bluuebunny/crossref_metadata_2025 huggingface dataset:
Non‐contrast‐enhanced flow‐independent peripheral MR angiography with balanced SSFP
Authors: Çukur Tolga , Lee Jin H. , Bangerter Neal K. , Hargreaves Brian A. , Nishimura Dwight G.
Published: April 2009

Flow‐independent angiography is a non‐contrast‐enhanced technique that can generate vessel contrast even with reduced blood flow in the lower extremities. A method is presented for producing these angiograms with magnetization‐prepared balanced steady‐state free precession (bSSFP). Because bSSFP yields bright fat signal, robust fat suppression is essential for detailed depiction of the vasculature. Therefore, several strategies have been investigated to improve the reliability of fat suppression within short scan times. Phase‐sensitive SSFP can efficiently suppress fat; however, partial volume effects due to fat and water occupying the same voxel can lead to the loss of blood signal. In contrast, alternating repetition time (ATR) SSFP minimizes this loss; however, the level of suppression is compromised by field inhomogeneity. Finally, a new double‐acquisition ATR‐SSFP technique reduces this sensitivity to off‐resonance. In vivo results indicate that the two ATR‐based techniques provide more reliable contrast when partial volume effects are significant. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.
Interaction of gadolinium‐based MR contrast agents with choline: Implications for MR spectroscopy (MRS) of the breast
Authors: Lenkinski Robert E. , Wang Xiaoen , Elian Mostafa , Goldberg S. Nahum
Published: April 2009

It has been shown that magnetic resonance spectroscopy (MRS) can improve the specificity of the MR examination by the spectroscopic detection of choline (Cho). Commonly, the lesion is first visualized on postcontrast studies, and the MRS voxel is prescribed accordingly. The implicit assumption made in this approach is that the presence of gadolinium‐based contrast agents will have a negligible effect on the MR spectra obtained from the lesion. In this work, we examined this assumption by determining the effects of six gadolinium‐based contrast agents: Magnevist, Multihance, Omniscan, Optimark, ProHance, and Dotarem, on the Cho peak in phantoms and in a rat model for breast cancer. We found that only the three negatively‐charged chelates: Magnevist, MultiHance, and Dotarem, broadened the Cho peak in phantoms and reduced the area of the Cho peak in vivo by an average of about 40%. The use of negatively‐charged chelates may lead to an underestimation of the levels of Cho present in human breast cancers, since most studies use MRS postcontrast administration. Therefore, we recommend the use of the neutral chelates in MRI/MRS studies of the breast. Magn Reson Med 2009 © 2009 Wiley‐Liss, Inc.
Time‐optimal design for multidimensional and parallel transmit variable‐rate selective excitation
Authors: Lee Daeho , Lustig Michael , Grissom William A. , Pauly John M.
Published: April 2009

Variable‐rate selective excitation (VERSE) is a radio frequency (RF) pulse reshaping technique. It is most commonly used to reduce the peak magnitude and specific absorption rate (SAR) of RF pulses by reshaping pulses and gradient waveforms to reduce RF magnitude while preserving excitation profiles. In this work, a general time‐optimal VERSE algorithm for multidimensional and parallel transmit pulses is presented. Time optimality is achieved by translating peak RF limits to gradient upper bounds in excitation k‐space. The limits are fed into a time‐optimal gradient waveform design technique. Effective SAR reduction is achieved by reducing peak RF subject to a fixed pulse length. The presented method is different from other VERSE techniques in that it provides a noniterative time‐optimal multidimensional solution, which drastically simplifies VERSE designs. Examples are given for 1D and 2D single channel and 2D parallel transmit pulses. Magn Reson Med, 61:1471–1479, 2009. © 2009 Wiley‐Liss, Inc.
Motion correction in periodically‐rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) and turboprop MRI
Authors: Tamhane Ashish A. , Arfanakis Konstantinos
Published: April 2009

Periodically‐rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) and Turboprop MRI are characterized by greatly reduced sensitivity to motion, compared to their predecessors, fast spin‐echo (FSE) and gradient and spin‐echo (GRASE), respectively. This is due to the inherent self‐navigation and motion correction of PROPELLER‐based techniques. However, it is unknown how various acquisition parameters that determine k‐space sampling affect the accuracy of motion correction in PROPELLER and Turboprop MRI. The goal of this work was to evaluate the accuracy of motion correction in both techniques, to identify an optimal rotation correction approach, and determine acquisition strategies for optimal motion correction. It was demonstrated that blades with multiple lines allow more accurate estimation of motion than blades with fewer lines. Also, it was shown that Turboprop MRI is less sensitive to motion than PROPELLER. Furthermore, it was demonstrated that the number of blades does not significantly affect motion correction. Finally, clinically appropriate acquisition strategies that optimize motion correction are discussed for PROPELLER and Turboprop MRI. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.
Inversion recovery with embedded self‐calibration (IRES)
Authors: Tan Ek T. , Riederer Stephen J.
Published: April 2009

