changes in HK morphology were followed by brightfield and confocal microscopy. After only 3 hours exposure to BCM, but not PCM, HK formed dendrite‐like extensions and displayed reduced viability. After 9 hours, there was an increase in apoptosis (p≤0.0004). At 24 hours, biofilm‐, BCM‐, and PCM‐exposed HK all exhibited reduced scratch closure (p≤0.0001). The results demonstrated that soluble products of both S. aureus planktonic cells and biofilms inhibit scratch closure. Furthermore, S. aureus biofilms significantly reduced HK viability and significantly increased HK apoptosis compared with planktonic S. aureus.
Deformation microstructures of olivine in peridotite from Spitsbergen, Svalbard and implications for seismic anisotropy
Authors: JUNG H. , MO W. , CHOI S. H.
Published: August 2009

To understand the deformation mechanism and seismic anisotropy in the uppermost mantle beneath Spitsbergen, Svalbard, in the Arctic, the deformation microstructures of olivine in the peridotite of Spitsbergen were studied. Seismic anisotropy in the upper mantle can be explained mainly by the lattice‐preferred orientation (LPO) of olivine. The LPOs of the olivine in the peridotites were determined using electron backscattered diffraction patterns. Eight specimens out of 10 showed that the [100] axis of the olivine was aligned subparallel to the lineation and that the (010) plane was subparallel to the foliation, showing a type A LPO. In the other two specimens the [100] axis of olivine was aligned subparallel to the lineation and both the [010] and [001] axes were distributed in a girdle nearly perpendicular to the lineation, showing a type D LPO. The dislocation density of the olivine in the samples showing a type D LPO was higher than that in the samples showing a type A LPO. The result of an Fourier transformation infrared study showed that both the types A and D samples were dry. These observations were in good agreement with a previous experimental study (Tectonophysics, 421, 2006, 1): samples showing a type D LPO for olivine were observed at a high stress condition and samples showing both types A and D LPO were deformed under dry condition. Observations of both strong LPOs and dislocations of olivine indicate that the peridotites studied were deformed by dislocation creep. The seismic anisotropy calculated from the LPOs of the olivine could be used to explain the seismic anisotropy of P‐ and S‐waves in the lithospheric mantle beneath Spitsbergen, Svalbard.
Benign epilepsy with centrotemporal spikes
Authors: Donald Shields W. , Carter Snead III Orlando
Published: August 2009

Benign epilepsy with centrotemporal spikes (BECTS) is a common disorder in childhood. After a brief overview of BECTS, a review of the data in favor of treatment with anticonvulsant medications is followed by the data indicating that treatment is not indicated. Some children appear to have cognitive consequences from BECTS. The parents and children with BECTS require a full discussion of the pros and cons of treatment, but based on data available at this time, it is concluded that treatment is generally not indicated for most patients. Future research may lead to changes in the recommendations.
Tonic and atonic seizures: What’s next—VNS or callosotomy?
Authors: Rosenfeld William E. , Roberts David W.
Published: August 2009

Medically intractable tonic and atonic seizures may be responsive to either vagus nerve stimulation (VNS) or corpus callosum section. VNS has been shown to be effective and is associated with very low morbidity. Callosotomy is a more ambitious procedure, with a higher risk of complications but greater likelihood of seizure improvement.
Use of a new antiepileptic drug or an old one as first drug for treatment of absence epilepsy
Authors: Penovich Patricia E. , James Willmore L.
Published: August 2009

Treatment of absence epilepsy requires understanding the efficacy and side effects of several drugs, one of which first became available more than 50 years ago. Methods for drug development and procedures for evaluating their safety and efficacy over that time have changed dramatically. Observational studies of the efficacy of ethosuximide, a drug developed in the 1950s, reported complete seizure control in 40–60% of patients. Valproic acid, a drug with a broad spectrum of effect, showed robust efficacy as well for control of absence seizures. Because side effects limit use in some patients, newer drugs were evaluated in patients with absence seizures. Of drugs becoming available in the last 15 years, lamotrigine has some effect in absence seizures. Although older and newer drugs presently are used without the rigorous underpinnings of the highest quality of evidence, our analysis found that ethosuximide, valproate, and lamotrigine are effective in the treatment of absence seizures, with ethosuximide quite possibly being the first drug of choice.
Should enzyme‐inducing antiepileptic drugs be considered first‐line agents?
Authors: Mintzer Scott , Mattson Richard T.
Published: August 2009

