bluuebunny/crossref_metadata_2025 huggingface dataset:
Skin Blood Flow in the Upper and Lower Extremities of Diabetic Patients with and without Autonomic Neuropathy
Authors: Urbancic-Rovan V. , Stefanovska A. , Bernjak A. , Ažman-Juvan K. , Kocijančič A.
Published: November 2004

Background: Microvascular blood flow in the human skin is subject to rhythmic variations reflecting the influence of heartbeat, respiration, intrinsic myogenic activity, neurogenic factors and endothelial activity. The aim of our study was to test the hypothesis that basal skin blood flow (BSBF) and its dynamic components differ (1) among diabetic patients without autonomic neuropathy and with it and healthy control subjects, and (2) among the upper and lower extremities. Patients and Methods: BSBF at four recording sites with predominantly nutritive capillary circulation (right and left caput ulnae, right and left medial malleolus) was measured by laser Doppler flowmetry in 25 diabetic patients without cardiovascular autonomic neuropathy (D), 18 neuropathic diabetic patients (DAN) and 36 healthy controls (C). Wavelet transform was applied to the laser Doppler signal. Results: In absolute terms, mean flow, mean amplitude of the total spectrum and mean amplitudes at all frequency intervals were highest in C, followed by DAN and lowest in D. However, these differences were statistically significant only in the left arm. Within all three groups, mean flow and spectral amplitudes were significantly higher in the arms than in the legs, besides there was a significant difference between the two arms in D. Conclusion: We have confirmed the differences in BSBF among D, DAN and C, and demonstrated differences among the four recording sites which have not been previously described. The latter indicates an uneven progression of autonomic neuropathy and allows for speculation that the left arm is the latest to be affected.
Implementation of the ACC/AHA Guidelines for Preoperative Cardiac Risk Assessment in a General Medicine Preoperative Clinic: Improving Efficiency and Preserving Outcomes
Authors: Almanaseer Yassar , Mukherjee Debabrata , Kline-Rogers Eva M. , Kesterson Sean K. , Sonnad Seema S. , Rogers Bruce , Smith Dean , Furney Scott , Ernst Robert , McCort Jane , Eagle Kim A.
Published: November 2004

Background: The American College of Cardiology/American Heart Association (ACC/AHA) publishes recommendations for cardiac assessment of patients undergoing noncardiac surgery with the intent of promoting evidence-based, efficient preoperative screening and management. We sought to study the impact of guideline implementation for cardiac risk assessment in a general internal medicine preoperative clinic. Methods: The study was an observational cohort study of consecutive patients being evaluated in an outpatient preoperative evaluation clinic before and after implementation of the ACC/AHA guideline. Data was gathered by retrospective abstraction of hospital and clinic charts using standard definitions. 299 patients were reviewed prior to guideline implementation and their care compared to 339 consecutive patients after the guideline was implemented in the clinic. Results: Guideline implementation led to a reduction in exercise stress testing (30.8% before, 16.2% after; p < 0.001) and hospital length of stay (6.5 days before, 5.6 days after; p = 0.055). β-Blocker therapy increased after the intervention (15.7% before; 34.5% after; p < 0.001) and preoperative test appropriateness improved (86% before to 94.1% after; p < 0.001). Conclusions: Implementation of the ACC/AHA guidelines for cardiac risk assessment prior to noncardiac surgery in an internal medicine preoperative assessment clinic led to a more appropriate use of preoperative stress testing and β-blocker therapy while preserving a low rate of cardiac complications.
Electrocardiographic Pattern as a Guide for Management and Radiofrequency Ablation of Idiopathic Ventricular Tachycardia
Authors: Tanner Hildegard , Wolber Thomas , Schwick Nicola , Fuhrer Juerg , Delacretaz Etienne
Published: November 2004

Background: Idiopathic ventricular tachycardia (VT) often originates from the right ventricular outflow tract (RVOT), but foci deep to the endocardium, in the epicardium, or in the left ventricle are not uncommon. Although these extra-RVOT foci can be targeted with ablation, risks involved are higher and success rates lower. Simple electrocardiographic (ECG) criteria allowing (1) discrimination of RVOT foci from extra-RVOT foci and (2) assessment of the chance of success of a right heart ablation procedure are desirable. Methods: Twenty-five consecutive patients referred for radiofrequency (RF) ablation of idiopathic VT or severely symptomatic idiopathic ventricular premature contractions were included. Localization of VT origin and success rates of VT ablation in the RVOT were analyzed according to the ECG pattern. Results: The analysis of the R wave in V2 was the strongest single predictor of whether the VT had an RVOT or an extra-RVOT origin. An R wave amplitude ≤30% of the QRS amplitude designated the VT focus in the RVOT with positive and negative predictive values of 95 and 100%, respectively. Analysis of R wave duration in V2 had similar predictive values, whereas the R/S transition zone in precordial leads had slightly lower predictive values. Seventeen of 20 arrhythmias (85%) with an R wave amplitude ≤30% of the QRS amplitude in V2 could be successfully abolished by an exclusively right heart procedure. Conclusions: The analysis of ECG pattern makes it possible to guide the management of patients with idiopathic VT in predicting the arrhythmias that can be safely targeted with RF ablation from the RVOT with high success rates.
Predictors of Cardiovascular Death in Patients with a Left Ventricular Restrictive Filling Pattern of the Mitral Inflow
Authors: Boccalandro Fernando , Loghin Catalin , Seung-Ho Kang , Barasch Eddy
Published: November 2004

