bluuebunny/crossref_metadata_2025 huggingface dataset:
Desire for Information and Involvement in Treatment Decisions: Elderly Cancer Patients' Preferences and Their Physicians' Perceptions
Authors: Elkin Elena B. , Kim Susie H.M. , Casper Ephraim S. , Kissane David W. , Schrag Deborah
Published: November 2007

Purpose

Shared decision making is a tenet of contemporary medicine and oncology practice. How involved elderly patients want to be in making treatment decisions and how physicians perceive patient preferences for such involvement are uncertain.

Patients and Methods

In structured interviews about multiple facets of chemotherapy treatment decision making, we asked patients age 70 years and older with a recent diagnosis of metastatic colorectal cancer (CRC) about their preferences for prognostic information and for involvement in treatment decision making. We also asked treating oncologists (n = 19) to describe their perceptions of patient preferences. Information and decision-making preferences were evaluated in relation to sociodemographic and clinical characteristics.

Results

Seventy-three patients age 70 to 89 years completed the study interview within 16 weeks of metastatic CRC diagnosis. Most patients (n = 70; 96%) had decided to receive chemotherapy and 61 had initiated treatment. Relatively few (n = 32; 44%) wanted information about expected survival when they made a treatment decision. Preference for prognostic information was more common among men than women (56% v 29%; P < .05). About half of the patients (n = 38; 52%) preferred a passive role in the treatment decision-making process. Physician perceptions were concordant with patient preferences for information in 44% of patient-physician pairs and for decision control in 41% of patient-physician pairs.

Conclusion

For older patients with advanced CRC, preferences for prognostic information and for an active role in treatment decision making are not easily predictable. Physicians' perceptions are often inconsistent with patients' stated preferences. Explicit discussion of preferred decision-making styles may improve patient-physician encounters.
Prognostic Role of Minimal Residual Disease in Mature B-Cell Acute Lymphoblastic Leukemia of Childhood
Authors: Mussolin Lara , Pillon Marta , Conter Valentino , Piglione Matilde , Lo Nigro Luca , Pierani Paolo , Micalizzi Concetta , Buffardi Salvatore , Basso Giuseppe , Zanesco Luigi , Rosolen Angelo
Published: November 2007

Purpose

To study the prevalence of t(8;14) at diagnosis and the response kinetics to treatment of minimal residual disease (MRD) in B-cell acute lymphoblastic leukemia (B-ALL) patients and determine its impact on prognosis.

Patients and Methods

A total of 68 children affected by de novo B-ALL enrolled onto the Berlin-Frankfurt-Muenster–based Italian Association of Pediatric Hematology and Oncology LNH-97 clinical protocol were studied. Bone marrow aspirate from each patient was analyzed for the presence of t(8;14)(q24;q32) by long-distance polymerase chain reaction at diagnosis, after the first chemotherapy cycle, and after subsequent cycles until negative for MRD. Morphologic and immunophenotypic analyses were reviewed centrally.

Results

A total of 47 patients (69%) were positive for t(8;14)(q24;q32). MRD response kinetics was determined in 39 patients. All of them reached clinical complete remission and most (31 of 39) became MRD negative after the first chemotherapy cycle. The 3-year relapse-free survival (RFS) was 38% (SE = 17%) in patients MRD positive after the first chemotherapy cycle compared with 84% (SE = 7%) in MRD-negative patients (P = .0005), whereas there was no difference in RFS for children who reached a clinical complete remission after the first chemotherapy cycle versus those who did not (RFS = 72% and SE = 9%; RFS = 79% and SE = 11%, respectively; P = .8). In multivariate analysis, MRD was shown to be predictive of higher risk of failure.

Conclusion

Our study demonstrated that MRD carries a negative prognostic impact in B-ALL patients and suggests that a better risk-adapted therapy, possibly including the use of anti-CD20 monoclonal antibody, should be considered in selected patients.
Phase II Trial of Bevacizumab in Persistent or Recurrent Epithelial Ovarian Cancer or Primary Peritoneal Cancer: A Gynecologic Oncology Group Study
Authors: Burger Robert A. , Sill Michael W. , Monk Bradley J. , Greer Benjamin E. , Sorosky Joel I.
Published: November 2007

Purpose

Vascular endothelial growth factor (VEGF) seems to be a promoter of tumor progression for epithelial ovarian cancer (EOC) and primary peritoneal cancer (PPC). We conducted a phase II trial to assess the efficacy and tolerability of single-agent bevacizumab, an anti-VEGF monoclonal antibody.

Patients and Methods

Eligible patients had persistent or recurrent EOC/PPC after one to two prior cytotoxic regimens, measurable disease, and Gynecologic Oncology Group performance status of at least 2. Treatment consisted of bevacizumab 15 mg/kg intravenously every 21 days until disease progression or prohibitive toxicity. Primary end points were progression-free survival (PFS) at 6 months and clinical response.

Results

The study consisted of 62 eligible and assessable patients, median age 57 years, 41 (66.1%) having received two prior regimens and 36 (58.1%) considered platinum resistant. Grade 3 adverse events at least possibly related to bevacizumab were hematologic (1), GI (3), hypertension (6), thromboembolism (1), allergy (2), hepatic (1), pain (3), coagulation (1), constitutional (1), and dyspnea (1). Grade 4 adverse events included pulmonary embolus (1), vomiting and constipation (1), and proteinuria (1). Thirteen patients (21.0%) experienced clinical responses (two complete, 11 partial; median response duration, 10 months), and 25 (40.3%) survived progression free for at least 6 months. Median PFS and overall survival were 4.7 and 17 months, respectively. There was no significant association of prior platinum sensitivity, age, number of prior chemotherapeutic regimens, or performance status with the hazard of progression or death.

