bluuebunny/crossref_metadata_2025 huggingface dataset:
COMPARATIVE RESPONSIVENESS OF JAPANESE VERSIONS OF THE DASH AND SF-36 QUESTIONNAIRES AND PHYSICAL MEASUREMENT TO CLINICAL CHANGES AFTER CARPAL TUNNEL RELEASE
Authors: Imaeda Toshihiko , Hirata Hitoshi , Toh Satoshi , Nakao Yasushi , Nishida Jun , Ijichi Masateru , Nagano Akira
Published: October 2006

The purpose of the present study was to test the responsiveness of the Japanese Society for Surgery of the Hand version of the Disability of the Arm, Shoulder and Hand questionnaire (DASH-JSSH) by evaluating effect size (ES) and standardised response mean (SRM) in patients undergoing carpal tunnel release. Subjects comprised 25 patients with carpal tunnel syndrome. All subjects completed the DASH-JSSH, medical outcomes 36-item short-form health survey (SF-36) and visual analogue scale (VAS) for pain and underwent objective assessment of grip strength, pinch strength and static two-point discrimination before and three months after surgery. DASH-JSSH displayed the highest sensitivity to changes at three months, followed by VAS. All subscales of SF-36 were much less sensitive and both grip and pinch strength were unchanged over the three-month period. DASH-JSSH demonstrated more responsiveness to changes after carpal tunnel release than SF-36, VAS and physical measurements, and displayed correlations with subscales of SF-36.
Lactate release from adipose tissue and skeletal muscle in vivo: defective insulin regulation in insulin-resistant obese women
Authors: Qvisth Veronica , Hagström-Toft Eva , Moberg Erik , Sjöberg Stefan , Bolinder Jan
Published: October 2006

To study the local tissue lactate production in the normal state and its possible disturbances in insulin resistance, rates of lactate release from adipose tissue (AT) and skeletal muscle (SM) were compared postabsorptively and during a hyperinsulinemic euglycemic clamp in 11 healthy nonobese and 11 insulin-resistant obese women. A combination of microdialysis, to measure interstitial lactate, and the 133Xe clearance technique, to determine local blood flow, were used. In the controls, local blood flow increased by 40% in SM ( P < 0.05) and remained unchanged in AT, whereas the interstitial-plasma difference in lactate doubled in AT ( P < 0.005) and was unaffected in SM during hyperinsulinemia. In the obese, blood flow and interstitial-plasma difference in lactate remained unchanged in both tissues during hyperinsulinemia. The lactate release (μmol100 g−1min−1) was 1.17 ± 0.22 in SM and 0.43 ± 0.11 in AT among the controls ( P < 0.01) and 0.86 ± 0.23 in SM and 0.83 ± 0.25 in AT among the obese women in the postabsorptive state. During insulin infusion, lactate release in the controls increased to 1.92 ± 0.26 in SM ( P < 0.005) and to 1.14 ± 0.22 in AT ( P < 0.005) but remained unchanged in the obese women. It is concluded that AT and SM are both significant sources of lactate release postabsorptively, and AT is at least as responsive to insulin as SM. The ability to increase lactate release in response to insulin is impaired in AT and SM in insulin-resistant obese women, involving defective insulin regulation of both tissue lactate metabolism and local blood flow.
AS160 phosphorylation is associated with activation of α2β2γ1- but not α2β2γ3-AMPK trimeric complex in skeletal muscle during exercise in humans
Authors: Treebak Jonas T. , Birk Jesper B. , Rose Adam J. , Kiens Bente , Richter Erik A. , Wojtaszewski Jørgen F. P.
Published: October 2006

We investigated time- and intensity-dependent effects of exercise on phosphorylation of Akt substrate of 160 kDa (AS160) in human skeletal muscle. Subjects performed cycle exercise for 90 min (67% V̇o2 peak, n = 8), 20 min (80% V̇o2 peak, n = 11), 2 min (110% of peak work rate, n = 9), or 30 s (maximal sprint, n = 10). Muscle biopsies were obtained before, during, and after exercise. In trial 1, AS160 phosphorylation increased at 60 min (60%, P = 0.06) and further at 90 min of exercise (120%, P < 0.05). α2β2γ3-AMP-activated protein kinase (AMPK) activity increased significantly to a steady-state level after 30 min, whereas α2β2γ1-AMPK activity increased after 60 min of exercise with a further significant increase after 90 min. α2β2γ1-AMPK activity and AS160 phosphorylation correlated positively ( r2 = 0.55). In exercise trials 2, 3, and 4, α2β2γ3-AMPK activity but neither AS160 phosphorylation nor α2β2γ1-AMPK activity increased. Akt Ser473 phosphorylation was unchanged in all trials, whereas Akt Thr308 phosphorylation increased significantly in trial 3 and 4 only. These results show that AS160 is phosphorylated in a time-dependent manner during moderate-intensity exercise and suggest that α2β2γ1- but not α2β2γ3-AMPK may act in a pathway responsible for exercise-induced AS160 phosphorylation. Furthermore, we show that AMPK complexes in skeletal muscle are activated differently depending on exercise intensity and duration.
Acute decrease in renal microvascular Po2 during acute normovolemic hemodilution
Authors: Johannes Tanja , Mik Egbert G. , Nohé Boris , Unertl Klaus E. , Ince Can
Published: October 2006