With self‐calibrated parallel acquisition, the calibration data used to characterize coil response are acquired within the actual, parallel scan. Although this eliminates the need for a separate calibration scan, it reduces the net acceleration factor of the parallel scan. Furthermore, this reduction gets worse at higher accelerations. A method is described for three‐dimensional inversion recovery gradient‐echo imaging in which calibration is incorporated into the sequence but with no loss of net acceleration. This is done by acquiring the calibration data using very small (≤4°) tip angle acquisitions during the delay interval after acquisition of the accelerated imaging data. The technique is studied at 3 Tesla with simulation, phantom, and in vivo experiments using both image‐space‐based and k‐space‐based parallel reconstruction methods. At nominal acceleration factors of 3 and 4, the newly described inversion recovery with embedded self‐calibration (IRES) method can retain effective acceleration with comparable SNR and contrast to standard self‐calibration. At a net two‐dimensional acceleration factor of 4, IRES can achieve higher SNR than standard self‐calibration having a nominal acceleration factor of 6 but the same acquisition time. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.
Cerebral venography using fluid‐suppressed STARFIRE
Authors: Edelman Robert R , Koktzoglou Ioannis , Ankenbrandt William J. , Dunkle Eugene E.
Published: April 2009

Fluid‐suppressed STARFIRE (Signal Targeting Alternative Radiofrequency and Flow‐Independent Relaxation Enhancement) is a noncontrast method for flow‐independent MR venography (MRV). It uses magnitude subtraction of two inversion recovery‐prepared segmented three‐dimensional (3D) balanced steady‐state free precession acquisitions to obtain isotropic cerebral venograms in which both fat and cerebrospinal fluid signals are suppressed. Unlike two‐dimensional time‐of‐flight (2D TOF) MRV, it is insensitive to the flow velocity of the cerebral veins. The method provided excellent depiction of the dural venous sinuses and cortical veins on maximum intensity projection images. Fluid‐suppressed STARFIRE and 2D TOF were compared with contrast‐enhanced 3D MRV as the reference standard in seven healthy subjects at 1.5 Tesla. Fluid‐suppressed STARFIRE compared favorably to 2D TOF on both quantitative and qualitative analyses. Contrast‐enhanced MRV provided the highest vein‐background relative contrast and best demonstrated the straight sinus, whereas STARFIRE depicted the most venous branches. Further investigation will be required to determine the accuracy for cerebral venous thrombosis. Magn Reson Med, 2009. © 2009 Wiley‐Liss, Inc.
Investigation of processing, thermal, and mechanical properties of a new composite matrix‐benzoxazine containing aldehyde group
Authors: Ran Qi‐chao , Tian Qiao , Li Cao , Gu Yi
Published: April 2009

A new benzoxazine aldehyde group containing monomer 3‐phenyl‐6‐formyl‐3, 4‐dihydro‐2H‐1, 3‐benzoxazine (Ald‐B) was synthesized via the Mannich reaction of formaldehyde, p‐hydroxybenzaldehyde, and aniline. The viscosities and curing behavior of the resins were studied. The results indicated that Ald‐B has an initial viscosity lower than 0.110 Pa s at 90°C and the maximum temperature of the exotherm was at 196°C. Dynamic mechanical analysis (DMA) of the copolymer of Ald‐B and methylenedianiline‐type bis‐benzoxazine (B‐BOZ) showed only one Tg of 251°C and high crosslink density in the matrix. The thermal stability of the copolymer was improved noticeably and the char yield at 800°C is 68.4%. The tensile strength and flexural strength of this resin cast are 72 and 137 MPa, respectively. Copyright © 2009 John Wiley & Sons, Ltd.
A novel preparation method for microspheres by glycerol modified solid‐in‐oil‐in‐water multi‐emulsion
Authors: Yuan Weien , Ren Tiantian , Wu Fei , Zhao Hao , Jin Tuo
Published: April 2009

Biodegradable material poly(D, L‐lactic‐co‐glycolic) acid (PLGA) plays an important role in drug‐sustained release systems. Here, we describe a glycerol modified solid‐in‐oil‐in‐water (m‐S/O/W) emulsion method for PLGA microspheres, in order to encapsulate proteins in PLGA by utilizing dextran glassy particles to protect the proteins from denaturing, unfolding, and aggregation during preparation and new external water phase to prevent the inner dextran glassy particles from leaking into the external water phase. External water phase containing 20, 40, 60, 80% glycerol showed that proteins released faster and more completely with increased glycerol content. According to their varied release profiles, microspheres of different formulations could be used to encapsulate vaccines or for delivering proteins over long‐term. Copyright © 2009 John Wiley & Sons, Ltd.
Blends of polypropylene and ethylene octene comonomer with conducting fillers: Influence of state of dispersion of conducting fillers on electrical conductivity
Authors: Hom Sheleena , Bhattacharyya Arup R. , Khare Rupesh A. , Kulkarni Ajit R. , Saroop Madhumita , Biswas Amit
Published: April 2009

Blends of polypropylene/ethylene octene comonomer (PP/EOC) with conducting fillers viz., carbon black (CB) and multiwall carbon nanotubes (MWNT) were prepared using melt mixing technique with varying filler concentration and blend compositions. Thermo gravimetric analysis studies indicated that presence of filler enhanced the thermal stability of PP/EOC blends. Morphological analysis revealed the formation of matrix‐dispersed droplet and co‐continuous type of morphology depending on the blend compositions. Significant reduction in droplet size and finer ligament thickness in co‐continuous structure were observed in the blends with filler due to compatibilization action. Fillers were found to be aggregated in the EOC phase irrespective of blends compositions and could be related to the affinity of the fillers toward EOC phase. The electrical conductivity of PP/EOC blends with CB and MWNT was found to be highest for 80/20 composition and decreased as EOC content increased. The percolation threshold of CB was between 10 and 15 wt% for the 80/20 and 70/30 blends whereas it was 15–20 wt% for blends with EOC content higher than 30 wt%. The percolation threshold was 2–3 wt% MWNT for PP/EOC blends. This was attributed to the aggregated filler network preferentially in the EOC phase. The melt‐rheological behavior of PP/EOC blends was significantly influenced in presence of both the fillers. POLYM. ENG. SCI., 2009. © 2009 Society of Plastics Engineers
Preparation and characterization of biodegradable agar/poly(butylene adipate‐co‐terephatalate) composites
Authors: Madera‐Santana T.J. , Misra M. , Drzal L.T. , Robledo D. , Freile‐Pelegrin Y.
Published: April 2009