Despite the introduction of a host of new antiepileptic drugs (AEDs) over the last 20 years, the older agents, which are potent inducers of the cytochrome P450 (CYP450) system, remain the AEDs most commonly prescribed throughout the world. At the same time, data have gradually and continuously emerged regarding the possible adverse consequences of CYP450 induction, such that it is now appropriate to pose the question of whether the inducing drugs should still be considered first‐line agents for the treatment of focal epilepsy. In this article we review the evidence suggesting that these drugs may have many detrimental metabolic effects, along with the data concerning their relative efficacy compared to the newer, noninducing AEDs. We conclude that longer and better‐powered studies are needed to truly establish whether the newer AEDs are equivalent in efficacy to the older, inducing agents. Pending this, however, the extant data are sufficiently concerning to suggest that it may be prudent to start with noninducing AEDs unless there is a clear indication for one of the inducing drugs.
Treatment algorithms in refractory partial epilepsy
Authors: Jobst Barbara C.
Published: August 2009

An algorithm is a “step‐by‐step procedure for solving a problem or accomplishing some end....in a finite number of steps.” (Merriam‐Webster, 2009). Medical algorithms are decision trees to help with diagnostic and therapeutic decisions. For the treatment of epilepsy there is no generally accepted treatment algorithm, as individual epilepsy centers follow different diagnostic and therapeutic guidelines. This article presents two algorithms to guide decisions in the treatment of refractory partial epilepsy. The treatment algorithm describes a stepwise diagnostic and therapeutic approach to intractable medial temporal and neocortical epilepsy. The surgical algorithm guides decisions in the surgical treatment of neocortical epilepsy.
Refractory seizures: Try additional antiepileptic drugs (after two have failed) or go directly to early surgery evaluation?
Authors: Kwan Patrick , Sperling Michael R.
Published: August 2009

The goal of antiepileptic therapy is to achieve long‐term seizure freedom with minimal or no adverse effects. Current evidence suggests that in many patients who have failed two appropriate antiepileptic drugs (AEDs) because of lack of efficacy, the chance of subsequent seizure freedom with further drug manipulation is low (reports ranging from as little as a few percent to nearly one‐fourth of patients). Achieving this may require repeated drug manipulations. Surgery, in appropriately selected candidates, may render up to 70% of patients seizure‐free when temporal resection is done, although frontal resection may have only a 25% yield. Both courses of actions (further drug trials and surgery) are associated with a plethora of potential adverse outcomes. Therefore, it is recommended that such patients be promptly referred to an epilepsy center for a comprehensive review of the diagnosis and management, which may include initial evaluation for surgery. Because presurgical evaluation and surgery itself may entail discomfort and risk, the decision to offer surgical treatment requires individual risk–benefit analysis that includes an assessment of possible success with additional trials of medication.
Rational polytherapy
Authors: French Jacqueline A. , Faught Edward
Published: August 2009

Monotherapy has been considered the gold standard for drug treatment of epilepsy. However, there is renewed interest in polytherapy because of the advent of new drugs with fewer drug interactions and novel mechanisms of action, and the realization that most patients with refractory epilepsy are eventually treated with drug combinations. Careful consideration must be given to drug additions and conversions; it may be less risky to add a drug than to convert from one monotherapy to another in patients with frequent or severe seizures. Rational choice of drug combinations is, at present, based more on avoidance of pharmacodynamic or pharmacokinetic side effects than on evidence for supra‐additive efficacy. There are indications that combinations of two sodium‐channel blocking agents are less effective than combinations of drugs with different primary mechanisms of action, and some human studies suggest that lamotrigine and valproate may be synergistic for efficacy. However, more animal and human research is needed, with attention to the effects of various combinations on both toxicity and seizure control.
Surgical treatment of the extratemporal epilepsies
Authors: Roper Steven N.
Published: August 2009

