bluuebunny/crossref_metadata_2025 huggingface dataset:
Lewy body variant of Alzheimer’s disease or cerebral type Lewy body disease? Two autopsy cases of presenile onset with minimal involvement of the brainstem
Authors: Yokota Osamu , Tsuchiya Kuniaki , Uchihara Toshiki , Ujike Hiroshi , Terada Seishi , Takahashi Mafuyu , Kimura Yuji , Ishizu Hideki , Akiyama Haruhiko , Kuroda Shigetoshi
Published: January 2007

Lewy bodies (LB) usually extend from the brainstem to the cerebrum in patients with Parkinson’s disease. However, whether the patterns of progression of LB and neuronal loss in Parkinson’s disease are identical to those in other Lewy body diseases (LBD) remains unclear. In addition, pathological data on the autonomic nervous system involvement in LBD are limited. We present here the clinicopathological characteristics of two autopsy cases with both Alzheimer’s disease and dementia with Lewy bodies (DLB), possibly diagnosed as having Lewy body variant of Alzheimer’s disease (LBV/AD). Our patients presented clinically with dementia without parkinsonism. Histopathologically, phosphorylated α‐synuclein‐positive LB and Lewy neurites were abundant in the limbic system, especially in the amygdala, and to a lesser degree, in the neocortex, including the primary motor cortex. The amygdala was also most severely affected by neuronal loss, and the other limbic areas and neocortex were affected to a lesser degree. Despite the existence of a small number of LB and many Lewy neurites, neurons in the brainstem nuclei were relatively well preserved. The Braak stages of concurrent neurofibrillary changes and senile plaques were stage V and C, respectively, in both cases. Tyrosine hydroxylase‐positive nerve fibers were relatively well spared in one case examined compared with Parkinson’s disease cases. Furthermore, many Lewy neurites immunopositive for phosphorylated α‐synuclein were found in the nerve fascicles of the epicardium in one case examined and in Parkinson’s disease cases to a lesser degree. These findings suggest that: (i) in at least some LBV/AD cases, the amygdala develops neuronal loss and Lewy‐related pathology prior to the brainstem nuclei; and (ii) the depletion of nerves in the heart tissue of LBV/AD is not necessarily complete despite the development of Lewy‐related pathology.
The effects of sevoflurane and desflurane anesthesia on QTc interval and cardiac rhythm in children
Authors: AYPAR EBRU , KARAGOZ AYSE HEVES , OZER SEMA , CELIKER ALPAY , OCAL TURGAY
Published: January 2007

Background:  Inhalational anesthetics may prolong QTc interval (QT interval corrected for heart rate) of the ECG and cause life‐threathening arrythmias. The effects of desflurane on QTc interval and cardiac rhythm have not been reported previously in children. We assessed the effects of desflurane anesthesia on QTc interval and cardiac rhythm and compared them with sevoflurane anesthesia in children.

Methods:  The study was performed on 20 children admitted for inguinal hernia repair, with normal QTc intervals. Anesthesia was induced with propofol and intubation was achieved with vecuronium. Anesthesia was maintained with 2% sevoflurane (group I, n = 11) or 6% desflurane (group II, n = 9) and 66% nitrous oxide in oxygen. Electrocardiogram recordings were obtained by Holter recorder. QTc intervals were measured at baseline, 5, 10, 15, and 30 min after inhalation.

Results:  None of the patients had significant arrythmia with desflurane anesthesia. One patient in the sevoflurane group had single, bigemini and multiform ventricular extrasystoles. There was no statistically significant difference in the baseline QTc values of the groups. Desflurane significantly prolonged QTc interval 5 min after induction until 30 min of anesthesia compared with baseline values (P = 0.029), while no significant prolongation was observed with sevoflurane (P = 0.141).