Conclusion

Bevacizumab seems to be well tolerated and active in the second- and third-line treatment of patients with EOC/PPC and merits phase III investigation.
Prognostic and Predictive Importance of p53 and RAS for Adjuvant Chemotherapy in Non–Small-Cell Lung Cancer
Authors: Tsao Ming-Sound , Aviel-Ronen Sarit , Ding Keyue , Lau Davina , Liu Ni , Sakurada Akira , Whitehead Marlo , Zhu Chang-Qi , Livingston Robert , Johnson David H. , Rigas James , Seymour Lesley , Winton Timothy , Shepherd Frances A.
Published: November 2007

Purpose

p53 and RAS are multifunctional proteins that are critical to cell cycle regulation, apoptosis, cell survival, gene transcription, response to stress, and DNA repair. We have evaluated the prognostic and predictive value of p53 gene/protein aberrations using tumor samples from JBR.10, a North American phase III intergroup trial that randomly assigned 482 patients with completely resected stage IB and II non–small-cell lung cancer (NSCLC) to receive four cycles of adjuvant cisplatin plus vinorelbine or observation alone.

Methods

p53 protein expression was evaluated by immunohistochemistry. Mutations in exons 5 to 9 of the p53 gene were determined by denaturing high-performance liquid chromatography and confirmed by sequencing. RAS mutations were identified by allelic specific oligonucleotide hybridization.

Results

Of 253 patients, 132 (52%) were positive for p53 protein overexpression. Untreated p53-positive patients had significantly shorter overall survival than did patients with p53-negative tumors (hazard ratio [HR] = 1.89; 95% CI, 1.07 to 3.34; P = .03). However, these p53-positive patients also had a significantly greater survival benefit from adjuvant chemotherapy (HR = 0.54; P = .02) compared with patients with p53-negative tumors (HR = 1.40; P = .26; interaction P = .02). Mutations of p53 and RAS genes were found in 124 (31%) of 397 and 117 (26%) of 450 patients, respectively. Mutations in these genes were neither prognostic for survival nor predictive of a differential benefit from adjuvant chemotherapy.

Conclusion

p53 protein overexpression is a significant prognostic marker of shortened survival, and also a significant predictive marker for a differentially greater benefit from adjuvant chemotherapy in completely resected NSCLC patients.
Costs and Cost-Effectiveness of a Low-Intensity Patient-Directed Intervention to Promote Colorectal Cancer Screening
Authors: Shankaran Veena , McKoy June M. , Dandade Neal , Nonzee Narissa , Tigue Cara A. , Bennett Charles L. , Denberg Tom D.
Published: November 2007

Purpose

Colorectal cancer (CRC) screening is the most underused evidence-based cancer screening test in the United States. Few studies have reported the cost-effectiveness of CRC screening promotional efforts. In a recent randomized controlled trial, a patient-directed intervention for average-risk patients who had been referred for screening colonoscopy led to a 12% increase in CRC screening rates. The objective of this secondary analysis is to assess the cost-effectiveness of this intervention.

Patients and Methods

Patients in the intervention arm received a customized mailed brochure that included a reminder to schedule a screening colonoscopy and general information about CRC, the importance of CRC screening, and how to prepare for the procedure. The end point was completion of screening colonoscopy. The costs and incremental cost-effectiveness ratio of this patient-directed intervention were derived. Sensitivity analyses were based on varying the costs of labor and supplies.

Results

Rates of CRC screening for the intervention (n = 386 patients) versus control (n = 395) arms were 71% and 59%, respectively (P = .001). The total cost of the intervention was $1,927 and the incremental cost-effectiveness ratio was $43 per additional patient screened ($38 to $47 in a sensitivity analysis).

Conclusion

An intervention based on mailing a customized brochure to patients who were referred for a screening colonoscopy improved CRC screening rates at a university-based general medicine clinic. This intervention was comparable in effectiveness and cost-effectiveness to a similar recently reported low-intensity patient-directed CRC screening intervention, and markedly more affordable and cost-effective than a previously reported physician-directed CRC screening promotion intervention.
Cytosolic Protein Tyrosine Phosphatase-ε Is a Negative Regulator of Insulin Signaling in Skeletal Muscle
Authors: Aga-Mizrachi Shlomit , Brutman-Barazani Tamar , Jacob Avraham I. , Bak Asia , Elson Ari , Sampson Sanford R.
Published: November 2007

Whereas positive regulatory events triggered by insulin binding to insulin receptor (IR) have been well documented, the mechanism by which the activated IR is returned to the basal status is not completely understood. Recently studies focused on the involvement of protein tyrosine phosphatases (PTPs) and how they might influence IR signaling. In this study, we examined the possibility that cytosolic PTPε (cytPTPε) is involved in IR signaling. Studies were performed on L6 skeletal muscle cells. cytPTPε was overexpressed by using pBABE retroviral expression vectors. In addition, we inhibited cytPTPε by RNA silencing. We found that insulin induced rapid association of cytPTPε with IR. Interestingly, this association appeared to occur in the plasma membrane and on stimulation with insulin the two proteins internalized together. Moreover, it appeared that almost all internalized IR was associated with cytPTPε. We found that knockdown of cytPTPε by RNA silencing increased insulin-induced tyrosine phosphorylation of IR and IR substrate (IRS)-1 as well as phosphorylation of protein kinase B and glycogen synthase kinase-3 and insulin-induced stimulation of glucose uptake. Moreover, overexpression of wild-type cytPTPε reduced insulin-induced tyrosine phosphorylation of IR, IRS-1, and phosphorylation of protein kinase B and glycogen synthase kinase-3 and insulin-induced stimulation of glucose uptake. Finally, insulin-induced tyrosine phosphorylation of IR and IRS-1 was greater in skeletal muscle from mice lacking the cytPTPε gene than that from wild-type control animals. We conclude that cytPTPε serves as another major candidate negative regulator of IR signaling in skeletal muscle.
Adrenal Gland Tumorigenesis after Gonadectomy in Mice Is a Complex Genetic Trait Driven by Epistatic Loci
Authors: Bernichtein Sophie , Petretto Enrico , Jamieson Stacey , Goel Anuj , Aitman Timothy J. , Mangion Jonathan M. , Huhtaniemi Ilpo T.
Published: November 2007