Large differences in the tolerance of organ systems to conditions of decreased O2 delivery such as hemodilution exist. The kidney receives ∼25% of the cardiac output and O2 delivery is in excess of the oxygen demand under normal circumstances. In a rat model of acute normovolemic hemodilution (ANH), we studied the effect of reduced hematocrit on renal regional and microvascular oxygenation. Experiments were performed in 12 anesthetized male Wistar rats. Six animals underwent four steps of ANH (hematocrit 25, 15, 10, and <10%). Six animals served as time-matched controls. Systemic and renal hemodynamic and oxygenation parameters were monitored. Renal cortical (c) and outer medullary (m) microvascular Po2 (μPo2) and the renal venous Po2 (PrvO2) were continuously measured by oxygen-dependent quenching of phosphorescence. Despite a significant increase in renal blood flow in the first two steps of ANH, cμPo2 and mμPo2 dropped immediately. From the first step onward oxygen consumption (V̇o2ren) became dependent on oxygen delivery (Do2ren). With a progressive decrease in hematocrit, a significant correlation between μPo2 and V̇o2ren could be observed, as well as a Po2 gap between μPo2 and PrvO2. Furthermore, there was a high correlation between V̇o2ren and RBF over a wide range of flows. In conclusion, the oxygen supply to the renal tissue is becoming critical already in an early stage of ANH due to the combination of increased V̇o2ren, decreased Do2ren, and intrarenal O2 shunt. This has clinical relevance as recent publications reporting that hemodilution during surgery forms a risk factor for postoperative renal dysfunction.
Disturbed Homeostasis in Sodium-Restricted Mice Heterozygous and Homozygous for Aldosterone Synthase Gene Disruption
Authors: Makhanova Natalia , Sequeira-Lopez Maria L.S. , Gomez R. Ariel , Kim Hyung-Suk , Smithies Oliver
Published: October 2006

We have determined that differences in expression of aldosterone synthase (AS) affect responses to a low-salt diet. In AS-null mice (AS
−/−
), but not in wild-type, low salt significantly decreased plasma sodium and increased potassium. The increased urine volume (1.5×wild-type) and decreased urine osmolality (0.7×wild-type), present in AS
−/−
mice on normal salt, became more severe (2.3×wild-type and 0.5×wild-type) on low salt, but neither changed in wild-type. In both genotypes, plasma vasopressin was similar on normal and low salt, and desmopressin injection significantly increased urine osmolality. Renal mRNA levels for aquaporin 1 and 3 were unchanged by genotype or diet and epithelial sodium channel and Na
+
-K
+
-2Cl
−
-cotransporter by genotype. In AS
−/−
mice, aquaporin 2 mRNA increased on normal salt, whereas Na
+
Cl
−
-cotransporter and cortex K
+
channel mRNAs decreased on both diets. The low blood pressure of AS
−/−
mice was decreased further by low salt, despite additional increases in renin, intrarenal arterial wall thickness, and macula densa cyclogenase-2 mRNA. In AS
+/−
mice on normal salt, adrenal AS mRNA was slightly decreased (0.7×wild-type), but blood pressure was normal. On low salt, their blood pressure was less than wild-type (101±2 mm Hg versus 106±2 mm Hg), even though renin mRNA increased to 2×wild-type. We conclude that aldosterone is critical for urine concentration and maintenance of blood pressure and even a mild reduction of AS expression makes blood pressure sensitive to low salt, suggesting that genetic differences of AS levels in humans may influence how blood pressure responds to dietary salt.
Clinical and Radiological Recurrence After Childhood Arterial Ischemic Stroke
Authors: Ganesan Vijeya , Prengler Mara , Wade Angela , Kirkham Fenella J.
Published: October 2006

Background—

Data on rates and risk factors for clinical and radiological recurrence of childhood arterial ischemic stroke (AIS) might inform secondary prevention strategies.

Methods and Results—

Consecutive Great Ormond Street Hospital patients with first AIS were identified retrospectively (1978–1990) and prospectively (1990–2000). Patients underwent repeat neuroimaging at the time of clinical recurrence or, if asymptomatic, at least 1 year after AIS. Cox and logistic regression analyses were used to explore the relationships between risk factors and clinical and radiological recurrence, respectively. A total of 212 patients were identified, of whom 97 had another prior diagnosis. Seventy-nine children had a clinical recurrence (29 strokes, 46 transient ischemic attacks [TIAs], 4 deaths with reinfarction 1 day to 11.5 years (median 267 days) later); after 5 years, 59% (95% confidence interval, 51% to 67%) were recurrence free. Moyamoya on angiography and low birth weight were independently associated with clinical recurrence in the whole group. Genetic thrombophilia was associated with clinical recurrence in previously healthy patients, independent of the presence of moyamoya. Sixty of 179 patients who had repeat neuroimaging had radiological reinfarction, which was clinically silent in 20. Previous TIA, bilateral infarction, prior diagnosis (specifically immunodeficiency), and leukocytosis were independently associated with reinfarction. Previous TIA and leukocytosis were also independently associated with clinically silent reinfarction.