Conclusions:  Use of 2% sevoflurane during maintenance of anesthesia does not significantly prolong QTc interval while 6% desflurane significantly prolonged QTc interval in children with normal QTc interval undergoing inguinal herniorrhaphy.
Regional anesthetic techniques are an alternative to general anesthesia for infants with Pompe's disease
Authors: WALKER ROBERT W.M. , BRIGGS GERAINT , BRUCE JAMES , FLETCHER JOAN , WRAITH E.D.
Published: January 2007

Pompe's disease or glycogen storage disease type II is a genetic disorder affecting skeletal and cardiac muscle. The infantile form is associated with gross hypertrophic cardiomegaly and death in the early years. General anesthesia is associated with potential major morbidity in these patients. We present our experience of regional anesthetic blocks used in five patients with the infantile form of glycogen storage disease type II with and without sedation for 11 surgical procedures during a clinical trial of replacement therapy for this condition. Both femoral nerve blockade and caudal epidural blockade were used with good result. The relative merits of the type of block are discussed in addition to the choice of sedation and risks of general anesthesia. The avoidance of general anesthesia in the newly presenting patient with Pompe's disease may reduce potential morbidity until enzyme replacement has been established.
Evolution and persistence of obligate mutualists and exploiters: competition for partners and evolutionary immunization
Authors: Ferrière Régis , Gauduchon Mathias , Bronstein Judith L.
Published: January 2007

Mutualisms are ubiquitous in nature, as is their exploitation by both conspecific and heterospecific cheaters. Yet, evolutionary theory predicts that cheating should be favoured by natural selection. Here, we show theoretically that asymmetrical competition for partners generally determines the evolutionary fate of obligate mutualisms facing exploitation by third‐species invaders. When asymmetry in partner competition is relatively weak, mutualists may either exclude exploiters or coexist with them, in which case their co‐evolutionary response to exploitation is usually benign. When asymmetry is strong, the mutualists evolve towards evolutionary attractors where they become extremely vulnerable to exploiter invasion. However, exploiter invasion at an early stage of the mutualism's history can deflect mutualists’ co‐evolutionary trajectories towards slightly different attractors that confer long‐term stability against further exploitation. Thus, coexistence of mutualists and exploiters may often involve an historical effect whereby exploiters are co‐opted early in mutualism history and provide lasting ‘evolutionary immunization’ against further invasion.
VOTING, INEQUALITY AND REDISTRIBUTION
Authors: Borck Rainald
Published: January 2007

Abstract This paper surveys models of voting on redistribution. Under reasonable assumptions, the baseline model produces an equilibrium with the extent of redistributive taxation chosen by the median income earner. If the median is poorer than average, redistribution is from rich to poor, and increasing inequality increases redistribution. However, under different assumptions about the economic environment, redistribution may not be simply rich to poor, and inequality need not increase redistribution. Several lines of argument are presented, in particular, political participation, public provision of private goods, public pensions, and tax avoidance or evasion.
REAL BUSINESS CYCLE MODELS OF THE GREAT DEPRESSION: A CRITICAL SURVEY
Authors: Pensieroso Luca
Published: January 2007

Abstract Recent years have witnessed a revival of interest in the Great Depression of the 1930s. Among the differing new interpretations, the real business cycle (RBC) approach is particularly significant. It represents an outstanding methodological innovation in trying to cast the Great Depression within an ‘equilibrium’ framework. This paper critically reviews the RBC interpretation of the Great Depression, clarifying its theoretical and methodological foundations, and paving the way for future assessments of its validity.
SELECTION BIAS CORRECTIONS BASED ON THE MULTINOMIAL LOGIT MODEL: MONTE CARLO COMPARISONS
Authors: Bourguignon François , Fournier Martin , Gurgand Marc
Published: January 2007