Postgonadectomy adrenocortical tumorigenesis is a strain-specific phenomenon in inbred mice, assumed to be caused by elevated LH secretion and subsequent ectopic LH receptor (LHR) overexpression in adrenal gland. However, the molecular mechanisms of this cascade of events remain unknown. In this study, we took advantage of the mouse strain dependency of the phenotype to unravel its genetic basis. Our results present the first genome-wide screening related to this pathology in two independent F2 and backcross populations generated between the neoplastic DBA/2J and the nonsusceptible C57BL/6J strains. Surprisingly, the postgonadectomy elevation of serum LH was followed by similar up-regulation of adrenal LHR expression in both parental strains and their crosses, irrespective of their tumor status, indicating that it is not the immediate cause of the tumorigenesis. Linkage analysis revealed one major significant locus for the tumorigenesis on chromosome 8, modulated by epistasis with another quantitative trait locus on chromosome 18. Weight gain, a secondary phenotype after gonadectomy, showed a significant but separate quantitative trait locus on chromosome 7. Altogether, postgonadectomy adrenocortical tumorigenesis in DBA/2J mice is a dominant trait that is not a direct consequence of adrenal LHR expression but is driven by a complex genetic architecture. Analysis of candidate genes in the tumorigenesis linkage region showed that Sfrp1 (secreted frizzled-related protein 1), a tumor suppressor gene, is differentially expressed in the neoplastic areas. These findings may have relevance to the human pathogenesis of macronodular adrenal hyperplasia and adrenocortical tumors in postmenopausal women and why some of them develop obesity.
Phosphorylation of Bone Morphogenetic Protein-15 and Growth and Differentiation Factor-9 Plays a Critical Role in Determining Agonistic or Antagonistic Functions
Authors: McMahon Heather E. , Sharma Shweta , Shimasaki Shunichi
Published: November 2007

Two highly homologous oocyte-secreted growth factors, bone morphogenetic protein (BMP)-15 and growth and differentiation factor (GDF)-9, are known to control folliculogenesis and ovulation through direct effects on granulosa cells in the developing follicles. Although much is known about the expression and biology of these proteins, the impact of posttranslational modifications of BMP-15 and GDF-9 is unknown. Here, we report that: 1) recombinant human (rh) BMP-15 and rhGDF-9 are phosphorylated; 2) the phosphorylation is essential for bioactivity; and 3) the dephosphorylated forms of rhBMP-15 and rhGDF-9 can abolish the bioactivity of rhBMP-15, rhGDF-9, and rhBMP-7, but not rh activin A. These results indicate that the phosphorylation state of rhBMP-15 and rhGDF-9 is a determinant of their agonistic and antagonistic activities.
Physically Walking in Digital Spaces — A Virtual Reality Installation for Exploration of Historical Heritage
Authors: Hernández Luis A. , Taibo Javier , Blanco David , Iglesias José A. , Seoane Antonio , Jaspe Alberto , López Rocío
Published: November 2007

Immersive Virtual Reality Systems have been extensively used during recent years for the exploration of architectonic spaces. This paper describes how the use of transitable immersive virtual reality systems, that is, those that allow the user to physically walk while exploring the virtual world, can greatly empower the experience of perception of space in architecture. The text describes a particular example of one installation of this kind that was developed by the authors and how it was implemented for the interactive experience of the virtual reconstruction of a housing unit on a pre-roman settlement. This installation is open to the public as part of a permanent exhibition and constitutes the final output of the research at this time.
Zoom-In, Zoom-Out: Architectural Scale and Digital Technology
Authors: Piantá Cláudia , Cabral Costa
Published: November 2007

This paper aims at contributing to the study of the relationship between technology, knowledge and representation. It is based on previous studies on architecture, art and technology in modernity and its development, as well as on studies about scale in architectural design. In despite of the fact that scale can be technically considered indifferent for computer-aided design, I intend to discuss how digital tools intercede in the process of clipping that selecting a specific scale eventually implies sustaining that, for architectural design, the concept of scale has to do both with representation and with knowledge of reality.
Plasma Fatty Acid-Binding Protein 4 Increases with Renal Dysfunction in Type 2 Diabetic Patients without Microalbuminuria
Authors: Cabré Anna , Lázaro Iolanda , Girona Josefa , Manzanares Josep M , Marimón Francesc , Plana Núria , Heras Mercedes , Masana Lluís
Published: November 2007

Background: Fatty acid–binding protein 4 (FABP4) has been linked to metabolic syndrome development, diabetes, and arteriosclerosis, but the role of FABP4 in target organ damage has not been assessed. We evaluated whether plasma FABP4 is associated with renal dysfunction in type 2 diabetic patients.

