bluuebunny/crossref_metadata_2025 huggingface dataset:
Heterocyclics and Selective Serotonin Reuptake Inhibitors in the Treatment and Prevention of Poststroke Depression
Authors: Bhogal Sanjit K. , Teasell Robert , Foley Norine , Speechley Mark
Published: June 2005

Objectives: To review the best current evidence on heterocyclic and serotonin‐reuptake inhibitor (SSRI) treatments of poststroke depression (PSD).

Design: A literature review using multiple databases was conducted to identify randomized, controlled trials of the treatment or prevention of PSD. Odds ratios were used to test for significant treatment response between the treatment arms for dichotomous outcomes. Continuous outcome measures were evaluated using weighted mean difference and 95% confidence intervals.

Setting: Literature review.

Participants: Patients with stroke enrolled in the study of PSD of each selected article.

Measurements: Frequency of patients with and without depression; frequency of patients who responded to treatment.

Results: Nine articles were reviewed. Six investigated use of antidepressant therapy on treatment of PSD, and three examined the prevention of PSD. There was evidence to suggest that patients responded to treatment with antidepressants and significantly improved on depression scales, but treatment, especially with heterocyclic antidepressants, led to a significant number of dropouts due to side effects. There were insufficient data to pool the results of the prevention‐based studies.

Conclusion: Treatment with heterocyclic antidepressants and SSRIs appears to be a viable option for PSD, but their absolute or relative efficacy has yet to be fully established. The effectiveness of early initiation of antidepressants in the prevention of PSD is not clear.
Caregiver‐Specific Outcomes in Antidementia Clinical Drug Trials: A Systematic Review and Meta‐Analysis
Authors: Lingler Jennifer Hagerty , Martire Lynn M. , Schulz Richard
Published: June 2005

Objectives: To describe the range of caregiver‐specific outcomes and approaches to their study within antidementia drug trials and to quantify the effect of cholinesterase inhibitors on burden and active time use of caregivers of persons with Alzheimer's disease (AD).

Design: Systematic review of English‐language publications and unpublished reports of antidementia clinical drug trials that included caregiver‐specific outcomes. Study characteristics and methodological quality were summarized. Random effects meta‐analyses were conducted for the outcomes of caregiver burden and active time use.

Setting: Community.

Participants: Informal caregivers of participants in clinical trials of antidementia drugs.

Measurements: Burden, time use, psychological well‐being, healthcare costs, and ease of use of or satisfaction with intervention.

Results: Seventeen studies involving 4,744 subjects were identified. Four trials (n=1,594) met criteria for inclusion in the burden analysis, and six trials (n=2,286) met criteria for inclusion in the time‐use analysis. Most investigations involved drugs now approved by the Food and Drug Administration for the treatment of AD; donepezil was the most frequently studied intervention in the set of studies. Methodological quality varied across trials. The weighted average effect sizes were Cohen's d=0.18 (95% confidence interval (CI)=0.04–0.32) and d=0.15 (95% CI=0.07–0.24) for the outcomes of caregiver burden and time use, respectively.

Conclusion: Cholinesterase inhibitors have a small beneficial effect on burden and active time use among caregivers of persons with AD. Recommendations to enhance the quality and interpretability of AD clinical trials that involve caregiver‐specific outcomes are presented.
Foot Musculoskeletal Disorders, Pain, and Foot‐Related Functional Limitation in Older Persons
Authors: Badlissi Fadi , Dunn Julie E. , Link Carol L. , Keysor Julie J. , McKinlay John B. , Felson David T.
Published: June 2005

Objectives: To examine whether common musculoskeletal disorders of feet are associated with pain and foot‐related functional limitation.

Design: A cross‐sectional study using stratified random sampling.

Setting: A residential community.

Participants: Ethnically diverse sample of elderly persons (n=784).

Measurements: Foot disorders (hallux valgus/bunion, pes planus (flat foot), pes cavus (high arch), hammertoe, mallet toe, claw toe, overlapping toes, bunionette, and plantar fasciitis), foot pain, the foot health functional status (FHFS, range 0–100, 100=no problems) scale, and walk time score (range 0–4, 4=fastest).

Results: Most commonly assessed musculoskeletal disorders, including hallux valgus and toe deformities, were not associated with pain or function limitation. Plantar fasciitis and, to a lesser extent, pes cavus were associated with worse FHFS scores; foot pain partially explained this association. Neither foot disorders nor foot pain were significantly associated with slower walk times.

Conclusion: Many foot disorders had little relationship with foot pain or function and may not require clinical attention when asymptomatic. Risk factors and preventive and therapeutic interventions for plantar fasciitis require further longitudinal investigation.
A Comparative Study of the Use of Four Fall Risk Assessment Tools on Acute Medical Wards
Authors: Vassallo Michael , Stockdale Rachel , Sharma Jagdish C. , Briggs Roger , Allen Stephen
Published: June 2005

Objectives: To compare the effectiveness of four falls risk assessment tools (STRATIFY, Downton, Tullamore, and Tinetti) by using them simultaneously in the same environment.

Design: Prospective, open, observational study.

Setting: Two acute medical wards admitting predominantly older patients.

Participants: One hundred thirty‐five patients, 86 female, mean age±standard deviation 83.8±8.01 (range 56–100).

Measurements: A single clinician prospectively completed the four falls risk assessment tools. The extent of completion and time to complete each tool was recorded. Patients were followed until discharge, noting the occurrence of falls. The sensitivity, specificity, negative predictive accuracy, positive predictive accuracy, and total predictive accuracy were calculated.