Abstract This survey presents the set of methods available in the literature on selection bias correction, when selection is specified as a multinomial logit model. It contrasts the underlying assumptions made by the different methods and shows results from a set of Monte Carlo experiments. We find that, in many cases, the approach initiated by Dubin and MacFadden (1984) as well as the semi‐parametric alternative recently proposed by Dahl (2002) are to be preferred to the most commonly used Lee (1983) method. We also find that a restriction imposed in the original Dubin and MacFadden paper can be waived to achieve more robust estimators. Monte Carlo experiments also show that selection bias correction based on the multinomial logit model can provide fairly good correction for the outcome equation, even when the IIA hypothesis is violated.
CALCULATING TRAGEDY: ASSESSING THE COSTS OF TERRORISM
Authors: Frey Bruno S. , Luechinger Simon , Stutzer Alois
Published: January 2007

Abstract The trends and consequences of terrorist activities are often captured by counting the number of incidents and casualties. More recently, the effects of terrorist acts on various aspects of the economy have been analyzed. These costs are surveyed and put in perspective. As economic consequences are only a part of the overall costs of terrorism, possible approaches for estimating the utility losses of the people affected are discussed. Results using the life satisfaction approach, in which individual utility is approximated by self‐reported subjective well‐being, suggest that people's utility losses may far exceed the purely economic consequences.
Stable expression of Gal/GalNAc lectin of Entamoeba histolytica in transgenic chloroplasts and immunogenicity in mice towards vaccine development for amoebiasis
Authors: Chebolu Seethamahalakshmi , Daniell Henry
Published: January 2007

Chloroplast genetic engineering offers several advantages, including high levels of transgene expression, transgene containment via maternal inheritance and multigene engineering in a single transformation event. Entamoeba histolytica infects 50 million people, causing about 100 000 deaths annually, but there is no approved vaccine against this pathogen. LecA, a potential target for blocking amoebiasis, was expressed for the first time in transgenic plants. Stable transgene integration into chloroplast genomes and homoplasmy were confirmed by polymerase chain reaction and Southern blot analyses. LecA expression was evaluated by Western blots and quantified by enzyme‐linked immunosorbent assay (up to 6.3% of total soluble protein or 2.3 mg LecA/g leaf tissue). Subcutaneous immunization of mice with crude extract of transgenic leaves resulted in higher immunoglobulin G titres (up to 1 : 10 000) than in previous reports. An average yield of 24 mg of LecA per plant should produce 29 million doses of vaccine antigen per acre of transgenic plants. Such high levels of expression and immunogenicity should facilitate the development of a less expensive amoebiasis vaccine.
Coupling two mercury resistance genes in Eastern cottonwood enhances the processing of organomercury
Authors: Lyyra Satu , Meagher Richard B. , Kim Tehryung , Heaton Andrew , Montello Paul , Balish Rebecca S. , Merkle Scott A.
Published: January 2007

Eastern cottonwood (Populus deltoides Bartr. ex Marsh.) trees were engineered to express merA (mercuric ion reductase) and merB (organomercury lyase) transgenes in order to be used for the phytoremediation of mercury‐contaminated soils. Earlier studies with Arabidopsis thaliana and Nicotiana tabacum showed that this gene combination resulted in more efficient detoxification of organomercurial compounds than did merB alone, but neither species is optimal for long‐term field applications. Leaf discs from in vitro‐grown merA, nptII (neomycin phosphotransferase) transgenic cottonwood plantlets were inoculated with Agrobacterium tumefaciens strain C58 carrying the merB and hygromycin resistance (hptII) genes. Polymerase chain reaction of shoots regenerated from the leaf discs under selection indicated an overall transformation frequency of 20%. Western blotting of leaves showed that MerA and MerB proteins were produced. In vitro‐grown merA/merB plants were highly resistant to phenylmercuric acetate, and detoxified organic mercury compounds two to three times more rapidly than did controls, as shown by mercury volatilization assay. This indicates that these cottonwood trees are reasonable candidates for the remediation of organomercury‐contaminated sites.
Understanding the 2001 UK Census Migration and Commuting Data: The Effect of Small Cell Adjustment and Problems of Comparison with 1991
Authors: Stillwell John , Duke-Williams Oliver
Published: January 2007

