bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal and Perinatal Outcome in Nulliparous Women Aged 35 and Older
Authors: Ziadeh Saed M.
Published: April 2003

Objective: To compare the maternal and perinatal outcome of nulliparous women 35 years and older at the time of delivery with nulliparous women 25–29 years old. Methods: A retrospective review of maternal and newborn records of singleton gestations only for first birth in women aged 35 and older (study group n = 143) were compared with pregnancies of women aged 25–29 (control group, n = 148) delivered at the same period with respect to pregnancy complications and outcome. The study was performed at the Princess Badeea Teaching Hospital in North Jordan between January 1, 1996 and July 1, 2000. Results: Most of the elderly nulliparous women were professionals (60%) and 20% had a history of infertility. Compared with women aged 20–29 years, women delivering their first child at or >35 years were at increased risk of weight gain, obesity, chronic and pregnancy-induced hypertension, antepartum haemorrhage, multiple gestation, malpresentation, and premature rupture of membranes. Women aged 35 years and older were also substantially more likely to have preterm labour, oxytocin use, and caesarean births. The older women differed significantly in neonatal outcomes: gestational age, birth weight, preterm delivery, low birth weight, small for gestational age, fetal distress and neonatal intensive care unit admissions. Conclusion: It is concluded that nulliparous women 35 years and older had higher risk of antepartum, intrapartum, and neonatal complications than nulliparous women aged 25–29 years, but these risks, for the most part, are manageable in the context of modern obstetrics. The excess rate of caesarean sections is only partially accounted for by gestational complications. Despite the increased risk of complications, perinatal death of the study group was similar to that of the control group. There were no maternal deaths.
Ultrasonographic Features following Thermal Balloon Endometrial Ablation Therapy
Authors: Järvelä I. , Tekay A. , Santala M. , Jouppila P.
Published: April 2003

The aim of this study was to evaluate the ultrasonographic changes taking place in the uterus after thermal balloon endometrial ablation therapy. The ultrasonographic findings in the uterus after thermal balloon endometrial ablation in 13 patients were compared to those found in 13 patients treated with gestagen therapy. Examinations took place before initiation of the treatment, on the 1st postoperative day (thermal balloon ablation group only), and 1 and 6 months later. One month after thermal balloon endometrial ablation therapy, the ultrasonographic examination revealed a clear-limited hyperechogenic zone surrounding the uterine cavity which was filled with fluid in 6 out of 10 patients. The ultrasonographic findings may represent a burn-injury-induced obstruction in the cervical canal with subsequent collection of fluid in the uterine cavity and a zone of coagulation in the submucosal layers. At the final examination in the thermal balloon group, the mean endometrial thickness was lower than the pretreatment level. No changes were observed in the gestagen therapy group.
Treatment of Vaginal Intraepithelial Neoplasia with Laser Ablation and Upper Vaginectomy
Authors: Diakomanolis Emmanuel , Rodolakis Alexandros , Boulgaris Zanis , Blachos Georgios , Michalas Stylianos
Published: April 2003

To assess the effectiveness of laser ablation and upper vaginectomy in the treatment of vaginal intraepithelial neoplasia (VAIN), we have reviewed the charts of 52 patients managed with laser ablation (28 patients) and upper colpectomy (24 patients). On the basis of our results, patient selection and operator skill have a significant influence on the outcome. In posthysterectomy patients with VAIN3 at the vaginal apex, in the region of vaginal cuff scar, upper vaginectomy is the treatment of choice, while multifocal VAIN2–3 or colposcopically well defined lesions, involving large areas of vaginal mucosa, could be successfully managed by CO2 laser ablation.
Comparison of Oxytocin and Oxytocin Antagonist Metabolism in the Plasma of Pregnant Humans and Baboons
Authors: Song Chang Hun , So Geum Young , Pak Sok Cheon , Jang Chul Ho , Choi Bum Chae , Flouret George , Mehendale Ramkrishna
Published: April 2003

Oxytocin antagonists may be useful in inhibiting the uterine contractions of preterm labor. One such compound is TT-235 (previously referred to as Antag III). The purpose of this study was to compare the resistance of TT-235 and oxytocin to enzymatic degradation by oxytocinase in the blood of humans and baboons during their 3rd trimester of pregnancy. Blood samples from pregnant women and baboons not in labor were incubated in vitro with known amounts of oxytocin and TT-235. Samples were collected at 0, 15, 30, 45, and 60 min for oxytocin analysis and at 0, 10, 60, and 360 min for TT-235 analysis. Oxytocin was analyzed by radioimmunoassay after extraction, while TT-235 was analyzed by radioreceptor assay. In human blood, oxytocin was readily metabolized with >83% disappearance over the 60-min incubation period. In contrast, TT-235 was stable up to 360 min of incubation. In the baboon, oxytocin did not diminish over the 60-min incubation period. The level of TT-235 was similar to that in human blood without change over 360 min of incubation. This study suggests (1) that in contrast to blood from pregnant humans, blood from pregnant baboons lacks oxytocinase at least in vitro and (2) that TT-235 is resistant to enzymatic degradation by human blood, implying that this oxytocin antagonist may have a prolonged activity in vivo in humans.
Plasma Levels of Vitamin E in Pregnant Women prior to the Development of Preeclampsia and Other Hypertensive Complications
Authors: Ben-Haroush Avi , Harell Daniella , Hod Moshe , Bardin Ron , Kaplan Boris , Orvieto Raoul , Bar Jacob
Published: April 2003