Results: The number of patients that the STRATIFY correctly identified (n=90) was significantly higher than the Downton (n=46; P<.001), Tullamore (n=66; P=.005), or Tinetti (n=52; P<.001) tools, but the STRATIFY had the poorest sensitivity (68.2%). The STRATIFY was also the only tool that could be fully completed in all patients (n=135), compared with the Downton (n=130; P=.06), Tullamore (n=130; P=.06), and Tinetti (n=17; P<.001). The time required to complete the STRATIFY tool (average 3.85 minutes) was significantly less than for the Downton (6.34 minutes; P<.001), Tinetti (7.4 minutes; P<.001), and Tullamore (6.25 minutes; P<.001). The Kaplan‐Meier test showed that the STRATIFY (log rank P=.001) and Tullamore tools (log rank P<.001) were effective at predicting falls over the first week of admission. The Downton (log rank P=.46) and Tinetti tools (log rank P=.41) did not demonstrate this characteristic.

Conclusion: Significant differences were identified in the performance and complexity between the four risk assessment tools studied. The STRATIFY tool was the shortest and easiest to complete and had the highest predictive value but the lowest sensitivity.
Genetic Influences Underlying Self‐Rated Health in Older Female Twins
Authors: Leinonen Raija , Kaprio Jaakko , Jylhä Marja , Tolvanen Asko , Koskenvuo Markku , Heikkinen Eino , Rantanen Taina
Published: June 2005

Objectives:To examine the genetic and environmental sources of variation in self‐rated health (SRH) in older female twins and to explore the roles of morbidity, functional limitation, and psychological well‐being as mediators of genetic and environmental effects on SRH.

Design:Cross‐sectional analysis of twin data.

Setting:Research laboratory.

Participants:One hundred two monozygotic and 115 dizygotic female twin pairs aged 63 to 76.

Measurements:SRH was categorized as good, average, or poor. Morbidity was described using a physician‐assessed disease‐severity scale together with information about the presence of diabetes mellitus and cancer. Maximal walking speed measured over 10 m was used to assess physical functional limitation; the Mini‐Mental State Examination and the Center for Epidemiologic Studies Depression Scale were used to characterize psychological well‐being. The contributions of genetic and environmental (defined as familial (shared by siblings) or nonshared (unique to each sibling)) effects were assessed using univariate and multivariate structural equation modeling of twin data.

Results:SRH did not have its own specific genetic effect but shared a genetic component in common with the genetic components underlying liability to disease severity, maximal walking speed, and depressive symptoms. It accounted for 64% of the variation in SRH, with environmental effects accounting for the remaining variation.

Conclusion:The current results suggest that there are no specific genetic effects on SRH but rather that genetic influences on SRH are mediated through genetic influences affecting chronic diseases, functional limitation, and mood.
Standing Orders in an Ambulatory Setting Increases Influenza Vaccine Usage in Older People
Authors: Goebel Lynne J. , Neitch Shirley M. , Mufson Maurice A.
Published: June 2005

Objectives: To determine whether standing orders for influenza vaccine increase its usage in an ambulatory setting in elderly patients.

Design: Retrospective analysis of influenza vaccine usage over 4 years (1999–2002).

Setting: University ambulatory setting.

Participants: Overall, 912 elderly patients of two physicians who issued standing orders and 884 elderly patients of two physicians who did not do so constituted the study group.

Measurements: Physicians were categorized as to whether they issued a verbal or written standing order to their nurses to administer the influenza vaccine to patients aged 65 and older. Rates of influenza vaccination of patients whose physicians used standing orders were compared with those of physicians who did not use standing orders.

Results: Five hundred seventy‐six (63%) patients of physicians who used standing orders received influenza vaccine, compared with 332 (38%) patients of physicians who did not use them (P<.001). Standing orders accounted for a significantly higher rate of influenza vaccination in each study year. Moreover, in 2001, when influenza vaccine delivery was delayed, physicians who used standing orders maintained their same rate of usage, but physicians who did not had rates of about one‐half their usage of the other 3 years.

Conclusion: More Medicare recipients received influenza vaccine when their physicians used standing orders for its administration than when their physicians did not. Influenza vaccine represents an important prevention modality that demands widespread implementation, and standing orders can increase its usage.
Measurement of the affinity of anti‐D in the serum of immunized mothers and in immunoglobulin preparations with unlabeled antibodies
Authors: Debbia Martine , Brossard Yves , Lambin Patrick
Published: June 2005

BACKGROUND: Few data are available on the affinity of maternal anti‐D responsible for hemolytic disease of the fetus and the newborn (HDN) and of anti‐D used for the prophylaxis of that disease. A method was recently described to measure the affinity (Ka) of untagged anti‐D monoclonal antibodies (MoAbs). In this work, the same method was applied to determine the Ka of polyclonal anti‐D.

STUDY DESIGN AND METHODS: O R1r red blood cells (RBCs) were sensitized with increasing concentrations of native anti‐D in serum samples from immunized mothers and donors and in RhIG preparations. At equilibrium, the amount of anti‐D bound to RBCs was measured by enzyme‐linked immunosorbent assay. Scatchard and Langmuir equations were used to determine Ka.

RESULTS: The experimental data fitted well with the Scatchard equation (mean r2 = 0.95) but a better correlation was observed with the Langmuir equation (mean r2 = 0.99). The mean Ka of anti‐D in 11 maternal serum samples, in 6 immunized donors, and in 5 lots of RhIG were 5.6 × 108 per M (from 2.8 × 108 to 12 × 108/M), 3.9 × 108 per M (from 1.5 × 108 to 6.8 × 108/M), and 3.4 × 108 per M (from 3.1 × 108 to 4.2 × 108/M), respectively. The comparison of anti‐D affinity in 5 cases of HDN with fetal anemia and in 6 cases of HDN with postnatal anemia showed no significant difference.