Origin–destination statistics have been produced from the last three UK censuses. The paper describes what is new about the 2001 census interaction data on migration and commuting, considers the disclosure control methods that were applied to cells containing small values and demonstrates the problems that are associated with making comparisons with 1991 data. The effect of small cell adjustment procedures on the interaction data sets is investigated by means of selective analyses at different spatial scales. Some recommendations are made in light of the problems that were manifest in 2001.
Statistical Learning Procedures for Monitoring Regulatory Compliance: an Application to Fisheries Data
Authors: Lennert-Cody Cleridy E. , Berk Richard A.
Published: January 2007

As a special case of statistical learning, ensemble methods are well suited for the analysis of opportunistically collected data that involve many weak and sometimes specialized predictors, especially when subject-matter knowledge favours inductive approaches. We analyse data on the incidental mortality of dolphins in the purse-seine fishery for tuna in the eastern Pacific Ocean. The goal is to identify those rare purse-seine sets for which incidental mortality would be expected but none was reported. The ensemble method random forests is used to classify sets according to whether mortality was (response 1) or was not (response 0) reported. To identify questionable reporting practice, we construct ‘residuals’ as the difference between the categorical response (0,1) and the proportion of trees in the forest that classify a given set as having mortality. Two uses of these residuals to identify suspicious data are illustrated. This approach shows promise as a means of identifying suspect data gathered for environmental monitoring.
The effect of oil exchange receipts on import in the Islamic Republic of Iran
Authors: Rad Abbas Alavi , Dehghan Mohammad Ali
Published: January 2007

This paper examines the determinants of aggregate imports in Iran between 1960 and 2000. With respect to the fact that the Islamic Republic of Iran is an oil‐exporting country, and most foreign exchange earnings result from oil export, recent study variable of oil exchange receipts to variables of traditional import demand function is added. Quantitative estimates, based on multivariate and univariate co‐integration analysis, indicate that oil exchange receipts, real income and relative prices all significantly determine the behaviour of total import in the long‐run. Findings also show that the income elasticity generally is within the range of 0.58 to 0.76. On the other hand, relative prices elasticity is within the range of −0.56 to −0.67. Additionally, we have used an error correction model to show the behaviour of import demand function in the short‐run. Finally, our analysis show that oil exchange receipts, as well as real income and relative prices, play a remarkable role in shaping import behaviour both in the long‐run and short‐run.
Physical properties of carbonate fault rocks, fucino basin (Central Italy): implications for fault seal in platform carbonates
Authors: AGOSTA F. , PRASAD M. , AYDIN A.
Published: January 2007

We documented the porosity, permeability, pore geometry, pore type, textural anisotropy, and capillary pressure of carbonate rock samples collected along basin‐bounding normal faults in central Italy. The study samples consist of one Mesozoic platform carbonate host rock with low porosity and permeability, four fractured host rocks of the damage zones, and four fault rocks of the fault cores. The four fractured samples have high secondary porosity, due to elongated, connected, soft pores that provide fluid pathways in the damage zone. We modeled this zone as an elastic cracked medium, and used the Budiansky–O'Connell correlation to compute its permeability from the measured elastic moduli. This correlation can be applied only to fractured rocks with large secondary porosity and high‐aspect ratio pores. The four fault rock samples are made up of survivor clasts embedded in fine carbonate matrices and cements with sub‐spherical, stiff pores. The low porosity and permeability of these rocks, and their high values of capillary pressure, are consistent with the fault core sealing as much as 77 and 140 m of gas and oil columns, respectively. We modeled the fault core as a granular medium, and used the Kozeny–Carmen correlation, assigning the value of 5 to the Kozeny constant, to compute its permeability from the measured porosities and pore radii. The permeability structure of the normal faults is composed of two main units with unique hydraulic characteristics: a granular fault core that acts as a seal to cross‐fault fluid flow, and an elastic cracked damage zone that surrounds the core and forms a conduit for fluid flow. Transient pathways for along‐fault fluid flow may form in the fault core during seismic faulting due to the formation of opening‐mode fractures within the cemented fault rocks.
Obesity in pregnancy: a study of the impact of maternal obesity on NHS maternity services
Authors: Heslehurst N , Lang R , Rankin J , Wilkinson JR , Summerbell CD
Published: January 2007

Objective  To gain a detailed understanding of healthcare professionals’ perceptions of the impact that caring for obese pregnant women has on maternity services.

