bluuebunny/crossref_metadata_2025 huggingface dataset:
Paragangliomas of the Head and Neck
Authors: Işık A. Cemal Ümit , İmamoğlu Mehmet , Erem Cihangir , Sarı Ahmet
Published: April 2007

Objectives: The purpose of this study was to determine the clinical characteristics of carotid body tumors and to analyze the benefits of different treatment modalities. Subjects and Methods: The clinical records of 13 patients with paragangliomas treated during the period of 1995–2005 were reviewed for age at diagnosis, sex, initial symptoms, duration of symptoms, evidence of secretory function, family history, radiographic studies, pre- and posttreatment cranial nerve deficits, multicentric tumors, angiography, operative procedures and findings, and complications. The diagnoses were established by computerized tomography and magnetic resonance imaging scanning. Angiography was performed on 3patients with carotid body tumor. Results: All of the patients were followed up for a duration ranging from 16 months to 9 years. The median follow-up was 5 years. Of all 18 head and neck tumors confirmed in 13 patients, 16 were in the carotid body, 1 in the vagus nerve and 1 in the middle ear cleft. Four patients had multiple paragangliomas, 2 bilateral synchronous and 1 bilateral asynchronous paragangliomas. The remaining patient had 3 asynchronous paragangliomas, i.e. left jugulotympanic, right carotid body and left vagal paraganglioma. All patients underwent successful surgical resection of the tumor after appropriate preoperative investigation. Conclusion: This study shows that surgical treatment is acceptably safe and effective in treating these neoplasms.
Solitary Intracranial Castleman’s Disease, Plasma Cell Variant: A Case Report
Authors: Mallik A.A. , Katchy K.C. , Clotan N.
Published: April 2007

Objective: We report a case of plasma cell variant of Castleman’s disease confined to the meninges. Clinical Presentation and Intervention: A 53-year-old woman presented with severe headache lasting a few months, which was insidious in onset but followed a progressive course with associated vomiting, blurring of vision and diplopia. Investigations revealed a dural-based mass that was considered both radiologically and intraoperatively as a meningioma. Total surgical excision of the mass was performed. Histologically, it was a plasma cell variant of Castleman’s disease with ĸ light chain restriction. Laboratory investigations and whole body computerized tomography scan showed no significant abnormality. A short course of local radiotherapy was given. The patient is well 2 years after treatment. Conclusion: This report highlights the rarity of solitary intracranial Castleman’s disease and the difficulty in radiological and intraoperative diagnosis.
Isolated Adrenocorticotropic Hormone Deficiency with Transient Thyroiditis Inducing an Adrenal Crisis
Authors: Hiraiwa Tetsuya , Furutama Daisuke , Sakane Sadaki , Ito Mitsuru , Imagawa Akihisa , Kimura Fumiharu , Hanafusa Toshiaki
Published: April 2007

Objective: It was the aim of this study to describe a patient with isolated adrenocorticotropic hormone deficiency presenting with a variety of involuntary movements who developed an adrenal crisis due to transient thyroiditis. Clinical Presentation and Intervention: A 61-year-old man was hospitalized with a variety of involuntary movements that were suspected manifestations of metabolic encephalopathy. After admission, his general status rapidly deteriorated to a life-threatening condition that included a degree of hyponatremia. The hyponatremia and metabolic encephalopathy provided clues toward a definitive diagnosis. After corticosteroid and sodium supplementation improved the status of the patient, endocrinological examinations revealed that he suffered from isolated adrenocorticotropic hormone deficiency followed by transient thyroiditis that induced an adrenal crisis. Conclusion: This case emphasizes the importance of considering hypoadrenalism when encountering hyponatremia or metabolic encephalopathy of unknown etiology.
Acute Myocardial Infarction following Sildenafil Intake in a Nitrate-Free Patient without Previous History of Coronary Artery Disease
Authors: Hayat S. , Al-Mutairy M. , Zubaid M. , Suresh C.
Published: April 2007

Objective: To report the occurrence of acute myocardial infarction (MI) associated with the intake of oral sildenafil (Viagra) in a nitrate-free patient without previous history of coronary artery disease. Case Presentation and Intervention: A 50-year-old manual laborer was admitted to the hospital with acute inferoposterior wall MI occurring approximately 30 min after taking oral sildenafil 50 mg. This occurred before any attempted sexual activity. Subsequent angiography showed a 70% stenotic lesion in the midsegment of the dominant circumflex artery. The Naranjo scale indicated that sildenafil was a probable cause of MI. Conclusion: This report shows a rare sildenafil-associated MI in a nitrate-free patient without a previous history of coronary artery disease.
Serum Asymmetric Dimethylarginine Negatively Correlates with Intima-Media Thickness in Early-Onset Atherosclerosis
Authors: Zsuga Judit , Török Janos , Magyar Mária Tünde , Valikovics Attila , Gesztelyi Rudolf , Kéki Sandor , Csiba Laszló , Zsuga Miklos , Bereczki Dániel
Published: April 2007