CONCLUSION: The method previously described for anti‐D MoAbs was applied to polyclonal anti‐D present in the serum of immunized subjects and in immunoglobulin preparations. The experimental data fitted well with the Langmuir equation, and the affinity of polyclonal of anti‐D was measured with accuracy.
ABO glycosyltransferases as potential source of minor histocompatibility antigens in allogeneic peripheral blood progenitor cell transplantation
Authors: Eiz‐Vesper Britta , Seltsam Axel , Blasczyk Rainer
Published: June 2005

BACKGROUND: Most studies indicate that the incidence of graft‐versus‐host disease (GVHD) is not increased in ABO‐mismatched allogeneic peripheral blood progenitor cell transplantation. These studies exclusively looked at ABO phenotypes without considering the fact that different genotypes hide behind identical phenotypes that encode for different sets of glycosyltransferases, thus providing a source for minor histocompatibility antigens (mHags).

STUDY DESIGN AND METHODS: Therefore, whether peptides derived from ABO glycosyltransferases are capable of stimulating peptide‐specific T cells was investigated. T‐cell responses were identified by measuring intracellular interleukin‐2 expression.

RESULTS: Individuals with ABO genotypes encoding glycosyltransferases lacking the peptide sequences used for stimulation showed T‐cell responses, whereas those expressing glycosyltransferases containing the respective peptide sequences proved to be tolerant, indicating that ABO peptides are allogeneic and may act as mHags. Interestingly, even ABO*O individuals were tolerant to O glycosyltransferase–derived peptides, which strongly suggests that truncated O transferases are expressed.

CONCLUSION: Considering allelic ABO sequences, at least 15 percent of all phenotypically ABO‐matched transplant pairs can be expected to have genotype constellations relevant to GVHD. Therefore, the genotype behind the ABO blood group phenotype should be considered to answer the question of whether ABO mismatch is a risk factor of GVHD.
Evaluation of a new LightCycler reverse transcription–polymerase chain reaction infectivity assay for detection of human parvovirus B19 in dry‐heat inactivation studies
Authors: Prikhod’ko Grigori G. , Vasilyeva Irina , Reyes Herbert , Wong Susan , Brown Kevin E. , Jameson Thomas , Busby Thomas F.
Published: June 2005

BACKGROUND: Human parvovirus B19 (B19) is a widely distributed infectious agent, which causes a variety of illnesses including erythema infectiosum (fifth disease) especially in children, arthritis, aplastic crisis, and hydrops fetalis. B19 can be transmitted from asymptomatic blood donors to recipients of their blood components. Fifth disease has been reported in patients receiving red blood cells, platelets, solvent/detergent‐treated plasma, and clotting factor concentrates.

STUDY DESIGN AND METHODS: A new B19‐specific Light Cycler (LC) reverse transcription–polymerase chain reaction (RT‐PCR) infectivity assay was developed for quantitative analysis of the infectivity of B19 in virus validation studies. The cycling conditions and the primers of the new assay were designed to amplify spliced RNA forms but not precursor RNA or B19 genome. One 50 percent infectious dose, determined on UT7/Epo‐S1 cells of low passage, equaled 3.74 ± 0.1 log international units of B19 DNA.

RESULTS: The efficiency of the dry‐heat process (100°C) on inactivation of B19 spiked and lyophilized with fibrinogen, a major component of the clotting factor concentrate and hemostatic dressing products, was investigated by use of B19‐specific LC RT‐PCR infectivity assay. At 1.3 to 1.7 percent residual moisture of fibrinogen, the infectivity of B19 was reduced dramatically by 3.3 to 5.1 log for 1 and 2 hours of dry‐heat treatment, respectively. B19 infectivity was reduced 1.5, 2.8, and 3.8 log for 1, 2, and 3 hours of dry‐heat treatment, respectively, at 0.5 to 0.7 percent residual moisture level.

CONCLUSION: These findings suggest that level of residual moisture of lyophilized fibrinogen with B19 spike correlated with a different resistance of B19 to dry‐heat treatment, and that low moisture may stabilize virus against heat.
Results of the Cord Blood Transplantation (COBLT) Study unrelated donor banking program
Authors: Kurtzberg Joanne , Cairo Mitchell S. , Fraser John K. , Baxter‐Lowe LeeAnn , Cohen Geoff , Carter Shelly L. , Kernan Nancy A.
Published: June 2005

BACKGROUND: The goals of the Cord Blood Transplantation (COBLT) Study banking program initiated in 1996 were to develop standard operating procedures (SOPs) for cord blood (CB) donor recruitment and banking and to build an ethnically diverse unrelated CB bank to support a transplantation protocol.

STUDY DESIGN AND METHODS: The program included collection centers, three banks, a steering committee, and a medical coordinating center (MCC) that developed and validated SOPs and a Web‐based data collection system. External oversight was performed by the National Heart, Lung, and Blood Institute and the MCC.

RESULTS: A total of 34,799 potential donors were screened and 20,710 consented. A total of 17,207 ethnically diverse units were collected between 1998 and 2001. A total of 11,077 (64%) units were cryopreserved and quarantined. Of these, 79 percent met eligibility criteria and were HLA‐typed and entered into the search registry. Higher CB volumes and cell counts were obtained from cesarean sections compared to vaginal deliveries. Units from African American persons contained lower cell counts per volume compared to other ethnicities. Birth weight correlated with volume and cell content. External oversight was accomplished through custom reports generated by the data collection system and periodic site visits. During maintenance, a breach in the SOPs was detected during a site visit at one of the banks. These units were designated for future use in nonclinical research.