Design  Qualitative interview study using purposeful sampling and face‐to‐face interviews.

Setting  Sixteen maternity units in NHS Trusts in the North East Government Office Region of England, UK.

Sample  Thirty‐three maternity and obstetric healthcare professionals with personal experience of managing the care of obese pregnant women.

Methods  Semi‐structured interviews with healthcare professionals representing each maternity unit in the region. Transcripts were analysed using systematic content analysis.

Main outcome measures  Views on the impact maternal obesity has on maternity services, the facilities required to care for obese mothers in pregnancy, and existing services directed towards maternal obesity.

Results  Five dominant themes relating to service delivery emerged; booking appointments, equipment, care requirements, complications and restrictions, and current and future management of care. Many of the issues identified were associated with managing the care of obese women in pregnancy safely, resources and cost issues to be able to do this, multidisciplinary care requirements because of coexisting morbidities when the mother is obese, and restricted care options and patient choice.

Conclusions  Healthcare professionals in the North East of England feel that maternal obesity has a major impact on services and resource, on the health of both the mother and child, and on the psychological wellbeing of the mother.
Being born small for gestational age increases the risk of severe pre‐eclampsia
Authors: Zetterström K , Lindeberg S , Haglund B , Magnuson A , Hanson U
Published: January 2007

Objective  The first aim of this study was to investigate the risk of pre‐eclampsia, both mild and severe, in women born small for gestational age (SGA). The second aim was to investigate whether the risk is modified by pre‐eclampsia in the previous generation.

Design  Population‐based cohort study.

Setting  Sweden.

Population  A population of 118 634 women registered both as newborns and as mothers in the Swedish Medical Birth Register of 1973–2003. Of these, 6883 had been born SGA. Only primiparas and singletons were included.

Methods  The pregnancies that the women were born out of were analysed with regard to presence of pre‐eclampsia, while their own pregnancies were analysed regarding age at delivery, smoking, body mass index and incidence of mild or severe pre‐eclampsia. Multiple logistic regression analysis was used. In a first step, we adjusted for maternal characteristics, and in a second step, for pre‐eclampsia in the previous generation.

Main outcome measures  Odds ratio for mild and severe pre‐eclampsia.

Results  In women born SGA, the adjusted odds ratio (first step) for mild pre‐eclampsia was 1.19 (95% CI 1.03–1.38), while for severe pre‐eclampsia it was 1.69 (95% CI 1.40–2.02) compared with those not born SGA. After the second‐step adjustment, the odds ratio for mild pre‐eclampsia was 1.16 (95% CI 1.00–1.35) and for severe pre‐eclampsia was 1.62 (95% CI 1.35–1.95). No statistically significant effect modification from pre‐eclampsia in the previous generation was shown.

Conclusions  Women born SGA suffer a markedly increased risk of severe pre‐eclampsia. Exposure to pre‐eclampsia during a woman’s own fetal development significantly increases her risk of pre‐eclampsia but does not modify the SGA effect.
Microsatellite markers developed from Theobroma cacao L. expressed sequence tags
Authors: BORRONE JAMES W. , BROWN J. STEVEN , KUHN DAVID N. , MOTAMAYOR JUAN C. , SCHNELL RAYMOND J.
Published: January 2007

