bluuebunny/crossref_metadata_2025 huggingface dataset:
Hermeneutics, Contexts, Identity: a Critical Discussion of the Bible in Africa
Authors: Snyman Gerrie F.
Published: November 2007

This article provides a critical discussion of some aspects in The Bible in Africa: Transactions, Trajectories, and Trends (West & Dube 2000). The book gives its intended Western reader the opportunity to see (an etic view) how others perceive the Western cultural context. The discussion focuses on the following aspects: (a) The role and possibilities of critical scholarship; (b) The possibility to find a common (for those living in the West and inAfrica) reading context in the light of Cancun and the new 'Empire (c) A model for deconstructing colonial Bible interpretation over against (d) a model of connectivity between the Bible and Africa in terms of resonance and continuity; (e) The essential role missionaries played in Bible translations; and (f) a reflection on some hermeneutical considerations in reading the Bible in Africa.
The Compassion Fatigue Scale: Its Use With Social Workers Following Urban Disaster
Authors: Adams Richard E. , Figley Charles R. , Boscarino Joseph A.
Published: November 2007

Objective: The present study has two goals: to assess the difference between secondary trauma and job burnout and to examine the utility of secondary trauma in predicting psychological distress. Method: The data come from a survey of social workers (N = 236) living in New York City 20 months following the September 11 terrorist attacks on the World Trade Center (WTC). Results: Social workers'involvement in WTC recovery efforts is related to secondary trauma but not burnout. Analyses also reveal that both secondary trauma and burnout are related to psychological distress after controlling for other risk factors. Conclusion: This study supports the importance of compassion fatigue as a risk factor for social workers counseling traumatized clients and its association with psychological problems.
`God' and Other `Do-Gooders'
Authors: McInnes Alison , Lawson-Brown Vicki
Published: November 2007

• Summary: This article explores the differences in status between General Practitioners (GPs) and social workers in England and explores the ways in which each profession is regulated.

• Findings: A brief historical overview of the professionalization of the role of GPs and social workers is used to contextualize and compare the development of the philosophy of regulatory practice that underpins the two professions. In particular, the level of involvement of people who use services is used to examine the similarities and differences in the regulation of the two professions. The perception of the public towards the two professions and interprofessional perceptions are explored. Some of the limitations of the comparative regulatory paradigms are also identified.

• Applications : This article concludes with a discussion about the balance of power (or lack of it) within the regulatory framework for GPs and social workers. There has been an increase in more stringent independent regulation of social workers; however, there appears to be less impetus towards an equivalent system of monitoring GPs. Professional bodies and those involved in the registration processes should be mindful of the findings in this article.
Lipid Peroxidation, Total Antioxidant Status, and Total Thiol Levels Predict Overall Survival in Patients With Oral Squamous Cell Carcinoma
Authors: Patel Beena P. , Rawal Upendra M. , Dave Tina K. , Rawal Rakesh M. , Shukla Shilin N. , Shah Pankaj M. , Patel Prabhudas S.
Published: November 2007

Tobacco is the major etiological factor for oral cancer development through the generation of oxidative stress. Therefore, markers of oxidative stress such as total antioxidant status, lipid peroxidation, and total thiol levels might be useful to monitor oxidative stress and predict overall survival in oral cancer patients. The study included 140 oral cancer patients and 50 healthy controls, who were classified as with the habit of tobacco and no habit of tobacco. Adjacent normal and malignant tissue samples were collected from oral cancer patients. Plasma and tissue levels of lipid peroxidation, thiol, and total antioxidant status were assayed by spectrophotometric methods. Thiol levels were significantly lower in controls with the habit of tobacco ( P = .033), oral cancer patients ( P = .0001), and malignant tissues ( P = .015) as compared to controls with no habit of tobacco, controls with the habit of tobacco, and adjacent normal tissues, respectively. Tobacco exposure was higher in oral cancer patients than controls with the habit of tobacco. Controls with the habit of tobacco who had lower thiol (odds ratio [OR] = 10.58, P = .008) and high tobacco exposure (OR = 0.251, P = .05) showed an elevated risk of oral cancer development. Patients showing a lipid peroxidation level above the cutoff level as compared to patients below the cutoff level showed poor overall survival, whereas those with thiol and total antioxidant status levels below the cutoff level as compared to their respective counterparts showed poor overall survival. In conclusion, lipid peroxidation and thiol could be useful for predicting the risk of oral carcinogenesis in healthy tobacco consumers and predicting overall survival of oral cancer patients.
Is Mixed Methods Social Inquiry a Distinctive Methodology?
Authors: Greene Jennifer C.
Published: November 2007

This article addresses the merits of and warrants for considering mixed methods social inquiry as a distinctive methodology. In each of four methodological domains—philosophy, methodology, practical guidelines, and sociopolitical commitments—the status of the mixed methods field is reviewed. Signal accomplishments are noted in each domain, as are important priorities for further development.
The retinoblastoma tumor suppressor is a critical intrinsic regulator for hematopoietic stem and progenitor cells under stress
Authors: Daria Deidre , Filippi Marie-Dominique , Knudsen Erik S. , Faccio Roberta , Li Zhixiong , Kalfa Theodosia , Geiger Hartmut
Published: November 2007