The survival, clinical and echocardiographic variables and the predictors of cardiovascular death were determined for a group of 168 patients (mean age 63 ± 13 years; 65 females; mean left ventricular ejection fraction 32 ± 10%) with restrictive filling of the left ventricle and depressed systolic function after a mean follow-up period of 2.7 ± 1 years. Shorter deceleration time (DT) of the mitral inflow was the only variable significantly different between survivors and nonsurvivors (p < 0.05) and the only predictor of death found by multivariate logistic regression analysis (odds ratio 2.2, 95% confidence interval 1.7–3.6). In this patient population, a DT of the early wave of the mitral inflow <140 ms identified the patients with the highest risk of cardiac death. DT is a practical echocardiographic parameter for risk stratification of patients with significant left ventricular systolic dysfunction and restrictive filling of the left ventricle.
Expression of Th1/Th2-Related Chemokine Receptors on Peripheral T Cells and Correlation with Clinical Disease Activity in Patients with Multiple Sclerosis
Authors: Nakajima Hideto , Fukuda Kazuhiro , Doi Yoshimitsu , Sugino Masakazu , Kimura Fumiharu , Hanafusa Toshiaki , Ikemoto Toshiyuki , Shimizu Akira
Published: November 2004

Th1 cells play an important role in the pathogenesis of multiple sclerosis (MS), a disease likely linked to an autoimmune process. We measured the levels of chemokines in serum or cerebrospinal fluid (CSF) samples by ELISA, and also studied the expression of Th1-related CXCR3/CCR5 chemokine receptors and Th2-related CCR4/CCR3 chemokine receptors on blood cells from MS patients using three-color flow cytometry. The Bonferroni correction was used for the statistical analysis. The levels of CXCL10, CCL3, and CCL5 in the CSF samples for the MS groups were significantly higher than those for the control group. However, the levels of CCL2 in both the CSF and serum samples for the remission group were significantly higher than those for the active group. The percentage of CXCR3-expressing CD4+ T cells in patients with MS was significantly elevated compared with the healthy controls. Moreover, MS patients in an active phase showed a more increased CD4+CXCR3+/CD4+CCR4+ ratio than patients in a remission phase. The increased percentage of CD4+CXCR3+ cells in the blood was associated with relapses in MS. This study suggested that the CD4+CXCR3+/CD4+CCR4+ ratio could be a sensitive maker of immune dysfunction in MS.
Some Neurological Aspects of Laughter
Authors: Pearce J.M.S.
Published: November 2004

This brief survey of laughter attempts an analysis of its neurological mechanisms, evolution, role in social behaviour and its clinicopathological importance. The mechanisms of laughter, its physiological consequences and its demonstration by sound spectrography are considered. Something resembling laughter occurs in certain primates, and possibly rodents, though there are important differences. The evolution of laughter in a social context is appraised. Pathological laughter arises rarely, usually caused by diseases of the frontal or temporal lobes, and in hypothalamic hamartomata in children.
A Note on Gelastic Epilepsy
Authors: Pearce J.M.S.
Published: November 2004

Laughter epilepsy or gelastic seizures have been described in various epilepsies arising from the temporal or frontal lobes, but most commonly from hypothalamic hamartomata. Gelastic seizures also arise from temporal and frontal lobe tumours and atrophic lesions. The essential clinical features are: stereotyped recurrence; absence of external precipitants; concomitance of other manifestations generally accepted as epileptic; presence of interictal or interictal EEG epileptiform discharges, and absence of conditions in which pathological laughter might occur. The history and clinical significance are discussed.
Effect of Granulocyte and Monocyte Adsorption Apheresis on Urinary Albumin Excretion and Plasma Endothelin-1 Concentration in Patients with Active Ulcerative Colitis
Authors: Nakamura Tsukasa , Kawagoe Yasuhiko , Matsuda Takaharu , Ueda Akiko , Ueda Yoshihiko , Takahashi Yutaka , Tanaka Araki , Koide Hikaru
Published: November 2004

Background/Aim: Increases in microalbuminuria and endothelin (ET-1) are involved in the development of ulcerative colitis (UC) and in its progress. Because granulocyte and monocyte adsorption apheresis has proven to be useful in the treatment of UC, we examined whether urinary albumin excretion and plasma ET-1 concentrations are altered and whether granulocyte and monocyte adsorption apheresis affects the concentrations of these two factors in patients with active UC. Methods: Twenty patients with active UC and 20 age-matched healthy volunteers (our hospital staffs) were included in this study. UC patients were randomly divided into two treatment groups: a granulocyte and monocyte adsorption treatment group (n = 10) and a conventional treatment group (n = 10). The urine albumin/creatinine ratio, plasma ET-1 concentration and tumor necrosis factor (TNF)-α were determined before and after treatment and compared between 2 treatment groups. The 10 adsorption treatment patients underwent 5 consecutive weekly apheresis sessions, each of 60 min duration at a flow rate of 30 ml/min. Results: The urine albumin/creatinine ratio in UC patients (6.4 ± 2.2 mg/mmol) were higher than that in healthy subjects (1.0 ± 0.7 mg/mmol, p < 0.01). In addition, the plasma ET-1 level in UC patients (3.5 ±1.5 pg/ml) was higher than that in healthy subjects (0.8 ± 0.4 pg/ml, p < 0.01). Plasma TNF-α was detected in UC patients (18.8 ± 8.4 pg/ml), but not in healthy subjects. The urine albumin/creatinine ratio was highly correlated with the plasma ET-1 level (r = 0.62; p < 0.01) and plasma TNF-a level (r = 0.66, p < 0.01). Granulocyte and monocyte adsorption apheresis reduced the urine albumin/ creatinine ratio from 6.6 ± 2.4 to 1.8 ± 0.6 mg/mmol (p < 0.01), reduced the plasma ET-1 level from 3.7 ± 1.6 to 1.4 ± 0.6 pg/ml (p < 0.05) and reduced the plasma TNF-α from 19.2 ± 8.6 to 3.8 ± 1.2 pg/ml (p < 0.01). Conventional treatment did not affect these factors. Conclusion: Our data suggest that increases in the urine albumin/creatinine ratio, ET-1 and TNF-α play an important role in active UC and that granulocyte and monocyte adsorption apheresis is effective in ameliorating such increases.
Insulin-Like Growth Factor Attenuates Apoptosis and Mucosal Damage in Hypoxia/Reoxygenation-Induced Intestinal Injury
Authors: Ozen Samim , Akisu Mete , Baka Meral , Yalaz Mehmet , Sozmen Eser Yildirim , Berdeli Afig , Kultursay Nilgun
Published: November 2004