Our aim was to investigate whether decreased levels of vitamin E can be measured during the early stages of pregnancy in women at risk of developing preeclampsia or other associated complications before the onset of the clinical syndrome. We prospectively measured the plasma concentrations of vitamin E in 62 pregnant women at 7–32 weeks of gestation who were at risk of developing preeclampsia and other complications, before the appearance of clinical signs. The results were compared with those of 16 healthy controls. Of the 62 study patients, 8 (13%) developed preeclampsia, and 18 (29%) had other complications, such as intrauterine growth restriction (n = 8), fetal or neonatal loss (n = 9), and preterm delivery (≤30 weeks of gestation; n = 7). Both gestational age at delivery and birth weight were significantly lower in the patients with complications than in the healthy controls. However, there were no significant differences in vitamin E levels between women who developed preeclampsia or other complications and those who did not. There was no significant correlation between plasma vitamin E and creatinine concentrations. A significant positive correlation was found in both the complicated and normal pregnancies between plasma vitamin E concentration and gestational week of blood collection (R = 0.485, p < 0.001, and R = 0.718, p = 0.004, respectively). We conclude that the vitamin E concentrations are not decreased prior to the development of preeclampsia or other complications in women at risk.
Accuracy and Reproducibility of Ultrasound Measurements in Obstetric Management
Authors: Nakai Akihito , Oya Atsuko
Published: April 2003

Objective: The aim of this study was to assess the potential of ultrasonography as a routine diagnostic tool in obstetric management. Subjects and Methods: For the investigation on interobserver reproducibility, 2 sonologists independently measured the biparietal diameter (BPD), femur length (FL), amniotic fluid index (AFI), and resistance index (RI) of the umbilical and middle cerebral arteries in 20 healthy pregnant women between 28 and 36 weeks of gestation using color and pulsed Doppler ultrasound. A second group of 10 healthy pregnant women between 30 and 35 weeks of gestation were examined to assess the level of intraobserver reproducibility of the Doppler and ultrasound measurements by 2 sonologists. For each patient in this group, the flow waveform was measured three times in succession. Calculations of the intraclass correlation coefficient (Ri) were used to determine the levels of reproducibility. The agreement was considered acceptable only when the Ri value was ≧ 0.6. Results: The interobserver Ris for BPD, FL, AFI, and RI of the umbilical and middle cerebral arteries were 0.93, 0.8, 0.58, 0.49 and 0.56, respectively. The intraobserver Ris of the 2 sonologists in BPD, FL, and RI of umbilical artery were >0.6, whereas those in AFI and RI of middle cerebral artery were <0.6. Conclusion: Both the interobserver and intraobserver reproducibilities of BPD and FL were clinically acceptable, but not in the AFI and RI of umbilical and middle cerebral arteries.
Effects of Deferiprone on Immune Status and Cytokine Pattern in Thalassaemia major
Authors: Del Vecchio Giovanni Carlo , Schettini Federico , Piacente Laura , De Santis Attilio , Giordano Paola , De Mattia Domenico
Published: April 2003

Objective: The present study was undertaken to evaluate the possible occurrence of immunological abnormalities in thalassaemia major patients treated with deferiprone (L1). Methods: Longitudinal observational cohort study. Results: The absolute number of CD8+ lymphocytes was high and the CD4/CD8 ratio low before L1 treatment; these parameters returned to normal after 3 months of L1 treatment. TNF-α, IL-2 and IL-2sRα were elevated before L1 treatment (11.83 ± 1.75, 11.75 ± 3.91, 1,409 ± 621 pg/ml, respectively), while IL-6 was normal (2.58 ± 0.79 pg/ml). After 12 months of treatment, IL-10 was higher than in previous periods, although always within the normal range. TNF-α, IL-2 and IL-2sRα returned to normal after 12, 6, and 3 months of L1 treatment, respectively.
A Simplified Screening for α-Thalassemia 1 (SEA Type) Using a Combination of a Modified Osmotic Fragility Test and a Direct PCR on Whole Blood Cell Lysates
Authors: Panyasai Sittichai , Sringam Patcharawadee , Fucharoen Goonnapa , Sanchaisuriya Kanokwan , Fucharoen Supan
Published: April 2003

In order to provide a rapid method for identifying α-thalassemia 1 in a region with massive population and limited resources, we have tested a rapid screening strategy. Preliminary screening was done using a modified onetube osmotic fragility test (OF test) followed by RBC indices; Hb analysis and detection of α-thalassemia 1 with the Southeast Asian deletion (SEA type) were performed by PCR. One hundred and seventy-five adult Thai subjects were studied. Fifty-one of the 175 subjects (29.1%) were positive for a modified OF test. They all had significantly lower MCV and MCH but higher RDW-CV values as compared to the OF negative group. A successful identification of α-thalassemia 1 deletion using a direct PCR on cell lysates was demonstrated. Among the 51 OF-test-positive subjects, 7 were found to be α-thalassemia 1 carriers, 3 of whom were also carriers of Hb E. No α-thalassemia 1 was detected in the OF-test-negative group. A combination of a modified OF test and a direct PCR analysis on whole blood cell lysates would therefore provide an effective screening for α-thalassemia 1 in the regions where a program of prevention and control of the disease remains underserved.
Can Glutamine and Growth Hormone Promote Protein Anabolism in Children with Cystic Fibrosis?
Authors: Hayes V. , Schaeffer D. , Mauras N. , Punati J. , Darmaun D.
Published: April 2003