A series of biocomposites were developed by reinforcing agar particles from red marine plant Gelidium robustum into poly(butylene adipate‐co‐terephatalate) (PBAT) using extrusion and injection molding technique. The effect of different content of agar (0, 10, 20, 30, and 40 wt%) on the physico‐mechanical properties of the biocomposite was evaluated. The dynamic mechanical behavior of the composites was studied to determine the storage and loss modulus. The incorporation of agar particles into PBAT enhanced the tensile strength and modulus with a reduced percentage of elongation at break. A reduction in the mechanical loss factor (tan δ) was noticed with the addition of agar particles into PBAT. A reverse trend was noticed for storage and loss modulus. The thermogravimetric analysis revealed that the degradation temperature of PBAT‐agar composites lies in between that of their individual components (agar and PBAT). An increase in melting (Tm) and crystallization (Tc) temperature of the biocomposites were noticed as agar particle content increased. The rheological study carried out by dynamic frequency experiments demonstrated that viscosity is increased with the presence of agar particles. The morphology of the biocomposites was analyzed using scanning electron microscope. POLYM. ENG. SCI., 2009. © 2009 Society of Plastics Engineers
The road to the unconscious self not taken: Discrepancies between self‐ and observer‐inferences about implicit dispositions from nonverbal behavioural cues
Authors: Hofmann Wilhelm , Gschwendner Tobias , Schmitt Manfred
Published: April 2009

To what extent can individuals gain insight into their own or another person's implicit dispositions' We investigated whether self‐perceivers versus neutral observers can detect implicit dispositions from nonverbal behavioural cues contained in video feedback (cue validity) and whether these cues are in turn used as a valid basis for explicit dispositional inferences (cue utilization). Across three studies in the domains of extraversion and anxiety we consistently obtained reliable cue validity and cue utilization for neutral observers but not for self‐perceivers. An additional measure of state inferences in Study 3 showed that one reason for the lack of mediation in self‐perceivers is their reluctance to use their state inferences as a basis for more general trait inferences. We conclude that people have a ‘blind spot’ with respect to the nonverbal behavioural manifestations of their unconscious selves, even though neutral observers may readily detect and utilize this information for dispositional inferences. Copyright © 2009 John Wiley & Sons, Ltd.
Comparative fire risk of motor vehicle fuels: Gasoline versus ethanol
Authors: Dillon S.E. , Carpenter A.R. , Ogle R.A.
Published: April 2009

If motor vehicles switch from gasoline to E‐85 ethanol, is the fire risk to the general public reduced or increased? This article explores the fire risk associated with four accident scenarios:

Transport from refinery to distributor (pipeline vs. truck or barge),

Transport from distributor to retail facility by truck,

Spill during fuel dispensing to motor vehicle, and

Motor vehicle fire following traffic accident.

Each of these scenarios represents a stage in the life cycle of the liquid fuel, from wholesale distribution and consumer usage.

In each case the risk of fire is composed of the probability of occurrence and the consequences of the fire. The probabilities were estimated from various compilations of accident statistics. Overall, the probability of an E‐85 ethanol release was greater than or equal to a gasoline release. This was due to the comparative accident frequency of different transportation modes and distances involved.

The fire consequences were quantified in terms of spill area, heat release rate and radiant heat flux to nearby targets. For spills of the same size, the gasoline fire tended to be more severe than the E‐85 ethanol fire. This is due to the differences in their physical properties, the enthalpies of combustion, and the emissivities of the flames. © 2009 American Institute of Chemical Engineers Process Saf Prog, 2009
Key performance indicators for inherent safety: Application to the hydrogen supply chain
Authors: Tugnoli Alessandro , Landucci Gabriele , Cozzani Valerio
Published: April 2009

The practice of inherent safety in process development and design asks for reliable and systematic assessment tools. In the present study, a novel quantitative approach developed for the inherent safety assessment of process flow diagrams in early design stages is presented. The output of the approach is a metric that quantifies the inherent safety fingerprint of the process scheme by a set of key performance indicators. Physical parameters are used for the quantification of the hazard deriving from materials, process conditions and equipment characteristics. The assessment resorts to the identification and modeling of credible accident consequences on humans and equipment. The adoption of tangible parameters based on consequence modeling yields a clear and sound picture of the inherent safety performance of a design option. An example of application focused on some envisaged options of the hydrogen supply chain (production, distribution, and utilization) is presented. © 2009 American Institute of Chemical Engineers Process Saf Prog, 2009
Safety and chemical engineering education—History and results
Authors: Louvar J. F.
Published: April 2009