Objective: Necrotizing enterocolitis (NEC) is a potentially lethal disease among premature infants. The aim of the present study was to investigate whether hypoxia-reoxygenation (H/R)-induced intestinal injury was due to increased apoptosis of the intestinal mucosa in young mice and whether pre-treatment of the animals with recombinant human insulin-like growth factor-I (IGF-I), a known anti-apoptotic factor, could protect the intestinal cells from H/R-induced apoptosis or intestinal injury. Study Design: Young mice were divided into three groups: group 1 mice (H/R) were hypoxia-reoxygenation; group 2 mice (H/R + IGF-I) were treated with recombinant human IGF-I by intraperitoneal injection (1 µg/g b.w. once daily) for 7 days, and group 3 mice served as control. Hypoxia was induced by placing young mice in a Plexiglas chamber consisting of 10% oxygen for 60 min. After hypoxia, the young mice were reoxygenated for 10 min with 100% oxygen. Intestinal generation of substances reactive to thiobarbituric acid (TBARS) and active caspase-3 were measured in H/R-induced intestinal injury. Results: Increased numbers of apoptotic cells (apoptotic index) across the villi in young mice subjected to H/R were observed with the TUNEL reaction whereas few apoptotic cells existed in the control animals. In addition, H/R-induced intestinal damage in the H/R + IGF-I group was greatly attenuated, with necrosis limited partially to the mucosa. Tissue-active caspase-3 levels in the H/R group were found to be significantly higher when compared with that of the H/R + IGF-I group of mice and control. However, TBARS concentrations in the intestine were similar in H/R groups when compared to the intestine of control animals. Conclusion: The present study suggests that both necrosis and apoptosis, via mechanisms occurring due to oxygen-derived free radicals and activation of caspase-3, play a role in the pathogenesis of H/R-induced bowel injury. We also show that IGF-I protect intestinal mucosa from necrosis and apoptosis from intestinal H/R injury.
Risk Factors for Stroke among Urbanised Indonesian Women of Reproductive Age: A Hospital-Based Case-Control Study
Authors: Kisjanto J. , Bonneux L. , Prihartono J. , Ranakusuma T.A.S. , Grobbee D.E.
Published: November 2004

Background: Stroke is a major cause of death in South-East Asia, but few empirical data exist on its risks in Asian populations. Methods: 235 cases and 682 age-matched controls of women of reproductive age (20–44 years) were recruited in 14 hospitals in Jakarta, Indonesia, between 1989 and 1993. Medical history was collected by a structured interview. In subsamples, glucosuria, serum cholesterol level and body mass index (BMI) were assessed. Results: In these young and lean Muslim women, with few users of tobacco, alcohol or oral contraceptives, risk factors related to increased weight were strongly related to stroke occurrence. A history of hypertension or diabetes or increased serum cholesterol level showed odds ratios (ORs) of 13.9, 7.4 and 3.7, respectively. A BMI >27 (unadjusted for its potential consequences) caused an OR of 2.9. High social class and higher level of education (both OR 0.7) were associated with a lower risk of stroke, but levels of risk factors were higher in higher socio-economic classes. Conclusion: The expected transition in lifestyle, characterised by a higher intake of calories and less physical activity, will increase stroke risks in Indonesian women. Increasing wealth should go together with raising levels of health education on nutrition and physical activity.
Semi-Intensive Monitoring in Acute Stroke and Long-Term Outcome
Authors: Silva Yolanda , Puigdemont Montserrat , Castellanos Mar , Serena Joaquín , Suñer Rosa M. , García María M. , Dávalos Antoni
Published: November 2004

Background and Purpose: Factors that determine the benefit of stroke units (SU) are unknown. The aim of our study was to analyze whether semi-intensive monitoring during the acute phase of stroke reduces mortality and dependency at long term. Methods: We studied patients with an ischemic stroke or intracerebral hemorrhage, consecutively admitted to our SU within 24 h of symptoms onset. Based on bed availability, patients were allocated to either a conventional care stroke unit (C-SU, n = 209) or a semi-intensive stroke unit (SI-SU, n = 321) with continuous monitoring of cardiac, respiratory, metabolic and neurological functions during the first 72 h. Both groups were treated following the same medical and nursing protocols. Criteria for exclusion were patients with stupor/coma, previously dependent (Barthel score <85) and with TIA. Using logistic regression models, we analyzed the influence of semi-intensive care on mortality and dependency at one year. Results: Baseline characteristics were similar between patients admitted to the SI-SU and the C-SU, except for a higher frequency of more severe stroke and intracerebral hemorrhage in the SI-SU. Twenty-six percent of patients in the SI-SU and 4% in the C-SU were randomized in acute clinical trials (p < 0.01), and 61% and 39% were seen by a neurologist in less than 6 h from the onset of symptoms (p < 0.01). At 1 year, mortality and combined mortality and dependency were not significantly different between the two groups. However, due to the presence of a significant interaction between the type of unit and stroke severity, the OR of mortality for SI-SU allocation was 0.19 (95% CI, 0.07–0.54) in patients with severe stroke (CSS ≤4), whereas it was 0.64 (95% CI, 0.37–1.11) in those with mild-to-moderate stroke. Conclusions: This study suggests that semi-intensive monitoring in a stroke unit reduces mortality at 1 year in patients with severe stroke, with no influence over dependency.
Delirium in Acute Subarachnoid Haemorrhage
Authors: Caeiro Lara , Menger Coraline , Ferro José M. , Albuquerque Rodolfo , Figueira M. Luísa
Published: November 2004