To determine whether recombinant human growth hormone (rhGH), glutamine (GLN) or a combination of both agents can enhance protein synthesis in cystic fibrosis (CF) patients, six 9.6 ± 0.5-year-old prepubertal children (4 M, 2 F) with CF and stable lung disease with undernutrition (weight/height <50th percentile) or delayed growth (height <5th percentile) received stable isotope infusions, in the postabsorptive state and on 4 separate study days: (a) at baseline, and after a 4-week treatment with either, (b) oral GLN (0.7 g/kg/day), (c) rhGH (0.3 mg/kg/week, SC), or (d) both GLN and rhGH. Four-hour infusions of 13C-leucine were used to assess leucine appearance rate (Ra, an index of protein breakdown), oxidation (Ox), and non-oxidative leucine disposal (NOLD, an index of protein synthesis). Results are expressed as changes (%) from baseline:We conclude that in children with CF: (1) due to high inter-subject variability, oral glutamine does not significantly enhance protein gain; (2) rhGH has significant anabolic effects which are mediated by stimulation of protein synthesis, and (3) glutamine does not enhance the effect of rhGH.
Malignant Neurofibroma of the Urinary Bladder
Authors: Mimata Hiromitsu , Kasagi Yasuhiro , Ohno Hitoshi , Nomura Yoshio , Iechika Seiji
Published: April 2003

Malignant neurofibroma of the urinary bladder is a very rare entity and usually associated with von Recklinghausen’s disease. We present the first case of sporadic malignant neurofibroma of the urinary bladder and a review of the literature.
Long-Term Analysis of Suprapubic Cystostomy Drainage in Patients with Neurogenic Bladder
Authors: Nomura Sakae , Ishido Tetsuo , Teranishi Jun-ichi , Makiyama Kazuhide
Published: April 2003

Objective: We assessed the roles of suprapubic cystostomy in patients with neurogenic bladder and analyzed the complications and their courses. Patients and Methods: We reviewed 118 patients with neurogenic bladder managed with suprapubic cystostomy. The original diseases were spinal cord injury in 90, degenerative disease of the central nervous system in 15, spina bifida in 6, cerebral palsy in 3, pontine bleeding in 1, Parkinson’s disease in 1, brain tumor in 1, and dysgenesis of the external sphincter in 1. Fifty-six (62.2%) of spinal cord-injured patients demonstrated cervical damage. Renal function, urinary pH and white blood cell values were measured and evaluated after insertion. The stone-free rate after insertion was estimated by the Kaplan-Meier method. Results: Indications for cystostomy were failure of clean intermittent catheterization in 62 (52.5%) and Credé’s maneuver in 2, severe urethral damage in 30 (25.4%), replacement of urethral catheter in 3, worsening of the original disease in 15 (12.7%), deterioration of the general condition in 2, mental retardation in 2, and traumatic vesical rupture in 1. Frequent complications were formation of the bladder calculi in 30 (25%) and urinary leakage through the urethra in 11 (10%). No fatal complications occurred. The stone-free rates 5 and 10 years after insertion were 77 and 64%, respectively. The urinary pH of the stone-forming group was significantly higher than that of the stone-free group. The high urinary pH group (>7.24) had a higher risk of stone formation. Conclusions: Although continuous cystostomy drainage is not considered to be ideal management for bladder emptying, some patients with neurogenic bladder may benefit from this procedure.
Modeling Electrosensory and Mechanosensory Images during the Predatory Behavior of Weakly Electric Fish
Authors: Nelson Mark E. , MacIver Malcolm A. , Coombs Sheryl
Published: April 2003

Black ghost knifefish (Apteronotus albifrons) are nocturnal, weakly electric fish that feed on insect larvae and small crustaceans in the freshwater rivers of South America. In the absence of visual cues, prey detection and localization in this species is likely to rely on weak electrosensory and mechanosensory cues generated by the prey. In this paper, a modeling approach is used to estimate contributions to prey capture behavior from three octavolateralis modalities: the high- (tuberous) and low- (ampullary) frequency components of the electric sense and the high-frequency (canal neuromast) component of the lateral line mechanosensory system. For each of these modalities, the physical stimulus generated by the prey is approximated using a simple dipole model. Model parameters are constrained using previously published data as well as new empirical data on the electrical impedance characteristics of Daphnia magna. Models of electrosensory and mechanosensory stimuli are combined with actual prey strike trajectories from infrared video recordings to reconstruct spatial images of the prey along the sensory surface of the fish during the behavior. Modeling results suggest that all three modalities might contribute and that the relative contributions may change as a function of environmental conditions (e.g., water conductivity) and as a function of time over the course of the prey capture event.
Statistical Properties of Teng and Risch’s Sibship Type Tests for Detecting an Association between Disease and a Candidate Allele
Authors: Li Zhaohai , Gail Mitchell H. , Pee David , Gastwirth Joseph L.
Published: April 2003