Conclusions—

Clinical and radiological recurrence are common after childhood AIS. The risk of clinical recurrence is increased in children with moyamoya and, in previously healthy patients, in those with genetic thrombophilia. Preexisting pathology, including immunodeficiency, and persistent leukocytosis are risk factors for radiological recurrence, which suggests a potential role for chronic infection.
Creatine Kinase Activity Is Associated With Blood Pressure
Authors: Brewster Lizzy M. , Mairuhu Gideon , Bindraban Navin R. , Koopmans Richard P. , Clark Joseph F. , van Montfrans Gert A.
Published: October 2006

Background—

We previously hypothesized that high activity of creatine kinase, the central regulatory enzyme of energy metabolism, facilitates the development of high blood pressure. Creatine kinase rapidly provides adenosine triphosphate to highly energy-demanding processes, including cardiovascular contraction, and antagonizes nitric oxide–mediated functions. Relatively high activity of the enzyme, particularly in resistance arteries, is thought to enhance pressor responses and increase blood pressure. Tissue creatine kinase activity is reported to be high in black people, a population subgroup with greater hypertension risk; the proposed effects of high creatine kinase activity, however, are not “race dependent.” We therefore assessed whether creatine kinase is associated with blood pressure in a multiethnic population.

Methods and Results—

We analyzed a stratified random sample of the population of Amsterdam, the Netherlands, consisting of 1444 citizens (503 white European, 292 South Asian, 580 black, and 69 of other ethnicity) aged 34 to 60 years. We used linear regression analysis to investigate the association between blood pressure and normal serum creatine kinase after rest, as a substitute measure of tissue activity. Creatine kinase was independently associated with blood pressure, with an increase in systolic and diastolic pressure, respectively, of 8.0 (95% CI, 3.3 to 12.7) and 4.7 (95% CI, 1.9 to 7.5) mm Hg per log creatine kinase increase after adjustment for age, sex, body mass index, and ethnicity.

Conclusions—

Creatine kinase is associated with blood pressure. Further studies are needed to explore the nature of this association, including how variation in cardiovascular creatine kinase activity may affect pressor responses.
Calcific Aortic Valve Stenosis in Old Hypercholesterolemic Mice
Authors: Weiss Robert M. , Ohashi Masuo , Miller Jordan D. , Young Stephen G. , Heistad Donald D.
Published: October 2006

Background—

Hypercholesterolemia and old age are clinical risk factors for development of aortic valve stenosis, and hypercholesterolemia is a putative therapeutic target. We tested the hypothesis that calcification and aortic valve stenosis would develop in genetically hypercholesterolemic old mice.

Methods and Results—

Twenty-four low-density lipoprotein receptor–deficient apolipoprotein B-100–only (
LDLr
−/−
ApoB
100/100
) mice were fed normal chow from weaning until age 20.1±0.5 months (mean±SE; range 17 to 22 months). Twenty-one age-matched (20.8±0.9 months, range 17 to 25 months) C57Bl/6 mice served as controls. Echocardiographic imaging was used to assess morphology and function of the aortic valve and left ventricle. A subset of 12 mice underwent invasive hemodynamic assessment of aortic valve function. Functionally significant aortic stenosis, with >75% reduction in valve area, occurred in 8 of 24
LDLr
−/−
ApoB
100/100
mice and in 0 of 21 controls (
P
=0.01). In the subset that underwent catheterization, mice with echocardiographic evidence of aortic stenosis had a systolic transvalvular gradient of 57±6 mm Hg. In the group of all
LDLr
−/−
ApoB
100/100
mice with aortic stenosis, left ventricular mass was increased by 67% (
P
=0.001) and ejection fraction was decreased by 30% (
P
=0.004) compared with
LDLr
−/−
ApoB
100/100
without aortic stenosis. Von Kossa staining of the aortic valve demonstrated abundant mineralization in
LDLr
−/−
ApoB
100/100
mice but not in control mice. Superoxide (oxyethidium fluorescence) was present in valve tissue from all 3 groups of mice and was more abundant in mice with aortic stenosis.

Conclusions—

Hypercholesterolemic
LDLr
−/−
ApoB
100/100
mice are prone to develop calcification and oxidative stress in the aortic valve, with functional valvular heart disease, mimicking the clinical syndrome. This discovery holds promise for elucidation of the pathophysiology of aortic valve disease mechanisms and for the design of effective nonsurgical treatment.
Privatization Ideology and Ownership Change in Poland
Authors: Aggestam Maria
Published: October 2006

This article examines the process of privatization in a service company in Poland from an institutionalist perspective. The study investigates privatization ideology as a powerful component of the radical change of an organization. Arguing that the privatization process is the fundamental element in radical institutional change, the author examines how the privatization ideology becomes institutionalized within an organization through a combination of macro- and microlevel forces. This article also looks at the consequences of privatization for the change process and shows how a privatization ideology facilitated a climate of acceptance of and commitment to the new rules of conduct. The study employs qualitative data collection methods combining semistructured interviews, participant observation, and extensive document analysis in a case study of the privatization process in an organization.
The Lost Boys (and Girls)
Authors: Gebhard Susan
Published: October 2006