Background: Delirium may be a presenting feature in acute subarachnoid haemorrhage (SAH). The aim of this study was to investigate the risk factors for delirium in acute SAH and to analyse the relation between delirium and location and amount of haematic densities and hydrocephalus. Methods: We assessed delirium in a sample of 68 consecutive patients with acute (≤4 days) SAH (33 aneurysmal, 33 non-aneurysmal, including 9 with perimesencephalic haemorrhage), before aneurysmal treatment, using DSM-IV-R criteria and the Delirium Rating Scale (DRS). DRS scores were related to: (1) the total amount of haematic densities at 10 basal cisterns/fissures and in the 4 ventricles, using a validated rating scale, (2) the haematic densities in the prepontine cistern and the convexity of the brain and (3) hydrocephalus, using the bicaudate index, obtained from a review of admission CT scans. Results: Eleven acute SAH patients presented with delirium. Older age (U = 316.5, p = 0.04), alertness disturbance (χ2 = 5.1, p = 0.02, OR = 7.6, 95% CI = 1.5–37.3), aphasia (U = 61.5, p = 0.007) and a Hunt and Hess score >2 (U = 362.5, p = 0.02) were associated with delirium. Higher amounts of intraventricular haematic densities (χ2 = 4.43, p = 0.04, U = 158, p = 0.001) and hydrocephalus (U = 215, p = 0.009) were also associated with higher DRS scores. Two delirious patients had basofrontal haematomas. Conclusions: Delirium was detected in 16% of acute SAH patients. Intraventricular bleeding, hydrocephalus and basofrontal haematomas contribute to the pathogenesis of delirium, through damage to anatomical networks subserving sustained attention, declarative memory and the expression of emotional behaviour.
Trends in Surgical and Management Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage in Izumo City, Japan, between 1980–1989 and 1990–1998
Authors: Inagawa Tetsuji
Published: November 2004

Background and Purpose: The purpose of this community-based study was to evaluate temporal changes in surgical and management outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH). Methods: The subjects were 358 patients with aneurysmal SAH who were treated during the 19-year period from 1980 to 1998 in Izumo City, Japan. We compared data during the 9-year period 1990–1998 (period B; 188 patients) with those during the 10-year period 1980–1989 (period A; 170 patients). Results: The proportion of patients 80 years of age or older or those with World Federation of Neurosurgical Societies grade V increased significantly (period A, 5 and 25%; period B, 18 and 35%, respectively). The operability rate did not change for patients 69 years of age or younger, whereas it increased significantly for those 70–79 years of age (period A, 48%; period B, 72%). The 6-month and 2-year case fatality rates in surgically treated patients decreased significantly (period A, 12 and 20%; period B, 2 and 8%, respectively), whereas they were virtually unchanged for overall management (period A, 41 and 46%; period B, 38 and 42%, respectively). In patients who underwent surgery, the incidence of permanent symptomatic vasospasm decreased from 21% during period A to 11% during period B, and there was no death from vasospasm in the later period. However, no significant difference was found in the functional outcome between the two periods, regardless of whether surgery was performed. The most important determinants of 6-month and 2-year survival rates were grade on admission, rebleeding and the site of the ruptured aneurysms. Age was also a significant predictor of the 6-month case fatality rate. Conclusions: For patients with SAH who underwent surgery, there were trends towards decreases in the case fatality rate and in the incidence of permanent symptomatic vasospasm. Nevertheless, the overall management outcome was still unsatisfactory, mainly because of increasing numbers of very elderly and/or high-risk patients.
Uniform Potent Activity of the Antiproliferative Metal Chelate Trans-Bis(resorcylaldoximato)copper(II) against a Large Panel of Human Tumor Cell Lines in vitro
Authors: Elo Hannu
Published: November 2004

Background: The copper chelate trans-bis(salicylaldoximato)copper(II), CuSAO2, is a powerful antitumor agent in vivo, being capable of drastically increasing the life span of mice bearing Ehrlich ascites carcinoma, and has in many cases even a curative effect. This compound as well as some congeners, most notably the 4-hydroxylated analogue trans-bis(resorcylaldoximato)copper(II), CuRES2, also have potent antiproliferative activity against tumor cells in vitro. Methods: CuRES2 was tested in vitro against a panel of 37 different types of human tumor cells (leukemias, small cell and non-small cell lung tumors, melanomas, as well as colon, breast, central nervous system, ovarian and renal tumors). The cells were incubated on microculture plates for 6 days, and the amount of viable cells was determined with the agent XTT, whose metabolic reduction gives a colored formazan compound. Results: CuRES2 inhibited the proliferation of all the 37 cell lines studied. The IC50 values ranged between 0.575 and 8.57 µg/ml and the IC90 values between 1.74 and 20.6 µg/ml. Thus, it had distinct and very potent activity against all the cell lines studied, and the differences between the susceptibilities of different tumor types and cell lines were not very large. Discussion: Clearly, CuRES2 is active against all the tumor cell lines studied. None of the cell lines (tumor types) demonstrates a significantly higher or lower susceptibility, but some trends appear to exist. Thus, most (but not all) of the leukemia and melanoma cell lines, the two ovarian cancer lines and one small cell lung cancer and one CNS cancer cell line were somewhat more susceptible than the cell lines on average. The results obtained for the melanomas are of special interest, since CuRES2 (and even more so CuSAO2) have very low aqueous solubilities. In cutaneous melanomas, their administration might, however, be very easy, since both compounds are soluble in dimethyl sulfoxide and could thus easily be administered topically in this solvent whose ability to be absorbed through the skin is well known. Conclusion: The present results on human tumor cell lines are in line with previous observations that CuSAO2 and CuRES2 essentially totally inhibit the proliferation of leukemia L1210 and Ehrlich ascites carcinoma cells in vitro in a concentration as low as ∼5 µg/ml.
Vancomycin Tolerance in Enterococci
Authors: Saribas Suat , Bagdatli Yasar
Published: November 2004