Risch and Teng [Genome Res 1998;8:1273–1288] and Teng and Risch [Genome Res 1999;9:234–241] proposed a class of transmission/disequilibrium test-like statistical tests based on the difference between the estimated allele frequencies in the affected and control populations. They evaluated the power of a variety of family-based and nonfamily-based designs for detecting an association between a candidate allele and disease. Because they were concerned with diseases with low penetrances, their power calculations assumed that unaffected individuals can be treated as a random sample from the population. They predicted that this assumption rendered their sample size calculations slightly conservative. We generalize their partial ascertainment conditioning by including the status of the unaffected sibs in the calculations of the distribution and power of the statistic used to compare the allele frequency in affected offspring to the estimated frequency in the parents, based on sibships with genotyped affected and unaffected sibs. Sample size formulas for our full ascertainment methods are presented. The sample sizes for our procedure are compared to those of Teng and Risch. The numerical results and simulations indicate that the simplifying assumption used in Teng and Risch can produce both conservative and anticonservative results. The magnitude of the difference between the sample sizes needed by their partial ascertainment approximation and the full ascertainment is small in the circumstances they focused on but can be appreciable in others, especially when the baseline penetrances are moderate. Two other statistics, using different estimators for the variance of the basic statistic comparing the allele frequencies in the affected and unaffected sibs are introduced. One of them incorporates an estimate of the null variance obtained from an auxiliary sample and appears to noticeably decrease the sample sizes required to achieve a prespecified power.
Ecocultural Understanding of Children's Developmental Pathways
Authors: Weisner Thomas S.
Published: April 2003

Every cultural community provides developmental pathways for children within some ecological-cultural (ecocultural) context. Cultural pathways are made up of everyday routines of life, and routines are made up of cultural activities children engage. Activities (bedtime, playing video games, homework, watching TV, cooking dinner, soccer practice, visiting grandma, babysitting for money, algebra class) are useful units for cultural analysis because they are meaningful units for parents and children, and they are amenable to ethnographic fieldwork, systemic observation, and interviewing. Activities crystallize culture directly in everyday experience, because they include values and goals, resources needed to make the activity happen, people in relationships, the tasks the activity is there to accomplish, emotions and motives of those engaged in the activity, and a script defining the appropriate, normative way to engage in that activity. The Ecocultural Family Interview provides a window into children''s and families'' daily routines and activities.
Interrogating Race and Ethnicity as Constructs in the Examination of Cultural Processes in Developmental Research
Authors: Lee Carol D.
Published: April 2003

This article examines the limitations of the construct of race in the study of the diversity of human development. The author proposes that a focus on ethnicity as relates to people of African descent in the United States offers greater explanatory power. The article acknowledges the value of moving away from social address registers in the study of human development, but cautions that this emerging theoretical orientation should not diminish the stable and enduring patterns of continuity within and across the African-American community. The author argues that the field faces both conceptual and methodological challenges in studying human development in its complexity. She offers additional cautions in terms of methodological approaches that seek to capture that complexity.
Populations, Communication and Child Development
Authors: LeVine Robert A.
Published: April 2003

A population psychology would provide empirical connections between individual differences studied under controlled conditions and the naturally occurring ecological parameters involved in transforming genotypes into phenotypes. Evidence from child development research indicates that the communicative environment of the child is the place to look for such parameters, which are located in communicative codes of symbolic meaning that children learn to master. These cultural codes may seem fixed to those who use them but are culturally variable, historically changeable and personally flexible – and should be studied in complex and changing environments.
Examining Culture within a Quantitative Empirical Research Framework
Authors: Cauce Ana Mari
Published: April 2003

This paper raises the question of how to best capture dynamic cultural processes in empirical research related to ethnic minority children and youth''s mental health. Three constructs, acculturation, ethnic identity, and ethnic minority socialization, are presented as examples of measurable dimensions of culture that can be used to enrich our understanding of the etiology, course, and treatment of mental health problems and to better help us develop policies to serve what will soon be the majority of children and youth in this country.
Tuberculin Skin Test and Anergy in Dialysis Patients of a Tuberculosis-Endemic Area
Authors: Fang Hua-Chang , Chou Kang-Ju , Chen Chien-Liang , Lee Po-Tsang , Chiou Yee-Hsuan , Hung Shih-Yuan , Chung Hsiao-Min
Published: April 2003

Background/Aim: Uremic patients are at an increased risk of being affected by tuberculosis (TB). Periodical tuberculin skin tests were suggested to detect TB-infected patients. These were replaced by chest radiographs in endemic areas like Taiwan. However, almost 50% of the TB incidence in dialysis patients was extrapulmonary. In this study, we tried to investigate the value of tuberculin tests in dialysis patients in endemic areas. Methods: The patients were recruited from our dialysis unit. Purified protein derivative (PPD) and control tests with antigens for Candida and toxoid were performed using the Mantoux method. PPD with >10-mm induration will be considered positive. Skin anergy meant that the indurations of all antigens were less than 5 mm. A follow-up was done 12 months after the tests. Results: A total of 177 patients were evaluated. Anergy was found in 40 patients (22.6%). A positive predictor of anergy was age >45 years (p = 0.03), while a negative predictor was prealbumin >20 mg/dl (p = 0.04). Fifty-three patients (30%) had positive PPD tests. Seven of the positive PPD patients (13.2%) developed active TB during the following years. Among the 40 patients with skin anergy, 6 (15%) were found to have active TB. Of the 48 patients (21.1%) with indurations of the PPD tests between 5 and 10 mm, none was found to have active TB. Conclusion: Although anergy will influence the sensitivity of PPD tests, these tests in combination with anergy tests could help to establish the diagnosis of TB in uremic patients, even in TB-endemic areas.
Efficacy and Toxicity of Intra-Arterial Cisplatin and Etoposide for Advanced Hepatocellular Carcinoma
Authors: Sangro Bruno , Rios Raquel , Bilbao Ignacio , Beloqui Oscar , Herrero Jose I. , Quiroga Jorge , Prieto Jesus
Published: April 2003