Epilepsy that originates outside of the temporal lobe can present some of the most challenging problems for surgical therapy. These epilepsies can be broadly categorized as lesional or non‐lesional, with the nonlesional cases being the most difficult to localize. Lesional cases can result from malformations of cortical development, tumors, vascular malformations, or areas of old injury. Some lesions, such as focal cortical dysplasia, can be challenging, in that the boundaries of the pathology can be difficult to define. Presurgical goals include defining the structural lesion, the physiologic abnormality, and normal function in the area. These goals can be achieved using a variety of noninvasive and invasive tests. Surgical techniques vary depending on location and pathology but they always include removal of the epileptic brain tissue while preserving en passage vessels and underlying white matter tracts. Surgical outcomes vary depending on the underlying pathology. Surgeries are usually planned with a goal of no expected postoperative deficits, although temporary deficits may be anticipated in some areas, such as the supplementary motor cortex. Extratemporal epilepsy can be managed well with surgical treatment; but proper patient selection, evaluation, and discussion of expected outcomes and risks are critical in this challenging patient population.
Shifting Conceptions of Self and Society in Fijian Kindergartens
Authors: Brison Karen J.
Published: August 2009

Play with peers in urban Fijian kindergartens leads to significant changes in conceptions of self, gender, ethnicity, and social class. Rural children play in mixed gender groups where relationships among children are defined by relative age and kinship; children learn to see themselves as playing a role in a community. In contrast, urban kindergarten children negotiate their way through large groups of unrelated same‐age peers by distinguishing friends from outsiders, leading to increased preoccupation with individual preferences and identities. Being in large groups of unfamiliar children of the same age causes Fijian children to categorize by gender, a relatively clear category marked by all the ethnic subcultures. Ethnic differences are de‐emphasized in school settings, whereas class differences are increasingly important, as upwardly mobile professional parents invest in multiple years of kindergarten to improve children's skills in English. Kindergarten attendance both marks, and contributes to creating, an emerging middle‐class community espousing modernist values and using consumption to index membership in an international community. [preschool, Fiji, acquisition of culture, gender, social class]
Maternal Politics and Religious Fervor: Exchanges between an Andean Market Woman and an Ethnographer
Authors: Seligmann Linda J.
Published: August 2009

The life story of one Peruvian market woman, Felicitas Lucrecia Mamani de Cardona Ríos, offers a window into the social context and cultural values that have an impact on her individual struggles. At the same time, less explicit exchange dynamics akin to transference and countertransference between Lucre and the ethnographer dynamically structure the interview process. The ethnographer desired and sought to emulate some of Lucre's qualities—her protective, maternal, yet tough demeanor, whereas Lucre sought to project an image of herself as well‐educated and of high social standing, yet also capable of great empathy and solidarity with working class women and Quechua peasants. The sharing of Lucre's life story with the ethnographer and the ethnographer's interpretation of it bring sharply into focus the complexity of lives and the negotiations that unfold at border crossings. [life story, transference, gender, market women, power]
Estrogen receptor β– an independent prognostic marker in estrogen receptor α and progesterone receptor‐positive breast cancer?
Authors: MÆHLE BJØRN O. , COLLETT KARIN , TRETLI STEINAR , AKSLEN LARS A. , GROTMOL TOM
Published: August 2009

Both subtypes of estrogen receptor (ER), ERα and ERβ, are normally present in the mammary gland. The role of ERα as a prognostic marker in breast cancer is well established due to the beneficial effect of providing tamoxifen as adjuvant therapy. The role of ERβ, however, is less clear. To gain insight into the importance of ERβ in breast cancer, 145 primary breast cancers were examined by immunohistochemistry for ERβ, and the expression level was compared with ERα and progesterone receptor (PR) status. Especially, we wanted to examine the significance of ERβ in the contrasting ERα+/PR+ and ERα−/PR− subgroups. In the ERα+/PR+ subgroup (dual positive), the survival difference between patients with low, medium and high ER β level was statistically significant (p = 0.004), with more than 70% of patients with medium and high ERβ levels surviving 100 months, compared with less than 30% in the group with low ERβ level. Further, for ERα+/PR+ patients there was a reduced risk of fatal outcome by multivariate analysis with increasing ERβ levels (p(trend) < 0.01 [univariate analysis]; p(trend) = 0.05 [multivariate analysis]). The risk was 31% and 27% for medium and high ERβ levels, respectively, compared with low ERβ level, adjusting for standard prognostic factors such as tumor diameter, nuclear tumor grade (quantified by mean nuclear area), lymph node status, and patient age at operation. For patients with ERα−/PR− tumors (dual negative), however, there was no association between ERβ levels and patient outcome. Our findings indicate that ERβ expression provides independent prognostic information for breast cancers with ERα/PR‐positive status, a feature typical among screen‐detected breast cancers. The role of ERβ needs to be further evaluated especially in this group of breast cancers.
Symptoms and signs in culture‐proven acute maxillary sinusitis in a general practice population
Authors: HANSEN JENS GEORG , HØJBJERG TOVE , ROSBORG JØRN
Published: August 2009