The Center for Chemical Process Safety (CCPS) started their Safety and Chemical Engineering Education (SACHE) efforts in 1985. The objective of CCPS's SACHE is to help professors add safety to their chemical engineering courses. This added education is needed because large chemical plant accidents continue to increase every year. The consequences are deaths, injuries, and environmental damage, and there is currently no sign that there will be fewer accidents in the future. The causes are the complexity of chemical processes, the aging of our existing plants, and sizes of our newer plants. Our students and engineers must be especially motivated to prevent these accidents in this complex environment. The ultimate goal of SACHE is to create a “safety culture” in our young professionals by adding elements of safety to the undergraduate curriculum. The idea is that if students are exposed to safety in small quantities throughout their education, then it will become a part of their inherent thinking both as students and when working as professionals. This safety culture will help our future professionals to be positive motivated to design, install, and manage safe plants in this challenging environment. Clearly the detailed education on specific process safety topics is the responsibility of industry; however, the effectiveness of this training will be substantially improved when working with engineers with a positive safety culture. These SACHE efforts include: a) motivating professors regarding the importance of process safety (workshops for professors in a plant environment), b) helping professors add safety to their courses (developing course safety materials), and c) motivating students regarding the importance of process safety (professors using these materials in their classes, AICHE Design Problem Awards, and SACHE Safety Certificates). © 2009 American Institute of Chemical Engineers Process Saf Prog, 2009
Competitive effects of the exotic Bombus terrestris on native bumble bees revealed by a field removal experiment
Authors: Nagamitsu Teruyoshi , Yamagishi Hiroki , Kenta Tanaka , Inari Naoki , Kato Etsushi
Published: April 2009

A commercialized bumble bee pollinator (Bombus terrestris) introduced from Europe has colonized in Japan and potentially competes with native bumble bees for food and nest sites. To examine the competitive impacts, a field removal experiment was conducted in an area in northern Japan where B. terrestris has become feral. In 2005 and 2006, totals of 1,511 and 2,978 B. terrestris bees, respectively, were killed in six removal sites. In those 2 years and the pre‐removal year (2004), the bee abundance and worker body size were measured in the six removal sites and seven control sites, and effects of the removal on the measurements were examined using statistical models. In 2005 only, the removal decreased the number of B. terrestris queens and increased that of two native species, B. ardens and B. hypocrita, the tongue length of which overlaps that of B. terrestris. The removal in 2005 affected the worker body size of neither B. terrestris nor any native species. These results show the competitive impacts of exotic B. terrestris on the queen abundance of the native species that are likely to share floral resources with B. terrestris.
Endoplasmic reticulum stress is implicated in retinal inflammation and diabetic retinopathy
Authors: Li Jingming , Wang Joshua J. , Yu Qiang , Wang Min , Zhang Sarah X.
Published: April 2009

Diabetic retinopathy is a chronic low‐grade inflammatory disease; however, the mechanisms remain elusive. In the present study, we demonstrated that endoplasmic reticulum (ER) stress was activated in the retina in animal models of diabetes and oxygen‐induced retinopathy (OIR). Induction of ER stress by tunicamycin resulted in significantly increased expression of inflammatory molecules in the retina. Inhibition of ER stress by chemical chaperone 4‐phenyl butyric acid ameliorated inflammation in cultured human retinal endothelial cells exposed to hypoxia, and in the retinas of diabetic and OIR mice. These findings indicate that ER stress is a potential mediator of retinal inflammation in diabetic retinopathy.
Essential role of p53 in TPEN‐induced neuronal apoptosis
Authors: Ra Hana , Kim Hyun-Lim , Lee Han-Woong , Kim Yang-Hee
Published: April 2009

Depletion of intracellular zinc with N,N,N′,N′‐tetrakis(2‐pyridylmethyl)ethylenediamine (TPEN) induces protein synthesis‐dependent apoptosis. In this study, we examined the requirement for p53 as an upstream transcription factor in TPEN‐induced neuronal apoptosis. Chemical or genetic blockade of p53 markedly attenuated TPEN‐induced neuronal apoptosis, while the stability and activity of p53 were increased by TPEN. In addition, expression of proapoptotic genes, PUMA and NOXA, and activation of caspase‐11 were increased by TPEN in a p53‐dependent manner. Inhibition of p53 blocked cytochrome C release from mitochondria to cytosol and prevented caspase‐3 activation. Therefore, p53 may be an essential regulatory factor for TPEN‐induced neuronal apoptosis.
TNF‐related apoptosis‐inducing ligand suppresses PRDX4 expression
Authors: Wang Hua-Qin , Du Zhen-Xian , Liu Bao-Qin , Gao Yan-Yan , Meng Xin , Guan Yifu , Zhang Hai-Yan
Published: April 2009

TNF‐related apoptosis‐inducing ligand (TRAIL) is currently considered a promising target for developing anti‐cancer therapies. Accumulating evidences have now shown that oxidative stress is involved in the TRAIL‐mediated cell death. The peroxiredoxins (PRDXs) are a ubiquitous family of proteins involved in protection against oxidative stress through the detoxification of cellular peroxides. Here we demonstrated that endogenous expression of PRDX4 was significantly decreased by TRAIL at the transcriptional level. In addition, overexpression of PRDX4 dramatically suppressed TRAIL‐induced apoptosis. Taken together, these data for the first time suggested that TRAIL suppressed the PRDX4 gene at the transcriptional level and that downregulation of PRDX4 might facilitate cell death induced by TRAIL.
Early identification and treatment of Alzheimer's disease: Social and fiscal outcomes
Authors: Weimer David L. , Sager Mark A.
Published: April 2009