Objective: To analyze the results of an intra-arterially delivered combination chemotherapy in a group of patients with regionally advanced hepatocellular carcinoma (HCC). Methods: 26 patients with proven locally advanced HCC treated with hepatic artery infusion of cisplatin (20 mg/m2, days 1–5) and etoposide (75 mg/m2, days 1–5) every 4 weeks were retrospectively studied. Results: In an intention-to-treat analysis, overall and complete response rates were 38 and 7%, respectively. Median duration of response was 5 months. Median survival time was 10 months and survival rates at 6, 12 and 24 months were 53, 33 and 24%, respectively. Survival was significantly longer for responders than for non-responders (median: 13 and 3 months, respectively). There were 4 treatment-related deaths among cirrhotics. Conclusions: Intra-arterial chemotherapy using cisplatin and etoposide seems to have some anti-tumor effect against advanced HCC, although a high rate of life- threatening complications precludes the indication of this regimen at least for patients with non-compensated cirrhosis.
A Phase I Study of Weekly Gemcitabine and Docetaxel in Patients with Advanced Cancer: A Hoosier Oncology Group Study
Authors: Ganjoo Kristen N. , Gordon Michael S. , Sandler Alan B. , Warner Ruth E. , Fife Karen , Poirier Shelley , Seshadri Roopa , Loehrer Patrick J.
Published: April 2003

Purpose: To determine the maximum tolerated dose (MTD) of weekly gemcitabine plus docetaxel, a dose escalation trial of both drugs was developed with each administered weekly for 3 weeks out of 4. Patients and Methods: Dose levels for gemcitabine (mg/m2) and docetaxel (mg/m2) were as follows: level 1: 600/25; level 2: 600/35; level 3: 750/35; and level 4: 900/35. Sixteen patients with adequate renal, hepatic, and hematologic function and an Eastern Cooperative Oncology Group performance status of 0–2 were treated. Primary sites included pancreas (12) and others (4). Results: Three patients were treated at each dose level from level 1 through level 4. The dose-limiting toxicity (DLT) was neutropenia, the maximum tolerated dose being 750 mg/m2 of gemcitabine and 35 mg/m2 of docetaxel. No grade 4 nonhematologic toxicity was seen. Three patients had grade 4 neutropenia. Of the 12 patients with pancreatic cancer, 1 had a partial remission and 7 had stable disease with a median duration of 8 weeks. Conclusions: Gemcitabine and docetaxel can be safely administered weekly at a dose of 750 and 35 mg/m2, respectively. The DLT was neutropenia. Disease stabilization suggests that this may be an active regimen in patients with metastatic pancreatic cancer.
Localization of Thymidine Phosphorylase Expression in Colorectal Carcinoma Tissues by in situ RT-PCR Assay
Authors: Mimori Koshi , Matsuyama Ayumi , Yoshinaga Keiji , Yamashita Keishi , Masuda Takaaki , Inoue Hiroshi , Ueo Hiroaki , Mori Masaki
Published: April 2003

Abundant expression of thymidine phosphorylase (TP) mRNA and protein was observed in human carcinoma tissues relative to the corresponding normal tissues. However, the distribution of cells that express TP has not yet been determined. In this study, we examined enzyme activity of TP in 24 primary colorectal carcinoma tissues and the corresponding normal tissue. Using in situ reverse-transcription polymerase chain reaction (RT-PCR), a new methodology to determine the localization of genes of interest objectively and clearly, cell distribution was compared. The expression of TP mRNA is observed in normal infiltrating cells adjacent to colon carcinoma cells by in situ RT-PCR. Similar to the protein activity, the average TP mRNA expression (amplified products/×400 field) in cases of Dukes C and D is 76.8, while that of Dukes A and B is 42.5, being significantly different (p = 0.001). Moreover, the number of amplified products in colon carcinoma tissues showed a significant correlation with the enzyme activity evaluated by high-performance liquid chromatography (p < 0.01, R = 0.76). In conclusion, the expression of TP mRNA is localized in stromal tissues as determined by in situ RT-PCR and can reflect the level of TP enzyme activity.
Screening for Cancer in Patients with Idiopathic Venous Thromboembolism: The Clinical Practice
Authors: Otten J.M.M.B. , Smorenburg S.M. , de Meij M.A. , van der Schoor C.A. , Brandjes D.P.M. , Büller H.R.
Published: April 2003

The reported incidence of concomitant cancer in patients with idiopathic venous thromboembolism (IVTE) varies between 4 and 24%, while the mean incidence of cancer within 3 years thereafter approximates 9%. Baseline investigations of patients with IVTE have been recommended. We evaluated the clinical practice regarding the screening of these patients according to these recommendations in two teaching hospitals. Medical history and physical examination were done reasonably exhaustively, except for investigations of the urogenital tract. Laboratory and imaging investigations were performed incompletely in a substantial proportion of the patients. The clinical evaluation regarding cancer, performed in patients with IVTE, could be improved. The implementation of a protocol should be considered.
Development of Intracranial Complications following Transoral Stab Wounds in Children
Authors: Shih Teng-Yuan , Kuo Yeh-Lin
Published: April 2003

Sharp penetrating trauma to the skull and brain is uncommon in children. The related pediatric literature consists mainly of cases involving penetrating stab wounds to the face or scalp resulting from assaults or accidents. Herein, we present two cases of perioral intracranial penetration. The first case was a 2-year-old boy who presented with septic complications and developed a brain abscess. The second case was a 2-year-old girl who presented with a subarachnoid hemorrhage and developed a traumatic pericallosal artery aneurysm. After craniotomy and clipping, both patients made a satisfactory recovery. A high index of suspicion, liberal use of neuroimaging and early operative intervention are important points in the successful management of such cases.
Atypical Teratoid/Rhabdoid Tumors of the Central Nervous System: Clinical, Radiographic and Pathologic Features
Authors: Bambakidis Nicholas C. , Robinson Shenandoah , Cohen Mark , Cohen Alan R.
Published: April 2003