Background: Asymmetric dimethylarginine (ADMA) assumes a significant role in atherosclerosis by inhibiting the endothelial nitric oxide synthase (eNOS). Moreover, ADMA inhibits the inducible NOS (iNOS), the isoform that triggers atherosclerosis via peroxynitrite formation. Therefore, we investigated whether ADMA is a risk or protective factor in the atherosclerotic process. Intima-media thickness (IMT) of the common carotid artery, a surrogate for vascular diseases, was chosen as the outcome variable of interest. Methods: Sixty patients younger than 55 years having at least 30% stenosis of the internal carotid artery and 30 age- and gender-matched controls were recruited at a community-based neurosonological laboratory. We investigated relatively young patients to circumvent the confounding effect age has in the development of atherosclerosis. Results: The IMT showed a negative correlation with ADMA upon analysis of the pooled data (Spearman correlation coefficient –0.300, p = 0.0041) and the atherosclerotic stratum (Spearman correlation coefficient –0.323, p = 0.012). A multiple linear regression model containing all determinant factors of IMT previously identified by simple regression was used to further quantify the relationship between IMT and ADMA. The negative association between IMT and ADMA remained statistically significant (β: –0.510, CI: –0.894, –0.127; p = 0.010), furthermore it was even stronger in the atherosclerotic stratum (β: –0.67, CI: –1.16, –0.18; p = 0.008). Conclusions: A minimal increase in ADMA concentration may be protective by inhibiting iNOS but not eNOS in states where iNOS is induced, e.g. inflammation accompanying atherosclerosis.
Duplex Scanning Diagnosis of Internal Carotid Artery Dissections
Authors: Alecu C. , Fortrat J.O. , Ducrocq X. , Vespignani H. , de Bray J.M.
Published: April 2007

Background: The reliability of duplex scanning (DS) for the diagnosis of internal carotid artery dissections (ICAD) is not clear. Methods: Nine DS signs known to be suggestive for the diagnosis of ICAD were compared between 70 patients with ICAD and 70 matched patients without dissection. Results: Visible internal tapering occlusion, regular eccentric narrowing channel, ectasia beyond the carotid bulb, resistive index asymmetry, blood flow slowdown, ophthalmic artery blood flow inversion, and biphasic flow are more frequent in cases than in controls (p < 0.001). Atheroma plaques were absent in 80% of ICAD. When DS direct signs and hemodynamic signs were studied, sensitivity was 90% and specificity 60%. Conclusion: Diagnosis of ICAD by DS could be improved if direct signs were combined with hemodynamic signs, giving a high sensitivity and a rather good specificity.
Elevated Serum sFlt-1/Ang-2 Ratio in Women with Preeclampsia
Authors: Hirokoshi Kumiko , Maeshima Yohei , Kobayashi Kazuko , Matsuura Eiji , Sugiyama Hitoshi , Yamasaki Yasushi , Masuyama Hisashi , Hiramatsu Yuji , Makino Hirofumi
Published: April 2007

Background: An imbalance of angiogenesis-associated factors may predispose to preeclampsia. Here, we determined the ratio of serum concentration of soluble fms-like tyrosine kinase 1 (sFlt-1), a natural inhibitor of pro-angiogenic vascular endothelial growth factor (VEGF) relative to angiopoietin-2 (Ang-2), a natural antagonist of angiopoietin-1 (Ang-1) involved in promoting angiogenesis in the presence of VEGF, in women with preeclampsia. Methods: The levels of serum sFlt-1 and Ang-2 were measured by enzyme-linked immunosorbent assay. Results: Significant decrease of serum Ang-2 and the increase of sFlt-1 were observed in women with preeclampsia as compared to healthy pregnant women. The serum sFlt-1/Ang-2 ratio was strikingly increased in preeclamptic women in contrast to healthy pregnant women exhibiting lower value similar to non-pregnant women. The serum sFlt-1 concentrations tended to positively correlate with mean blood pressure (BP) in preeclamptic women, but not in healthy pregnant women. A cut-off value >0.25 in the serum sFlt-1/Ang-2 ratio showed 87.1% sensitivity and 82.8% specificity in differentiating preeclamptic women from healthy pregnant women. Conclusion: The serum sFlt-1/Ang-2 ratio is significantly elevated in preeclamptic women as compared to healthy pregnant women. Remarkable difference of sFlt-1/Ang-2 ratio between these two groups with excellent specificity and sensitivity suggests the clinical usefulness of the serum sFlt-1/Ang-2 ratio in diagnosing and potentially predicting the onset of preeclampsia.
Long-Term Oral Sodium Bicarbonate Supplementation Does Not Improve Serum Albumin Levels in Hemodialysis Patients
Authors: Bossola Maurizio , Giungi Stefania , Tazza Luigi , Luciani Giovanna
Published: April 2007

Metabolic acidosis, a frequent event in hemodialysis patients, has been implicated as a potential cause of protein-energy malnutrition. Unfortunately, correction of metabolic acidosis by means of high bicarbonate concentration in the dialysate does not seem to lead to significant changes in nutritional parameters. The project was a single-arm, open-label, 12-month pilot study at a university-based tertiary care center aimed at evaluating whether correction of metabolic acidosis through long-term oral sodium bicarbonate supplementation improves serum albumin levels and other nutritional parameters in patients undergoing maintenance hemodialysis. Twenty highly acidotic hemodialysis patients patients were invited to consume an oral supplementation of sodium bicarbonate (1 g, thrice daily), for 12 months. Patients were followed at baseline and every month, until month 12. At each follow-up visit, dry body weight, BMI, blood pressure, presence of edema, venous bicarbonate, and serum albumin were measured. Total lymphocyte count, fasting total cholesterol and C-reactive protein were assessed every 2 months. At baseline and at 12 months, the subjective global assessment of nutritional status and the protein equivalent of nitrogen appearance normalized to actual body weight were determined. Plasma bicarbonate level rose from 18.1 ± 2.7 to 22.1 ± 4.5 mmol/l after 10 months (p = 0.001). Mean serum albumin levels were 3.8 ± 0.2 mg/dl at baseline and 3.9 ± 0.2 at the end of the study. Repeated measure ANOVA showed that there was no significant effect of bicarbonate treatment on serum albumin levels (p = 0.29), dry weight (p = 0.1), serum total cholesterol (p = 0.97), total lymphocyte count (p = 0.69), or C-reactive protein (p = 0.85). Mean subjective global assessment score was 4.53 ± 0.37 at baseline and 4.58 ± 0.54 at 12 months (p = 0.1). Mean nPNA (g/kg/day) was 0.86 ± 0.05 at baseline and 0.85 ± 0.08 at month 12. The present study demonstrates that long-term oral sodium bicarbonate at the dose of 1 gram thrice daily has no significant effect on nutritional status of HD patients.
P1,P4-Diadenosine Tetraphosphate (Ap4A) Inhibits Proximal Tubular Reabsorption of Sodium in Rats
Authors: Stiepanow-Trzeciak Anna , Jankowski Maciej , Angielski Stefan , Szczepanska-Konkel Miroslawa
Published: April 2007