Theobroma cacao L. expressed sequence tags (ESTs) were converted into useful genetic markers for fingerprinting individuals and genetic linkage mapping. Primers were designed to microsatellite‐containing ESTs. Twenty‐two T. cacao accessions, parents of various mapping populations segregating for disease resistance and crop yield characteristics, were tested. Twenty‐seven informative loci were discovered with 26 primer pairs. The number of detected alleles ranged from two to 11 and averaged 4.4 per locus. All 27 markers could be mapped into at least one of the existing F1 or F2 populations segregating for agronomically important traits.
Identifying management zones in agricultural fields using spatially constrained classification of soil and ancillary data
Authors: Frogbrook Z. L. , Oliver M. A.
Published: January 2007

Site‐specific management requires accurate knowledge of the spatial variation in a range of soil properties within fields. This involves considerable sampling effort, which is costly. Ancillary data, such as crop yield, elevation and apparent electrical conductivity (ECa) of the soil, can provide insight into the spatial variation of some soil properties. A multivariate classification with spatial constraint imposed by the variogram was used to classify data from two arable crop fields. The yield data comprised 5 years of crop yield, and the ancillary data 3 years of yield data, elevation and ECa. Information on soil chemical and physical properties was provided by intensive surveys of the soil. Multivariate variograms computed from these data were used to constrain sites spatially within classes to increase their contiguity. The constrained classifications resulted in coherent classes, and those based on the ancillary data were similar to those from the soil properties. The ancillary data seemed to identify areas in the field where the soil is reasonably homogeneous. The results of targeted sampling showed that these classes could be used as a basis for management and to guide future sampling of the soil.
Administrative Data Algorithms Can Describe Ambulatory Physician Utilization
Authors: Shah Baiju R. , Hux Janet E. , Laupacis Andreas , Zinman Bernard , Cauch‐Dudek Karen , Booth Gillian L.
Published: January 2007

Objective. To validate algorithms using administrative data that characterize ambulatory physician care for patients with a chronic disease.

Data Sources. Seven‐hundred and eighty‐one people with diabetes were recruited mostly from community pharmacies to complete a written questionnaire about their physician utilization in 2002. These data were linked with administrative databases detailing health service utilization.

Study Design. An administrative data algorithm was defined that identified whether or not patients received specialist care, and it was tested for agreement with self‐report. Other algorithms, which assigned each patient to a primary care and specialist physician, were tested for concordance with self‐reported regular providers of care.

Principal Findings. The algorithm to identify whether participants received specialist care had 80.4 percent agreement with questionnaire responses (κ=0.59). Compared with self‐report, administrative data had a sensitivity of 68.9 percent and specificity 88.3 percent for identifying specialist care. The best administrative data algorithm to assign each participant's regular primary care and specialist providers was concordant with self‐report in 82.6 and 78.2 percent of cases, respectively.

Conclusions. Administrative data algorithms can accurately match self‐reported ambulatory physician utilization.
Voxel‐based T2 Relaxation Rate Measurements in Temporal Lobe Epilepsy (TLE) with and without Mesial Temporal Sclerosis
Authors: Mueller Susanne G. , Laxer Kenneth D. , Schuff Norbert , Weiner Michael W.
Published: January 2007

Summary:  Introduction: Quantitative measurements of T2 relaxation in the hippocampus for focus lateralization in mesial temporal lobe epilepsy (mTLE) are well established. Less is known to what degree such relaxation abnormalities also affect regions beyond the ipsilateral hippocampus. Therefore, the aim of this study was to characterize extent and distribution pattern of extrahippocampal relaxation abnormalities in TLE with (TLE‐MTS) and without MRI evidence of mesial‐temporal sclerosis (TLE‐no).

Methods: Double spin echo images (TE1/2: 20/80 ms) acquired in 24 TLE‐MTS and 18 TLE‐no were used to calculate relaxation rate maps. These maps were analyzed by SPM2 and by selecting regions of interest (ROI) in the hippocampus and several extrahippocampal brain regions.