The objective of this study was to assess symptoms and signs in patients with maxillary sinusitis and a bacteriological diagnosis obtained by sinus aspiration or lavage. Designed as a prospective cohort study in general practice, the study included 174 patients, aged 18–65 years, suspected of having acute maxillary sinusitis by their general practitioner. The main outcome measures were the independent association of symptoms, signs, erythrocyte sedimentation rate (ESR), and C‐reactive protein (CRP) concentration and confirmed infection with the predominant bacterial pathogens Streptococcus pneumoniae and Haemophilus influenzae. The predominant organisms found in patients with acute maxillary sinusitis were S. pneumoniae and H. influenzae. Body temperature >38 °C and maxillary toothache were significantly associated with the presence of S. pneumoniae and H. influenzae. Positive bacteriological culture results were significantly associated with increasing ESR and CRP values. None of the symptoms and signs, with the exception of body temperature >38 °C and maxillary toothache, were particularly sensitive indicators of the specific aetiology in patients with acute maxillary sinusitis. Elevated ESR and CRP values were significantly associated with positive bacteriological culture results. On the other hand, absence of these symptoms and signs did not exclude the presence of acute maxillary sinusitis.
Large‐scale genomic instability in colon adenocarcinomas and correlation with patient outcome
Authors: BONDI JOHAN , PRETORIUS MARIA , BUKHOLM IDA , DANIELSEN HÅVARD
Published: August 2009

The purpose of this study was to evaluate the association between DNA content in colon adenocarcinomas using high‐resolution image cytometry and patient outcome. Tumours from 219 patients operated for colon adenocarcinoma were analysed using high‐resolution image cytometry. Proteins involved in cell cycle propulsion (cyclins A, D1, D3 and E) and cell proliferation (c‐Myc and non‐membranous β‐catenin) have previously been reported in the same cohort and were included in this study. The results were related to disease‐free survival and to cancer‐specific death. Patients with aneuploid tumours showed shorter relapse‐free survival than patients with euploid tumours (univariate log‐rank test, p = 0.004 and multivariate Cox regression model p = 0.009, HR 0.51, 95% CI 0.31–0.84). Also the risk of death from cancer was greater in patients with aneuploid tumours (log‐rank test, p = 0.006 multivariate Cox regression model p = 0.014, HR 0.47, 95% CI 0.26–0.86). When analysing patients with Dukes stages A and B, nuclear expression of β‐catenin was highly significantly associated with both shorter relapse‐free survival (p < 0.005, HR 5.0, 95% CI 1.6–15.5) and cancer‐specific death (p = 0.036, HR 6.9, 95% CI 1.1–42.1). DNA content in colon adenocarcinomas measured by image cytometry is an independent predictor of prognosis in our patients operated for colon adenocarcinoma.
Clinical evaluation of a new collagen matrix (Mucograft® prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial
Authors: Sanz Mariano , Lorenzo Ramón , Aranda Juan J. , Martin Conchita , Orsini Marco
Published: August 2009

Aim: The aim of this study was to test a new collagen matrix (CM) aimed to increase keratinized gingiva/mucosa when compared with the free connective tissue graft (CTG).

Material and Methods: This randomized longitudinal parallel controlled clinical trial studied 20 patients with at least one location with minimal keratinized tissue (1 mm).

Main Outcome Measure: The 6‐month width of keratinized tissue. As secondary outcomes, the aesthetic outlook, the maintenance of periodontal health and the patient morbidity were assessed pre‐operatively at 1, 3 and 6 months.