Background/Aims: P1,P4-diadenosine tetraphosphate (Ap4A) is a vasoactive dinucleotide possessing natriuretic activity. It is unclear, however, which part of the nephron is the target site of action for Ap4A. Methods: We evaluated the tubular sites of Ap4A action using the lithium clearance technique. Results: Ap4A at a priming dose of 2 µmol/kg with subsequent infusion at 20 nmol/kg/min increased fractional water and sodium excretion 2.5- and 5.6-fold, respectively. Moreover, Ap4A increased lithium clearance 1.9-fold and fractional lithium excretion 2.8-fold. Fractional water and sodium excretion from distal nephron segments was not significantly affected by Ap4A. Conclusion: These results suggest that Ap4A induces natriuresis mainly through inhibition of proximal tubular reabsorption of sodium.
In vivo Dilatation of the Postnatal Ductus Arteriosus by Atrial Natriuretic Peptide in the Rat
Authors: Toyoshima Katsuaki , Momma Kazuo , Imamura Shinichiro , Nakanishi Toshio
Published: April 2007

Background: α-Human atrial natriuretic peptide (hANP) reportedly increases in premature infants with patent ductus arteriosus (PDA). Objectives: To clarify a possible hANP effect to reopen the postnatal ductus, we studied in vivo reopening of the postnatal DA by a recombinant hANP, carperitide, in rats. Methods: Near-term rat pups were incubated at 33°C following caesarean section. The inner diameter of the ductus was measured with a microscope and a micrometer following rapid whole-body freezing. The DA constricted quickly after birth, and the inner diameter was 0.80 and 0.08 mm at 0 min (fetal state) and 60 min after birth. hANP concentration in the pup blood and the ductus-dilating effect of hANP were studied by subcutaneous injection of hANP at 60 min after birth, and by measurement 7, 15, 30 and 60 min later. Results: The peak hANP concentration was 790 pg/ml at 7 min with 1 mg/kg, which is similar to the level seen in preterm infants with symptomatic PDA. hANP dilated the postnatal ductus dose dependently and maximally at 7 min after injection. hANP dilated the postnatal constricted ductus completely to 0.79 mm in diameter with a large dose (10 mg/kg) and to 0.55 mm with 1 mg/kg. Conclusions: hANP reopens the constricted postnatal DA dose dependently in rats. The increased hANP, accompanying premature PDA, may delay closure of the DA.
A Model for the Involvement of Neural Cell Adhesion Molecules in Stress-Related Mood Disorders
Authors: Sandi Carmen , Bisaz Reto
Published: April 2007

Critical interactions between genetic and environmental factors – among which stress is one of the most potent non-genomic factors – are involved in the development of mood disorders. Intensive work during the past decade has led to the proposal of the network hypothesis of depression [Castren E: Nat Rev Neurosci 2005;6:241–246]. In contrast to the earlier chemical hypothesis of depression that emphasized neurochemical imbalance as the cause of depression, the network hypothesis proposes that problems in information processing within relevant neural networks might underlie mood disorders. Clinical and preclinical evidence supporting this hypothesis are mainly based on observations from depressed patients and animal stress models indicating atrophy (with basic research pointing at structural remodeling and decreased neurogenesis as underlying mechanisms) and malfunctioning of the hippocampus and prefrontal cortex, as well as the ability of antidepressant treatments to have the opposite effects. A great research effort is devoted to identify the molecular mechanisms that are responsible for the network effects of depression and antidepressant actions, with a great deal of evidence pointing at a key role of neurotrophins (notably the brain-derived neurotrophic factor) and other growth factors. In this review, we present evidence that implicates alterations in the levels of the neural cell adhesion molecules of the immunoglobulin superfamily, NCAM and L1, among the mechanisms contributing to stress-related mood disorders and, potentially, in antidepressant action.
Efficacy of Tonimer® Gel Spray on Postoperative Nasal Care after Endonasal Surgery
Authors: Ercan İbrahim , Cakir Burak Omur , Ozcelik Muge , Turgut Suat
Published: April 2007

Objective: To investigate the effect of the addition of Tonimer® gel spray into nasal mucosa care on nasal mucosal findings and patient comfort in the postoperative period of endonasal surgery. Material and Method: 40 patients who underwent endonasal surgery were included in the study. For the postoperative nasal care, isotonic saline was applied to both nasal cavities, and subsequently, Tonimer nasal gel spray was additionally applied to the right nasal cavity. Patients were examined on the 2nd, 7th, and 15th postoperative days. The findings of the examinations were scored with respect to crusting and the patient nasal comfort was assessed using the visual analog scale (VAS). Results: The VAS values which measure patient comfort and crusting were significantly lower on the Tonimer side compared to control (p < 0.01). Conclusion: Tonimer and saline combination was found to be superior to saline per se in decreasing crusting and improving patient nasal comfort in the postoperative period.
Effect of the Thickness of the Cartilage Disk on the Hearing Results after Perichondrium/Cartilage Island Flap Tympanoplasty
Authors: Atef Ahmed , Talaat Neseem , Fathi Ahmed , Mosleh Mohammed , Safwat Sherif
Published: April 2007