Methods: In 263 individuals (161 type 2 diabetic patients and 102 healthy nondiabetic controls), we analyzed the correlation between FABP4 and creatinine or glomerular filtration index (MDRD-GFR) regarding the presence or absence of microalbuminuria. Patients with severe chronic kidney disease (MDRD-GFR <30 mL/min/1.73 m2) or albuminuria were not included.

Results: FABP4 concentrations were higher in diabetic patients with MDRD-GFR <60 mL/min/1.73 m2 (P <0.001). We observed a significant, direct correlation between FABP4 and creatinine (r = 0.446, P <0.001) and an inverse correlation between FABP4 and MDRD-GFR (r = −0.511, P <0.001) in type 2 diabetic patients, but not in nondiabetic individuals. These correlations were sustained when only those patients without microalbuminuria were analyzed (r = 0.414, P <0.001 and r = −0.510, P <0.001, respectively). Type 2 diabetic patients with FABP4 in the highest tertile compared with those in the lower tertiles had increased adjusted odds ratios for moderate renal dysfunction [7.5 (95%CI 1.8–30.7), P = 0.005 and 15.3 (3.1–76.4), P = 0.001; respectively], independent of microalbuminuria.

Conclusions: High FABP4 plasma concentrations are associated with high plasma creatinine and low MDRD-GFR in patients with type 2 diabetes even in the absence of microalbuminuria or clinically relevant alterations of creatinine and MDRD-GFR values. FABP4 concentrations should be taken into consideration as an early marker of kidney damage in patients with type 2 diabetes.
Lumazine proteins from photobacteria: localization of the single ligand binding site to the N-terminal domain
Authors: Illarionov Boris , Eisenreich Wolfgang , Wirth Martina , Yong Lee Chan , Eun Woo Young , Bacher Adelbert , Fischer Markus
Published: November 2007

Lumazine protein is believed to serve as an optical transponder in bioluminescence emission by certain marine bacteria. Sequence arguments suggest that the protein comprises two similarly folded riboflavin synthase-type domains, but earlier work also suggested that only one domain binds 6,7-dimethyl-8-ribityllumazine (DMRL). We show that the replacement of serine-48 or threonine-50 in the N-terminal domain of lumazine protein of Photobacterium leiognathi modulates the absorbance and fluorescence properties of bound DMRL or riboflavin. Moreover, the replacement of these amino acids is accompanied by reduced ligand affinity. Replacement of serine-48 by tryptophan shifts the 13C NMR signal of the 6-methyl group in bound DMRL upfield by 2.9 ppm as compared to the wild-type protein complex. Replacement of threonine-50 causes a downfield shift of approximately 20 ppm for the 15N NMR signal of N-5, as well as an upfield shift of 3 ppm for the 13C NMR signal of C-7 in bound DMRL, respectively. The replacement of the topologically equivalent serine-144 and proline-146 in the C-terminal domain had no significant impact on optical properties, chemical shifts and apparent binding constants of bound DMRL. These data show that the N-terminal domain is the unique site for ligand binding in lumazine protein.
Novel zinc-responsive post-transcriptional mechanisms reciprocally regulate expression of the mouse Slc39a4 and Slc39a5 zinc transporters (Zip4 and Zip5)
Authors: Weaver Benjamin P. , Dufner-Beattie Jodi , Kambe Taiho , Andrews Glen K.
Published: November 2007

Dietary zinc deficiency in mice is accompanied by enhanced expression of the zinc uptake transporter Slc39a4 (Zip4) and repressed expression of Slc39a5 (Zip5) in tissues which regulate zinc homeostasis (intestine, pancreas and visceral yolk sac). Herein, mechanisms controlling this differential expression were investigated. The induction of Zip4 mRNA during zinc deficiency, and its repression in response to zinc repletion were found to reflect changes in Zip4 mRNA stability and not changes in the relative rate of transcription of this gene. During zinc deficiency, ZIP4 protein levels are increased and this protein is localized on the apical membranes. Administration of an oral gavage of zinc caused ZIP4 internalization and degradation in enterocytes and visceral endoderm cells. Similarly, ZIP4 is induced by zinc deficiency in cultured mouse Hepa cells and is rapidly degraded in response to added zinc. Zip5 mRNA abundance does not change in response to zinc, but the translation of this mRNA was found to be zinc-responsive. During zinc deficiency, Zip5 mRNA remains associated with polysomes, while the protein is internalized and degraded in enterocytes, acinar cells and endoderm cells. After zinc-gavage, ZIP5 is rapidly resynthesized and targeted to the basolateral membranes of these cell types.
Overexpression and mass spectrometry analysis of mature human acid ceramidase
Authors: Schulze Heike , Schepers Ute , Sandhoff Konrad
Published: November 2007

Human acid ceramidase catalyzes the last step of lysosomal sphingolipid degradation, the hydrolysis of ceramide to sphingosine and free fatty acid. Inherited deficiency of acid ceramidase activity leads to Farber disease (Farber lipogranulomatosis). In this study, we describe the overexpression and processing of recombinant human acid ceramidase in Sf21 insect cells, its purification and characterization. Infection of Sf21 cells with a recombinant baculovirus encoding acid ceramidase precursor led to a mixture of human acid ceramidase precursor and mature enzyme secreted into the medium. Acidification of the cell culture supernatant to pH 4.2–4.3 triggered the processing of the precursor and resulted in a homogeneous sample of mature human acid ceramidase. The enzyme was purified by chromatography on Concanavalin A Sepharose and Octyl Sepharose yielding 1 mg purified protein per liter of supernatant. The recombinant enzyme was deglycosylated with peptide N-glycosidase F and the main component of the released oligosaccharides was identified as GlcNAc2(Fuc)Man3 by electrospray mass spectrometry. Apparently, five of the six potential N-glycosylation sites were used. Tryptic digestion of the functional recombinant enzyme and matrix-assisted laser desorption/ionization time-of-flight- and electrospray ionization-mass spectrometry analysis of the resulting peptides indicated disulfide bridges between C10–C319, C122–C271 and C367–C371.
SARS-CoV accessory protein 7a directly interacts with human LFA-1
Authors: Hänel Karen , Willbold Dieter
Published: November 2007