Results: At 6 months, the CTG attained a mean width of keratinized tissue of 2.6 (0.9) mm, while the CM was 2.5 (0.9) mm, these differences being insignificant. In both groups, there was a marked contraction (60% and 67%, respectively) although the periodontal parameters were not affected. The CM group had a significantly lower patient morbidity (pain and medication intake) as well as reduced surgery time.

Conclusions: These results prove that this new CM was as effective and predictable as the CTG for attaining a band of keratinized tissue, but its use was associated with a significantly lower patient morbidity.
Association between periodontitis and anti‐cardiolipin antibodies in Buerger disease
Authors: Chen Yi‐Wen , Nagasawa Toshiyuki , Wara‐Aswapati Nawarat , Ushida Yuka , Wang Dongqing , Takeuchi Yasuo , Kobayashi Hiroaki , Umeda Makoto , Inoue Yoshinori , Iwai Takehisa , Ishikawa Isao , Izumi Yuichi
Published: August 2009

Aim: Anti‐cardiolipin (CL) antibodies can be induced in Buerger disease (BD), an inflammatory occlusive disorder affecting peripheral blood vessels, in response to bacteria bearing homology to the TLRVYK peptide of a phospholipid‐binding plasma protein β‐2‐glycoprotein I. TLRVYK homologies are present in Porphyromonas gingivalis (TLRIYT) and Treponema denticola (TLALYK). This study investigated the association between periodontal infection and anti‐CL antibodies in BD patients.

Material and Methods: Periodontal conditions were examined in 19 BD patients and 25 systemically healthy control subjects. All subjects were heavy smokers. Serum anti‐CL, anti‐TLRVYK, anti‐TLRIYT, and anti‐TLALYK antibodies were assessed using the enzyme‐linked immunosorbent assay.

Results: BD patients had a significantly higher prevalence of periodontitis, more severe periodontal destruction and increased titres of serum anti‐CL, anti‐TLRVYK, anti‐TLRIYT, and anti‐TLALYK antibodies compared with healthy subjects. The levels of anti‐CL antibodies positively correlated with those of the three anti‐peptide antibodies. Anti‐CL antibody titres were significantly associated with the percentage of sites with clinical attachment level 4 mm in BD patients.

Conclusion: Elevated anti‐CL antibody levels were associated with periodontal destruction in BD patients. Periodontopathic bacteria may serve as exogenous antigens that stimulate the anti‐CL antibody production through molecular mimicry between the bacterial peptides and a host plasma protein.
Fibro‐osseous pseudotumor of the digit: a clinicopathological study of 17 cases
Authors: Chaudhry Iskander H. , Kazakov Dmitry V. , Michal Michal , Mentzel Thomas , Luzar Boštjan , Calonje Eduardo
Published: August 2009

Fibro‐osseous pseudotumor (FP) of the digit is a rare, non‐neoplastic heterotopic ossifying lesion involving the subcutaneous tissues of the digits. To date, there are only a few published series in the literature. Our study of 17 cases, retrieved from the authors' referral archives, shows that the condition chiefly affects young to middle‐aged adults (median = 34 years), with a slight female predominance and involves the fingers (n = 8) and toes (n = 8). One identical lesion was identified on the forehead (n = 1). Lesional size ranges from 0.8 to 5.6 cm. Treatment was by surgical excision. Histologically, 14 cases show a fairly well‐circumscribed dermal (n = 10) or dermal and subcutaneous (n = 7) lesion with surface ulceration (n = 7). The lesion is composed of fascicles of variably cellular, spindle‐shaped cells [calponin (n = 14) and smooth muscle actin (SMA) (n = 11) positivity], with minimal to mild atypia (n = 5), dispersed in a myxoid stroma, focally reminiscent of nodular fasciitis. At least focal irregular trabeculae with osteoid formation and osteoblastic rimming are seen in all cases. The main differential diagnosis is an extraskeletal osteosarcoma; however, this afflicts an older age group, with prominent cytological atypia and atypical mitoses. Clinical follow‐up (range: 18 months – 14 years, n = 12) reveals evidence of local recurrence in some cases (n = 2), but no evidence of metastases. In conclusion, we report an additional 17 cases of this rare lesion to increase awareness amongst dermatopathologists.