The retinoblastoma tumor suppressor protein (RB) plays important roles in the control of the cell division cycle. It is estimated that RB is dysfunctional/inactivated in up to 40% of human leukemias. The consequences of loss of RB on hematopoietic stem and progenitor cell (HSPC) function in vivo are incompletely understood. Here, we report that mice genetically deficient in Rb in all hematopoietic cells (Vav-Cre Rb knockout [KO] animals) showed altered contribution of distinct hematopoietic cell lineages to peripheral blood, bone marrow, and spleen; significantly increased extramedullary hematopoiesis in the spleen; and a 2-fold increase in the frequency of hematopoietic progenitor cells in peripheral blood. Upon competitive transplantation, HSPCs from Vav-Cre Rb KO mice contributed with an at least 4- to 6-fold less efficiency to hematopoiesis compared with control cells. HSPCs deficient in Rb presented with impaired cell-cycle exit upon stress-induced proliferation, which correlated with impaired function. In summary, Rb is critical for hematopoietic stem and progenitor cell function, localization, and differentiation.
Pulmonary tumour with high carcinoembryonic antigen titre caused by chronic propolis aspiration
Authors: Lin W-C. , Tseng Y-T. , Chang Y-L. , Lee Y-C.
Published: November 2007

Carcinoembryonic antigen (CEA) titre elevation is sometimes found in benign diseases, such as gastro-intestinal tract inflammatory disease and chronic obstructive pulmonary disease; however, very high CEA titre is rarely encountered in benign pulmonary disease.

A 36-yr-old female, who had suffered from body weight loss, was found to have high serum CEA titre (60.8 ng·mL−1). Image studies revealed one pulmonary tumour at the left lower lobe, satellite nodules and mediastinal lymphadenopathy.

Left lower lobectomy and lymph node dissection were performed for suspicious pulmonary malignancy. The pathological examination revealed that the tumourous lesion was composed of small and fragmented foreign bodies, fibrinopurulent exudate and heavy eosinophils. The bronchial epithelium was characterised by goblet cell hyperplasia and CEA overexpression. The remaining lung parenchyma possessed similar foreign body reaction. The patient’s medical history was reviewed and it was found that she had spread propolis topically on nasal mucosa as an adjuvant therapy to asthma for 6 months prior to this medical event. The CEA titre decreased after the operation to 14.2 and 7.88 ng·mL−1after 2 weeks and 6 months, respectively.

Propolis is used widely in folk medicine but it also has strong sensitising potential. One rare case of propolis aspiration is reported with presentation mimicking lung cancer.
A structural analysis of in vitro catalytic activities of hammerhead ribozymes
Authors: Shao Yu , Wu Susan , Chan Chi Yu , Klapper Jessie R , Schneider Erasmus , Ding Ye
Published: November 2007

Background

Ribozymes are small catalytic RNAs that possess the dual functions of sequence-specific RNA recognition and site-specific cleavage. Trans-cleaving ribozymes can inhibit translation of genes at the messenger RNA (mRNA) level in both eukaryotic and prokaryotic systems and are thus useful tools for studies of gene function. However, identification of target sites for efficient cleavage poses a challenge. Here, we have considered a number of structural and thermodynamic parameters that can affect the efficiency of target cleavage, in an attempt to identify rules for the selection of functional ribozymes.

Results

We employed the Sfold program for RNA secondary structure prediction, to account for the likely population of target structures that co-exist in dynamic equilibrium for a specific mRNA molecule. We designed and prepared 15 hammerhead ribozymes to target GUC cleavage sites in the mRNA of the breast cancer resistance protein (BCRP). These ribozymes were tested, and their catalytic activities were measured in vitro. We found that target disruption energy owing to the alteration of the local target structure necessary for ribozyme binding, and the total energy change of the ribozyme-target hybridization, are two significant parameters for prediction of ribozyme activity. Importantly, target disruption energy is the major contributor to the predictability of ribozyme activity by the total energy change. Furthermore, for a target-site specific ribozyme, incorrect folding of the catalytic core, or interactions involving the two binding arms and the end sequences of the catalytic core, can have detrimental effects on ribozyme activity.

Conclusion

The findings from this study suggest rules for structure-based rational design of trans-cleaving hammerhead ribozymes in gene knockdown studies. Tools implementing these rules are available from the Sribo module and the Srna module of the Sfold program available through Web server at http://sfold.wadsworth.org.
The Fer tyrosine kinase regulates an axon retraction response to Semaphorin 3A in dorsal root ganglion neurons
Authors: Shapovalova Zoya , Tabunshchyk Kyrylo , Greer Peter A
Published: November 2007

Background

Fps/Fes and Fer are the only two members of a distinct subclass of cytoplasmic protein tyrosine kinases. Fps/Fes was previously implicated in Semaphorin 3A (Sema3A)-induced growth cone collapse signaling in neurons from the dorsal root ganglion (DRG) through interaction with and phosphorylation of the Sema3A receptor component PlexinA1, and members of the collapsin response mediator protein (CRMP) family of microtubule regulators. However, the potential role of the closely related Fer kinase has not been examined.