The SARS-CoV accessory protein 7a is a type I membrane protein with an extracellular domain of 81 amino acid residues. It is described to be expressed during infection and to be a component of the virus particle surface. In this study, we demonstrate that protein 7a binds directly and specifically to human lymphocyte function-associated antigen 1 (LFA-1) on the cell surface of Jurkat cells. The binding is increased upon artificial cell activation with phorbol ester. These observations are confirmed by directin vitrobinding of recombinant protein 7a to the wild type and mutant K287C/K294C I domain showing that the I domain is the 7a binding site in the αLchain of LFA-1. Consequences of the LFA-1 interaction with 7a are discussed. In particular, our data suggest LFA-1 to be an attachment factor or the receptor for SARS-CoV on human leukocytes.
Simple Shear Test for Interfaces Between Core and Filter Soils in Rock-Fill Dams
Authors: Zhang Bingyin , Yu Yuzhen , Fu Jian , Hu Liming
Published: November 2007

The mechanical behavior of the interface between core and filter soils plays an important role in the construction of rock-filled dams with a composite earth core as a permeability barrier. This paper describes the use of a laminar-ring simple shear apparatus that was developed to test interface properties, a device that uses stacked steel rings to contain the specimen. A series of interface tests between core and filter soils were conducted using the developed apparatus. During the test, the normal stress was kept constant, and the shear stress and the relative displacement were measured. Furthermore, the deformation features of specimen were measured using LVDTs placed at each of the laminar-rings. Test results show that the shear strength of the interface is controlled by the weaker of the two individual soils.
Development of a Modified in situ Direct Shear Test Technique to Determine Shear Strength Parameters of Mine Rock Piles
Authors: Fakhimi A. , Boakye K. , Sperling D. J. , McLemore V. T.
Published: November 2007

A modified direct shear test apparatus was designed and used to measure cohesion and friction angle of rock pile materials. Two test apparatuses were constructed, a 30-cm square metal shear box and a 60-cm square metal shear box. In addition to the shear box, the testing apparatus has a metal top plate, a fabricated roller plate, normal and shear dial gages with wooden supports, and two hydraulic jacks and cylinders with a maximum oil pressure of 70 MPa (10,000 psi) and a load capacity of ten tons. The main difference between the in situ shear box and its conventional laboratory equivalent is that the in situ shear box consists of a single box that confines an excavated block of rock pile material. The lower half of the block consists of the rock pile material underneath the shear plane that is a semi-infinite domain. This modification in the shear test apparatus reduces the time needed for block preparation, helps perform several tests at different levels of the same sample block, and allows for accommodating large shear displacement with no reduction in the area of the shear plane.
Verismo: Origin, Corruption, and Redemption of an Operatic Term
Authors: GIGER ANDREAS
Published: November 2007

Verismo, a term originally applied to nineteenth-century art and literature of various degrees of realism, has been the subject of controversy when applied to opera. While literary scholarship has come to measure verismo against the narrowly defined models provided by the theories, novels, and short stories of Luigi Capuana and Giovanni Verga, operatic scholarship has either superimposed these same theories on the dramatic genre of the libretto or it has constructed concepts of questionable historical foundation. Drawing mainly on a large corpus of neglected nineteenth- and early twentieth-century discussions of verismo, this article uncovers the original meanings of the termand outlines how we have come to adopt a view of verismo that is problematic in regard to both literature and opera. Contrary to this view, verismo was seen in the nineteenth century primarily as a reaction to the idealism and conventionality of earlier artworks; in this sense it had already been applied to opera before 1890, and it is, in fact, a perfectly appropriate designation for opera in the late nineteenth and early twentieth centuries. In comparison to Romantic Italian opera, with its conventional forms of both libretto and music, verismo opera reacts to idealism in any combination of categories ranging from plot to vocabulary, verse, harmony and melody, performance practice, and production.
Dandy, Interrupted: Sublimation, Repression, and Self-Portraiture in Maurice Ravel's Daphnis et Chloé (1909–1912)
Authors: PURI MICHAEL J.
Published: November 2007

Whether understood as the elevation of material to a higher state of aesthetic being or the redirection of the libido toward socially seemly ends, the concept of sublimation has played a central but underappreciated role in accounts of Ravel and his music over the past century. Similarly, Ravel's identity as a dandy —who, according to Baudelaire, aspires to be “sublime without interruption” —has been mentioned consistently in biographical appraisals, but never deeply investigated. Incorporating a representation of the dandy's genesis from the sublimation of desire, Ravel's Daphnis et Chloé (1909–1912) offers the analyst an excellent opportunity to examine both entities in depth while also broaching a variety of related topics: repression, queer sexuality, camp aesthetics, contemporary musical politics (dandyism versus d'Indyism), and theories of autobiography.
Emotional Ornamentation in Performances of a Handel Sonata
Authors: Timmers Renee , Ashley Richard
Published: November 2007