Using published research studies, writings of experts in the literacy field, and anecdotes from the author’s own experiences, this article examines the reading motivation and disposition of preser-vice teachers and suggests ways that children’s literature courses positively affect both. Ideas of social modeling, constructivist course design, and the role of influential teachers are also discussed. The title is derived from the classic book, Peter Pan and Wendy, and hints at the possibility that future generations of readers may be “lost” if teacher preparation programs do not consider and promote positive reading dispositions.
A Victim of Its Own Success: Internationalization, Neoliberalism, and Organizational Involution at the Business Council of Australia
Authors: Bell Stephen
Published: October 2006

The focus of this article is on the Business Council of Australia (BCA), an association of the CEOs of the 100 or so largest companies operating in Australia. Since its inception the BCA has been an influential supporter of largely successful efforts to neoliberalize and internationalize the Australian economy. Running in parallel with these developments, however, the BCA has moved from being a “somewhat strong” to a relatively weak policy organization. This article argues these two trends are causally related. Neoliberal-inspired economic restructuring and economic internationalization have weakened the “logic of membership” and the “logic of influence” of the BCA, leading to a process of organizational involution. Furthermore, potential offsets to what I describe as the organizational predations of neoliberalism and internationalization—especially via a willingness or capacity to forge supportive or mutualistic relations with the state—have not been realized.
Simultaneous Inductive and Deductive Modeling of Ecological Systems via Evolutionary Computation and Information Theory
Authors: Hoffmann James P.
Published: October 2006

The addition of two emerging technologies (evolutionary computation and ecoinformatics) to computational ecology can advance our ability to build better ecological models and thus deepen our understanding of the mechanistic complexity of ecological systems. This article describes one feasible approach toward this goal–the combining of inductive and deductive modeling techniques with the optimizing power of simple algorithms of Darwinian evolution that include information-theoretic model selection methods. Specifically, the author shows a way to extend classic genetic algorithms beyond typical parameter fitting of a single, previously chosen model to a more flexible technique that can work with a suite of possible models. Inclusion of the Akaike information-theoretic model selection method within an evolutionary algorithm makes it possible to accomplish simultaneous parameter fitting and parsimonious model selection.Experiments with synthetic data show the feasibility of this approach, and experiments with time-series field data of the zebra mussel invasion of Lake Champlain (United States) result in a model of the invasion dynamics that is consistent with the known hydrodynamic features of the lake and the motile life history stage of this invasive species.The author also describes a way to extend this approach with a modified genetic programming algorithm.
The Nature of the Business Group: A Social Network Perspective
Authors: Smångs Mattias
Published: October 2006

This article takes as its point of departure the ambiguous and inconsistent way in which the concept of the ‘business group’ and other associated concepts has been used in the literature to describe and label different types of interfirm relationships. To remedy this state of affairs, a preliminary conception of the business group is presented and elaborated upon, in which the business group is conceptualized as comprising three analytically separable elements: network(s) of interrelated firms, the institutionalized logic of reciprocity, and the intersubjective interpretation of actors inside as well as outside the group. Further, a social network perspective on organizations is suggested for the analysis of business groups.
Changing dynamics in the Canadian voluntary sector: challenges in sustaining organizational capacity to support healthy communities
Authors: Steedman Eric , Rabinowicz Jane
Published: October 2006

The voluntary sector is recognized, by citizens, industry and government, as an increasingly vital contributor to healthy communities within Canadian society, called upon to provide front-line service delivery in areas of community support that were in the past often served by government and or religious charity. (The voluntary sector is large, consisting of an estimated 180,000 non-profit organizations [of which 80,000 are registered as charities] and hundreds of thousands more volunteer groups that are not incorporated [Statistics Canada, 2002].) The dynamics of the sector have changed considerably over the past decade, as government has pulled back the level of core organizational funding support and the role of the church has diminished.

As community health is directly related to the organizational health of service-providing non-profits and charities, these organizations are looking increasingly towards corporate and individual donors, along with new self-financing approaches that generate revenues. They are also facing challenges in attracting and retaining skilled and motivated volunteers.

As the scope of the voluntary sector and its overall influence grows, so do the organizational and financial challenges it faces. This article will address in particular the issue of funding support for healthy communities and examine a number of potential and existing best practices for sustaining community health in Canada. We will also look at the issue of volunteerism and human resource capacity challenges for organizations. This is an area in which the Canadian government has decided to focus as a result of explicit policy decisions taken in the late 1990s.
Focusing researchers’ minds: contrasting experiences of using focus groups in feminist qualitative research
Authors: Jowett Madeleine , O’Toole Gill
Published: October 2006

In this article, we reflect on our contrasting experiences of using focus groups in two different empirical research projects, one that explored the attitudes of mature students in further education towards possible participation in higher education, the other that examined young women’s relationships to feminism. In particular, we analyse the ways in which our research questions and approaches were challenged, honed and sometimes transformed in the light of our participants’ responses to our chosen method of research. For, while the mature students of the former project - many of whom had previously experienced formal education as negative - felt discomfort at the atmosphere of collective examination that the group engendered, and resisted discussion on their thoughts and feelings, the young women of the latter study welcomed the legitimacy that the formal focus group lent to their desire to discuss the socially taboo subject of feminism. We thus seek to show how we gained knowledge and understanding about our research topics through our participants’ responses to the method we selected as well as through their direct contributions in the research moment.
Comprehensive analysis of gene expression patterns of hedgehog-related genes
Authors: Hao Limin , Johnsen Robert , Lauter Gilbert , Baillie David , Bürglin Thomas R
Published: October 2006

Background

TheCaenorhabditis elegansgenome encodes ten proteins that share sequence similarity with the Hedgehog signaling molecule through their C-terminal autoprocessing Hint/Hog domain. These proteins contain novel N-terminal domains, andC. elegansencodes dozens of additional proteins containing only these N-terminal domains. These gene families are calledwarthog,groundhog,ground-likeandquahog, collectively calledhedgehog(hh)-related genes. Previously, the expression pattern of seventeen genes was examined, which showed that they are primarily expressed in the ectoderm.