Objective/Hypothesis: The aim of this study was to analyze the effect of the thickness of the cartilage disk on the hearing results after perichondrium/cartilage island flap tympanoplasty. Our hypothesis was that thinning the rigid thick cartilage disk to half of its thickness could increase the compliance and give better acoustic gain and hearing results to patients with a reconstructed tympanic membrane. Study Design: A prospective before/after clinical trial was conducted between January 2003 and March 2004. Method: Patients with chronic suppurative otitis media (mucosal type), central perforations and intact ossicular chain were randomly divided into 2 groups: the 1st group was treated with the perichondrium/cartilage island flap technique using the full-thickness cartilage disk, while the 2nd group was treated with the same technique but after bisecting the cartilage to half of its thickness. Hearing was evaluated using a 4-frequency (500, 1,000, 2,000, 3,000 Hz) pure-tone average air-bone gap before and then 8–9 months after tympanoplasty, and the results were compared statistically.
Distortion Product Otoacoustic Emission Findings in Behçet’s Disease and Rheumatoid Arthritis
Authors: Bayazit Yildirim A. , Yilmaz Metin , Gunduz Bulent , Altınyay Senay , Kemaloglu Yusuf K. , Onder Meltem , Gurer Mehmet Ali
Published: April 2007

Background and Objective: This study aimed to assess cochlear functions in Behçet’s disease and rheumatoid arthritis (RA) using otoacoustic emission testing (OAE), which objectively assesses outer hair cells in the cochlea. Methods: Patients with Behçet’s disease (n = 16) and RA (n = 11) as well as 20 controls were tested using pure tone audiometry and transiently evoked (TEOAEs) and distortion product OAEs (DPOAEs). Results: Pure tone results in the Behçet’s group were not significantly different from controls (p > 0.05). Pure tone results in the RA group were significantly different than in controls at 250, 500 and 6,000 Hz (p < 0.05). TEOAEs could be obtained in all participants. DPOAE amplitudes in the RA group and controls were similar (p > 0.05). DPOAE amplitudes were significantly higher in the Behçet’s group than in controls at 1 and 2 kHz (p < 0.05). Conclusion: A subtle deterioration in hearing can be seen at low and high frequencies in RA, which is not related to outer hair cell dysfunction as detected by DPOAE testing. In the patients with Behçet’s disease who have hearing thresholds within the normal limits, outer hair cell functions seem spared with an increased activity in the apical regions of the cochlea.
Upper Lateral Cartilage Inner Mucoperichondrial Flap Technique for the Repair of Nasal Septal Perforation
Authors: Ceylan Alper , Ileri Fikret , Çelenk Fatih , Yilmaz Metin , Uslu Sabri
Published: April 2007

Treatment of nasal septal perforations which decrease quality of life is a surgical challenge with variable success rates. Numerous surgical methods have been proposed for closure of perforations. The technique described in this article, i.e. closure of the perforation with an upper lateral cartilage mucoperichondrial flap through an external septorhinoplasty approach, is an alternative surgical technique. Twenty-four patients with symptomatic nasal septal perforation were operated on using this technique and followed up for a mean duration of 28 months. Preoperative and postoperative symptom scores for crusting, nasal obstruction, bleeding, discharge, whistling, headache, nasal pain, snoring and olfactory loss as well as overall discomfort levels were compared using a visual analogue scale. Complete closure of the perforation was achieved in 19 patients.
Telomere Length Shortening of Peripheral Blood Mononuclear Cells in Solid-Cancer Patients Undergoing Standard-Dose Chemotherapy Might Be Correlated with Good Treatment Response and Neutropenia Severity
Authors: Yoon So Young , Sung Hwa Jung , Park Kyong Hwa , Choi In Keun , Kim Seok Jin , Oh Sang Cheul , Seo Jae Hong , Choi Chul Won , Kim Byung Soo , Shin Sang Won , Kim Yeul Hong , Kim Jun Suk
Published: April 2007

This study evaluated the telomere length changes (ΔTL) of peripheral blood mononuclear cells before and after repetitive standard-dose nonmyeloablative chemotherapy and the association of ΔTL with treatment response and myelosuppression severity. TL was measured with Southern blot analysis in 32 solid-cancer patients without bone marrow metastasis. The mean TL before chemotherapy (t0 TL) and after the 2nd (t1 TL), 4th (t2 TL) and 6th cycle (t3 TL) was 8.49, 8.33, 8.08 and 8.10 kb, respectively. TL became significantly decreased after 4 (p = 0.005) and 6 (p = 0.026) cycles of chemotherapy. The mean value of ΔTL before and after completion of chemotherapy (t0 TL – t3 TL) was 0.46 kb. ΔTL has a significant correlation with good treatment response (r = 0.448, p = 0.005) and the frequency of severe neutropenia (r = 0.417, p < 0.05). Consequently, TL of peripheral blood mononuclear cells was decreased by the repetitive nonmyeloablative standard-dose chemotherapy in solid-cancer patients without bone marrow metastasis, and ΔTL was associated with good treatment response and neutropenia severity.
Impact of Enteral Supplements Enriched with ω–3 Fatty Acids and/or ω–6 Fatty Acids, Arginine and Ribonucleic Acid Compounds on Leptin Levels and Nutritional Status in Active Crohn’s Disease Treated with Prednisolone
Authors: Nielsen Aneta Aleksandra , Nielsen Jens Nederby , Grønbæk Henning , Eivindson Martin , Vind Ida , Munkholm Pia , Brandslund Ivan , Hey Henrik
Published: April 2007