ORNAMENTATION IS ONE ASPECT OF MUSIC ASSOCIATED with emotional affect in Baroque music. In an empirical study, the relationship between ornamentation and emotion was investigated by asking a violinist and flutist to ornament three melodies in different ways to express four emotions: happiness, sadness, love, and anger. The performers adapted the type of ornaments to the instructed emotion as well as the characteristics of the ornaments. The flutist specifically varied the duration, timing, and complexity of the ornamentation, while the violinist varied the complexity, density, and sound level of the performances. The ability of the performers to communicate the emotions was tested in a listening experiment. Communication was found to be generally successful, with the exception of the communication of happiness. This success was not due to general consensus about the expression of emotions through ornamentation. Rather the listeners were sensitive to a performer's specific use of ornamentation.
Music as Socio-Emotional Confluence: A Comment on Bispham
Authors: Graham Rodger
Published: November 2007

BISPHAM'S (2006) ADDRESS OF THE QUESTION 'WHY' humans demonstrate musical rhythmic behavior provides a compelling evolutionary, contextualized view of rhythm as an essentially corporate activity yielding convergence of emotional and motivational states in ways that augment individuals' fitness. In broad agreement with this viewpoint it is tentatively suggested here that such a model could be termed 'socio-emotional confluence signaling.' Adoption of an accordingly integrative biomusicological position circumvents many of the impasses incurred in the demarcated research agendas currently evident within this early phase of the study of human origins of music. Such a model provides a suitably broad theoretical substrate to facilitate a wide range of experimental studies that are necessary to enable the nascent field of biomusicology to progress beyond conjecture.
Early Discrimination of Atlantic Salmon Smolt Age: Time Course of the Relative Effectiveness of Body Size and Shape
Authors: Pearlstein Jamie H. , Letcher Benjamin H. , Obedzinski Mariska
Published: November 2007

The goal of this study was to test the relative effectiveness of morphological measurements and body size in predicting the smolt age of Atlantic salmon Salmo salar and to determine the time course of body size and shape differences between smolt ages. Analyses were conducted on age‐0 to age‐2 fish that were stocked as fry in the West Brook, Massachusetts and on laboratory‐raised age‐0 to age‐1 fish. Using both body size and shape, we could partition the age‐0 fish collected during fall into future early or late smolts, although the predictive ability of body shape was somewhat weaker than that of body size, especially in the laboratory. Classification success averaged 81% (size) and 79% (shape) in the field and 85% (size) and 73% (shape) in the laboratory. Despite differences in smolt age between the field and the laboratory, the relative timing of growth rate differences between future early and late smolts was similar in the field and the laboratory and peaked at 50‐60% of development from fry to smolt. While body shape differed between early and late smolts well before smoltification, it did not improve classification based on size alone.
Miocardiopatia diabética
Authors: Okoshi Katashi , Guimarães Julliano F. Campos , Di Muzio Bruno Paulino , Fernandes Ana Angélica H. , Okoshi Marina Politi
Published: November 2007

A miocardiopatia diabética é uma doença do músculo cardíaco causada pelo diabetes mellitus e não relacionada às patologias vascular e valvular ou à hipertensão arterial sistêmica. Observações experimentais e clínicas têm demonstrado hipertrofia, necrose, apoptose e aumento do tecido intersticial miocárdico. Acredita-se que a miocardiopatia diabética seja decorrente de anormalidades metabólicas como hiperlipidemia, hiperinsulinemia e hiperglicemia, e de alterações do metabolismo cardíaco. Tais alterações podem causar aumento do estresse oxidativo, fibrose intersticial, perda celular e comprometimento do trânsito intracelular de íons e da homeostase do cálcio. Clinicamente, é possível a detecção de disfunção diastólica assintomática na fase inicial. No momento em que surgem os sinais e sintomas de insuficiência cardíaca, observamos disfunção diastólica isolada, sendo que o comprometimento da função sistólica, habitualmente, é tardio. O tratamento da miocardiopatia diabética com insuficiência cardíaca não difere das miocardiopatias de outras etiologias e deve seguir as diretrizes de acordo com o comprometimento da função ventricular, se diastólica isolada ou diastólica e sistólica.
Cross-talk das vias de sinalização de insulina e angiotensina II: implicações com a associação entre diabetes mellitus e hipertensão arterial e doença cardiovascular
Authors: Carvalho-Filho Marco A. de , Carvalheira José Barreto C. , Velloso Lício Augusto , Saad Mario José Abdalla
Published: November 2007

Insulina (Ins) e Angiotensina II (AII) são fundamentais no controle de dois sistemas vitais e inter-relacionados: o metabólico e o cardiocirculatório, respectivamente. A disfunção de qualquer um desses hormônios pode levar ao desenvolvimento de duas doenças de alta prevalência, muitas vezes concomitantes e, talvez, com fisiopatologia integrada - diabetes mellitus (DM) e hipertensão arterial (HA). Vários estudos mostram que os sistemas de sinalização intracelular de Ins e AII estão conectados e influenciam um ao outro. Esta comunicação molecular ocorre em diferentes etapas da sinalização celular e é importante para vários fenômenos fisiológicos, desde o desenvolvimento de hipertrofia cardíaca e aquisição de energia pelo coração, até a ação de drogas anti-hipertensivas. No nível extracelular, a enzima de conversão de angiotensina regula a síntese de AII e o acúmulo de bradicinina, e ambos desempenham papel regulador sobre a sinalização de Ins. No nível intracelular, a interação dos sinais de Ins e AII ocorre em dois momentos distintos. Inicialmente, em etapas mais precoces da sinalização celular, a AII, atuando através da cascata JAK-2/IRS-1/PI3-quinase, JNK e ERK, provoca a fosforilação em serina e a conseqüente inibição de elementos-chave da via de sinalização da Ins. Finalmente, a AII induz a expressão da proteína regulatória SOCS-3, que impõe um controle mais tardio sobre o sinal de Ins. Esta revisão discute os avanços mais recentes neste campo e a importância dessa interação molecular na fisiopatologia e na associação clínica de DM e HA.
O papel da lipemia pós-prandial na gênese da aterosclerose: particularidades do diabetes mellitus
Authors: Signori Luis Ulisses , Plentz Rodrigo Della Méa , Irigoyen Maria Cláudia , Schaan Beatriz D'Agord
Published: November 2007