Background

Alzheimer's disease (AD) is a progressive neurodegenerative disease that places substantial burdens on those who provide support for family members with declining cognitive and functional abilities. Many AD patients eventually require formal long‐term care services because of the absence, exhaustion, or inability of family members to provide care. The costs of long‐term care, and especially nursing home care, often deplete private financial resources, placing a substantial burden on state Medicaid programs. Current evidence suggests that pharmacological treatments and caregiver interventions can delay entry into nursing homes and potentially reduce Medicaid costs. However, these cost savings are not being realized because many patients with AD are either not diagnosed or diagnosed at late stages of the disease, and have no access to Medicare‐funded caregiver support programs.

Methods and Results

A Monte Carlo cost‐benefit analysis, based on estimates of parameters available in the medical literature, suggests that the early identification and treatment of AD have the potential to result in large, positive net social benefits as well as positive net savings for states and the federal government.

Conclusions

These findings indicate that the early diagnosis and treatment of AD are not only socially desirable in terms of increasing economic efficiency, but also fiscally attractive from both state and federal perspectives. These findings also suggest that failure to fund effective caregiver interventions may be fiscally unsound.
Impact of Hydronephrosis on Treatment Outcome of Solitary Proximal Ureteral Stone After Extracorporeal Shock Wave Lithotripsy
Authors: Hsiao Hsi‐Lin , Huang Shu‐Pin , Wu Wen‐Jeng , Lee Yung‐Chin , Li Wei‐Ming , Chou Yii‐Her , Chang Ai‐Wen , Huang Chun‐Hsiung , Sun Shu‐Chin , Liu Chia‐Chu
Published: April 2009

The purpose of this study was to investigate the impact of hydronephrosis on the treatment outcome of patients with a solitary proximal ureteral stone after extracorporeal shock wave lithotripsy (ESWL). A total of 182 consecutive patients who underwent ESWL for a solitary proximal ureteral stone of between 5 and 20 mm in size in our institution were included in this study. The degree of hydronephrosis was defined by renal ultrasonography. Patient data, stone size, shock wave numbers and shock wave energy were also recorded. Treatment outcome was evaluated 3 months after the first session of ESWL. In multivariate analysis, only the maximal stone length (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.03–0.91; p = 0.04) and the degree of hydronephrosis (OR, 0.40; 95% CI, 0.16–0.98; p = 0.045) were significant predicting factors for stone‐free status 3 months after ESWL. For stones ≤ 10 mm, the stone‐free rate decreased from 80% in patients with mild hydronephrosis to 56.4% in those with moderate to severe hydro‐nephrosis. For stones > 10 mm, the stone‐free rate decreased further, from 65.2% in patients with mild hydronephrosis to 33.3% in those with moderate to severe hydronephrosis. In summary, patients with a solitary proximal ureteral stone and a stone > 10 mm, the treatment outcome after ESWL was not good if moderate to severe hydronephrosis was noted on ultrasonography. Alternative treatments, such as ureteroscopic lithotripsy, may be appropriate as initial treatment or after failure of one session of ESWL.
Mediators Affecting Family Function in Families of Children with Duchenne Muscular Dystrophy
Authors: Chen Jih‐Yuan
Published: April 2009

Most families of children with Duchenne muscular dystrophy (DMD) first receive professional information about the disease at the time of their child's diagnosis. Generally, as the families begin to build a supportive care system for their children, the parents will research DMD on their own or gather formal knowledge about the disease from professionals. However, gaining access to care is a major challenge because they often do not know how to ask the right questions. In particular, vulnerable populations may experience difficulties in assisting their child's emotional adjustment to the disability and use of available services. The purpose of this study was to test the possible effects of psychosocial mediators of parental health, family hardiness and family support on family function in relation to the age at diagnosis of children with DMD. One hundred and twenty‐six Taiwanese parents of children with DMD who are members of the Taiwan Muscular Dystrophy Association filled out questionnaires. Subjects received a phone call before and again within the first week after we mailed them a questionnaire, a stamped return‐addressed envelope, and a consent form. The questionnaires included the Family Hardiness Index, Family Assessment Device, Family APGAR, Duke Health Profile and demographic questions. Hierarchical multiple regressions were conducted to test whether family hardiness, parental health, or family support mediated or moderated the association between age at diagnosis and family function. Family hardiness positively mediated the association between age at diagnosis and family function. These findings may help the design of interventions to develop family hardiness in families of children with DMD.
A Water Extract of Pueraria Lobata Inhibited Cytotoxicity of Enterovirus 71 in a Human Foreskin Fibroblast Cell Line
Authors: Su Fu‐Min , Chang Jung‐San , Wang Kuo‐Chih , Tsai Jih‐Jin , Chiang Lien‐Chai
Published: April 2009