Chaudhry IH, Kazakov DV, Michal M, Mentzel T, Luzar B, Calonje E. Fibro‐osseous pseudotumor of the digit: a clinicopathological study of 17 cases.
Pedunculated cutaneous spindle cell/pleomorphic lipoma
Authors: Gurel Duygu , Kargı Aydanur , Lebe Banu
Published: August 2009

Spindle cell/pleomorphic lipoma is an infrequently seen benign adipose tissue tumor. This tumor, mostly arising from the subcutaneous tissue, usually affects male patients and occurs in back, shoulders, head and neck area. It is rarely localized to dermis. Cutaneous spindle cell/pleomorphic lipoma differs from its subcutaneous counterpart by wider anatomical distribution, female predilection and infiltrative margins. We here present a pedunculated type, cutaneous pleomorphic lipoma case localized to the nasolabial region of 59‐year‐old man.

Gurel D, Kargı A, Lebe B. Pedunculated cutaneous spindle cell/pleomorphic lipoma.
Gene and haplotype polymorphisms of the Prion gene (PRNP) in Japanese Brown, Japanese native and Holstein cattle
Authors: MSALYA George , SHIMOGIRI Takeshi , OKAMOTO Shin , KAWABE Kotaro , MINEZAWA Mitsuru , NAMIKAWA Takao , MAEDA Yoshizane
Published: August 2009

Polymorphisms in the prion protein gene (PRNP) are known to be associated with transmissible spongiform encephalopathies in human, sheep and goats. There is tentative association between PRNP promoter polymorphism and bovine spongiform encephalopathy (BSE) susceptibility in cattle. In this study, we genotyped for six bovine PRNP polymorphic sites including a 23‐bp indel in the promoter, a 12‐bp indel in the intron 1, two nonsynonymous single nucleotide polymorphisms (SNPs), octapeptide repeats in the coding region and a 14‐bp indel in the 3′‐untranslated region in 178 animals representing Japanese Brown, Kuchinoshima feral, Mishima, Japanese Shorthorn and Holstein. In 64 Japanese Brown cattle, three indel sites were polymorphic. All of the six sites were monomorphic in Kuchinoshima. The 23‐bp and 12‐bp indel sites were polymorphic in Mishima cattle. The 23‐bp and 14‐bp indel sites were polymorphic in Japanese Shorthorn cattle. Both SNP sites were monomorphic in all cattle examined in this study. At the 23‐bp indel site, the genotype frequencies of Japanese Brown and Holstein breeds were similar to that of BSE affected cattle. We estimated 12 different haplotypes from these genotypic data. A ‘23‐12‐K6S14+’ haplotype was the major haplotype in all populations, whose frequencies ranged from 0.50 to 1.00.
Metabolic Syndrome and Sexual (Dys)function
Authors: Borges Ricardo , Temido Paulo , Sousa Luís , Azinhais Paulo , Conceição Paulo , Pereira Bruno , Leão Ricardo , Retroz Edson , Brandão Álvaro , Cristo Lídio , Sobral Fernando
Published: August 2009

Introduction

The general worldwide increase in metabolic syndrome (MS) among most populations may result in more individuals with sexual dysfunction.

Aim

To provide an update on clinical and experimental evidence regarding sexual dysfunction in patients with MS from both sexes and treatment modalities.

Methods

A comprehensive literature review was performed using MEDLINE with the MeSH terms and keywords for “metabolic syndrome,”“obesity,”“female sexual dysfunction,”“erectile dysfunction,”“androgen deficiency,”“weight loss,” and “bariatric surgery.”

Main Outcome Measures

To examine the data relating to sexual function in both men and women with MS, its relationship and the impact of treatment.

Results

The MS is strongly correlated with erectile dysfunction, hypogonadism (predictors of future development of MS), and female sexual dysfunction. Few studies have been addressed in the treatment of these dysfunctions in the special setting of MS, other than the observational effects on sexual function of individual risk factors correction. This can be a result of their understudied etiopathogeny. Nonsurgical weight loss has been shown to improve sexual function (with the mainstay on sedentarism prevention), whereas the efficacy of bariatric surgery in this respect, which has been suggested by some preliminary evidence, needs to be further confirmed by adequate clinical trials.