Introduction: Atypical teratoid/rhabdoid tumors (ATT/RT) of the central nervous system (CNS) are uncommon malignancies of childhood with an aggressive course and a uniformly fatal outcome. Methods: The medical records, radiographic images and pathologic files at the Rainbow Babies and Childrens Hospital over the previous 6 years were retrospectively reviewed. Results: Eight children underwent surgery for CNS ATT/RT at our institution since 1996. There were 6 boys and 2 girls. Median age at presentation was 21 months. Four tumors had multifocal disease at the time of diagnosis. Six patients received multiagent chemotherapy including 3 patients with autologous bone marrow transplantation, and 6 patients received radiation therapy. Median survival was 9 months from the time of diagnosis. Conclusions: In spite of aggressive therapy, the prognosis for ATT/RT remains dismal. The search for effective treatment strategies will require a better understanding of the biology and molecular genetics of this tumor.
Epidemiological Perspectives for the Development of Future Diagnostic Systems
Authors: Kessler Ronald C.
Published: April 2003

Three uses of epidemiological data for diagnostic revisions are suggested. (1) Psychometric analysis of community cases over the full spectrum of symptom severity can help determine whether true discrete disease entities underlie particular symptom profiles. (2) Analysis of external validators in community samples can help select optimal cut-points for defining diagnostic criteria. (3) Clinical epidemiological studies can provide quick and comparatively inexpensive preliminary checks, prior to carrying out expensive experimental treatment trials, on the plausibility of proposed subtyping distinctions based on nonexperimental evidence regarding differential treatment response. Correction of a number of basic conceptual and methodological flaws that have hampered previous studies would allow epidemiological research of these three sorts to play a much more important part in future diagnostic revisions than they have in past revisions.
Molecular Basis of Arthropod Cross-Reactivity: IgE-Binding Cross-Reactive Epitopes of Shrimp, House Dust Mite and Cockroach Tropomyosins
Authors: Ayuso Rosalia , Reese Gerald , Leong-Kee Susan , Plante Matthew , Lehrer Samuel B.
Published: April 2003

Background: Shrimp may cross-react with other crustaceans and mollusks and nonedible arthropods such as insects (cockroach and chironomids), arachnids (house dust mites) and even nematodes. Since the muscle protein tropomyosin has been implicated as a possible cross-reacting allergen, this study characterized the IgE-binding epitopes in shrimp tropomyosin, Pen a 1, that cross-react with other allergenic invertebrate tropomyosins in house dust mites (Der p 10, Der f 10) and cockroaches (Per a 7). Pen a 1-reactive sera from shrimp-allergic subjects were used to evaluate the effect on IgE binding of different amino acid substitutions in Pen a 1 epitopes based on homologous sequences in Per a 7 and Der p 10/Der f 10. Methods: Peptides were synthesized spanning the length of Pen a 1 IgE-binding epitopes and amino acid substitutions were performed based on homologous amino acid sequences from Per a 7 and Der p 10/Der f 10. Results: 7/8 individually recognized Pen a 1 epitopes (2, 3a, 3b, 4, 5a, 5b and 5c) had an identical amino acid sequence with lobster allergen, Hom a 1, 4/8 (3a, 3b, 4 and 5a) with Der p 10 and Der f 10, and 5/8 (2, 3a, 3b, 4 and 5a) with Per a 7. In addition, even homologous regions of other arthropod tropomyosins that differ in one or more amino acids from the sequences of Pen a 1 epitopes are still recognized by shrimp-allergic IgE antibodies. In total, shrimp-allergic sera recognize 6/8 peptides homologous to Pen a 1 epitopes in Per a 7, 7/8 in Der p 10/Der f 10, and 7/8 epitopes in Hom a 1. Conclusions: The IgE recognition by shrimp-allergic individuals of identified and/or similar amino acid sequences homologous to Pen a 1 epitopes in mite, cockroach and lobster tropomyosins are the basis of the in vitro cross-reactivity among invertebrate species. Based on amino acid sequence similarity and epitope reactivity, lobster tropomyosin has the strongest and cockroach the least cross-reactivity with shrimp. The clinical relevance of these cross-reactivities in developing allergic reactions to different arthropods needs to be determined.
Identification of Sequential IgE-Binding Epitopes on Bovine αs2-Casein in Cow’s Milk Allergic Patients
Authors: Busse Paula J. , Järvinen Kirsi-Marjut , Vila Leticia , Beyer Kirsten , Sampson Hugh A.
Published: April 2003

Background: Caseins are the major allergens responsible for cow’s milk allergy (CMA). We have previously identified the IgE-binding epitopes of the major cow’s milk (CM) proteins except for αs2-casein. Methods: Overlapping decapeptides representing the entire length of αs2-casein were synthesized on a cellulose-derivatized membrane. Sera from 13 CM-allergic children, 4–15 years of age, with a median level of CM-specific IgE >100 kU/l (range 33.7 to > 100 kU/l) were used to identify IgE-binding epitopes. Results: Four major and six minor sequential IgE-binding regions were identified on αs2-casein. The first major region is located in the middle of the protein at amino acids (AA) 83–100, and the other three major regions are located in the carboxy terminal portion of the protein at AA 143–158, 157–172 and 165–188. The minor IgE-binding regions were identified at AA 31–44, 43–56, 93–106, 105–114, 117–128, and 191–200. Conclusion: We identified 10 sequential IgE-binding regions on αs2-casein and performed the first crucial step in the development of immunotherapeutic interventions for CMA.
Spectrographic Measures of the Speech of Young Children with Cleft Lip and Cleft Palate
Authors: Casal Carmen , Domínguez Catalina , Fernández Ana , Sarget Ramón , Martínez-Celdrán Eugenio , Sentís-Vilalta Joan , Gay-Escoda Cosme
Published: April 2003