CONCLUSION: The COBLT Study demonstrated that SOPs and data collection can be implemented in multiple banks coordinated by one MCC. Relationships between donor demographics and CB content may be useful in the development of other CB banking programs.
Detection of Functional Recovery Using Low‐Dose Dobutamine and Myocardial Contrast Echocardiography After Acute Myocardial Infarction Treated with Successful Thrombolytic Therapy
Authors: Sbano João Cesar Nunes , Tsutsui Jeane Mike , Andrade José Lazaro , Carlos Nicolau José , Meneghetti José Claudio , Franchini Ramires José , Mathias Wilson
Published: June 2005

Objective: We studied the value of low‐dose dobutamine stress echocardiography (LDDE) and myocardial contrast echocardiography (MCE) in early prediction of left ventricular functional recovery (LVFR) after acute myocardial infarction (AMI) treated with successful thrombolysis. Design: LDDE and MCE using second‐harmonic intermittent imaging were performed in first week after AMI. LVFR was defined as an absolute ≥5% increase in ejection fraction, from early to 6 months of follow‐up by Technetium‐99m‐Sestamibi single‐photon emission computed tomography. Patients: Out of 50 patients studied, 19 evolved with LVFR (group 1) and 31 without LVFR (group 2). Regional dysfunction was detected in 103 (37%) infarcted‐related segments in group 1 and in 173 (63%) segments in group 2. Results: Sensitivity, specificity, positive, and negative predictive values and accuracy for detecting LVFR by LDDE were 94.7% (18/19), 87.1% (27/31), 81.8% (18/22), 96.4% (27/28), and 90% (45/50), respectively, and by MCE were 94.7% (18/19), 51.6% (16/31), 54.5% (18/33), 94.1% (16/17), and 68% (34/50). In group 1, functional improvement was observed in 86.9% (53/61) of segments with contractile reserve by LDDE and in 65.8% (52/79) of segments with microvascular perfusion by MCE. In group 2, functional improvement was observed in 78.3% (18/23) of segments with contractile reserve by LDDE and in 25.5% (25/98) of segments with microvascular perfusion by MCE. All segments without perfusion by MCE evolved without functional recovery. Conclusion: LDDE was an accurate predictor of late left ventricular function recovery after AMI, while MCE was sensitive and has a high negative predictive value demonstrating that microvascular perfusion is essential for LVFR.
An Unusual Case of Recurrent Mass in the Right Atrium: Intravenous Leiomyomatosis
Authors: Özer Necla , Engin Hüseyin , Akgül Ebru , Şahiner Levent , Atalar Enver , Aksöyek Serdar , Övünç Kenan , Özmen Ferhan , Kes Sırrı
Published: June 2005

Intravenous leiomyomatosis with a cardiac extension is an extremely rare condition. In this report, a case of a 43‐year‐old female patient is described: she was operated for right atrial mass protruding into the inferior vena cava, which was later diagnosed as leiomyoma. After a 3‐year symptom‐free period, recurrence of the extension through the inferior vena cava was observed. After abdominal ultrasonographic examination, which revealed bilateral ovarian and retroperitoneal mass, bilateral oopherectomy, retroperitoneal, and right atrial mass excision was done. The retroperitoneal and right atrial mass was reported as leiomyoma. On her last admission, she had complaints of dizziness, abdominal pain, and bilateral leg edema; and right atrial mass extending through the common iliac vein was noted, but the patient did not accept any further treatment modality.
Effect of Microbubble Exposure to Ultrasound on Quantitation of Myocardial Perfusion
Authors: Leong‐Poi Howard , Swales James , Jayaweera Ananda R. , Bin Jian‐Ping , Kaul Sanjiv , Lindner Jonathan R.
Published: June 2005

Background: The purpose of this study was to determine whether acoustic disruption of microbubbles in the left ventricular (LV) cavity prior to entry in the coronary circulation or their gradual destruction in the myocardium during myocardial contrast echocardiography (MCE) affects quantitative parameters of myocardial perfusion.
Methods: MCE was performed in 12 open chest dogs with both intermittent high‐power imaging (IHPI) and real‐time low‐power imaging (RLPI). To assess the affects of microbubble destruction in the LV cavity, MCE parameters of myocardial perfusion were compared for imaging planes that included versus avoided the LV cavity. To assess the effects of gradual disruption of microbubbles in the microcirculation during RLPI, MCE parameters from frames acquired continuously were compared to that from acquiring only end‐systolic frames. Results: Destruction of microbubbles in the LV cavity did not alter perfusion data for either form of imaging unless RLPI was performed using long (6‐frame) destructive pulse sequences. With RLPI, a gradual decay in microbubble signal occurred during their myocardial transit, the degree of which was related to the acoustic power. Signal decay during microbubble transit resulted in an overestimation of the microvascular blood velocity (β‐value) and an underestimation of the microvascular blood volume (A‐value). Conclusions: MCE parameters of perfusion at low power can be significantly altered by microbubble destruction in the LV cavity and in the myocardial microcirculation during RLPI. Short microbubble destruction pulse sequences and imaging only at end‐systole can reduce these effects.
Myocardial Postsystolic Motion in Ischemic and Not Ischemic Myocardium: The Clinical Value of Tissue Doppler
Authors: Citro Rodolfo , Galderisi Maurizio
Published: June 2005