Results: In TLE‐MTS, the results of the SPM and ROI analysis were in good agreement and showed the most severe relaxation rate decreases in the ipsilateral hippocampus but also in other ipsilateral temporal regions, orbitofrontal, and parietal regions and to a lesser degree in contralateral frontal regions. The relaxation rate decreases in TLE‐no were confined to small regions in the ipsilateral anterior inferior and medial temporal lobe in the SPM analysis while ROI analysis showed additional regions in the ipsilateral hippocampus, amygdala, and anterior cingulate.

Conclusion: TLE‐MTS showed extensive, widespread but predominantly ipsilateral temporal and also extratemporal T2 relaxation rate decreases. In contrast, the findings of the SPM and ROI analyses in TLE‐no suggested that if relaxation rate decreases are present, they are less uniform and generally milder than in TLE‐MTS. This further supports the hypothesis that TLE‐no is a distinct clinicopathological entity from TLE‐MTS and probably heterogeneous in itself.
Lower Extremity Ischemia, Calf Skeletal Muscle Characteristics, and Functional Impairment in Peripheral Arterial Disease
Authors: McDermott Mary M. , Hoff Frederick , Ferrucci Luigi , Pearce William H. , Guralnik Jack M. , Tian Lu , Liu Kiang , Schneider Joseph R. , Sharma Leena , Tan Jin , Criqui Michael H.
Published: January 2007

OBJECTIVES: To determine whether lower ankle brachial index (ABI) levels are associated with lower calf skeletal muscle area and higher calf muscle percentage fat in persons with and without lower extremity peripheral arterial disease (PAD).

DESIGN: Cross‐sectional.

SETTING: Three Chicago‐area medical centers.

PARTICIPANTS: Four hundred thirty‐nine persons with PAD (ABI<0.90) and 265 without PAD (ABI 0.90–1.30).

MEASUREMENTS: Calf muscle cross‐sectional area and the percentage of fat in calf muscle were measured using computed tomography at 66.7% of the distance between the distal and proximal tibia. Physical activity was measured using an accelerometer. Functional measures included the 6‐minute walk, 4‐meter walking speed, and the Short Physical Performance Battery (SPPB).

RESULTS: Adjusting for age, sex, race, comorbidities, and other potential confounders, lower ABI values were associated with lower calf muscle area (ABI<0.50, 5,193 mm2; ABI 0.50–0.90, 5,536 mm2; ABI 0.91–1.30, 5,941 mm2; P for trend<.001). These significant associations remained after additional adjustment for physical activity. In participants with PAD, lower calf muscle area in the leg with higher ABI was associated with significantly poorer performance in usual‐ and fast‐paced 4‐meter walking speed and on the SPPB, adjusting for ABI, physical activity, percentage fat in calf muscle, muscle area in the leg with lower ABI, and other confounders (P<.05 for all comparisons).

CONCLUSION: These data support the hypothesis that lower extremity ischemia has a direct adverse effect on calf skeletal muscle area. This association may mediate previously established relationships between PAD and functional impairment.
The Consortium of E‐Learning in Geriatrics Instruction
Authors: Ruiz Jorge G. , Teasdale Thomas A. , Hajjar Ihab , Shaughnessy Marianne , Mintzer Michael J.
Published: January 2007

This paper describes the activities of the Consortium of E‐Learning in Geriatrics Instruction (CELGI), a group dedicated to creating, using, and evaluating e‐learning to enhance geriatrics education. E‐learning provides a relatively new approach to addressing geriatrics educators' concerns, such as the shortage of professionals trained to care for older people, overcrowded medical curricula, the move to transfer teaching venues to community settings, and the switch to competency‐based education models. However, this innovative education technology is facing a number of challenges as its use and influence grow, including proof of effectiveness and efficiency. CELGI was created in response to these challenges, with the goal of facilitating the development and portability of e‐learning materials for geriatrics educators. Members represent medical and nursing schools, the Department of Veterans Affairs healthcare system, long‐term care facilities, and other institutions that rely on continuing streams of quality health education. CELGI concentrates on providing a coordinated approach to formulating and adapting specifications, standards, and guidelines; developing education and training in e‐learning competencies; developing e‐learning products; evaluating the effect of e‐learning materials; and disseminating these materials. The vision of consortium members is that e‐learning for geriatric education will become the benchmark for valid and successful e‐learning throughout medical education.
Modification of cardiovascular risk in hemodialysis patients: An evidence‐based review
Authors: JOHNSON David W. , CRAVEN Ann‐Maree , ISBEL Nicole Maree
Published: January 2007