Background: Patients with Crohn’s disease (CD) often develop malnutrition due to disease activity. We aimed to assess the effect of two different enteral supplements of Impact® Powder (IP; Novartis, Switzerland) on leptin levels and nutritional status in active CD patients during prednisolone treatment and tapering. Methods: Thirty-one CD patients were randomized to IP Extra (group 1) or IP Standard (group 2). Leptin levels, nutritional, clinical and biochemical markers were studied at inclusion, after 5 and after 9 weeks of the study. Results: Leptin levels, body mass index (BMI) and total cholesterol increased significantly within both groups at week 5 compared to inclusion. Leptin levels correlated with BMI in both groups at inclusion and in group 2 at week 9. In group 1, triglyceride levels remained unchanged, while levels in group 2 increased significantly at week 5 compared to inclusion. Clinical and biochemical markers improved during the study compared to inclusion. Conclusions: Increased leptin levels during the study progress were transient, decreasing due to prednisolone withdrawal at the end of the study. Both formulas used as adjuvant therapy to prednisolone treatment were able to improve nutritional status in CD patients.
Antiplatelet Therapy and the Risk of Bleeding Induced by Gastrointestinal Endoscopic Procedures
Authors: Kimchi N.A. , Broide E. , Scapa E. , Birkenfeld S.
Published: April 2007

Antiplatelet drugs may increase the risk of bleeding induced by gastrointestinal endoscopic procedures. The antiplatelet effect of cyclooxygenase-1 inhibitors lasts less than 4 h. Skin and colonic bleeding times are prolonged for 3 and 5 days after aspirin and ticlopidine withdrawal respectively. Major bleeding from endoscopic biopsies is extremely rare. In the four recent largest series, the general incidence of polypectomy-induced major bleeding was 0.11–0.42%. In more than half of the cases the bleeding was delayed, usually up to 2 weeks after the endoscopy. Although three retrospective studies suggested that aspirin does not increase the risk of polypectomy-induced bleeding, the power of these studies is limited. Similarly, it is difficult to draw conclusions from the two studies that assessed the risk of aspirin use during sphincterotomy. Aspirin withdrawal may be harmful in susceptible patients, mainly if it is for more than 7 days. There is no indication to stop aspirin before esophagogastroduodenoscopy, which may reveal aspirin-induced lesions. We recommend discontinuation of aspirin 4–7 days (according to the cardiovascular risk) before other endoscopic procedures. When aspirin is indicated for primary prevention, it can be resumed 14 and 10 days after polypectomy and sphincterotomy respectively. In cases of secondary prevention, it should be resumed after 1 week.
Evaluating Appropriateness of Treatment for Crohn’s Disease: Feasibility of an Explicit Approach
Authors: Guessous Idris , Juillerat Pascal , Pittet Valerie , Froehlich Florian , Burnand Bernard , Mottet Christian , Felley Christian , Michetti Pierre , Vader John-Paul
Published: April 2007

Background: Situations where practical therapeutic decisions differ from guidelines in the management of patients with Crohn’s disease (CD) have been described through opinion surveys. The feasibility of actually documenting these situations using an explicit approach has not been examined. Objective: The aim of this study was to evaluate the feasibility of a retrospective application of appropriateness criteria to a population of CD patients. Methods: Medical records of a cohort of patients diagnosed with CD were systematically reviewed. We used appropriateness criteria for treatment of CD that had been developed by the European Panel on the Appropriateness of Crohn’s Disease Therapy (EPACT). First we evaluated the level of precision of the elements abstracted from medical records needed in order to be able to apply these criteria. We then assessed the appropriateness of treatment for different CD categories. Only participants with at least one physician encounter during the preceding 6 months were included. Results: 260 patient medical records were reviewed on site at 22 gastroenterologists’ offices over a 2-month period in 2005. 116 (44%) patients were excluded because they had not had at least one medical visit at their referred gastroenterologist during the preceding 6 months. Medical records for 8 additional patients (3%) were not accessible. 136 (53%) medical records including 148 encounters were available for analysis. Overall, elements necessary to determine the appropriateness of treatment were available in 94% (139/148) of encounters. These elements were available in more than 90% of cases for all CD categories except for mild-moderate luminal active CD where 66% were available. Among those with all necessary elements available, 18% of treatments were judged as appropriate, 29% inappropriate, 38% uncertain according to the EPACT criteria, and for the other 15%, appropriateness had not been rated by the EPACT panel. Conclusions: The information necessary to assess the appropriateness of treatment of major types of CD was generally both present and precise in medical records. Therefore, in addition to the intended prospective use of these criteria, retrospective evaluation of the appropriateness of CD treatment using medical records is also feasible with the EPACT criteria.
Myocardial Adaptation to Anemia and Red Blood Cell Transfusion in Premature Infants Requiring Ventilation Support in the 1st Postnatal Week
Authors: Cambonie Gilles , Matecki Stephan , Milési Christophe , Voisin Michel , Guillaumont Sophie , Picaud Jean-Charles
Published: April 2007