Background: Tolerance can be defined as the ability of bacteria to grow in the presence of high concentrations of bactericide antimicrobics, so that the killing action of the drug is avoided but the minimal inhibitory concentration (MIC) remains the same. We investigated vancomycin tolerance in the Enterococcus faecium and Enterococcus faecalis strains isolated from different clinical specimens. Methods: Vancomycin was obtained from Sigma Chemical Co. We studied 100 enterococci strains. Fifty-six and 44 of Enterococcus strains were idendified as E. feacalis and E. faecium, respectively. To determine MICs and minimal bactericidal concentration (MBC), we inoculated strains from an overnight agar culture to Müller-Hinton broth and incubated them for 4–6 h at 37°C with shaking to obtain a logarithmic phase culture. The inoculum was controlled by performing a colony count for each test. We determined MBC values and MBC/MIC ratios to study tolerance to vancomycin. Vancomycin tolerance was defined as a high MBC value and an MBC/MIC ratio ≧32. Results: Fifty-six and 44 of the Enterococcus strains were identified as E. faecium and E. faecalis, respectively. Thirty-one E. faecium and 48 E. faecalis were found to be susceptible to vancomycin and these susceptible strains were included in this study. The MICs of susceptible strains ranged from ≤1 to 4 mg/l, the MBCs were ≧512 mg/l. Tolerance was detected in all E. faecalis and E. faecium strains. The standard E. faecalis 21913 strain also exhibited tolerance according to the high MBC value and the MBC/MIC ratio. We defined the tolerant strains as having no bactericidal effect and MBC/MIC ≧32. We found that a 100% tolerance was present in susceptible strains. Conclusions: One of the hypotheses for tolerance is that tolerant cells fail to mobilize or create the autolysins needed for enlargement and division. Our data suggests that tolerance may compromise glycopeptide therapy of serious enterococci infections. To add an aminoglycoside to the glycopeptide therapy unless MBCs are unavailable can be useful in the effective treatment of serious Enterococcus infections.
Excessive Tumor Necrosis Factor Activation After Infarction Contributes to Susceptibility of Myocardial Rupture and Left Ventricular Dysfunction
Authors: Sun Mei , Dawood Fayez , Wen Wen-Hu , Chen Manyin , Dixon Ian , Kirshenbaum Lorrie A. , Liu Peter P.
Published: November 2004

Background—

We investigated the potential contributions of tumor necrosis factor-α (TNF-α) on the incidence of acute myocardial rupture and subsequent chronic cardiac dysfunction after myocardial infarction (MI) in TNF knockout (TNF
−/−
) mice compared with C57/BL wild-type (WT) mice.

Methods and Results—

Animals were randomized to left anterior descending ligation or sham operation and killed on days 3, 7, 14, and 28. We monitored cardiac rupture rate, cardiac function, inflammatory response, collagen degradation, and net collagen formation. We found the following: (1) within 1 week after MI, 53.3% (n=120) of WT mice died of cardiac rupture, in contrast to 2.5% (n=80) of TNF
−/−
mice; (2) inflammatory cell infiltration and cytokine expression were significantly higher in the infarct zone in WT than TNF
−/−
mice on day 3; (3) matrix metalloproteinase-9 and -2 activity in the infarcted myocardium was significantly higher in WT than in TNF
−/−
mice on day 3; (4) on day 28 after MI compared with sham, there was a significant decrease in LV developed pressure (74%) and ±dP/dt
max
(68.3%/65.3%) in WT mice but a less significant decrease in ±dP/dt
max
(25.8%/28.8%) in TNF
−/−
mice; (5) cardiac collagen volume fraction was lower in WT than in TNF
−/−
mice on days 3 and 7 but higher on day 28 compared with TNF
−/−
mice; and (6) a reduction in myocyte apoptosis in TNF
−/−
mice occurred on day 28 compared with WT mice.

Conclusions—

Elevated local TNF-α in the infarcted myocardium contributes to acute myocardial rupture and chronic left ventricle dysfunction by inducing exuberant local inflammatory response, matrix and collagen degradation, increased matrix metalloproteinase activity, and apoptosis.
Sympathetic Nerve Activity in Response to Hypotensive Stress in the Postural Tachycardia Syndrome
Authors: Bonyhay Istvan , Freeman Roy
Published: November 2004

Background—

Increased central sympathetic activity and/or deficient peripheral sympathetic nerve function are among the proposed pathophysiological changes in patients with the postural tachycardia syndrome (POTS). Little is known about sympathetic nerve outflow and its role in hemodynamic control in this disorder.