Postsystolic motion (PSM) is a delayed ejection motion of the myocardium occurring after the aortic valve closure, during a generally prolonged isovolumic relaxation time (IVRT). In this review we analyze the physiopathologic mechanisms underlying PSM and the contribution of tissue Doppler for its understanding. By using various techniques, this phenomenon has been described in experimental observations and related to myocardial ischemia produced by gradual or abrupt coronary occlusion. In clinical studies, it is associated with recovery of regional myocardial function. Tissue Doppler, providing a velocity map of myocardial motion, allows an easy, noninvasive detection of PSM in the clinical setting. PSM, as identified by tissue Doppler, appears a hallmark of myocardial ischemia and viability but it may occur also in nonischemic conditions as left ventricular (LV) hypertrophy and volume overload, left bundle branch block and even in normal individuals. Strain and strain rate (SR), obtainable by off‐line color tissue Doppler, may be useful to identify the mechanisms underlying PSM since these measurements reflect, respectively, the intrinsic rate and the percentage of deformation of a given myocardial segment, and are relatively independent of both overall cardiac movement and tethering of the neighboring LV segments. By using SR imaging, the ratio of PSM to regional systolic longitudinal strain can be used to separate ischemic from nonischemic PSM and appears the best quantitative parameter to identify ischemia during dobutamine stress. A method to detect LV wall asynchrony and immediate benefit of cardiac resynchronization therapy has been developed combining the assessment of tissue‐tracking (TT) derived delayed longitudinal contraction and of SR‐derived PSM.
Diagnostic Accuracy and Prognostic Value of Dobutamine Stress Myocardial Contrast Echocardiography in Patients with Suspected Acute Coronary Syndromes
Authors: Tsutsui Jeane M. , Xie Feng , O'Leary Edward L. , Elhendy Abdou , Anderson James R. , McGrain Anna C. , Porter Thomas R.
Published: June 2005

Background: Both early stress testing and cardiac troponin I (cTnI) measurements are useful in assessing the prognosis of patients with acute coronary syndrome (ACS). We sought to determine the accuracy and prognostic value of wall motion analysis (WMA) and myocardial perfusion analysis (MPA) with real‐time myocardial contrast echocardiography (RTMCE) during dobutamine stress in this patient population. Methods: We performed dobutamine stress RTMCE to assess perfusion in 158 consecutive patients (mean age: 61 ± 13 years) with chest pain and possible ACS. Of these, 119 had normal cTnI, while 39 had isolated elevations of cTnI (range: 0.5–9.0 ng/ml). Quantitative angiography was performed within 1 month of RTMCE in 61 patients. Patients were followed for 16 months (range: 6–46 months). Cardiac events included death, nonfatal myocardial infarction, recurrent unstable angina, or need for urgent revascularization. Results: The sensitivity, specificity, and accuracy of MPA for detecting a >50% coronary stenosis were 92%, 77%, and 88%, respectively, while they were 62%, 85%, and 67% for WMA. Three‐year event‐free survival was 87% in patients with negative WMA and MPA, 49% in those with positive WMA and MPA, and 51% in patients with negative WMA but positive MPA. Age‐adjusted multivariate analysis demonstrated that the only independent predictors of cardiac events were a positive MPA (hazard ratio = 3.23; 95% CI = 1.23–8.49) and male sex (hazard ratio = 3.29; 95% CI = 1.21–8.97). Conclusions: In patients suspected of having an ACS, RTMCE improved the accuracy of dobutamine stress echocardiography for detecting coronary artery disease, and was an independent predictor of outcome.
Relationship between obesity, glucose tolerance, and periodontal disease in Japanese women: the Hisayama study
Authors: Saito T. , Shimazaki Y. , Kiyohara Y. , Kato I. , Kubo M. , Iida M. , Yamashita Y.
Published: June 2005

Background:  Recent studies have reported a relationship between obesity and periodontal disease. Obesity is the strongest risk factor for type 2 diabetes, which is, in turn, a risk factor for periodontal disease. An oral glucose tolerance test is necessary to diagnose diabetes; however, no study has examined the relationship between obesity and periodontal disease by taking oral glucose tolerance test results into consideration.

Methods:  In all, 584 Japanese women aged between 40 and 79 years old, with at least 10 teeth, underwent health examinations. Body mass index, waist–hip ratio, body fat, and oral glucose tolerance test results were used as independent variables with known risk factors for periodontal disease. Mean probing pocket depth and mean attachment loss were used as the dependent variables.

Results:  In all of the analyses, body mass index, body fat, and waist–hip ratio were significantly associated with the highest quintile of mean probing pocket depth, even when adjusted for oral glucose tolerance test results. In the multivariate analysis, the subjects with the highest quartile of body mass index had a significantly higher odds ratio (OR) for the highest quintile of mean probing pocket depth [OR, 4.3; 95% confidence interval (CI), 2.1–8.9; p < 0.001], whereas neither impaired glucose tolerance nor diabetes were significantly associated with deep pockets. The relationships between the obesity indexes and mean attachment loss did not reach statistical significance.

Conclusion:  Obesity was associated with deep pockets in Japanese women, even after adjusting for oral glucose tolerance test.
Accessing Self‐development through Narrative Approaches in Child and Adolescent Psychotherapy
Authors: DeSocio Janiece E.
Published: June 2005

TOPIC:  Narrative psychotherapy with children and adolescents.

PURPOSE:  To demonstrate the integration of developmental theory with narrative approaches to psychotherapy as a means of accessing self‐development during childhood and adolescence.

SOURCES:  Published literature and the author's experience in using narrative therapy with an 8‐year‐old and his foster mother.