Background: Although transfusion practice in very premature infants is becoming more restrictive, little is known about myocardial adaptation to anemia during the 1st postnatal week. Objectives: To determine the central hemodynamic effects of anemia and red blood cell transfusion in very preterm infants undergoing intensive care. Methods: Twenty-nine neonates of less than 30 weeks gestational age were treated for respiratory distress syndrome, following a strict protocol. Echocardiographies were performed at the 4th and 6th postnatal days, which corresponded to, respectively, just before and 48 h after an erythrocyte transfusion of 15 ml/kg in the 12 anemic infants. Results: Anemic infants had increased stroke volume [2.1 (1.8–2.3) vs. 1.5 (1.3–1.6) ml/kg] and left ventricular (LV) output [312 (271–345) vs. 206 (177–240) ml/min/kg]. The relationship of the heart rate-corrected velocity of circumferential fiber shortening to LV end-systolic meridional wall stress indicated a higher contractile state in the anemic infants, with a higher y-intercept (p = 0.03) and a steeper slope (p = 0.05) of the regression line than in the nonanemic patients. Posttransfusion, the stroke volume, LV output, shortening fraction, and contractile state decreased to the values observed in the nonanemic infants. Conclusions: Myocardial contractility was a major component of the circulatory adjustments in the anemic premature infants requiring ventilation support in the early neonatal period. Changes in LV performance associated with anemia were reversed by transfusion with no detrimental effect on right ventricular function, LV preload or the respiratory status of these patients.
Cerebello-Pallido-Thalamic Connections in Man
Authors: Larson Sanford J. , Sances Jr. Anthony , Wetzel Nicholas
Published: April 2007

The brains of 5 patients who died at varying intervals following stereotactic pallidotomy or thalamotomy were examined using the Marchi stain for degenerating myelin. In 2 patients, the lesion was directed at the globus pallidus; in 2 the target was nucleus ventralis lateralis, and in 1 the target was n. ventralis posterior medialis. The observations indicated that the globus pallidus is reciprocally connected with n. ventralis lateralis, while the cerebellum is reciprocally connected with n. ventralis intermedius. Degenerating fibers from the medial lemniscus end within n. ventralis posterior, none reaching n. ventralis intermedius. On the basis of cytoarchitecture and subcortical connections, n. ventralis lateralis, n. ventralis intermedius, and n. ventralis posterior appear as distinct entities. However, each nucleus projects to both sensory and motor cortex, suggesting a functional unity.
Modified Skull Attachment for Todd-Wells Stereotactic Apparatus
Authors: Montagno Elson de A. , Nashold Jr. Blaine S.
Published: April 2007

Newly designed pins combine the safety of a single percutaneous puncture with the ability to make smooth microadjustments for precise positioning of a patient’s head under guided laser beams for stereotactic procedures in the operating room.
Negative Blood Culture Infective Endocarditis in the Elderly: Long-Term Follow-Up
Authors: Pérez de Isla Leopoldo , Zamorano José , Lennie Vera , Vázquez Jorge , Ribera José Manuel , Macaya Carlos
Published: April 2007

Background and Aim: Since the appearance of transesophageal echocardiography, the long-term prognosis of patients with negative blood culture infective endocarditis (NBCIE) has been found to be similar to that of patients with positive blood culture infective endocarditis (PBCIE). Nevertheless, the prognostic implications of NBCIE in the elderly (>65 years) has not, to date, been well documented. Our aim was to study the long-term prognosis of elderly patients with NBCIE and compare it with that of elderly patients with PBCIE. Methods: Our study group was composed of 60 consecutive patients >65 years old with a diagnosis of IE (confirmed by vegetation analysis or following Duke’s criteria). Every patient underwent transthoracic and transesophageal echocardiography. Fifty patients (83.3%) had PBCIE and 10 (16.7%) had NBCIE. All patients were followed up long-term, and the study end point was a composite one of death or need for valvular heart surgery. Results: Mean age was 72.9 ± 5 years (56.7% male). Similar clinical and echocardiographic characteristics were found in both groups. Global mortality, need for surgery, predisposing factors and infection location were also similar in both groups. In addition, no differences were found in the long-term prognosis (log rank p = 0.29). Conclusions: In our series, the long-term prognosis in elderly patients with IE is independent of the presence of a negative or positive blood culture. Thus, age cannot be considered an independent risk factor of negative outcome in elderly patients with NBCIE.
Corticosterone Impairs Insulin-Stimulated Translocation of GLUT4 in the Rat Hippocampus
Authors: Piroli Gerardo G. , Grillo Claudia A. , Reznikov Leah R. , Adams Sheila , McEwen Bruce S. , Charron Maureen J. , Reagan Lawrence P.
Published: April 2007

Background: Exposure to stress levels of glucocorticoids produces physiological responses that are characteristic of type 2 diabetes, such as peripheral insulin resistance and impairment in insulin-stimulated trafficking of glucose transporter 4 (GLUT4) in muscle and fat. In the central nervous system, stress produces neuroanatomical and neurochemical changes in the hippocampus that are associated with cognitive impairments. Methods: In view of these observations, the current studies examined the effects of short-term (1 week) exposure of stress levels of glucocorticoids upon insulin receptor (IR) expression and signaling, including GLUT4 translocation, in the rat hippocampus. Results: One week of corticosterone (CORT) treatment produced insulin resistance in response to peripheral glucose challenge. In the hippocampus, IR expression was unchanged in CORT-treated rats as compared with vehicle-treated rats. However, insulin-stimulated phosphorylation of the IR, total Akt levels and total GLUT4 levels were reduced in CORT-treated rats when compared to controls. In addition, insulin-stimulated translocation of hippocampal GLUT4 to the plasma membrane was completely abolished in CORT-treated rats. Conclusions: These results demonstrate that in addition to eliciting peripheral insulin resistance, short-term CORT administration impairs insulin signaling in the rat hippocampus, effects that may contribute to the deleterious consequences of hypercortisolemic/hyperglycemic states observed in type 2 diabetes.
Extracellular Water/Intracellular Water Is a Strong Predictor of Patient Survival in Incident Peritoneal Dialysis Patients
Authors: Chen Wei , Guo Li-Juan , Wang Tao
Published: April 2007