Methods and Results—

We recorded peroneal muscle sympathetic nerve activity in 9 POTS patients and 9 control subjects at rest and during a nitroprusside-induced hypotensive stimulus. Baseline blood pressure (BP) and heart rate were significantly higher in POTS patients than in controls. At rest, the burst frequency was similar in POTS patients and controls (18.1±6.2 and 20.1±7.9 bursts/min, respectively;
P
=NS), whereas the burst incidence was significantly lower (23.1±6.8 versus 32.2±11.4 bursts/100 heartbeats,
P
<0.05). Nitroprusside increased sympathetic outflow significantly more in POTS patients than in controls despite a similar BP decrease (burst frequency 20.4±7.5 versus 12.1±4.1 bursts/min,
P
=0.008, and burst incidence 21.8±8.4 versus 14.4±5.2 bursts/100 heartbeats,
P
=0.03). The change in mean burst area, a measure of the number of actively firing sympathetic neurons, was similar in patients and controls (117±15% versus 114±21%,
P
=NS).

Conclusions—

At rest, the tachycardia and normal burst frequency result in normal or even elevated BP in POTS patients. During a hypotensive stimulus, cardiovascular homeostasis is maintained by the increased sympathetic outflow and normal heart rate response despite the lack of concomitant increase in mean burst area that is most likely due to sympathetic denervation.
Differentiation of Intraplaque Versus Juxtaluminal Hemorrhage/Thrombus in Advanced Human Carotid Atherosclerotic Lesions by In Vivo Magnetic Resonance Imaging
Authors: Kampschulte A. , Ferguson M.S. , Kerwin W.S. , Polissar Nayak L. , Chu B. , Saam T. , Hatsukami T.S. , Yuan C.
Published: November 2004

Background—

Intraplaque hemorrhage and juxtaluminal hemorrhage/thrombus may differ in cause and clinical implications. This study tested the hypothesis that MRI can distinguish between intraplaque hemorrhage and juxtaluminal hemorrhage/thrombus and investigated the association between hemorrhage and underlying lesion types.

Methods and Results—

Twenty-six patients scheduled for carotid endarterectomy were imaged with a 1.5-T GE scanner by a multicontrast-weighted MRI technique. Hemorrhages were identified with previously established MRI criteria, and differentiations were made between intraplaque and juxtaluminal hemorrhage/thrombus. Corresponding histology was used to confirm the magnetic resonance findings. Tissues underlying areas of hemorrhage/thrombus were histologically categorized according to modified American Heart Association criteria. Of 190 matched sections, 140 contained areas of hemorrhage by histology, of which MRI correctly detected 134. The sensitivity and specificity for MRI to correctly identify cross sections that contained hemorrhage were 96% and 82%, respectively. Furthermore, MRI was able to distinguish juxtaluminal hemorrhage/thrombus from intraplaque hemorrhage with an accuracy of 96%. The distribution of lesion types underlying hemorrhages differed significantly (
P
=0.004). Intraplaque hemorrhage had an underlying lipid-rich type IV/V lesion in 55% of histological sections, whereas juxtaluminal hemorrhage/thrombus had an underlying calcified lesion type VII in 70% of sections.

Conclusions—

In vivo high-resolution MRI can detect and differentiate intraplaque hemorrhage from juxtaluminal hemorrhage/thrombus with good accuracy. The association of hemorrhage and lesion types suggests potential differences in origin. Noninvasive MRI therefore provides a possible tool for prospectively studying differences in origin of plaque hemorrhage and the association of plaque progression and instability.
Right Ventricular Enlargement on Chest Computed Tomography
Authors: Schoepf U. Joseph , Kucher Nils , Kipfmueller Florian , Quiroz Rene , Costello Philip , Goldhaber Samuel Z.
Published: November 2004

Background—

In patients with acute pulmonary embolism (PE), rapid and accurate risk assessment is paramount in selecting the appropriate treatment strategy. Right ventricular (RV) enlargement on chest CT has previously been shown to correlate with an unstable hospital course, but its role as a predictor of death is unknown.

Methods and Results—

We evaluated 431 consecutive patients (mean age, 59±16 years; 55% women) with acute PE confirmed by multidetector-row chest CT. With the use of multiplanar reformats of axial CT data, CT 4-chamber (4-CH) views were reconstructed and right and left ventricular dimensions (RV
D
, LV
D
) were measured. RV enlargement, defined as RV
D
/LV
D
>0.9, was present in 276 (64.0%; 95% CI, 59.5% to 68.6%) patients. Thirty-day mortality rate was 15.6% (95% CI, 11.3% to 19.9%) in patients with and 7.7% (95% CI, 3.5% to 12.0%) without RV enlargement (log rank,
P
=0.018). The hazard ratio of RV
D
/LV
D
>0.9 for predicting 30-day death was 3.36 (95% CI, 1.13 to 9.97;
P
=0.029). On multivariable analysis, RV enlargement predicted 30-day death (hazard ratio, 5.17; 95% CI, 1.63 to 16.35;
P
=0.005) after adjusting for pneumonia (hazard ratio, 2.95; 95% CI, 1.19 to 3.83;
P
=0.002), cancer (hazard ratio, 2.13; 95% CI, 1.19 to 3.83;
P
=0.011), chronic lung disease (hazard ratio, 2.00; 95% CI, 1.04 to 3.86;
P
=0.039), and age (hazard ratio, 1.03; 95% CI, 1.01 to 1.05;
P
=0.005).

Conclusions—

In patients with acute PE, RV enlargement on reconstructed CT 4-CH view helps predict early death.
Left Atrial Tachycardia Originating From the Mitral Annulus–Aorta Junction
Authors: Gonzalez Mario D. , Contreras Leonardo J. , Jongbloed Monique R.M. , Rivera Jaime , Donahue Timothy P. , Curtis Anne B. , Bailey Michael S. , Conti Jamie B. , Fishman Glenn I. , Schalij Martin J. , Gittenberger–de Groot Adriana C.
Published: November 2004

Background—

At the mitral annulus–aorta (MA-Ao) junction, the left atrium is continuous through the subaortic curtain with the musculature of the anterior mitral leaflet. Under experimental conditions, this region can generate abnormal electrical activity. In patients with left atrial tachycardia, we investigated whether this region could be the source of this arrhythmia.