CONCLUSIONS:  When informed by developmental theory, narrative approaches can be used effectively with children and adolescents to assist them in constructing positive life stories that can influence their identity formation.
Characterization of the Replication Region of Plasmid pLS32 from the Natto Strain ofBacillus subtilis
Authors: Tanaka Teruo , Ishida Hirofumi , Maehara Tomoko
Published: June 2005

Plasmid pL32 from the Natto strain ofBacillus subtilisbelongs to a group of low-copy-number plasmids in gram-positive bacteria that replicate via a theta mechanism of replication. We studied the DNA region encoding the replication protein, RepN, of pLS32, and obtained the following results. Transcription of therepNgene starts 167 nucleotides upstream from the translational start site ofrepN. The copy number ofrepN-coding plasmid pHDCS2, in which therepNgene was placed downstream of the IPTG (isopropyl-1-thio-β-d-galactopyranoside)-inducible Pspacpromoter, was increased 100 fold by the addition of IPTG. Histidine-tagged RepN bound to a specific region in therepNgene containing five 22-bp tandem repeats (iterons) with partial mismatches, as shown by gel retardation and foot printing analyses. Sequence alterations in the first three iterons resulted in an increase in plasmid copy number, whereas those in either the forth or fifth iteron resulted in the failure of plasmid replication. The iterons expressed various degrees of incompatibility with an incomingrepN-driven replicon pSEQ243, with the first three showing the strongest incompatibility. Finally, by using a plasmid, pHDMAEC21, carrying the sequence alterations in all the five iterons inrepNand thus unable to replicate but encoding intact RepN, the region necessary for replication was confined to a 96-bp sequence spanning the 3′-terminal half of the fourth iteron to an A+T-rich region located downstream of the fifth iteron. From these results, we conclude that the iterons inrepNare involved in both the control of plasmid copy number and incompatibility, and we suggest that the binding of RepN to the last two iterons triggers replication by melting the A+T-rich DNA sequence.
Calcium-Induced Virulence Factors Associated with the Extracellular Matrix of MucoidPseudomonas aeruginosaBiofilms
Authors: Sarkisova S. , Patrauchan M. A. , Berglund D. , Nivens D. E. , Franklin M. J.
Published: June 2005

Pseudomonas aeruginosacolonizes the pulmonary tissue of patients with cystic fibrosis (CF), leading to biofilm-associated infections. The pulmonary fluid of CF patients usually contains elevated concentrations of cations and may contain theP. aeruginosaredox-active pigment pyocyanin, which is known to disrupt calcium homeostasis of host cells. Since divalent cations are important bridging ions for bacterial polysaccharides and since they may play regulatory roles in bacterial gene expression, we investigated the effect of calcium ions on the extracellular matrix constituents ofP. aeruginosabiofilms. For mucoid strainP. aeruginosaFRD1, calcium addition (1.0 and 10 mM as CaCl2) resulted in biofilms that were at least 10-fold thicker than biofilms without added calcium. Scanning confocal laser microscopy showed increased spacing between cells for the thick biofilms, and Fourier transform infrared spectroscopy revealed that the material between cells is primarily alginate. AnalgDtranscriptional reporter demonstrated that calcium addition caused an eightfold increase inalggene expression in FRD1 biofilms. Calcium addition also resulted in increased amounts of three extracellular proteases (AprA, LasB, and PrpL). Immunoblots of the biofilm extracellular material established that AprA was harbored within the biofilm extracellular matrix. AnaprAdeletion mutation and a mutation in gene for a putativeP. aeruginosacalmodulin-like protein did not significantly affect calcium-induced biofilm structure. Two-dimensional gel electrophoresis showed increased amounts of phenazine biosynthetic proteins in FRD1 biofilms and in calcium-amended planktonic cultures. Spectrochemical analyses showed that the calcium addition causes a three- to fivefold increase in pyocyanin production. These results demonstrate that calcium addition affects the structure and extracellular matrix composition of mucoidP. aeruginosabiofilms, through increased expression and stability of bacterial extracellular products. The calcium-induced extracellular matrix of mucoidP. aeruginosaconsists primarily of the virulence factor alginate and also harbors extracellular proteases and perhaps pyocyanin, a biomolecule that may further disrupt cellular calcium levels.
Choline-Binding Protein D (CbpD) inStreptococcus pneumoniaeIs Essential for Competence-Induced Cell Lysis
Authors: Kausmally Louise , Johnsborg Ola , Lunde Merete , Knutsen Eivind , Håvarstein Leiv Sigve
Published: June 2005

Streptococcus pneumoniaeis an important human pathogen that is able to take up naked DNA from the environment by a quorum-sensing-regulated process called natural genetic transformation. This property enables members of this bacterial species to efficiently acquire new properties that may increase their ability to survive and multiply in the human host. We have previously reported that induction of the competent state in a liquid culture ofStreptococcus pneumoniaetriggers lysis of a subfraction of the bacterial population resulting in release of DNA. We have also proposed that such competence-induced DNA release is an integral part of natural genetic transformation that has evolved to increase the efficiency of gene transfer between pneumococci. In the present work, we have further elucidated the mechanism behind competence-induced cell lysis by identifying a putative murein hydrolase, choline-binding protein D (CbpD), as a key component of this process. By using real-time PCR to estimate the amount of extracellular DNA in competent relative to noncompetent cultures, we were able to show that competence-induced cell lysis and DNA release are strongly attenuated in acbpDmutant. Ectopic expression of CbpD in the presence or absence of other competence proteins revealed that CbpD is essentially unable to cause cell lysis on its own but depends on at least one additional protein expressed during competence.
Acetobacter aceti
Possesses a Proton Motive Force-Dependent Efflux System for Acetic Acid
Authors: Matsushita Kazunobu , Inoue Taketo , Adachi Osao , Toyama Hirohide
Published: June 2005