Enterovirus 71 (EV71) can cause brain encephalitis and mortality. However, effective vaccines or chemotherapeutic agents are not yet available. We tested the hypothesis that Pueraria lobata could inhibit the cytotoxic effect of EV71 in a human foreskin fibroblast cell line by the XTT method. Our results showed that the water extract of P. lobata could inhibit cytopathy induced by EV71 when given before (p < 0.0001), simultaneously with (p < 0.0001), or after viral infection (p < 0.0001). Water extract of P. lobata was effective and its minimal concentration that inhibited 50% of the cytopathic effect (IC50) was 0.028 μg/mL. P. lobata was also safe with a selectivity index greater than 107,000. Water extract of P. lobata appeared to inhibit viral attachment (p < 0.0001) and penetration (p < 0.0001). The anti‐EV71 activity of the water extract of P. lobata was not mediated by interferons. In conclusion, the water extract of P. lobata was effective in the management of the disease induced by EV71 infection.
Extrathoracic Bypass of an Orifice Occlusive Lesion in the Arch Vessels: Case Reports and Literature Review
Authors: Chin Hsien‐Kuo , Chang Yee‐Phoung , Chao Chia‐Sheng
Published: April 2009

Arterial occlusive disease of the arch vessels is often associated with flow reversal in the vertebral artery of such patients, the so‐called subclavian steal syndrome. We treated two such cases that were diagnosed based on symptoms, physical examination and angiography. In the first case, the occlusive lesion was found at the origin of left subclavian artery, while the occlusion was positioned at the origin of innominate artery in the second case. A carotid–subclavian and a carotid–carotid bypass using 8‐mm PTFE grafts were performed, respectively. No complications were noted and the patients have retained a symptom‐free status during a follow‐up of 5 years. Taking into account the expense of stenting and the patency rate, extrathoracic bypass surgery using a PTFE graft for the treatment of orifice occlusive lesions of arch vessels is cheaper and has an overall better patency rate. Furthermore, because it is the final choice of treatment after percutaneous transluminal angioplasty fails, it should be considered as an ideal therapy for lesions at the origin of arch vessels.
Dual‐Phase 99MTc‐MIBI Parathyroid Imaging Reveals Synchronous Parathyroid Adenoma and Papillary Thyroid Carcinoma: A Case Report
Authors: Chang Ming‐Che , Tsai Shih‐Chuan , Lin Wan‐Yu
Published: April 2009

The possibility of a coincidental appearance of hyperparathyroidism and thyroid cancer is not often considered because of its low incidence. Here, we present a case of a 49‐year‐old woman with a parathyroid adenoma coexisting with two sites of papillary thyroid carcinoma. Dual‐phase 99mTc‐methoxyisobutylisonitrile (MIBI) parathyroid imaging before the operation correctly visualized the site of the parathyroid adenoma. In addition, two papillary thyroid carcinomas showed faint uptake of 99mTc‐MIBI on delayed image. Total thyroidectomy and parathyroidectomy of a solitary parathyroid adenoma were performed. The patient subsequently underwent radioiodine‐131 ablation and was treated with T4 suppression. This case illustrates the need for clinical awareness of concomitant hyperparathyroidism and thyroid cancer. Dual‐phase 99mTc‐MIBI parathyroid imaging may be useful for detecting indolent thyroid cancer before it becomes a distinct disease.
Cytologic Diagnosis of Primary Effusion Lymphoma in an HIV‐Negative Patient
Authors: Su Yue‐Chiu , Chai Chee‐Yin , Chuang Shih‐Sung , Liao Yung‐Liang , Kang Wan‐Yi
Published: April 2009

Primary effusion lymphoma (PEL) is an unusual and rare type of non‐Hodgkin's lymphoma characterized by lymphomatous effusion of pleural, pericardial or peritoneal cavities without lymphadenopathy or organomegaly. It is associated with human herpes virus‐8 (HHV‐8) and occurs most often in immunodeficient patients. We present a case of PEL in a 69‐year‐old male presenting with pleural effusion and ascites. Fluid aspiration showed a monomorphic population of atypical lymphoid cells, which were medium‐ to large‐sized, with mono‐ or binucleated hyper‐chromatic nuclei and a small to moderate amount of basophilic cytoplasm containing cytoplasmic vesicles. Immunohistochemically, the lymphoid cells expressed CD138 and multiple myeloma oncogene 1, were positive for HHV‐8, and were monoclonal for immunoglobulin heavy chain gene rearrangement. They were negative for Epstein‐Barr virus by in situ hybridization. Unfortunately, the patient died during the first course of chemotherapy with cyclophosphamide, vincristine and prednisone.
Advances in Health Care in Taiwan: Lessons for Developing Countries
Authors: Watt John R.
Published: April 2009

Taiwan's health services, now among the best in the world, were largely developed after 1947 under conditions of epidemiological and political crisis. Its medical, nursing, and public health leaders knew the importance of focusing on preventive health strategies, and its central government leaders knew how important health care was to the achievement of economic goals. Although there were from time to time setbacks and difficulties, the leadership learned from their mistakes and made effective use of international advice and resources. Taiwan's record makes the case that modernization of health care contributes to economic development and should not be viewed solely as a budgetary cost. Its record provides a mine of information for countries seeking to develop health services compatible with sustained economic and social development.
A New Application of Spatiotemporal Analysis for Detecting Demographic Variations in AIDS Mortality: An Example from Florida
Authors: Chiu Yu‐Wen , Wang Min‐Qi , Chuang Hung‐Yi , Hsu Chiehwen Ed , Nkhoma Ella T.
Published: April 2009