Methods and Results—

In 10 (28%) of 35 consecutive patients with left atrial tachycardia, the arrhythmia originated from the MA-Ao junction. Sustained, self-limited episodes of atrial tachycardia (cycle length, 340±56 ms; duration, 125±69 seconds) were repeatedly induced. Prematurity of the extrastimulus and time to first atrial tachycardia complex were directly correlated (
R
=0.66;
P
<0.001). During tachycardia, bipolar electrograms at the earliest site preceded onset of the P wave by 44±14 ms and were of longer duration and lower amplitude than those recorded from nearby left atrial sites (52±8 versus 24±4 ms,
P
<0.001; and 0.53±0.08 versus 3.45±0.96 mV, respectively;
P
<0.001). Ablation eliminated the tachycardia with no recurrence after a mean follow-up of 24±19 months. A comparative study in mouse embryos demonstrated the presence of the developing specialized conduction system in the MA-Ao region starting at embryonic age 11.5.

Conclusions—

The MA-Ao junction can be a frequent source of left atrial tachycardia. This previously unrecognized site of origin may explain why catheter ablation has been less successful in eliminating left versus right atrial tachycardias. Remnants of the developing specialized conduction system could be the underlying substrate of this arrhythmia.
Restitution Properties During Ventricular Fibrillation in the In Situ Swine Heart
Authors: Huang Jian , Zhou Xiaohong , Smith William M. , Ideker Raymond E.
Published: November 2004

Background—

Although restitution has been hypothesized to determine action potential duration (APD) during ventricular fibrillation (VF), cardiac memory may also be important.

Methods and Results—

Transmembrane recordings were made with a floating microelectrode from the anterior right ventricular wall in 6 pigs during up to 60 seconds of VF. The recordings were divided into 5-second intervals, and APD
60
and the diastolic interval (DI) were calculated for each activation cycle throughout each interval. Stepwise linear regression was used to determine how well each APD
60
[APD
60
(n)] was predicted by the 4 previous DIs (n−1, n−2, n−3, n−4) and the 3 previous APD
60
s (n−1, n−2, n−3). A mean±SD of 3±1.5 of the variables entered the regression equation. DI(n−1) (70% of intervals) and APD
60
(n−1) (71% of intervals) appeared most frequently in the regression equations and were the first or second variables entered during the stepwise regression in 87% and 76% of the intervals in which they were present, respectively. The coefficients of DI(n−1) and APD
60
(n−1) were positive 89% and 98% of the time, respectively.
R
2
of the regression for all entered variables during all intervals was 0.39±0.05.

Conclusions—

The high incidence and positive coefficient of DI(n−1) indicate that restitution is important in determining APD during VF, whereas the similarly high incidence and positive coefficient of APD(n−1) indicate that cardiac memory is equally important. The finding that the regression equation accounts for only 39% of the variability of APD indicates that factors other than restitution and memory are also important in determining APD during VF.
Stromal Cell–Derived Factor-1α Plays a Critical Role in Stem Cell Recruitment to the Heart After Myocardial Infarction but Is Not Sufficient to Induce Homing in the Absence of Injury
Authors: Abbott J. Dawn , Huang Yan , Liu Dingang , Hickey Reed , Krause Diane S. , Giordano Frank J.
Published: November 2004

Background—

After myocardial infarction (MI), bone marrow–derived cells (BMDCs) are found within the myocardium. The mechanisms determining BMDC recruitment to the heart remain unclear. We investigated the role of stromal cell–derived factor-1α (SDF-1) in this process.

Methods and Results—

MI produced in mice by coronary ligation induced SDF-1 mRNA and protein expression in the infarct and border zone and decreased serum SDF-1 levels. By quantitative polymerase chain reaction, 48 hours after intravenous infusion of donor-lineage BMDCs, there were 80.5±15.6% more BDMCs in infarcted hearts compared with sham-operated controls (
P
<0.01). Administration of AMD3100, which specifically blocks binding of SDF-1 to its endogenous receptor CXCR4, diminished BMDC recruitment after MI by 64.2±5.5% (
P
<0.05), strongly suggesting a requirement for SDF-1 in BMDC recruitment to the infarcted heart. Forced expression of SDF-1 in the heart by adenoviral gene delivery 48 hours after MI doubled BMDC recruitment over MI alone (
P
<0.001) but did not enhance recruitment in the absence of MI, suggesting that SDF-1 can augment, but is not singularly sufficient for, BDMC recruitment to the heart. Gene expression analysis after MI revealed increased levels of several genes in addition to SDF-1, including those for vascular endothelial growth factor, matrix metalloproteinase-9, intercellular adhesion molecule-1, and vascular cell adhesion molecule-1, which might act in concert with SDF-1 to recruit BMDCs to the injured heart.