Background: The mortality rate of peritoneal dialysis (PD) patients is still high and controversies persist regarding the mortality predictor. This study was designed to identify the predictability of the extracellular water/intracellular water ratio (E/I) on mortality in PD patients. Methods: 227 incident PD patients were included. Time-dependent Cox proportional hazard regression was used to investigate the predictability of E/I on mortality. Results: The 2- and 3-year survival was 74 and 65%, respectively. Univariate Cox proportional hazard regression analysis showed that the significant predictors of mortality were age, sex, Charlson Comorbidity Index, total Kt/V, serum albumin, pulse pressure, presence of malnutrition, and E/I. However, the final Cox proportional hazard models revealed that E/I was the only significant predictor. For every increase of 0.1 in the E/I value, the relative risk of death was 1.368. Conclusions: E/I is a strong independent predictor of mortality in incident PD patients.
Doxycycline: A Pilot Study to Reduce Diabetic Proteinuria
Authors: Naini Afsoon Emami , Harandi Ali Amini , Moghtaderi Javad , Bastani Bahar , Amiran Ali
Published: April 2007

Background: Activity of matrix metalloproteinases (MMPs), the enzymes primarily responsible for the deposition of extracellular matrix proteins, contributes to the pathogenesis of diabetic proteinuria. We evaluated the effect of doxycycline, a potent nonselective MMPs inhibitor, on reduction of proteinuria in diabetic patients. Material and Methods: In a self-control clinical trial, 35 patients with overt diabetic nephropathy (proteinuria >300 mg/24 h) received oral doxycycline 100 mg/day for 2 months. Twenty-four-hour urine volume, Cr and protein excretion were measured at baseline, after 1 and 2 months of treatment, and after 4 months of its discontinuation. Treatment-related side effects were closely monitored and documented. Results: Mean (±SD) 24-hour urine protein was 888 ± 419 mg at baseline, 884 ± 368 mg after 1 month, and 643 ± 386 mg after the 2 months of doxycycline treatment. There was statistically significant reduction in proteinuria at 2 months of treatment vs. at the baseline (p < 0.001). Mean 24-hour urine protein excretion increased to 1,021 ± 422 mg 4 months after doxycycline was discontinued. The changes in serum sodium, potassium, BUN and Cr concentrations, and blood pressure measurements during the 2 months of treatment and follow-up period were not statistically significant. Conclusion: Proteinuria in patients with diabetic nephropathy can be reduced with low dose doxycycline therapy over a 2-month period of drug administration. Further studies are necessary to determine the long-term effect, the optimal dose, and the optimal duration of this potentially novel therapy.
Effects of mating, breeding system and parasites on reproduction in hermaphrodites: pulmonate gastropods (Mollusca)
Authors: Jordaens Kurt , Dillen Lobke , Backeljau Thierry
Published: April 2007

There are approximately 20 000 pulmonate gastropod species that are all hermaphroditic and (with a few exceptions) can act in both (i.e., male and female) sexual roles. Life history traits such as growth (rate), age at first reproduction, fecundity, fertility, future survival and offspring survival are highly variable within pulmonate species, even among individuals of the same population. Here, we review some aspects of reproduction (availability of partners, size-dependent sex allocation, courtship, (multiple) mating, sperm longevity/viability, social facilitation), breeding system (self-fertilisation, outcrossing or mixed) and parasitism that may influence an individual's reproductive success and therefore account for part of the intraspecific variation in life history traits. A literature study showed that fecundity, fertility and/or growth are significantly affected by: i) the mating group size through changes in interference competition (e.g., crowding), breeding system and sex allocation; ii) individual body size with larger individuals producing more eggs than smaller individuals; iii) mating whereby female fitness may be positively or negatively affected; iv) social facilitation whereby female fitness is positively affected by the presence of conspecifics; v) the breeding system including the phenomena of inbreeding and outbreeding depression; and vi) parasites that may suppress or stimulate reproduction, especially egg-laying, in parasitised individuals. Moreover, multiple mating and multiple paternity seem very common in pulmonates. Interestingly, several of the above-mentioned aspects seem to interact or even act synergetically. Although many aspects of life history variation in pulmonate gastropods are still poorly understood which makes it difficult to draw general conclusions, pulmonates offer ample opportunities to study the evolution of major topics in evolution and life history strategies. Indeed, there is a growing number of basommatophoran and stylommatophoran model species, experimental setups and molecular, histological and histochemical techniques that are used to test current hypothesis on sex allocation, sexual selection (sexual conflict, sperm competition or cryptic female choice), the evolution of breeding systems and host-parasite interactions which will yield much information for the study of life history strategies as well.
Use of the dart apparatus by the hermaphroditic land snail Polymita muscarum (Lea, 1834)
Authors: Reyes-Tur Bernardo , Koene Joris
Published: April 2007

Many species of pulmonate land snails are equipped with one or more so-called "love darts". Even though the number and shape of these calcareous darts vary considerably between species, dart use has only been investigated in very few species. Here, we redescribe the mating behaviour of Polymita muscarum because previous reports did not include the use of the dart apparatus. Mating in this hermaphroditic land snail can be divided into three stages: courtship, copulation and post-copulatory activity. During courtship, full eversion of the genital atrium is reached, thus exposing the sensitive zone, genital lobes and dart apparatus. We observed that P. muscarum pushes the everted dart apparatus repeatedly onto different parts of the partner's body and does not lose its dart after stabbing. Dissected specimens had a single, slender dart with a round base, a broad corona and a circular cross-section. We propose that the morphology of P. muscarum 's dart is consistent with the idea of simple darts needing to be stabbed more often in order to increase the transfer of mucus, which contains a biologically active substance (i.e. allohormone) that enhances the chances of paternity. Besides adding to the growing diversity in the use of love darts in land snails, these findings contribute to the understanding of the evolution of this peculiar reproductive act.
Effects of Structurally Competitive Multilevel Goals for an Interdependent Task
Authors: Crown Deborah F.
Published: April 2007