Results

With the completion of theC. elegansgenome sequence in November 2002, we reexamined and identified 61hh-related ORFs. Further, we identified 49hh-related ORFs inC. briggsae. ORF analysis revealed that 30% of the genes still had errors in their predictions and we improved these predictions here. We performed a comprehensive expression analysis using GFP fusions of the putative intergenic regulatory sequence with one or two transgenic lines for most genes. Thehh-related genes are expressed in one or a few of the following tissues: hypodermis, seam cells, excretory duct and pore cells, vulval epithelial cells, rectal epithelial cells, pharyngeal muscle or marginal cells, arcade cells, support cells of sensory organs, and neuronal cells. Using time-lapse recordings, we discovered that somehh-related genes are expressed in a cyclical fashion in phase with molting during larval development. We also generated several translational GFP fusions, but they did not show any subcellular localization. In addition, we also studied the expression patterns of two genes with similarity to Drosophilafrizzled, T23D8.1 and F27E11.3A, and the ortholog of the Drosophila genedally-like,gpn-1, which is a heparan sulfate proteoglycan. The twofrizzledhomologs are expressed in a few neurons in the head, andgpn-1is expressed in the pharynx. Finally, we compare the efficacy of our GFP expression effort with EST, OST and SAGE data.

Conclusion

No bona-fide Hh signaling pathway is present inC. elegans. Given that thehh-related gene products have a predicted signal peptide for secretion, it is possible that they constitute components of the extracellular matrix (ECM). They might be associated with the cuticle or be present in soluble form in the body cavity. They might interact with the Patched or the Patched-related proteins in a manner similar to the interaction of Hedgehog with its receptor Patched.
Synaptic proteins as multi-sensor devices of neurotransmission
Authors: Brachya Guy , Yanay Chava , Linial Michal
Published: October 2006

Neuronal communication is tightly regulated in time and space. Following neuronal activation, an electrical signal triggers neurotransmitter (NT) release at the active zone. The process starts by the signal reaching the synapse followed by a fusion of the synaptic vesicle (SV) and diffusion of the released NT in the synaptic cleft. The NT then binds to the appropriate receptor and induces a membrane potential change at the target cell membrane. The entire process is controlled by a fairly small set of synaptic proteins, collectively called SYCONs. The biochemical features of SYCONs underlie the properties of NT release.

SYCONs are characterized by their ability to detect and respond to changes in environmental signals. For example, consider synaptotagmin I (Syt1), a prototype of a protein family with over 20 gene and variants in mammals. Syt1 is a specific example of a multi-sensor device with a large repertoire of discrete states. Several of these states are stimulated by a local concentration of signaling molecules such as Ca2+. The ability of this protein to sense signaling molecules and to adopt multiple biochemical states is shared by other SYCONs such as the synapsins (Syns). Specific biochemical states of Syns determine the accessibility of SV for NT release. Each of these states is defined by a specific alternative spliced variant with a unique profile of phosphorylation modified sites.

The plasticity of the synapse is a direct reflection of SYCON's multiple biochemical states. State transitions occurs in a wide range of time scales, and therefore these molecules need to cope with events that last milliseconds (i.e., exocytosis in fast responding synapses) and with events that can carry on for many minutes (i.e., organization of SV pools). We suggest that SYCONs are optimized throughout evolution as multi-sensor devices. A full repertoire of the switches leading to alternation of protein states and a detailed characterization of protein-protein network within the synapse is critical for the development of a dynamic model of synaptic transmission.
Radiological, pathological and DNA remission in recurrent metastatic nasopharyngeal carcinoma
Authors: Chan Stephen L , Hui Edwin P , Leung Sing F , Chan Anthony TC , Ma Brigette BY
Published: October 2006

Background

Circulating plasma Epstein Barr Virus DNA (EBV-DNA) is a sensitive and specific marker of nasopharyngeal carcinoma (NPC). The mainstay of treatment of metastatic NPC is systemic chemotherapy and resection for solitary metastasis. Despite high response rate to chemotherapy, complete remission is uncommonly seen.

Case Presentation

We report a case of recurrent metastatic NPC in a 43-year-old man, who achieved complete remission three times with chemotherapy and surgery. Serial plasma EBV-DNA levels were measured during the course of disease. The patient had three episodes of recurrences of NPC manifested as distant metastasis. Both time, rise in the plasma EBV-DNA level preceded detection of recurrences by imaging. Following systemic chemotherapy, he achieved complete remission each time, of which was confirmed by 18-flourodeoxyglucose positron emission tomography and hepatectomy pathology. The plasma EBV-DNA level dropped to zero copy/ml at the time of each remission.