Conclusion—

SDF-1/CXCR4 interactions play a crucial role in the recruitment of BMDCs to the heart after MI and can further increase homing in the presence, but not in the absence, of injury.
Job Strain, Ethnicity, and Sympathetic Nervous System Activity
Authors: Thomas KaMala S. , Nelesen Richard A. , Ziegler Michael G. , Bardwell Wayne A. , Dimsdale Joel E.
Published: November 2004

Several studies have demonstrated that blacks have heightened pressor sensitivity in response to the α-agonist, phenylephrine. However, studies examining whether psychosocial factors contribute to this difference are scarce. We examined the effects of job strain on pressor sensitivity in 76 whites and 46 blacks who were enrolled in a study of stress, sleep, and blood pressure. Responses to phenylephrine were examined at an inpatient clinical research center. After a 3-minute baseline period, a 100-microgram phenylephrine bolus was administered to participants intravenously. To measure catecholamines, 24-hour urine samples were also collected from participants. There was a significant relationship between job strain and pressor sensitivity, such that individuals with low decisional control and high job demands experienced a greater increase in diastolic pressure after receiving phenylephrine. Low decisional control was also associated with decreased baroreflex sensitivity. There was an interaction between ethnicity and job control on blood pressure responses to phenylephrine and on 24-hour urinary norepinephrine levels. Blacks who perceived less control experienced a greater increase in diastolic pressure after receiving phenylephrine and had elevated norepinephrine levels. These findings suggest possible mechanisms by which job strain may be associated with cardiovascular disease.
Angiotensin Subtype-2 Receptors Inhibit Renin Biosynthesis and Angiotensin II Formation
Authors: Siragy Helmy M. , Xue Chun , Abadir Peter , Carey Robert M.
Published: November 2004

Renin is regulated by angiotensin subtype 1 (AT
1
) receptor, but it is unknown whether angiotensin subtype 2 (AT
2
) receptor contributes to this regulation. We hypothesized that AT
2
receptors inhibit angiotensin II (Ang II) through inhibition of renin biosynthesis. We monitored changes in renal Ang II, renin mRNA and protein expression, and plasma renin concentration (PRC) in response to renal cortical administration of the AT
1
receptor blocker valsartan or the AT
2
receptor blocker PD 123319 (PD) in conscious rats administered low sodium intake (LS). Renal interstitial Ang II increased by 47-fold in response to LS and increased further in response to valsartan or PD by 67-fold and 61-fold from normal sodium diet (NS) and by ≈41% and 29% from LS, respectively. Renin mRNA increased 63% during LS, and either valsartan or PD increased it further by 600% and 250% from NS and 538% and 187% from LS, respectively. Similarly, renal renin content and PRC increased in response to LS and increased further in response to combined LS and valsartan or PD administration. Immunostaining for renal renin protein demonstrated an increase in its expression in juxtaglomular and tubular cells during LS and increased further during AT
1
or AT
2
receptor blockade. These data demonstrate for the first time to our knowledge that AT
2
receptors regulate the renin-angiotensin system activity via inhibition of renin synthesis.
A Confirmatory Factor Analysis of the Structure of Temperament Questionnaire
Authors: Bishop David I. , Hertenstein Matthew J.
Published: November 2004

This study examines the factor structure of scores on the English-language version of the Structure of Temperament Questionnaire. Scores from 300 college students were subjected to maximum-likelihood confirmatory factor analyses (CFA). A first-order model consisting of eight correlated factors and a second-order model consisting of two superordinate factors and eight first-order factors were tested. The results of the analyses indicate that the first-order correlated model is the best fit for the data. The English-language version of the Structure of Temperament Questionnaire can be used to measure eight correlated yet theoretically unique dimensions of temperament.
Validity Studies Psychometric Properties of Scores on the French and Korean Versions of the Hexaco Personality Inventory
Authors: Boies Kathleen , Yoo Tae-Yong , Ebacher Annik , Lee Kibeom , Ashton Michael C.
Published: November 2004

Recent lexical studies of personality structure suggest that there are six independent major dimensions of personality. TheHEXACOPersonality Inventory (HEXACO-PI), a new questionnaire that measures these six lexically derived personality constructs, was examined in two different cultural contexts using samples of 149 Francophone and 211 Korean respondents. Scores on the scales of the French and Korean versions of the HEXACO-PI were shown to have acceptable psychometric properties, including appropriate score distributions, high internal-consistency reliabilities, and low scale intercorrelations. In addition, the HEXACO-PI variables showed the expected pattern of correlations with markers of the Big Five and of lexical Honesty-Humility.
Impact of the Number of Response Categories and Anchor Labels on Coefficient Alpha and Test-Retest Reliability
Authors: Weng Li-Jen
Published: November 2004

A total of 1,247 college students participated in this study on the effect of scale format on the reliability of Likert-type rating scales. The number of response categories ranged from 3 to 9. Anchor labels on the scales were provided for each response option or for the end points only. The results indicated that the scales with fewresponse categories tended to result in lower reliability, especially lower test-retest reliability. The scales with all the response options clearly labeled were likely to yield higher test-retest reliability than those with only the end points labeled. Scale design that leads to consistent participant responses as indicated by test-retest reliability should be preferred.
From Inspired Vision to Impossible Dream
Authors: Shulman Judith H.
Published: November 2004

This article will present a case study of an unrequited teacher-learning collaboration, an attempt to work with an experienced teacher to redesign his practice in consonance with Fostering a Community of Learners (FCL) principles and practices. The author’s purpose in presenting this case will be threefold: first, to provide a coherent account of a modest attempt to assist an experienced teacher to reform his practice within a school context that was itself at least as traditional as the teacher himself; second, to use this account to illustrate the usefulness of a conceptual framework for representing how teachers learn and think about the essential features of teachers’ capacities that are the focal points of change; and third, to offer a process analysis of a teacher learning not to engage in a new practice and doing so in an intentional and reflective manner.
Race, Labor, and the Twentieth-Century American State
Authors: Frymer Paul
Published: November 2004

The author examines the federal government’s civil rights promotion in labor unions, focusing in particular on the consequences of this halting, fragmented effort. After the government deflected racial politics from labor policy in the 1930s, it attempted to integrate unions not by reforming labor law but by developing new agencies and empowering federal courts. This created an institutional environment where different agencies worked at cross-purposes, and courts imposed great financial costs on unions. The result of this effort was a host of unintended consequences for unions and civil rights groups. By putting race at the center, it also suggests an alternative understanding of the twentieth-century American state.