Results

Here we provide novel biochemical and genetic evidence that Fer plays a prominent role in microtubule regulation in DRG neurons in response to Sema3A. Although Fps/Fes and Fer were both expressed in neonatal brains and isolated DRGs, Fer was expressed at higher levels; and Fer, but not Fps/Fes kinase activity was detectedin vivo. Fer also showed higherin vitrokinase activity toward tubulin, as an exogenous substrate; and this activity was higher when the kinases were isolated from perinatal relative to adult brain stages. CRMP2 was a substrate for both kinasesin vitro, but both CRMP2 and PlexinA1 inhibited their autophosphorylation activities. Cultured mouse DRG neurons retracted their axons upon exposure to Sema3A, and this response was significantly diminished in Fer-deficient, but only slightly attenuated in Fps/Fes-deficient DRG neurons.

Conclusion

Fps/Fes and Fer are both capable of phosphorylating tubulin and the microtubule regulator CRMP2in vitro; and theirin vitrokinase activities were both inhibited by CRMP2 or PlexinA1, suggesting a possible regulatory interaction. Furthermore, Fer plays a more prominent role than Fps/Fes in regulating the axon retraction response to Sema3A in DRG neurons. Therefore, Fps/Fes and Fer may play important roles in developmental or regenerative axon pathfinding through signaling from Sema3A to the microtubule cytoskeleton.
Regulation of nestin expression by thrombin and cell density in cultures of bone mesenchymal stem cells and radial glial cells
Authors: Wautier Franz , Wislet-Gendebien Sabine , Chanas Grazyna , Rogister Bernard , Leprince Pierre
Published: November 2007

Background

Bone marrow stromal cells and radial glia are two stem cell types with neural phenotypic plasticity. Bone marrow mesenchymal stem cells can differentiate into osteocytes, chondrocytes and adipocytes, but can also differentiate into non-mesenchymal cell, i.e. neural cells in appropriate in vivo and in vitro experimental conditions. Likewise, radial glial cells are the progenitors of many neurons in the developing cortex, but can also generate astrocytes. Both cell types express nestin, an intermediate filament protein which is the hallmark of neural precursors.

Results

In this study, we demonstrate that thrombin, a multifunctional serine protease, stimulates the growth of radial glial cells (RG) and mesenchymal stem cells (MSCs) in a dose-dependent manner. In RG, the mitogenic effect of thrombin is correlated with increased expression of nestin but in MSCs, this mitogenic effect is associated with nestin down-regulation. Both cell types express the PAR-1 type receptor for Thrombin and the effect of Thrombin on both cell types can be mimicked by its analogue TRAP-6 activating specifically this receptor subtype or by serum which contains various amount of thrombin. Moreover, we also demonstrate that serum deprivation-induced expression of nestin in MSCs is inhibited by high cell density (> 50,000 cells/cm2).

Conclusion

This work shows that thrombin stimulates the growth of both RG and MSCs and that nestin expression by MSCs and RG is regulated in opposite manner by thrombin in vitro. Thrombin effect is thus associated in both cell types with a proliferating, undifferentiated state but in RG this involves the induction of nestin expression, a marker of immaturity for neural progenitors. In MSCs however, nestin expression, as it corresponds to a progression from the mesenchymal "undifferentiated", proliferating phenotype toward acquisition of a neural fate, is inhibited by the mitogenic signal.
Grey matter abnormalities in Brazilians with first-episode
psychosis
Authors: Schaufelberger Maristela S. , Duran Fabio L. S. , Lappin Julia M. , Scazufca Marcia , Amaro Edson , Leite Claudia C. , De Castro Claudio C. , Murray Robin M. , McGuire Philip K. , Menezes Paulo R. , Busatto Geraldo F.
Published: November 2007

Background

In low-and middle-income countries people with schizophrenia are reported
to experience better outcomes than those in high-income countries

Aims

To examine structural brain differences in people with first-episode
psychosis and controls in Brazil

Method

Magnetic resonance imaging using voxel-based morphometry was performed on
122 people with first-episode psychosis and 94 controls

Results

There were significant decreases in grey matter in the left superior
temporal and inferior prefrontal cortices, insula bilaterally and the
right hippocampal region in first-episode psychosis
(P<0.05, corrected for multiple comparisons). The
subgroup of people with schizophrenia (n=62) exhibited a
similar pattern of decrease in grey matter relative to controls

Conclusions

Structural abnormalities reported in psychosis in high-income countries
are also present in first-episode psychosis in Brazil
Duration of prodromal phase and severity of volumetric
abnormalities in first-episode psychosis
Authors: Lappin Julia , Dazzan Paola , Morgan Kevin , Morgan Craig , Chitnis Xavier , Suckling John , Fearon Paul , Jones Peter B. , Leff Julian , Murray Robin M. , McGuire Philip K.
Published: November 2007

Background

First-episode psychosis is typically preceded by a prodrome in which
there is deterioration in global and social functioning

Aims

To examine whether the duration of the prodromal phase influences grey
and white matter volumes at the onset of psychosis

Methods

Eighty-two people were scanned using magnetic resonance imaging when they
developed a first episode of psychosis. The duration of the prodromal
phase was estimated from detailed interviews and medical records.
Voxel-based morphometry was used to assess neuroanatomical
abnormalities