The purpose of the present study was to characterize, geographically and temporally, the patterns of acquired immune deficiency syndrome (AIDS) death disparity in 67 Florida jurisdictions, and to determine if the detected trends varied according to age, race, and sex. The space‐time scan statistic proposed by Kulldorff et al was used to examine the excess AIDS deaths that occurred between 1987 and 2004. Results were geographically referenced in maps using EpiInfo and EpiMap made available by the Centers for Disease Control. Miami‐Dade and the nearby counties including Broward, Martin, and Palm Beach are the most likely clusters (observed/expected: 1505.16) with temporal dimension (also called cluster's age) persisting from 1996 to the present. Union county had the longest cluster for the cluster period 1987–1998, but not for 1999–2004. African‐Americans contributed to more clusters compared with whites. Time trends indicated that AIDS mortality peaked in 1995 and then sharply dropped until 1998, when the decrease stopped. By accounting for the temporal dimension of disease clustering, the present study revealed the persistence of geographic clusters, which is not often provided by other geographic detection methods. These findings may be informative for medical resource allocation and better focus public health intervention strategies for AIDS care.
Carcinoma Showing Thymus‐Like Differentiation (CASTLE) of Thyroid: A Case Report and Literature Review
Authors: Chan Leong‐Perng , Chiang Feng‐Yu , Lee Ka‐Wo , Kuo Wen‐Rei
Published: April 2009

Carcinoma showing thymus‐like differentiation (CASTLE) is a rare malignant neoplasm that occurs in the thyroid gland, or head and neck. This tumor arises from either ectopic thymus tissue or remnants of branchial pouches, which retain the potential to differentiate along the thymus line. Clinical presentation and imaging can be consistent with a malignant lesion such as thyroid cancer or thymic carcinoma. Immunohistochemical staining with CD5 can differentiate CASTLE from other malignant thyroid neoplasms. A 54‐year‐old male had initially presented with a painless, left neck mass for 3 months. He underwent left thyroid lobectomy via a median sternotomy approach. Carcinoma showing thymus‐like differentiation was the final histopathologic diagnosis. After 36 months of follow‐up, no evidence of recurrence was observed. A median sternotomy is an excellent approach for CASTLE with anterior mediastinum involvement. Complete resection is important to improve the long‐term survival rate and the locoregional recurrence rate.
Reversed‐Flow Superior Thyroid Artery: An Alternative Recipient Vessel in Head and Neck Reconstruction
Authors: Huang Shu‐Hung , Wu Sheng‐Hua , Wang Wen‐Her , Cheen Mau‐Chang , Lai Cheng‐Sheng , Lin Sin‐Daw , Chang Kao‐Ping
Published: April 2009

In neoadjuvant intra‐arterial infusion chemotherapy patients, the common recipient arteries are frequently damaged owing to preoperative chemotherapy‐induced intima injury. When ante‐grade arterial inflow to the free flap is not available, end‐to‐side carotid arterial anastomosis or exploration of another recipient artery may be an appropriate solution. However, reversed arterial flow is an alternative to such a situation. We report a case with squamous cell carcinoma on the right buccal area, which was successfully reconstructed using a free anterolateral thigh flap with reverse superior thyroid arterial inflow. This alternative method might shorten the operation time and also reduce further exploration injury in the operation field.
Abdominal Splenosis Mimicking Hepatic Tumor: A Case Report
Authors: Yeh Ming‐Lun , Wang Liang‐Yen , Huang Ching‐I , Hsieh Ming‐Yen , Lin Zu‐Yau , Chuang Wan‐Long , Chang Wen‐Tsan , Wu Chun‐Chieh , Chen Chiao‐Yun
Published: April 2009

Diagnosis of abdominal splenosis is often undiagnosed until treatment for splenic rupture or splenectomy. This report describes a patient with splenosis mimicking hepatic tumor. The patient had a history of splenic trauma with splenectomy and chronic hepatitis C. After routine abdominal ultrasound revealed a liver nodule, further imaging studies, including magnetic resonance imaging, computed tomography and angiography, were performed. After the patient eventually underwent surgery, pathology revealed splenic tissue. Despite its distinguishable clinical features, splenosis is difficult to identify by modern imaging modalities. Therefore, accurate and timely diagnosis of this disease requires constant vigilance.
Pneumoperitoneum Caused by Air Leakage Through the Percutaneous Puncture Tract as a Complication of Rendezvous Technique: A Case Report
Authors: Chuang Chiao‐Hsiung , Chen Chiung‐Yu , Tsai Hong‐Ming
Published: April 2009

The rendezvous technique, combining percutaneous and endoscopic procedures, is a safe and effective method to achieve biliary cannulation if an endoscopic approach fails. The two procedures in this technique can be carried out simultaneously or in stages. A simultaneous approach is reported to be associated with fewer complications, and patients undergoing this approach can recover and be discharged more rapidly. Here, we report a complication of pneumoperitoneum in a patient who underwent percutaneous and endoscopic procedures simultaneously for the removal of a common bile duct stone. It was supposed that prolonged air insufflation during endoscopy forced intestinal air to track into the peritoneal cavity through the bile ducts and the puncture tract. Accordingly, a short wait before removing the percutaneous catheter to deflate the intestinal air will be helpful to avoid such a complication.
Experiences of Interprofessional Implementation of a Healthcare Matrix
Authors: Lee Su‐Shin , Chiang Hung‐Che , Chen Meng‐Chum , Chen Ling‐Sui , Hsu Pei‐Ling , Sun I‐Feng , Lai Chung‐Sheng
Published: April 2009