Conclusion

This case highlights the high chemosensitivity of NPC by illustrating a rare occurrence of complete response of metastatic NPC to chemotherapy. This case also underscores the usefulness of EBV-DNA as a useful tool in monitoring NPC by its ability to detect early recurrence and excellent correlation with treatment response.
Health-related quality of life in diabetic patients and controls without diabetes in refugee camps in the Gaza strip: a cross-sectional study
Authors: Eljedi Ashraf , Mikolajczyk Rafael T , Kraemer Alexander , Laaser Ulrich
Published: October 2006

Background

Prevalence of diabetes mellitus is increasing in developed and developing countries. Diabetes is known to strongly affect the health-related quality of life (HRQOL). HRQOL is also influenced by living conditions. We analysed the effects of having diabetes on HRQOL under the living conditions in refugee camps in the Gaza strip.

Methods

We studied a sample of 197 diabetic patients who were recruited from three refugee camps in the Gaza strip and 197 age- and sex-matched controls living in the same camps. To assess HRQOL, we used the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) including four domains (physical health, psychological, social relations and environment). Domain scores were compared for cases (diabetic patients) and controls (persons without diabetes) and the impact of socio-economic factors was evaluated in both groups.

Results

All domains were strongly reduced in diabetic patients as compared to controls, with stronger effects in physical health (36.7 vs. 75.9 points of the 0–100 score) and psychological domains (34.8 vs. 70.0) and weaker effects in social relationships (52.4 vs. 71.4) and environment domains (23.4 vs. 36.2). The impact of diabetes on HRQOL was especially severe among females and older subjects (above 50 years). Low socioeconomic status had a strong negative impact on HRQOL in the younger age group (<50 years).

Conclusion

HRQOL is strongly reduced in diabetic patients living in refugee camps in the Gaza strip. Women and older patients are especially affected.
Morphologic and immunophenotypic evidence of in-situ Kaposi's sarcoma
Authors: Konstantinopoulos Panagiotis A , Dezube Bruce J , Pantanowitz Liron
Published: October 2006

Background

The spectrum of Kaposi's sarcoma (KS) has been expanded to include pre-KS lesions.

Case Presentation

We report, for the first time, a case providing direct histological evidence of the development of early (in-situ) KS from mediastinal lymphatic vessels in the setting of chronic lymphedema in an HIV-positive patient. Spindle-shaped and endothelial cells in these early KS-appearing lesions were immunoreactive for HHV8, D2-40 and CD34.

Conclusion

Our findings suggest that HHV8-infected spindle-shaped cells associated with lymphangiogenesis that evolve into KS lesions, acquire from the outset an aberrant mixed vascular and lymphatic endothelial cell phenotype.
An improved and highly sensitive microfluorimetric method for assessing susceptibility of Plasmodium falciparum to antimalarial drugs in vitro
Authors: Quashie Neils B , de Koning Harry P , Ranford-Cartwright Lisa C
Published: October 2006

Background

The standard in vitro protocol currently in use for drug testing against Plasmodium falciparum, based on the incorporation of the purine [3H]-hypoxanthine, has two serious drawbacks. Firstly it is unsuitable for the testing of drugs that directly or indirectly impact on purine salvage or metabolism. Secondly, it relies on the use of expensive radiolabelled material, with added issues concerning detection, storage and waste disposal that make it unsuitable for use in many disease-endemic areas. Recently, the use of fluorochromes has been suggested as an alternative, but quenching of the fluorescence signal by the haemoglobin present in cultures of Plasmodium falciparum-infected erythrocytes severely limits the usefulness of this approach.

Methods

In order to resolve this problem, a new PicoGreen®-based procedure has been developed which incorporates additional steps to remove the interfering haemoglobin. The 50% inhibitory concentration (IC50) values of chloroquine and pyrimethamine against P. falciparum laboratory lines 3D7 and K1 were determined using the new protocol.

Results

The IC50 values of chloroquine and pyrimethamine against P. falciparum laboratory lines 3D7 and K1 determined with the new fluorescence-based protocol were statistically identical to those obtained using the traditional 3H-hypoxanthine incorporation method, and consistent with literature values.

Conclusion

The new method proved to be accurate, reproducible and sensitive, and has the advantage of being non-radioactive. The improved PicoGreen® method has the potential to replace traditional in vitro drug resistance assay techniques.
Inorganic phosphate nanorods are a novel fluorescent label in cell biology
Authors: Patra Chitta Ranjan , Bhattacharya Resham , Patra Sujata , Basu Sujit , Mukherjee Priyabrata , Mukhopadhyay Debabrata
Published: October 2006