Forty preexistent corporate and student performance teams participated in two sessions to explore the effects of structurally competitive individual and group goals on an independent task. Results indicated that on a time-constrained task, the simultaneous administration of dual multilevel goals resulted in lower group performance than groups given either a group goal or no specific goals. Individual performance also was lower when dual multilevel goals were administered than when subjects were given only individual goals. Structurally competitive multilevel goals also stimulated more competitive individual strategy choices than no specific goals or group goals.
The angiogenic factor CCN1 promotes adhesion and migration of circulating CD34+ progenitor cells: potential role in angiogenesis and endothelial regeneration
Authors: Grote Karsten , Salguero Gustavo , Ballmaier Matthias , Dangers Marc , Drexler Helmut , Schieffer Bernhard
Published: April 2007

Tissue regeneration involves the formation of new blood vessels regulated by angiogenic factors. We reported recently that the expression of the angiogenic factor CCN1 is up-regulated under various pathophysiologic conditions within the cardiovascular system. Because CD34+ progenitor cells participate in cardiovascular tissue regeneration, we investigated whether CCN1—detected for the first time in human plasma—promotes the recruitment of CD34+ progenitor cells to endothelial cells, thereby enhancing endothelial proliferation and neovascularization. In this study, we demonstrated that CCN1 and supernatants from CCN1-stimulated human CD34+ progenitor cells promoted proliferation of endothelial cells and angiogenesis in vitro and in vivo. In addition, CCN1 induced migration and transendothelial migration of CD34+ cells and the release of multiple growth factors, chemokines, and matrix metalloproteinase-9 (MMP-9) from these cells. Moreover, the CCN1-specific integrins αMβ2 and αVβ3 are expressed on CD34+ cells and CCN1 stimulated integrin-dependent signaling. Furthermore, integrin antagonists (RGD-peptides) suppressed both binding of CCN1 to CD34+ cells and CCN1-induced adhesion of CD34+ cells to endothelial cells. These data suggest that CCN1 promotes integrin-dependent recruitment of CD34+ progenitor cells to endothelial cells, which may contribute to paracrine effects on angiogenesis and tissue regeneration.
A screening and intervention program aimed to reduce mortality and serious morbidity associated with severe neonatal alloimmune thrombocytopenia
Authors: Kjeldsen-Kragh Jens , Killie Mette Kjær , Tomter Geir , Golebiowska Elzbieta , Randen Ingrid , Hauge Reidun , Aune Berit , Øian Pål , Dahl Lauritz B. , Pirhonen Jouko , Lindeman Rolf , Husby Henrik , Haugen Guttorm , Grønn Morten , Skogen Bjørn , Husebekk Anne
Published: April 2007

The study's objective was to identify HPA 1a–negative women and to offer them an intervention program aimed to reduce morbidity and mortality of neonatal alloimmune thrombocytopenia (NAIT). HPA 1 typing was performed in 100 448 pregnant women. The HPA 1a–negative women were screened for anti–HPA 1a. In immunized women, delivery was performed by Cesarean section 2 to 4 weeks prior to term, with platelets from HPA 1a–negative donors reserved for immediate transfusion if petechiae were present and/or if platelet count was less than 35 × 109/L. Of the women screened, 2.1% were HPA 1a negative, and anti–HPA 1a was detected in 10.6% of these. One hundred seventy pregnancies were managed according to the intervention program, resulting in 161 HPA 1a–positive children. Of these, 55 had severe thrombocytopenia (< 50 × 109/L), including 2 with intracranial hemorrhage (ICH). One woman with a twin pregnancy missed the follow-up and had one stillborn and one severely thrombocytopenic live child. In 15 previous prospective studies (136 814 women) there were 51 cases of severe NAIT (3 intrauterine deaths and 7 with ICH). Acknowledging the limitation of comparing with historic controls, implementation of our screening and intervention program seemed to reduce the number of cases of severe NAIT-related complications from 10 of 51 to 3 of 57.
Hydroxyurea therapy lowers transcranial Doppler flow velocities in children with sickle cell anemia
Authors: Zimmerman Sherri A. , Schultz William H. , Burgett Shelly , Mortier Nicole A. , Ware Russell E.
Published: April 2007

Hydroxyurea has hematologic and clinical efficacy in sickle cell anemia (SCA), but its effects on transcranial Doppler (TCD) flow velocities remain undefined. Fifty-nine children initiating hydroxyurea therapy for clinical severity had pretreatment baseline TCD measurements; 37 with increased flow velocities (≥ 140 cm/s) were then enrolled in an institutional review board (IRB)–approved prospective phase 2 trial with TCD velocities measured at maximum tolerated dose (MTD) and one year later. At hydroxyurea MTD (mean ± 1 SD = 27.9 ± 2.7 mg/kg per day), significant decreases were observed in the right middle cerebral artery (MCA) (166 ± 27 cm/s to 135 ± 27 cm/s, P < .001) and left (MCA) (168 ± 26 cm/s to 142 ± 27 cm/s, P < .001) velocities. The magnitude of TCD velocity decline was significantly correlated with the maximal baseline TCD value. At hydroxyurea MTD, 14 of 15 children with conditional baseline TCD values improved, while 5 of 6 with abnormal TCD velocities whose families refused transfusions became less than 200 cm/s. TCD changes were sustained at follow-up. These prospective data indicate that hydroxyurea can significantly decrease elevated TCD flow velocities, often into the normal range. A multicenter trial is warranted to determine the efficacy of hydroxyurea for the management of increased TCD values, and ultimately for primary stroke prevention in children with SCA.