The Taiwan Joint Commission on Hospital Accreditation endorsed the Institute of Medicine (IOM) dimensions of health care quality as safe, timely, effective, efficient, equitable, and patient‐centered. The Taiwan Association of Medical Education has also adopted the Accreditation Council for Graduate Medical Education (ACGME) outcome project and core competencies for Taiwan physicians in training. These schemes focus on patient care, medical knowledge and skills, interpersonal and communication skills, professionalism, system‐based practice and practice‐based learning and improvement. Bingham (2004) described a Healthcare Matrix that links to the ACGME Core Competencies and the IOM Dimensions of Quality as a tool to improve health care. The matrix provides a blueprint to help residents learn the core competencies in patient care, and to help the faculty to link mastery of the competencies with improvements in quality of care. However, the “six‐by‐six” framework was too complicated to fill in. Furthermore, the translation of the IOM aims and ACGME core competencies into the Chinese language seemed incoherent and difficult to remember. We simplified the matrix by merging some columns of the original Healthcare Matrix, and reduced the 6 × 6 form into a 4 × 5 framework. The matrix was applied in case conferences, mortality and morbidity conferences, combined meetings and nursing quality assurance meetings in different departments. This format organizes the presentation and discussion, highlighting strengths or deficiencies in key aspects of patient care. With interprofessional collaboration, the matrix has been used in the departments of Plastic Surgery, and Nursing and Performance Management in our hospital. The achievements are encouraging. The Taiwan Edition Healthcare Matrix is worthy of consideration, having been used in a Mandarin‐speaking region of Asia.
OSCE for the Medical Licensing Examination in Korea
Authors: Lee Yoon‐seong
Published: April 2009

Objective structured clinical examinations (OSCEs) will be introduced in the Medical Licensing Examination in Korea next year. To evaluate the competency of new medical graduates, a written examination is not sufficient to test the clinical skills and attitudes of medical school graduates. The Korean Society of Medical Education and National Health Personnel Licensing Examination Board have been preparing for OSCEs to be included in the licensing examination for a number of years, following the declaration by the Minister of Health and Welfare, of the Korean Government. One center in Seoul will provide two identical sets of stations. The OSCE will have 12 stations. Six short stations will test procedural techniques and skills, and six long stations will feature standardized patients. The test items for the short stations and the clinical presentations of the long stations will be made available to applicants. However, the checklists will not be made available. It is hoped that the OSCE will raise the standard of competencies of new medical doctors and change clinical education in the medical schools.
The Role of Standardized Patient and Trainer Training in Quality Assurance for a High‐Stakes Clinical Skills Examination
Authors: Furman Gail E.
Published: April 2009

For over 30 years, medical educators have used standardized patients (SPs), laypersons trained to portray a patient case in a realistic manner, to teach and to assess clinical skills. All medical schools in the US have SP programs in place, and the US and Canada require national examinations using SPs to assess the competency of those wishing to obtain licensure to practice medicine in these countries. To ensure a valid and reliable examination, unwanted variance that can be introduced by SP performance must be addressed. The goal of SP training is to imbue the SP with the characteristics, mannerisms and history of a real patient so that the portrayal is consistent and accurate. The challenge is to ensure consistent portrayal of each case with sufficient realism to elicit the expected clinical performance and to ensure standardized SP performance across multiple examinees. This paper considers the quality assurance methods applied to training the SP trainers and the protocols used to train the SPs, to ensure that the SP performances are sufficiently accurate and standardized, and that the evaluators completing the checklists and scales used for scoring do so correctly and consistently.
Effects of the Emergency Trauma Training Course on the Confidence of Final‐Year Medical Students Dealing with Trauma Patients
Authors: Lin Hsing‐Lin , Chen Chao‐Wen , Lee Wei‐Che , Kuo Liang‐Chi , Cheng Yuan‐Chia , Lin Yen‐Ko , Lin Jiun‐Nong , Chan Hon‐Man
Published: April 2009

Trauma is an important issue that has been neglected in the training of medical students. This study evaluated the effects of the Emergency Trauma Training Course (ETTC), after completion of standard medical training, on seventh‐year medical students. The ETTC was designed in Taiwan by the Taiwan Society of Emergency Medicine to train physicians and registered nurses who care for trauma patients in the emergency department (ED). We implemented the course for our medical students' internship. One hundred and fifty‐one participants were divided into three groups: Group A included 36 medical students before they entered their internship in hospital; Group B included 41 medical students who had received 6 months of internship training in hospital; and Group C included 74 ED nurses. Group C was used to test Cronbach's alpha coefficient of the questionnaire. After the training course, the participants had a final examination and filled out a questionnaire about the training course and their levels of self‐confidence. There were no differences in scores between the medical students in Groups A and B (p = 0.064). Using repeated measures analysis of variance, we found that confidence before training was low, with no difference between Groups A and B. Confidence improved after training, but there was still no significant difference between the groups (p = 0.875). However, there were significant differences between confidence levels before and after the training course (p < 0.001). Therefore, although inhospital training for 6 months failed to increase confidence, the confidence of final year medical students after completion of their training was improved by the ETTC. This indicates that the ETTC could increase the confidence of participants. This is the first evaluation of the implementation of the ETTC for final‐year medical students in Taiwan. Based on our results, we highly recommend that this training course be taught to final‐year medical students before they practice in hospital.