We report the first use of inorganic fluorescent lanthanide (europium and terbium) ortho phosphate [LnPO4·H2O, Ln = Eu and Tb] nanorods as a novel fluorescent label in cell biology. These nanorods, synthesized by the microwave technique, retain their fluorescent properties after internalization into human umbilical vein endothelial cells (HUVEC), 786-O cells, or renal carcinoma cells (RCC). The cellular internalization of these nanorods and their fluorescence properties were characterized by fluorescence spectroscopy (FS), differential interference contrast (DIC) microscopy, confocal microscopy, and transmission electron microscopy (TEM). At concentrations up to 50 μg/ml, the use of [3H]-thymidine incorporation assays, apoptosis assays (TUNEL), and trypan blue exclusion illustrated the non-toxic nature of these nanorods, a major advantage over traditional organic dyes
Predicting a local recurrence after breast-conserving therapy by gene expression profiling
Authors: Nuyten Dimitry SA , Kreike Bas , Hart Augustinus AM , Chi Jen-Tsan Ashley , Sneddon Julie B , Wessels Lodewyk FA , Peterse Hans J , Bartelink Harry , Brown Patrick O , Chang Howard Y , van de Vijver Marc J
Published: October 2006

Introduction

To tailor local treatment in breast cancer patients there is a need for predicting ipsilateral recurrences after breast-conserving therapy. After adequate treatment (excision with free margins and radiotherapy), young age and incompletely excised extensive intraductal component are predictors for local recurrence, but many local recurrences can still not be predicted. Here we have used gene expression profiling by microarray analysis to identify gene expression profiles that can help to predict local recurrence in individual patients.

Methods

By using previously established gene expression profiles with proven value in predicting metastasis-free and overall survival (wound-response signature, 70-gene prognosis profile and hypoxia-induced profile) and training towards an optimal prediction of local recurrences in a training series, we establish a classifier for local recurrence after breast-conserving therapy.

Results

Validation of the different gene lists shows that the wound-response signature is able to separate patients with a high (29%) or low (5%) risk of a local recurrence at 10 years (sensitivity 87.5%, specificity 75%). In multivariable analysis the classifier is an independent predictor for local recurrence.

Conclusion

Our findings indicate that gene expression profiling can identify subgroups of patients at increased risk of developing a local recurrence after breast-conserving therapy.
Attachment theory in adult psychiatry. Part 1: Conceptualisations, measurement and clinical research findings
Authors: Ma Kenneth
Published: October 2006

Since its original conception by Bowlby to explain an important evolutionary function of the child–caregiver relationship, attachment theory has been supported by much empirical research in a variety of settings. However, although attachment theory began as a clinical enterprise, its wider application to the everyday clinical understanding of adult mental health problems has lagged behind the available research. The theory can afford valuable insight not only into the developmental nature of common psychiatric disorders, but also into the development of the therapeutic relationship. This article gives an overview of (a) the current conceptualisations of attachment and the measurement of attachment for clinical research purposes and (b) the application of attachment theory to different psychopathologies. The importance of attachment to the therapeutic relationship will be discussed in a future article.
The Home Office Mental Health Unit
Authors: Srinivas Jayanth , Denvir Sarah , Humphreys Martin
Published: October 2006

Over the years, the number of mentally disordered offenders in England and Wales subject to restriction orders has steadily increased. The Home Secretary, through the Mental Health Unit at the Home Office, is responsible for overseeing the treatment of these individuals. As psychiatrists work in partnership with the Mental Health Unit in the treatment of these patients, it is essential to understand the Unit's role and functions. In this article, we describe the philosophy, structure and functions of the Mental Health Unit and its statutory role in the care of mentally disordered offenders subject to restriction orders.
Auditing the care programme approach for people with learning disability: a 4-year audit cycle
Authors: Ali Afia , Hall Ian , Taylor Claire , Attard Stephen , Hassiotis Angela
Published: October 2006

Aims and Method

Annual audits of the enhanced care programme approach (CPA) were conducted from 2002 to 2005 to evaluate and improve the implementation of CPA in two inner-London community learning disability services. The CPA standards included those stipulated by the Department of Health. The notes of all patients on enhanced CPA were analysed using a structured data collection form.

Results

There was a gradual improvement in the attainment of targets by both services. Areas of strength included allocating a date for the next CPA review, crisis plans and documentation of service users' comments. Areas of weakness included completion and review of risk assessments and the availability of a care plan for the previous 6 months.

Clinical Implications

Completing the audit cycle and reauditing improves attainment of targets and encourages service development, but further progress is required.
The Mental Health (Care and Treatment) (Scotland) Act 2003: legislation for mentally disordered offenders
Authors: Thomson Lindsay D. G.
Published: October 2006

The Mental Health (Care and Treatment) (Scotland) Act 2003 contains major amendments to the Criminal Procedure (Scotland) Act 1995 that have a direct effect on the assessment and management of mentally disordered offenders. The major developments and provisions of this new legislation are described.
Refugee doctors as doctors' assistants in psychiatry
Authors: Sinclair Julia M. A. , Latifi Abdul Hameed , Latifi Abdul Waheed
Published: October 2006