Twenty-two consecutive children with repaired cleft lip and/or palate [isolated cleft lip (CL) 6, isolated cleft palate (CP) 7, unilateral cleft lip and palate (UCLP) 7, and bilateral cleft lip and palate 2] with a mean age of 27 months underwent spectrographic measures of tape-recorded speech (DSP Sona-Graph digital unit). Controls were 22 age- and sex-matched noncleft children. Data analyzed included (1) the Spanish vocalic variables [a, i, u, e, o]: first formant, second formant, duration, and context; (2) obstruent variables [p, t, k]: burst, voice onset time, and duration, and (3) nasal variables [m]: first formant, second formant, and duration. Statistically significant differences were observed between the CL group and the control group in the first formant of [e] and in the increase of the frequency of the [t] burst. Comparison between UCLP and controls showed differences in the second formant of [a], in the first formant of [o], and in the second formant of [o]. These results suggest a small but significant influence of either the cleft lip or its repair on lip rounding for [o] and [u]. In addition, tongue position differences were most likely responsible for the differences seen with [a] and [e]. Spectrographic differences in the current patients did not contribute to meaningful differences in speech sound development. Individualized care (orthodontics, surgery, speech therapy) in children with cleft lip and/or palate attended at specialized craniofacial units contributes to normalization of speech development.
Segmental Level Analysis of Laryngeal Function in Persons with Motor Speech Disorders
Authors: Bunton Kate , Weismer Gary
Published: April 2003

Laryngeal behavior for segmental function is often disturbed in motor speech disorders. Loss of voicing contrasts has been shown to significantly contribute to speech intelligibility deficits. The present study was designed to examine two commonly erred laryngeal contrasts, the word-initial voiced-voiceless and glottal-null contrasts using acoustic analysis techniques. Acoustic measures were compared to expectations for the contrast based on data in the literature as well as listeners’ perception of the token. Findings indicate a mismatch between acoustic data and both expectations for the contrasts and listener perception. There is some indication that changes in laryngeal segmental function are related to aging in general and may be exaggerated in persons with motor speech disorders.
Effect of Low-Molecular-Weight Heparin on Potassium Homeostasis
Authors: Abdel-Raheem Majdi M. , Potti Anil , Tadros Sherine , Koka Vijay , Hanekom David , Fraiman Genise , Danielson Byron D.
Published: April 2003

Background: Low-molecular-weight heparins (LMWHs) are being preferred to unfractionated heparin (UFH) because of their superior convenience and a comparable or slightly better toxicity profile. Whether LMWH has an inhibitory effect on aldosterone that causes hyperkalemia is yet uncertain. Methods: Twenty-eight patients (all male; mean age: 70 years, range 52–87 years) placed on LMWH therapy (40 mg subcutaneously every 12 h) for deep venous thrombosis prophylaxis after an operation were included in the study. Transtubular potassium concentration gradient (TTKG) was calculated 1 day prior to LMWH therapy and again after 4 days of treatment. Of the 28 patients enrolled in the study, we were able to calculate the TTKG in only 19 patients: 9 had a urinary osmolarity (either before or after LMWH therapy) less than the serum osmolarity, making the TTKG calculation unreliable. The Wilcoxon signed-rank test was used to analyze differences in the median serum potassium levels and TTKG before and after LMWH therapy. Results: All patients had adequate renal function (creatinine clearance >90 ml/min). Mean (± SD) serum potassium concentration before LMWH was 4.25 (± 0.40) mmol/dl. It increased to 4.35 (± 0.41) mmol/dl after initiating LMWH therapy (p = 0.09). Similarly, the mean (± SD) TKKG calculated was 5.52 (± 2.33) before and 5.97 (± 3.06) after 4 days of LMWH (p = 0.54). Conclusions: Unlike UFH, LMWH (Lovenox®) in doses used for postoperative prophylaxis against deep venous thrombosis does not seem to have a significant effect on potassium homeostasis.
Thromboplastin Bilbao: Reproducibility and Sensitivity of a Spanish Thromboplastin
Authors: Vacas M. , Aguirrebeitia M.J. , Lafuente P.J. , Unanue I. , Iriarte J.A.
Published: April 2003

Prothrombin time (PT) is the control test for oral anticoagulant therapy as well as the screening test for defects of the extrinsic pathway of coagulation. Its responsiveness to decreased extrinsic clotting factors depends on the source and type of tissue factor thromboplastin extract. In 1994, a rabbit brain thromboplastin – Thromboplastin Bilbao (TBi) – was introduced as a replacement for a human brain preparation used since 1983, with the aim of establishing a national standard. The purpose of this study was to check the reproducibility, the inter-assay/intra-assay accuracy and the stability of this reagent under temperature changes and over time. A method modified from Frei et al. [World Health Organisation Regional Publications, Eastern Mediterranean Series, Alexandria, 1995] was used for the preparation of thromboplastin extract. Thirty-five batches of human TBi were prepared from 1983 to 1988, while from 1993 to 1999 13 batches of rabbit TBi were produced. The inter-assay reproducibility of rabbit TBi exhibited a coefficient of variation (CV) of 1.07–1.57% for normal plasma and of 1.25–2.56% for anticoagulated plasma. The intra-assay CV was 0.06–1.30% for normal plasma and 1.23–2.66% for anticoagulated plasma. The stability of the reagent to temperature changes and time was also estimated, with similar results for the two thromboplastins. As a result of the Oral Anticoagulant Treatment Quality Assessment Scheme in the Basque Country, an in-house rabbit thromboplastin with good sensitivity and reproducibility was developed.
Comparison of the Activities of Na+,K+-ATPase in Brains of Rats at Different Ages
Authors: Koçak Hikmet , Öner Pernur , Öztaş Baria
Published: April 2003