Acetic acid bacteria are obligate aerobes able to oxidize ethanol, sugar alcohols, and sugars into their corresponding acids. Among them,
Acetobacter
and
Gluconacetobacter
species have very high ethanol oxidation capacity, leading to accumulation of vast amounts of acetic acid outside the cell. Since these bacteria are able to grow in media with high concentrations of acetic acid, they must possess a specific mechanism such as an efflux pump by which they can resist the toxic effects of acetic acid. In this study, the efflux pump of
Acetobacter aceti
IFO 3283 was examined using intact cells and membrane vesicles. The accumulation of acetic acid/acetate in intact cells was increased by the addition of a proton uncoupler and/or cyanide, suggesting the presence of an energy-dependent efflux system. To confirm this, right-side-out and inside-out membrane vesicles were prepared from
A. aceti
IFO 3283, and the accumulation of acetic acid/acetate in the vesicles was examined. Upon the addition of a respiratory substrate, the accumulation of acetic acid/acetate in the right-side-out vesicles was largely decreased, while its accumulation was very much increased in the inside-out vesicles. These respiration-dependent phenomena observed in both types of membrane vesicles were all sensitive to a proton uncoupler. Acetic acid/acetate uptake in the inside-out membrane vesicles was dependent not on ATP but on the proton motive force. Furthermore, uptake was shown to be rather specific for acetic acid and to be pH dependent, because higher uptake was observed at lower pH. Thus,
A. aceti
IFO 3283 possesses a proton motive force-dependent efflux pump for acetic acid.
Regulation ofPseudomonasQuinolone Signal Synthesis inPseudomonas aeruginosa
Authors: Wade Dana S. , Calfee M. Worth , Rocha Edson R. , Ling Elizabeth A. , Engstrom Elana , Coleman James P. , Pesci Everett C.
Published: June 2005

Pseudomonas aeruginosais an opportunistic pathogen that causes chronic lung infections in cystic fibrosis patients and is a major source of nosocomial infections. This bacterium controls many virulence factors by using two quorum-sensing systems,lasandrhl. Thelassystem is composed of the LasR regulator protein and its cell-to-cell signal,N-(3-oxododecanoyl) homoserine lactone, and therhlsystem is composed of RhlR and the signalN-butyryl homoserine lactone. A third intercellular signal, thePseudomonasquinolone signal (PQS; 2-heptyl-3-hydroxy-4-quinolone), also regulates numerous virulence factors. PQS synthesis requires the expression of multiple operons, one of which ispqsABCDE. Previous experiments showed that the transcription of this operon, and therefore PQS production, is negatively regulated by therhlquorum-sensing system and positively regulated by thelasquorum-sensing system and PqsR (also known as MvfR), a LysR-type transcriptional regulator protein. With the use of DNA mobility shift assays and β-galactosidase reporter fusions, we have studied the regulation ofpqsRand its relationship topqsA,lasR, andrhlR. We show that PqsR binds the promoter ofpqsAand that this binding increases dramatically in the presence of PQS, implying that PQS acts as a coinducer for PqsR. We have also mapped the transcriptional start site forpqsRand found that the transcription ofpqsRis positively regulated bylasRand negatively regulated byrhlR. These results suggest that a regulatory chain occurs wherepqsRis under the control of LasR and RhlR and where PqsR in turn controlspqsABCDE, which is required for the production of PQS.
Binding of
Pseudomonas aeruginosa
AlgZ to Sites Upstream of the
algZ
Promoter Leads to Repression of Transcription
Authors: Ramsey Deborah M. , Baynham Patricia J. , Wozniak Daniel J.
Published: June 2005

Mucoid variants of the opportunistic pathogen
Pseudomonas aeruginosa
produce the exopolysaccharide alginate and colonize the respiratory tracts of cystic fibrosis patients. The genes encoding the alginate biosynthetic enzymes are clustered in a single operon, which is under tight transcriptional control. One essential activator of the alginate operon is AlgZ, a proposed ribbon-helix-helix DNA binding protein that shares 30% amino acid identity with the Mnt repressor of
Salmonella enterica
serovar Typhimurium bacteriophage P22. In the current study, we examined the role of AlgZ as an autoregulator. Using single-copy
algZ-lacZ
transcription fusions, an increase in
algZ
transcription was observed in an
algZ
mutant compared to the isogenic wild-type strain, suggesting that AlgZ may have an additional role as a repressor. To identify the AlgZ binding site, overlapping regions upstream of
algZ
were incubated with AlgZ and analyzed by electrophoretic mobility shift assays. Specific binding activity was localized to a region spanning from 66 to 185 base pairs upstream of the
algZ
transcriptional start site. Two AlgZ binding sites were defined using copper-phenanthroline footprinting and deletion analyses, with one site centered at 93 base pairs and the other centered at 161 base pairs upstream of the
algZ
promoter. Deletion of both binding sites resulted in the loss of AlgZ binding. These results indicate that AlgZ represses
algZ
transcription, and this activity is mediated by multiple AlgZ-DNA interactions.
Glutamyl-tRNA Reductase of
Chlorobium vibrioforme
Is a Dissociable Homodimer That Contains One Tightly Bound Heme per Subunit
Authors: Srivastava Alaka , Beale Samuel I.
Published: June 2005