Refugee doctors differ from other international health professionals in that most left their country of origin under duress, rather than being part of the induced migration of many healthcare workers from low- to highincome countries. There are now over 1000 such doctors registered with the British Medical Association Refugee Council voluntary database of refugee and asylumseeking doctors (British Medical Association, 2006). Having obtained refugee status (or indefinite leave to remain), many wish to use their skills within the National Health Service (NHS) and contribute to their host country. However, they need to obtain the requisite qualifications (i.e. 70% in the International English Language Test and passes in both the written and clinical parts of the Professional and Linguistic Assessment Board) before being registered with the General Medical Council. They also need to gain an understanding of the culture and context of medical practice within the UK, as well as good references, if they are to compete successfully for training posts with UK graduates and other international medical graduates. The most recent figures available (September 2005) show that only 77 of those registered with the database are currently working in the NHS and 207 doctors have the required accreditation but are not yet employed (British Medical Association, 2006).
Recipient Choice Can Address the Efficiency-Equity Trade-off in Kidney Transplantation: A Mechanism Design Model
Authors: Su Xuanming , Zenios Stefanos A.
Published: October 2006

In kidney allocation, transplant candidates may have private information about their propensity to enjoy good outcomes after transplantation or about their relative expected improvement in quality of life after transplantation. This paper develops a mechanism design model to investigate the effect of such information asymmetry on the kidney allocation system. In this model, there are n transplant queues corresponding to n candidate types. Candidate types are only observed by the candidates, and each candidate chooses the queue to join by reporting a type. Kidneys have heterogeneous types, and each kidney will be assigned to one of the queues depending on its type. Candidates report their type strategically to join the queue that maximizes their utility. Candidate utility depends on the type of kidney received and the expected waiting time, which is calculated using fluid approximations. We consider two alternative social welfare functions: aggregate utility (emphasizing efficiency) and minimum utility across all candidates (emphasizing equity). The kidney allocation problem is to divide the organ supply among the different queues so that social welfare is maximized, and this problem is solved explicitly under both objective functions. There are three findings: (1) The allocation mechanism induces truth telling by ensuring that candidates who wait longer receive better kidneys; (2) Information rents are earned by high-risk candidates under the efficiency objective and by low-risk candidates under the equity objective; (3) a choice-based kidney allocation system in which candidates choose the type of queue to join leads to outcomes in the middle of the efficiency-equity spectrum.
Network Software Security and User Incentives
Authors: August Terrence , Tunca Tunay I.
Published: October 2006

We study the effect of user incentives on software security in a network of individual users under costly patching and negative network security externalities. For proprietary software or freeware, we compare four alternative policies to manage network security: (i) consumer self-patching (where no external incentives are provided for patching or purchasing); (ii) mandatory patching; (iii) patching rebate; and (iv) usage tax. We show that for proprietary software, when the software security risk and the patching costs are high, for both a welfare-maximizing social planner and a profit-maximizing vendor, a patching rebate dominates the other policies. However, when the patching cost or the security risk is low, self-patching is best. We also show that when a rebate is effective, the profit-maximizing rebate is decreasing in the security risk and increasing in patching costs. The welfare-maximizing rebates are also increasing in patching costs, but can be increasing in the effective security risk when patching costs are high. For freeware, a usage tax is the most effective policy except when both patching costs, and security risk are low, in which case a patching rebate prevails. Optimal patching rebates and taxes tend to increase with increased security risk and patching costs, but can decrease in the security risk for high-risk levels. Our results suggest that both the value generated from software and vendor profits can be significantly improved by mechanisms that target user incentives to maintain software security.
Exploratory Innovation, Exploitative Innovation, and Performance: Effects of Organizational Antecedents and Environmental Moderators
Authors: Jansen Justin J. P. , Van Den Bosch Frans A. J. , Volberda Henk W.
Published: October 2006

Research on exploration and exploitation is burgeoning, yet our understanding of the antecedents and consequences of both activities remains rather unclear. We advance the growing body of literature by focusing on the apparent differences of exploration and exploitation and examining implications for using formal (i.e., centralization and formalization) and informal (i.e., connectedness) coordination mechanisms. This study further examines how environmental aspects (i.e., dynamism and competitiveness) moderate the effectiveness of exploratory and exploitative innovation. Results indicate that centralization negatively affects exploratory innovation, whereas formalization positively influences exploitative innovation. Interestingly, connectedness within units appears to be an important antecedent of both exploratory and exploitative innovation. Furthermore, our findings reveal that pursuing exploratory innovation is more effective in dynamic environments, whereas pursuing exploitative innovation is more beneficial to a unit’s financial performance in more competitive environments. Through this richer explanation and empirical assessment, we contribute to a greater clarity and better understanding of how ambidextrous organizations coordinate the development of exploratory and exploitative innovation in organizational units and successfully respond to multiple environmental conditions.
Dynamic Control of an M/M/1 Service System with Adjustable Arrival and Service Rates
Authors: Ata Bariş , Shneorson Shiri
Published: October 2006

We study a service facility in which the system manager dynamically controls the arrival and service rates to maximize the long-run average value generated. We initially consider a rate-setting problem where the service facility is modeled as an M/M/1 queue with adjustable arrival and service rates and solve this problem explicitly. Next, we use this solution to study a price-setting problem, where customers are utility maximizing and price- and delay-sensitive, and the system manager chooses state-dependent service rates and prices. We find that the optimal arrival rate is decreasing and the optimal service rate is increasing in the number of customers in the system; however, the optimal price need not be monotone. We also show that under the optimal policy, the service facility operates as one with a finite buffer. Finally, we study a numerical example to compare the social welfare achieved using a dynamic policy to that achieved using static policies and show the dynamic policy offers significant welfare gains.