Results

A long prodromal phase was associated with smaller grey matter volumes in
the cingulate, frontal and left insular cortex, and with less white
matter volume bilaterally in the superior longitudinal and uncinate
fasciculi and the cingulum

Conclusions

The severity of volumetric abnormalities in first-episode psychosis was
greater in those with a long prodrome
Molecular imaging studies of the striatal dopaminergic system in psychosis and predictions for the prodromal phase of psychosis
Authors: Howes Oliver D. , Montgomery Andrew J. , Asselin Marie-Claude , Murray Robin M. , Grasby Paul M. , Mcguire Philip K.
Published: November 2007

The dopamine hypothesis has been the major pathophysiological theory of psychosis in recent decades. Molecular imaging studies have providedin vivoevidence of increased dopamine synaptic availability and increased presynaptic dopamine synthesis in the striata of people with psychotic illnesses. These studies support the predictions of the dopamine hypothesis, but it remains to be determined whether dopaminergic abnormalities pre-date or are secondary to the development of psychosis. We selectively review the molecular imaging studies of the striatal dopaminergic system in psychosis and link this to models of psychosis and the functional subdivisions of the striatum to make predictions for the dopaminergic system in the prodromal phase of psychosis
Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms
Authors: Morriss Richard , Dowrick Christopher , Salmon Peter , Peters Sarah , Dunn Graham , Rogers Anne , Lewis Barry , Charles-Jones Huw , Hogg Judith , Clifford Rebecca , Rigby Christine , Gask Linda
Published: November 2007

Background

Reattribution is frequently taught to general practitioners (GPs) as a structured consultation that provides a psychological explanation for medically unexplained symptoms.

Aims

To determine if practice-based training of GPs in reattribution changes doctor–patient communication, thereby improving outcomes in patients with medically unexplained symptoms of 3 months' duration.

Method

Cluster randomised controlled trial in 16 practices, 74 GPs and 141 patients with medically unexplained symptoms of 6 hours of reattribution training v. treatment as usual.

Results

With training, the proportion of consultations mostly consistent with reattribution increased (31 v. 2%, P=0.002). Training was associated with decreased quality of life (health thermometer difference −0.9, 95% CI −1.6 to −0.1; P=0.027) with no other effects on patient outcome or health contacts.

Conclusions

Practice-based training in reattribution changed doctor–patient communication without improving outcome of patients with medically unexplained symptoms.
Effects of Twinning and Periconceptional Undernutrition on Late-Gestation Hypothalamic-Pituitary-Adrenal Axis Function in Ovine Pregnancy
Authors: Rumball C. W. H. , Oliver M. H. , Thorstensen E. B. , Jaquiery A. L. , Husted S. M. , Harding J. E. , Bloomfield F. H.
Published: November 2007

The relationships between reduced size at birth, increased activity of the hypothalamic-pituitary-adrenal (HPA) axis, and increased risk of disease in adulthood are well described in singletons but are much less clear in twins. This may be because the physiological processes underlying reduced size at birth are different in singletons and twins. Periconceptional undernutrition can cause altered activity of the fetal and postnatal HPA axis without altering size at birth. However, the independent effects of periconceptional undernutrition and twinning on activity of the maternal and fetal HPA axes are not well described. We therefore studied maternal and fetal HPA axis function during late gestation in twin and singleton sheep pregnancies, either undernourished around conception or fed ad libitum. We found that twinning led to suppressed baseline HPA axis function and decreased adrenal sensitivity to ACTH stimulation but increased fetal pituitary ACTH response both to direct stimulation by CRH (ACTH area under the curve response: 29.7 ± 2.2 vs. 17.1 ± 1.6 ng/min·ml, P < 0.01) and to decreased cortisol negative feedback. In contrast, periconceptional undernutrition resulted in a decreased pituitary response (ACTH area under the curve response: 19.4 ± 1.6 vs. 26.1 ± 2.2 ng/min·ml, P = 0.02) but no difference in adrenal response. Thus, the HPA axis function of twin sheep fetuses in late gestation is very different from that of control and undernourished singletons. If the HPA axis is an important mediator between fetal adaptations and adult disease, these data may help explain why the relationship between fetal growth and postnatal physiology and disease risk is inconsistent in twins.
Intracellular Mechanisms Regulating Corticotropin-Releasing Hormone Receptor-2β Endocytosis and Interaction with Extracellularly Regulated Kinase 1/2 and p38 Mitogen-Activated Protein Kinase Signaling Cascades
Authors: Markovic Danijela , Punn Anu , Lehnert Hendrik , Grammatopoulos Dimitris K.
Published: November 2007