δ-Aminolevulinic acid, the biosynthetic precursor of tetrapyrroles, is synthesized from glutamate via the tRNA-dependent five-carbon pathway in the green sulfur bacterium
Chlorobium vibrioforme
. The enzyme glutamyl-tRNA reductase (GTR), encoded by the
hemA
gene, catalyzes the first committed step in this pathway, which is the reduction of tRNA-bound glutamate to produce glutamate 1-semialdehyde. To characterize the GTR protein, the
hemA
gene from
C. vibrioforme
was cloned into expression plasmids that added an N-terminal His
6
tag to the expressed protein. The His-tagged GTR protein was purified using Ni affinity column chromatography. GTR was observable as a 49-kDa band on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) gels. The native molecular mass, as determined by gel filtration chromatography, appeared to be approximately 40 kDa, indicating that native GTR is a monomer. However, when the protein was mixed with 5% (vol/vol) glycerol, the product had an apparent molecular mass of 95 kDa, indicating that the protein is a dimer under these conditions. Purified His
6
-GTR was catalytically active in vitro when it was incubated with
Escherichia coli
glutamyl-tRNA
Glu
and purified recombinant
Chlamydomonas reinhardtii
glutamate-1-semialdehyde aminotransferase. The expressed GTR contained 1 mol of tightly bound heme per mol of pep tide subunit. The heme remained bound to the protein throughout purification and was not removed by anion- or cation-exchange column chromatography. However, the bound heme was released during SDS-PAGE if the protein was denatured in the presence of β-mercaptoethanol. Added heme did not inhibit the activity of purified expressed GTR in vitro. However, when the GTR was expressed in the presence of 3-amino-2,3- dihydrobenzoic acid (gabaculine), an inhibitor of heme synthesis, the purified GTR had 60 to 70% less bound heme than control GTR, and it was inhibited by hemin in vitro.
Transport and Metabolism of Citrate by
Streptococcus mutans
Authors: Korithoski Bryan , Krastel Kirsten , Cvitkovitch Dennis G.
Published: June 2005

Streptococcus mutans
, a normal inhabitant of dental plaque, is considered a primary etiological agent of dental caries. Two virulence determinants of
S. mutans
are its acidogenicity and aciduricity (the ability to produce acid and the ability to survive and grow at low pH, respectively). Citric acid is ubiquitous in nature; it is a component of fruit juices, bones, and teeth. In lactic acid bacteria citrate transport has been linked to increased survival in acidic conditions. We identified putative citrate transport and metabolism genes in
S. mutans
, which led us to investigate citrate transport and metabolism. Our goals in this study were to determine the mechanisms of citrate transport and metabolism in
S. mutans
and to examine whether citrate modulates
S. mutans
aciduricity. Radiolabeled citrate was used during citrate transport to identify citrate metal ion cofactors, and thin-layer chromatography was used to identify metabolic end products of citrate metabolism.
S. mutans
was grown in medium MM4 with different citrate concentrations and pH values, and the effects on the growth rate and cell survival were monitored. Intracellular citrate inhibited the growth of the bacteria, especially at low pH. The most effective cofactor for citrate uptake by
S. mutans
was Fe
3+
. The metabolic end product of citrate metabolism was aspartate, and a citrate transporter mutant was more citrate tolerant than the parent.
Transposon Mutagenesis in a Marine
Synechococcus
Strain: Isolation of Swimming Motility Mutants
Authors: McCarren J. , Brahamsha B.
Published: June 2005

Certain marine unicellular cyanobacteria of the genus
Synechococcus
exhibit a unique type of swimming motility characterized by the absence of flagella or any other obvious organelles of motility. While the abundant cell surface-associated 130-kDa glycoprotein SwmA is known to be required for the generation of thrust, identification of other components of the motility apparatus has, until recently, been unsuccessful. Here we report on the development of a transposon mutagenesis system for use with marine
Synechococcus
sp. strain WH8102, a model organism for which the genome has been sequenced. Utilizing this mutagenesis technique, we have isolated 17 independent mutants impaired in swimming motility. These 17 transposon insertions are located in nine open reading frames, which cluster in three separate regions of the genome. Included within these clusters are several multicomponent transport systems as well as a number of glycosyltransferases.
OmcF, a Putative
c
-Type Monoheme Outer Membrane Cytochrome Required for the Expression of Other Outer Membrane Cytochromes in
Geobacter sulfurreducens
Authors: Kim Byoung-Chan , Leang Ching , Ding Yan-Huai R. , Glaven Richard H. , Coppi Maddalena V. , Lovley Derek R.
Published: June 2005

Outer membrane cytochromes are often proposed as likely agents for electron transfer to extracellular electron acceptors, such as Fe(III). The
omcF
gene in the dissimilatory Fe(III)-reducing microorganism
Geobacter sulfurreducens
is predicted to code for a small outer membrane monoheme
c
-type cytochrome. An OmcF-deficient strain was constructed, and its ability to reduce and grow on Fe(III) citrate was found to be impaired. Following a prolonged lag phase (150 h), the OmcF-deficient strain developed the ability to grow in Fe(III) citrate medium with doubling times and yields that were ca. 145% and 70% of those of the wild type, respectively. Comparison of the
c
-type cytochrome contents of outer membrane-enriched fractions prepared from wild-type and OmcF-deficient cultures confirmed the outer membrane association of OmcF and revealed multiple changes in the cytochrome content of the OmcF-deficient strain. These changes included loss of expression of two previously characterized outer membrane cytochromes, OmcB and OmcC, and overexpression of a third previously characterized outer membrane cytochrome, OmcS, during growth on Fe(III) citrate. The
omcB
and
omcC
transcripts could not be detected in the OmcF-deficient mutant by either reverse transcriptase PCR or Northern blot analyses. Expression of the
omcF
gene in
trans
restored both the capacity of the OmcF-deficient mutant to reduce Fe(III) and wild-type levels of
omcB
and
omcC
mRNA and protein. Thus, elimination of OmcF may impair Fe(III) reduction by influencing expression of OmcB, which has previously been demonstrated to play a critical role in Fe(III) reduction.