Background: Na+,K+-ATPase is known to be responsible for the ionic homeostasis in excitable tissues. The energy cost of Na+,K+-ATPase activity is increased in the active brain, so it would be important to ascertain whether defects in brain metabolism in aging are associated with changes in the properties of Na+,K+-ATPase. Objective: The aim of this study was to investigate the influence of age on the Na+,K+-ATPase activity in developing rat brains from the age of 1 day to 24–28 months. Methods: Crude microsomal preparations were obtained from the brains of newborn (n = 8), 18-day-old (n = 8), 4- to 5-month-old (n = 12), and 24- to 28-month-old (n = 14) rats. Then the ATPase activity was measured and expressed as micromoles of inorganic phosphorus released per milligram of protein per hour. Results: The increased tendency in brain Na+,K+-ATPase activity from newborn to 18 days of age suggested that the Na pump is mature soon after birth. No significant differences could be detected in the enzyme activity between newborn and adult rats. In contrast, the Na+,K+-ATPase activity in aged rat brains was found to be significantly lower than in the other age groups of rats tested (p < 0.001). Conclusion: Our results suggest that aging-induced inhibitions in the brain Na+,K+-ATPase activity may be implicated in the depression of neuronal excitability and in the age-related impairments of cognitive functions.
Effect of Changes in Load Carriage while Walking on the Left Ventricular Function in Highly Trained Elderly Subjects
Authors: Sagiv Michael , Ruddoy Jacob , Sagiv Amira , Ben-Gal Shlomo , Ben-Sira David
Published: April 2003

Background: In previous studies, the effect of isometric stress on the dynamic performance of a graded exercise test in normal subjects augmented afterload and brought about changes in left ventricular function more often than did results from physical exercise. Objective: This study used the metabolic charts and echocardiography to examine the influence of two different types of load carriage during 30 min of treadmill walking on left ventricular function, hemodynamics, and cardiovascular responses. Methods: Fifteen elderly (age 66.1 ± 3.5 years) aerobically well-trained male subjects (VO2 peak 44.2 ± 5.0 ml·kg–1·min–1) volunteered in this study. The subjects walked on a treadmill (at a speed of 4.5 km·h–1), carrying a load of 20 kg during one session and a load of 30 kg during a second session. Results: Following the 30-min exercise in each session, significant (p < 0.05) differences were noted between the 20-kg and the 30-kg work loads with regard to cardiac output (6.8 ± 0.5 and 7.8 ± 0.4 l·min–1), heart rate (114.0 ± 11.0 and 126.0 ± 10.0 beats·min–1), diastolic blood pressure (79.4 ± 5.0 and 84.3 ± 5.0 mm Hg, mean arterial blood pressure (104.0 ± 4.0 and 109.2 ± 3.0 mm Hg), and left ventricular contractility ratio (3.3 ± 0.4 and 3.6 ± 0.3). No significant differences were noted between the work loads with regard to systolic blood pressure, cardiac output, left ventricular volumes, and ejection fraction. Conclusions: This study suggests that in the highly trained elderly, the influence of the autoregulation mechanism dominates during combined dynamic and isometric exercises, thus the opposing force to the left ventricular ejection is reduced which in turn does not change left ventricular global function.
Nutritional Markers, Acute Phase Reactants and Tissue Inhibitor of Matrix Metalloproteinase 1 in Elderly Patients with Pressure Sores
Authors: Perier C. , Granouillet R. , Chamson A. , Gonthier R. , Frey J.
Published: April 2003

Background: Loss of collagen and elastin is observed in the elderly. In geriatric inpatients, chronic protein malnutrition could induce susceptibility to additional morbidity such as pressure sores. Objective: The purpose of this study was to explore the relationship between nutritional and inflammatory status and the production of tissue inhibitor of matrix metalloproteinase 1 (TIMP-1). Methods: Chronically ill elderly inpatients, without or with pressure sores, were enrolled. Nutritional protein markers, acute phase reactants, and TIMP-1 were determined, and changes in these biological parameters were compared. Results: Chronic inflammatory process and protein malnutrition were observed in all enrolled patients. The severity of these two pathophysiological processes was independent of the occurrence of pressure sores. The serum prealbumin and albumin levels were lower in patients with pressure sores than in those without. In addition, the general increase in the TIMP-1 level was independent of the occurrence of pressure sores. The TIMP-1 level was mainly related to the prognostic inflammatory and nutritional index. Conclusions: The general increase in acute-phase reactants observed in the elderly could be related to the intercurrent diseases. The generally low serum albumin level, lowest in patients with pressure sores, may be considered evidence of protein malnutrition and hypercatabolism. Regarding the morbidity, the increase in TIMP-1 levels could be explained as an adaptive process to prevent intrinsic protein expenditure of extracellular matrices.