Many important physiological roles of the urocortin (UCN) family of peptides as well as CRH involve the type 2 CRH receptor (CRH-R2) and downstream activation of multiple pathways. To characterize molecular determinants of CRH-R2 functional activity, we used HEK293 cells overexpressing recombinant CRH-R2β and investigated mechanisms involved in attenuation of CRH-R2 signaling activity and uncoupling from intracellular effectors. CRH-R2β-mediated adenylyl cyclase activation was sensitive to homologous desensitization induced by pretreatment with either UCN-II or the weaker agonist CRH. CRH-R2β activation induced transient β-arrestin1 and β-arrestin2, as well as clathrin, recruitment to the plasma membrane. β-Arrestin2 appeared to be the main β-arrestin subtype associated with the receptor. This was followed by CRH-R2β endocytosis in a mechanism that exhibited distinct agonist-dependent temporal characteristics. CRH-R2β also induced transient activation of the ERK1/2 and p38MAPK signaling cascades that peaked at 5 min and returned to basal within 20–30 min. Unlike p38MAPK, activated ERK1/2 was localized both in the cytoplasm and nucleus. Experiments employing inhibitors of receptor endocytosis showed that CRH-R2β-MAPK interaction does not require β-arrestin, clathrin, or receptor endocytosis. Site-directed mutagenesis studies on CRH-R2β C terminus showed that the amino acid cassette TAAV at the end of the C terminus is important for CRH-R2β signaling because loss of a potential phospho-acceptor site in mutant receptors containing deletion or Ala substitution of the cassette TAAV resulted in reduced ERK1/2 activation and accelerated receptor internalization. These findings provide new insights about the signaling mechanisms regulating CRH-R2β functional activity and determining its biological responses.
Structure, ratios and patterns of release in the sex pheromone of an aphid, Dysaphis plantaginea
Authors: Stewart-Jones Alex , Dewhirst Sarah Y. , Durrant Lisa , Fitzgerald Jean D. , Hardie Jim , Hooper Antony M. , Pickett John A. , Poppy Guy M.
Published: November 2007

Insect communication is primarily via chemicals. In Aphidinae aphids, the structure and ratio of iridoid (monoterpenoid) chemicals are known to be important components of the sex pheromone. However, for enhanced species specificity, it has been suggested that release of sex pheromone might be restricted to a narrow time period within the diel cycle. Here, we determine the structure, ratios and release patterns of iridoid chemicals produced by a serious global pest, the rosy apple aphid, Dysaphis plantaginea. Volatiles were collected from batches of oviparae (sexual females) and chemicals identified by gas chromatography, mass-spectrometry and microscale NMR spectroscopy.(1R,4aS,7S,7aR)-Nepetalactol and(4aS,7S,7aR)-nepetalactone were detected in a 3.7:1 ratio. To investigate timing of release, we constructed a sequential sampling device that allowed volatile chemicals to be captured hourly from 95 same-aged oviparae over 20 consecutive days. Release patterns of the two sex pheromone components show that D. plantaginea oviparae release high levels of the two components during photophase and low levels during scotophase. Release of the two components increased significantly during the first 3 h of photophase and thereafter remained at a high level until the onset of scotophase. The ratio of(1R,4aS,7S,7aR)-nepetalactol to(4aS,7S,7aR)-nepetalactone released did not change significantly between days two to 14 of the adult stadium, but from the 15th day onward there was a significant decrease in the relative amount of(1R,4aS,7S,7aR)-nepetalactol. Pheromone release was greatest on the eighth day of the adult stadium, with up to 8.4 ng of pheromone released per ovipara per hour. This is the first report on the full structural identification and ratios of volatile iridoid components collected from D. plantaginea oviparae and is also the most detailed temporal study on sex pheromone release from any aphid species. The lack of a temporally narrow and distinct period of very high sex pheromone release suggests that alternative mechanisms or factors for species recognition and isolation may be important. Findings are discussed broadly in relation to the biology of the aphid.
Use of Bedside Ultrasonography for Endotracheal Tube Placement in Pediatric Patients: A Feasibility Study
Authors: Galicinao Jeanette , Bush Andrew J. , Godambe Sandip A.
Published: November 2007

OBJECTIVE. The purpose of our study was to evaluate the usefulness of bedside ultrasonography in verifying endotracheal tube placement in the pediatric population.

METHODS. This study consisted of 2 phases. In phase I, subjects were examined while intubated and after extubation to determine the presence of the endotracheal tube by applying each of 2 ultrasound transducers to the cricothyroid membrane. In phase II, pediatric patients were examined in the emergency department during intubation or immediately after intubation to ascertain proper endotracheal tube placement by using bedside ultrasonography. These results were compared with the results obtained with a colorimetric end-tidal carbon dioxide detector and chest radiographs.

RESULTS. Forty-nine and 50 patients (age: 1 day to 17 years) were recruited in the first and second phases of the study, respectively. The endotracheal tube was detected in all 99 patients by using bedside ultrasonography. Two views were required to show accurately the presence of the endotracheal tube in the trachea. Visualization was obtained in all cases, although short necks and cervical collars made the procedure more challenging. The sniffing position allowed for the best acquisition of high-quality images. Our linear transducer provided the best images but, because of its size, it was not ideal when space was limited. Therefore, the curvilinear transducer was used exclusively for phase II. During phase II, the mean times to acquire bedside ultrasonographic images of the endotracheal tube through the cricothyroid membrane and to obtain a chest radiograph were 17.1 seconds and 14.0 minutes, respectively. In 3 cases, bedside ultrasonographic images proved to be invaluable when the colorimetric end-tidal carbon dioxide detector yielded false-negative or equivocal readings.