A aterosclerose é uma doença multifatorial e complexa, que determina eventos clínicos causadores de morbi-mortalidade significativa, representada pela ocorrência de infarto agudo do miocárdio, angina e morte súbita. Está associada a anormalidades lipídicas, ativação plaquetária, trombose, inflamação, disfunção endotelial, estresse oxidativo e alterações metabólicas da matriz, entre outros distúrbios. Todas essas anormalidades são mais comuns e acentuadas no paciente com diabetes, assim como no estado pós-prandial. Dentre os fatores de risco para doença arterial coronariana que ainda não são efetivamente empregados nas estratégias de prevenção da doença em grandes populações destaca-se a hiperlipemia pós-prandial, possível marcador precoce de anormalidades metabólicas e disfunção vascular não observadas em jejum. Recentes resultados mostram que as alterações que ocorrem após uma única sobrecarga lipídica se relacionam negativamente à função endotelial, sendo que as alterações na reatividade vascular estão fortemente associadas à progressão da aterosclerose e aos eventos cardiovasculares. Essas alterações podem revelar um estado de intolerância às gorduras que já são detectadas em indivíduos saudáveis, antes mesmo que anormalidades em jejum sejam percebidas. Esta revisão aborda a fisiopatologia envolvida na lipemia pós-prandial e sua relação com a aterogênese, com ênfase no diabetes mellitus.
Impacto cardiovascular da neuropatia autonômica do diabetes mellitus
Authors: Schmid Helena
Published: November 2007

As alterações neuropáticas relacionadas ao diabetes afetam o sistema nervoso somático, simpático e parassimpático. Como resultado, as complicações clínicas são extremamente variadas. Em pacientes com neuropatia autonômica ocorrem manifestações relacionadas a lesões dos sistemas genitourinário, gastrointestinal, da sudorese e cardiovascular, que, além de levarem à perda da qualidade de vida, se relacionam à morte súbita por arritmias cardíacas, bem como a aumento das taxas de mortalidade por outras causas. A neuropatia autonômica cardiovascular provavelmente contribui para o mau prognóstico da doença cardíaca coronariana e insuficiência cardíaca tanto no diabetes mellitus tipo 1 como no tipo 2. Para os diabetologistas, as complicações neurológicas do diabetes são resultado da entrada excessiva de glicose em células de tecidos como o neuronal e o endotelial. Evidências mostram que, com o objetivo de prevenir essas complicações, os pacientes diabéticos devem ser diagnosticados precocemente e instruídos a procurar um controle glicêmico adequado. O uso de inibidores da enzima conversora da angiotensina e dos bloqueadores beta-adrenérgicos é provavelmente de impacto na prevenção das complicações cardíacas do diabetes.
Doença cardiovascular no diabetes mellitus: análise dos fatores de risco clássicos e não-clássicos
Authors: Siqueira Antonela F.A. , Almeida-Pititto Bianca de , Ferreira Sandra R.G.
Published: November 2007

A doença cardiovascular (DCV), incluindo a doença arterial coronariana (DAC), acidente vascular cerebral (AVC) e doença arterial periférica (DAP), é importante causa de morte em populações, especialmente na diabética. Indivíduos diabéticos apresentam risco aumentado de 3 a 4 vezes de sofrer evento cardiovascular e o dobro do risco de morrer deste evento quando comparados à população geral. Tem havido declínio na mortalidade por DCV, porém a queda nas mortes por DAC em portadores de diabetes tem sido bastante inferior à de não-diabéticos. Vários fatores presentes no diabetes favorecem a maior ocorrência de DCV, como a hiperglicemia, a resistência à insulina, além de fatores de risco clássicos e não-clássicos (hipertensão arterial sistêmica, dislipidemia, obesidade, estado inflamatório subclínico e outros). É possível que o potencial aterogênico da obesidade decorra em parte da produção aumentada de citocinas pelos adipócitos. Devido à marcante associação entre diabetes e DCV, e prognóstico desfavorável após um evento, é importante identificar quais são os indivíduos de mais alto risco e como rastreá-los. A American Heart Association e a American Diabetes Association recomendam estratificação do risco de pacientes sintomáticos por testes diagnósticos. O desafio está em identificar pacientes diabéticos assintomáticos que se beneficiariam de testes diagnósticos para detecção precoce de DCV, visando viabilizar medidas preventivas ou terapêuticas, capazes de reduzir morbi-mortalidade. O benefício do controle glicêmico e dos demais fatores de risco na prevenção de eventos CV no diabetes já documentado, justifica estabelecer estratégias que otimizem a identificação e possibilitem intervenções nos pacientes de alto risco, buscando reduzir mortalidade.
Cateterismo cardíaco, diagnóstico (angiografia) e terapêutico (angioplastia) na doença arterial coronária dos pacientes diabéticos
Authors: Lima Valter C.
Published: November 2007