Conclusion

As the global incidence of MS increases, more individuals may experience sexual dysfunction and a systematic evaluation should be emphasized in this patient population, in order to identify those who are in need of intervention.
Impaired Cavernous Reinnervation After Penile Nerve Injury in Rats with Features of the Metabolic Syndrome
Authors: Nangle Matthew R. , Proietto Joseph , Keast Janet R.
Published: August 2009

Introduction

The metabolic syndrome is a cluster of cardiovascular risk factors that predispose toward the development of diseases such as diabetes. Erectile dysfunction (ED) is common in men with metabolic syndrome, but its etiology is poorly understood. Pro-erectile nitrergic nerves innervating penile erectile tissue are also susceptible to mechanical injury during pelvic surgical procedures, which can lead to sexual dysfunction.

Aims

The aims of this article are: (i) to examine erectile function in an experimental model of metabolic syndrome, the phosphoenolpyruvate carboxykinase (PEPCK)-overexpressing rat; and (ii) to study function and cavernous reinnervation after penile nerve crush injury, which permits regeneration, in transgenic rats.

Methods

We analyzed the density of noradrenergic and nitrergic nerves and performed organ bath pharmacology to assess neurogenic activity.

Main Outcome Measures

By analyzing changes in neural structure, function, and pharmacologic responses of cavernous tissue after nerve crush injury, we were able to reveal neurologic deficits in rats with metabolic syndrome.

Results

Animals with features of metabolic syndrome did not develop notable changes in cavernous autonomic nerve density or nerve-evoked smooth muscle activity. However, regeneration of nitrergic nerves after crush injury in transgenic rats was impaired compared with injured controls. This was manifested as a deficit in axon regrowth and responses to axon activation. However, unlike injured controls, injured PEPCK-overexpressing rats did not develop a reduced maximal response to the nitric oxide (NO) donor, sodium nitroprusside. This suggests preserved NO responsiveness in tissues from rats with metabolic syndrome, despite impaired regeneration and return of function.

Conclusions

This study revealed that rats with features of metabolic syndrome display impaired cavernous nerve regeneration after penile nerve injury, but the degree of functional impairment may be attenuated due to reduced plasticity of NO signaling. This reinnervation deficit may be of clinical relevance for understanding why ED persists in some (particularly aged) men after pelvic surgery.
Cell‐free DNA in the Peritoneal Effluent of Peritoneal Dialysis Solutions
Authors: Pajek Jernej , Kveder Radoslav , Guček Andrej , Škoberne Andrej , Bren Andrej , Bučar Maja , Černe Darko , Lukač‐Bajalo Jana
Published: August 2009

The beneficial effects of novel peritoneal dialysis solutions low in glucose degradation products regarding peritoneal cell apoptosis and necrosis are well established in vitro, however in vivo data is lacking. Cell‐free DNA quantification is a possible method to determine cell damage through apoptosis and necrosis in vivo. We performed a prospective, cross‐over study on 26 stable continuous ambulatory peritoneal dialysis (CAPD) patients, treating each patient for 3 months in a randomized order with a conventional, lactate‐buffered, acidic solution (solution D) and a novel, bicarbonate/lactate‐buffered neutral solution (solution P). The timed overnight peritoneal effluent was sampled for cell‐free DNA quantification using a fluorometric assay. The effluent samples of eighteen patients were finally available for DNA quantification. The concentration range of cell‐free DNA in the peritoneal effluents was 1.8–9.5 µg/L. The coefficient of intrapatient variation in overnight effluent cell‐free DNA appearance was 15.6 ± 12.4%. Cell‐free DNA peritoneal appearance using solutions D and P was 14.9 ± 6.8 µg and 11.8 ± 3.4 µg, respectively (P = 0.02), with the average difference of 3.1 µg (95% CI, 0.7–5.6 µg). Our results show that cell‐free DNA is present in the overnight peritoneal effluent of stable CAPD patients. A significant decrease in the cell‐free DNA appearance with solution P was found; however, before accepting this as an indicator of a more biocompatible profile causing less peritoneal membrane cell necrosis and apoptosis, confirmatory data on larger patient samples are needed. Our results indicate the potential future role of cell‐free DNA in the diagnosis and prognosis of therapy‐related peritoneal membrane degeneration.