CONCLUSIONS. Bedside ultrasonography can be used to accurately and rapidly determine the presence of the endotracheal tube within the trachea in pediatric patients.
Clinical Characteristics of Peanut-Allergic Children: Recent Changes
Authors: Green Todd D. , LaBelle Virginia S. , Steele Pamela H. , Kim Edwin H. , Lee Laurie A. , Mankad Vaishali S. , Williams Larry W. , Anstrom Kevin J. , Burks A. Wesley
Published: November 2007

OBJECTIVE. The goal was to determine whether patients seen in a referral clinic are experiencing initial allergic reactions to peanuts earlier, compared with a similar population profiled at a different medical center 10 years ago, and to investigate other changes in clinical characteristics of the patients between the 2 groups.

METHODS. We reviewed the medical charts of peanut-allergic patients seen in the Duke University pediatric allergy and immunology clinic between July 2000 and April 2006.

RESULTS. The median ages of first peanut exposure and reaction were 14 and 18 months, respectively; the respective ages in a similar population profiled between 1995 and 1997 were 22 and 24 months. Within our patient group, those born before 2000 were first exposed to peanuts at a median age of 19 months and reacted at a median age of 21 months, compared with first exposure at 12 months and first reaction at 14 months for those born in or after 2000. Most patients (68%) demonstrated sensitization or clinical allergy to other foods (53% to eggs, 26% to cow's milk, 20% to tree nuts, 11% to fish, 9% to shellfish, 7% to soy, 6% to wheat, and 6% to sesame seeds).

CONCLUSIONS. In the past decade, the ages of first peanut exposure and reaction have declined among peanut-allergic children seen in a referral clinic. Egg allergy is very common in peanut-allergic patients, and sesame seeds should perhaps be considered one of the major food allergens. The decline in the age of first peanut reaction seems to be attributable to earlier exposure.
Stability of Antibiotics in Portable Pumps Used for Bronchial Superinfection: Guidelines for Prescribers
Authors: Arlicot Nicolas , Rochefort Gaël Y. , Schlecht Deborah , Lamoureux Fabien , Marchand Sophie , Antier Daniel
Published: November 2007

OBJECTIVES. The aims of this study were (1) to collect data on the stability of antibiotics in portable pumps for the treatment of bronchial superinfection in patients with cystic fibrosis and (2) to provide guidelines for prescribers.

METHODS. The stability over 72 hours, in portable pumps stored at 35°C, of piperacillin plus tazobactam, ticarcillin plus clavulanic acid, cefsulodin, cefepime, and aztreonam was checked at 3 different concentrations. Stability was assessed through visual examination, pH measurements, and direct measurements of drug concentrations by using high-performance liquid chromatography. All parameters were measured at time 0, time 0 plus 24 hours, and time 0 plus 72 hours.

RESULTS. Degradation rates for penicillin plus β-lactamase inhibitor combinations remained <10% at time 0 plus 24 hours for all drugs, but the rate for piperacillin reached 12% for the highest concentration tested. The cephalosporins cefepime and cefsulodin had significant respective degradation rates of 18% and 28% at time 0 plus 24 hours and 60% and 68.5% at time 0 plus 72 hours, which were linked to the storage temperature. Aztreonam seemed to be stable over 72 hours.

CONCLUSIONS. This work provides data on drug stability that were lacking, allowing recommendations for physicians to optimize the safety and efficacy of antibiotic treatment of patients with cystic fibrosis. Piperacillin plus tazobactam and ticarcillin plus clavulanic acid infusions must be limited to 24 hours, and patients receiving cefepime or cefsulodin must wear a cold pack close to the ambulatory drug-delivery device during the infusion.
Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report
Authors: Barlow Sarah E. ,   and the Expert Committee
Published: November 2007

To revise 1998 recommendations on childhood obesity, an Expert Committee, comprised of representatives from 15 professional organizations, appointed experienced scientists and clinicians to 3 writing groups to review the literature and recommend approaches to prevention, assessment, and treatment. Because effective strategies remain poorly defined, the writing groups used both available evidence and expert opinion to develop the recommendations. Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. The writing groups also recommend changing office systems so that they support efforts to address the problem. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child';s obesity risk. For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. For assessment, the recommendations include methods to screen for current medical conditions and for future risks, and methods to assess diet and physical activity behaviors. For treatment, the recommendations propose 4 stages of obesity care; the first is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient's age and degree of excess weight. These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.
“Late-Preterm” Infants: A Population at Risk
Authors: Engle William A. , Tomashek Kay M. , Wallman Carol ,   and the Committee on Fetus and Newborn
Published: November 2007

Late-preterm infants, defined by birth at 34\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({0}/{7}\) \end{document} through 36\batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({6}/{7}\) \end{document} weeks' gestation, are less physiologically and metabolically mature than term infants. Thus, they are at higher risk of morbidity and mortality than term infants. The purpose of this report is to define “late preterm,” recommend a change in terminology from “near term” to “late preterm,” present the characteristics of late-preterm infants that predispose them to a higher risk of morbidity and mortality than term infants, and propose guidelines for the evaluation and management of these infants after birth.
Gemcitabine-Induced Reversible Posterior Leukoencephalopathy Syndrome: A Case Report and Review of the Literature
Authors: Rajasekhar Anita , George Thomas J.
Published: November 2007

Learning Objectives

After completing this course, the reader will be able to: Describe the clinical and radiologic manifestations of RPLS.Define agents or inciting risk factors that have been implicated in the development of RPLS.Describe the treatment and outcome of RPLS, emphasizing supportive care and urgent discontinuation of the offending agent.

Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com
Guidelines, Tramlines, and Faultlines
Authors: Healy David , Savage M. , Tranter R. , Austin R. , Ijaz Q. , Hughes J. A. , Oberholzer D. , Gutting P. , Roberts A. P.
Published: November 2007

It would be irrational to want our health care providers to practice in accordance with anything other than the best possible evidence. Given this, it seems entirely sensible to have expert panels regularly assess the current state of the controlled trial evidence for particular treatment options and codify these assessments in guidelines. If these panels are independent, this is surely a good mechanism to ensure that clinicians’ practice will be relatively independent of drug company blandishments. We might be able to depend on such a bolster against commercial pressure—if the clinical trials being conducted were genuine scientific exercises and were being reported transparently and honestly. However, recent developments in even independent guidelines raise the prospect that the pharmaceutical industry has captured the guideline process and is using it as a mechanism to gain and control markets. This article aims at bringing out the key issues by considering recent National Institute of Clinical Excellence (NICE) guidelines for pediatric depression and bipolar disorder, and the difficulties such guidelines can pose in certain settings.
Sudden Improvement of Insulin Sensitivity Related to an Endodontic Treatment
Authors: Schulze A. , Schönauer M. , Busse M.
Published: November 2007

Background: Inflammation contributes to the pathogenesis of diabetes. A reciprocal relationship exists between diabetes and chronic periodontitis. This report describes the effects of an acute focal dental inflammation and subsequent endodontic treatment on the required insulin dosage of a 70‐year‐old man who had moderately controlled diabetes.

Methods: Following an exacerbation of a combined endodontic‐periodontic (endo‐perio) lesion of tooth #3, the patient noticed a sudden increase in his insulin demand. After 3 weeks, the required dosage was ∼100% greater. In association with hyperglycemic incidents, he reported a prickling sensation in this tooth. The radiograph showed circular bone loss around the tooth.

Results: Just 1 day after the root‐canal preparation, the insulin need decreased to ∼50% of that required prior to treatment. Subsequently, an incision and systemic antibiotics were necessary because of the formation of a periodontal abscess. The insulin demand remained low despite this complication. Forty days after endodontic treatment, the insulin dosage was at a level comparable to that taken 4 weeks before the root‐canal preparation.

Conclusions: This clinical case revealed a highly relevant correlation between insulin resistance and a local dental inflammation. To avoid an increase in insulin resistance, it seems important to attend to radically non‐vital teeth as well as any other dental inflammation in diabetic patients.
Retention of Hopeless Teeth: The Effect on the Adjacent Proximal Bone Following Periodontal Surgery
Authors: Machtei Eli E. , Hirsch Ilan
Published: November 2007

Background: Clinical wisdom often suggests that retention of periodontally hopeless teeth may accelerate the destruction of the adjacent periodontium. The purpose of this study was to examine the effect of retaining hopeless teeth on the adjacent alveolar bone following periodontal surgery.

Methods: A retrospective study was conducted based on intraoral radiographs. Teeth were considered hopeless if they had lost ≥70% bone height at either of the proximal surfaces. The minimal follow‐up period after surgery was 24 months. All subjects completed periodontal therapy, including scaling and root planing (SRP), and periodontal surgery at these sites. Ninety‐three subjects with 110 hopeless teeth were included in this study. Cases were sorted into two groups: retained, which included 57 hopeless teeth (50 subjects) that were maintained; and extracted, which included 53 hopeless teeth (43 subjects) that were removed at surgery. All radiographs were digitized, and measurements of radiographic bone distance (RBD) were made using computerized software.

Results: Mean follow‐up was 4.40 ± 0.23 years. For the retained hopeless teeth, there was a mean bone gain of 0.82 mm from baseline (7.18 ± 0.35 mm) to the final examination (6.45 ± 0.41 mm; P = 0.0061). Likewise, the postoperative percentage of RBD of the retained hopeless teeth showed a statistically significant improvement from baseline (57.46% ± 1.5%) to the final examination (52.32% ± 2.03%; P = 0.0032). Teeth adjacent to a hopeless tooth had a slight radiographic bone gain postoperatively, which was greater in the extracted group. However, it was significant only for the distal neighboring teeth (1.50% versus 11.36%, respectively; P = 0.0119).

Conclusion: Long‐term preservation of hopeless teeth following periodontal surgery is an attainable goal with no detrimental effect on the adjacent proximal teeth.
Enamel Matrix Derivative Induces Connective Tissue Growth Factor Expression in Human Osteoblastic Cells
Authors: Heng Nora H.M. , N'Guessan Philippe D. , Kleber Bernd‐Michael , Bernimoulin Jean‐Pierre , Pischon Nicole
Published: November 2007

Background: Enamel matrix derivative (EMD) stimulates the production of transforming growth factor‐beta (TGF‐β), which has been suggested to play a role in mediating the effects of EMD in periodontal tissue regeneration. Connective tissue growth factor (CTGF) is a mediator of TGF‐β and promotes cell development. The interaction between EMD and CTGF is unknown. This study explored the effects of EMD on CTGF expression in human osteoblastic cells and whether the interaction is modulated by the TGF‐β signaling pathway. Also, the roles of CTGF in cell proliferation, cell cycle progression, and mineralized nodule formation of EMD‐induced osteoblastic cultures were examined.