O rastreamento, o diagnóstico e a revascularização da doença arterial coronária (DAC) no diabetes tipo 2 representam enormes desafios para a prática médica. Neste contexto, o cateterismo cardíaco diagnóstico (angiografia) e terapêutico (angioplastia) são recursos fundamentais na avaliação clínica e manejo da aterosclerose coronária. Avaliações das particularidades anatômicas da DAC no diabetes são detalhadamente caracterizadas pela angiografia coronária, associada ou não ao ultra-som intracoronário. Por outro lado, a resposta pior aos procedimentos de revascularização (angioplastia e cirurgia) da DAC nos diabéticos representa umas das áreas de maior investigação clínica contemporânea. A despeito das controvérsias, cerca de um quarto dos pacientes submetidos a angioplastia e um terço dos pacientes submetidos a cirurgia são diabéticos. Dois grandes estudos multicêntricos randomizados, em andamento, investigam o melhor manejo da DAC nos diabéticos. O BARI 2D está randomizando pacientes com DAC assintomáticos ou com sintomas leves para tratamento clínico ou revascularização (angioplastia ou cirurgia, conforme melhor julgamento clínico). O FREEDOM está randomizando pacientes diabéticos estáveis com DAC multiarterial, para angioplastia com stent farmacológico ou cirurgia, com ou sem uso de circulação extra-corpórea. Enquanto as evidências não estão disponíveis, a prática médica atual é balanceada por um conjunto de variáveis na decisão sobre a melhor alternativa de revascularização. Condições que favorecem a angioplastia: estenoses curtas, vasos grandes, ausência de estenose na artéria descendente anterior (ADA), cirurgia de revascularização prévia e risco cirúrgico elevado. Condições que favorecem a indicação de cirurgia: estenoses longas, vasos pequenos, presença de estenose da ADA e cirurgia valvar associada.
Prevenção cardiovascular em pacientes com diabetes: revisão baseada em evidências
Authors: Furtado Mariana Vargas , Polanczyk Carisi Anne
Published: November 2007

Diabetes mellitus é uma doença associada com elevada incidência de doença aterotrombótica, especialmente cardíaca. Diversos estudos demonstraram que é possível reduzir a carga de doença nesta população através de estratégias preventivas. Este artigo revisa as evidências sobre a estimativa de risco cardiovascular nessa população e ações de prevenção, levando em consideração as principais recomendações na área. Modificações no estilo de vida, como dieta pobre em carboidratos, redução de peso e prática regular de atividade física, devem ser instituídas. Todo paciente de alto risco ou com evidências de doença cardiovascular deve manter sua glicemia < 100 mg/dl e A1c < 7%. É recomendado uso diário de AAS em doses baixas e estatinas para controle de lípides, tendo como alvo LDL < 100 mg/dl, HDL > 50 mg/dl e triglicerídios < 150 mg/dl. O controle da pressão arterial deve ser buscado com medidas não-farmacológicas e anti-hipertensivos, sendo inibidores do sistema renina-angiotensina indicados na maioria dos casos, especialmente naqueles pacientes com nefropatia, associado a diuréticos tiazídicos na sua maioria para alcançar níveis tensionais-alvo < 130/80 mmHg.
Tratamento clínico adjuvante no paciente diabético submetido à intervenção coronariana percutânea
Authors: Lima Filho Moysés de Oliveira , Figueiredo Geraldo Luiz de , Haddad Jorge Luis , Schmidt André , Lima Nereida Kilza da Costa
Published: November 2007

Os autores descrevem o tratamento medicamentoso adjuvante durante e após intervenção coronária percutânea (ICP) com o objetivo de obter-se redução da taxa de eventos cardiovasculares. Parece haver relação entre a taxa de reestenose angiográfica que ocorre nos seis primeiros meses após ICP e a taxa de eventos tardios. Porém, tal relação não foi encontrada em muitos estudos. No seguimento clínico do paciente diabético após ICP, deve ser dada ênfase nas medidas gerais para controle dos fatores de risco cardiovascular. Dentre essas medidas é fundamental um controle glicêmico adequado, que pode ser obtido com as práticas clínicas habituais. Quanto à anti-agregação plaquetária, está bem estabelecido o benefício do uso combinado de aspirina e uma medicação tienopiridínica, enquanto que a utilização dos inibidores de GPIIb/IIIa como adjuvante não deve ser irrestrita em pacientes diabéticos como preconizado por muitos; a sua utilização deve ser assegurada apenas naqueles casos com uma grande carga trombótica.
Dietas hiperglicídicas: efeitos da substituição isoenergética de gordura por carboidratos sobre o metabolismo de lipídios, adiposidade corporal e sua associação com atividade física e com o risco de doença cardiovascular
Authors: Polacow Viviane O. , Lancha Junior Antonio H.
Published: November 2007

Há vários anos, vem sendo recomendada à população em geral a diminuição da gordura dietética, a fim de se prevenir doenças cardiovasculares, obesidade, diabetes mellitus tipo 2, dentre outras doenças crônicas. A conseqüência desta recomendação tem sido a substituição de gorduras por carboidratos, resultando na adoção de dietas hiperglicídicas. Porém, ainda é muito discutido se dietas hiperglicídicas devem ser recomendadas à população geral. Pesquisas apontam controvérsias a respeito da associação entre este tipo de dieta e efeitos deletérios sobre a saúde e aspectos metabólicos, tais como aumento da lipogênese de novo, aumento da trigliceridemia, diminuição das concentrações de HDL e efeitos sobre a adiposidade. Esta revisão aborda os efeitos de mudanças na composição dietética, particularmente da dieta hiperglicídica, sobre fatores de risco para doenças cardiovasculares, tais como dislipidemia, e obesidade. Revisa, também, sua interação com a atividade física, uma vez que ainda não se sabe com que extensão ela pode minimizar possíveis efeitos deletérios de dietas hiperglicídicas em longo prazo.