Methods: Human osteoblastic cells (Saos‐2) were treated with 25 to 100 μg/ml EMD with or without the addition of TGF‐β inhibitor. CTGF mRNA expression was detected by reverse transcription‐polymerase chain reaction (RT‐PCR), and CTGF protein levels were assayed by Western blot analysis. In addition, cell cycle progression and DNA synthesis were determined by flow cytometry and 5‐bromo‐2′‐deoxyuridine (BrdU) incorporation following EMD treatment with or without CTGF antibody. Mineralization was examined by alizarin red staining and quantified by elution with cetylpyridinium chloride.

Results: Western blot and RT‐PCR analysis demonstrated a dose‐dependent increase of CTGF expression by EMD. EMD‐induced CTGF expression was reduced significantly in the presence of TGF‐β inhibitor. Cell cycle and BrdU analysis revealed an increase in cell proliferation following EMD treatment, which was due to an increase in the percentage of cells in the G2/M phase of the cell cycle. No significant effect was found when anti‐CTGF antibody was added. Conversely, mineralization was inhibited significantly in EMD‐treated cultures in the presence of anti‐CTGF antibody.

Conclusions: EMD stimulates CTGF expression, and the interaction is modulated via TGF‐β in osteoblastic cells. Also, CTGF affects EMD‐induced osteoblastic mineralization but not cell proliferation. To our knowledge, these results provide novel insight into EMD–CTGF interaction, two biomodifiers that have therapeutic relevance to tissue engineering and regeneration.
Markers of Systemic Bacterial Exposure in Periodontal Disease and Cardiovascular Disease Risk: A Systematic Review and Meta‐Analysis
Authors: Mustapha Indra Z. , Debrey Sarah , Oladubu Michael , Ugarte Richard
Published: November 2007

Background: Recent meta‐analyses reported a weak association between periodontal disease (PD) on clinical examination and cardiovascular disease (CVD). Systemic bacterial exposure from periodontitis, which correlates poorly with the clinical examination, has been proposed as the more biologically pertinent risk factor. The purpose of this study was to review and analyze the association between PD with elevated systemic bacterial exposure and CVD.

Methods: We searched in the PubMed, Cochrane Controlled Trials Register, EMBASE, and SCOPUS databases for all literature examining PD and CVD. From 10 selected publications, we extracted 12 cohort (N = 5) and cross‐sectional (N = 7) studies and included 11 of these in a meta‐analysis. With stratified analyses, this resulted in 14 analyses of coronary heart disease (CHD; N = 7), stroke (N = 4), and carotid intima‐medial thickening (CIMT; N = 3) as a measure of early atherosclerosis. Systemic bacterial exposure was measured by periodontal bacterial burden (N = 1), periodontitis‐specific serology (N = 12), or C‐reactive protein (N = 1).

Results: Periodontal disease with elevated markers of systemic bacterial exposure was associated strongly with CHD compared to subjects without PD, with a summary odds ratio of 1.75 (95% confidence interval (CI): 1.32 to 2.34; P <0.001). This group was not associated with CVD events or with stroke but was associated with a significant increase in mean CIMT (0.03 mm; 95% CI: 0.02 to 0.04).

Conclusion: Periodontal disease with elevated bacterial exposure is associated with CHD events and early atherogenesis (CIMT), suggesting that the level of systemic bacterial exposure from periodontitis is the biologically pertinent exposure with regard to atherosclerotic risk.
Er:YAG Laser Osteotomy for Intraoral Bone Grafting Procedures: A Case Series With a Fiber‐Optic Delivery System
Authors: Stübinger Stefan , Landes Constantin , Seitz Oliver , Sader Robert
Published: November 2007

Background: With a wavelength of 2.94 μm, the erbium‐doped:yttrium, aluminum, and garnet (Er:YAG) laser is suitable for cutting vital osseous tissue. To analyze the benefit of laser osteotomy in implant dentistry, a fiber‐guided Er:YAG laser was used for harvesting intraoral bone grafts.

Methods: In 10 consecutive patients (six males and four females), 12 block grafts were obtained from the ramus (nine cases), chin (two cases), and tuberosity (one case) region. For the osteotomies, the laser settings included a pulse energy of 500 mJ, a pulse duration of 250 microseconds, and a pulse frequency of 12 Hz. During osteotomy, the laser fiber tip was kept 1 to 2 mm away from the bone surface.

Results: Cut efficiency was satisfactory with almost no constraint on the positioning of the laser tip. Laser osteotomy was precise and allowed the blocks to be prepared with minimal waste of bone. The risk for accidentally injuring adjacent soft tissues was minimal. The postoperative wound‐healing process was not impaired, and there were no signs of carbonization; however, the surgical procedures were time consuming.

Conclusions: Using the Er:YAG laser with the aforementioned settings, successful laser osteotomy was achieved without any complications. However, because laser osteotomy was time‐intensive and offered no depth control, it demonstrated only slight advantages for intraoral bone‐grafting procedures. If the ablation process could be accelerated, the Er:YAG laser would be a promising alternative to conventional instruments for this surgical technique.