Cardiovascular disease accounts for 40% to 50% of deaths in dialysis populations. Overall, the risk of cardiac mortality is 10‐fold to 20‐fold greater in dialysis patients than in age and sex‐matched controls without chronic kidney disease. The aim of this paper is to review critically the evidence that cardiac outcomes in dialysis patients are modified by cardiovascular risk factor interventions. There is limited, but as yet inconclusive controlled trial evidence that cardiovascular outcomes in dialysis populations may be improved by antioxidants (vitamin E or acetylcysteine), ensuring that hemoglobin levels do not exceed 120 g/L (especially in the setting of known cardiovascular disease), prescribing carvedilol in the setting of dilated cardiomyopathy, and by using cinacalcet in uncontrolled secondary hyperparathyroidism. Similarly, there are a number of negative controlled trials, which have demonstrated that statins, high‐dose folic acid, angiotensin‐converting enzyme inhibitors, multiple risk factor intervention via multidisciplinary clinics, and high‐dose or high‐flux dialysis are ineffective in preventing cardiovascular disease. Although none of these studies could be considered conclusive, the negative trials to date should raise significant concerns about the heavy reliance of current clinical practice guidelines on extrapolation of findings from cardiovascular intervention trials in the general population. It may be that cardiovascular disease in dialysis populations is less amenable to intervention, either because of the advanced stage of chronic kidney disease or because the pathogenesis of cardiovascular disease in dialysis patients is different from that in the general population. Large, well‐conducted, multicenter randomized‐controlled trials in this area are urgently required.
Hemolysis‐induced acute pancreatitis secondary to kinked hemodialysis blood lines
Authors: ABTAHI Mahdi , UZAN Martine , SOUID Marc
Published: January 2007

Hemolytic reactions have become extremely rare in chronic maintenance hemodialysis. We present the case of a young dialysis patient with hemolysis‐induced acute pancreatitis secondary to kinked hemodialysis blood lines. With new blood lines on the market, attention to this aspect of dialysis is mandatory.
Can a left internal jugular catheter be used in the hemodialysis of a patient with persistent left superior vena cava?
Authors: STYLIANOU Konstantinos , KORSAVAS Konstantinos , VOLOUDAKI Argyro , PATRIANAKOS Alexandros , VARDAKI Eleftheria , TZENAKIS Nikolaos , DAPHNIS Eugene
Published: January 2007

A patient with a persistent left superior vena cava (PLSVC) was incidentally diagnosed after positioning of a dual lumen catheter for hemodialysis into the left internal jugular vein. Although PLSVC is a relatively rare condition, it is the most common congenital anomaly of thoracic venous circulation. It represents the persistence of the left horn of the embryonic sinus venosus, which normally involutes during embryogenesis to become the coronary sinus. The existence of a PLSVC can cause a significant diagnostic dilemma during catheterization of the left internal jugular vein, pertaining to the positioning of the catheter. It may also be associated with significant clinical implications such as systemic embolization, provocation of arrhythmia, and thrombosis of the vessel. The safety of such catheterization has not been adequately evaluated due to the rarity of this condition. We believe that a diagnostic workup including blood gas analysis, echocardiography, and computed tomography is necessary to confirm a right atrial drainage and a patent innominate vein as prerequisites to maintain the catheter in position.
Complications associated with the development of bacteremia with Staphylococcus aureus
Authors: TROIDLE Laura , EISEN Thomas , PACELLI Lisa , FINKELSTEIN Fredric
Published: January 2007

Access‐related infections are a leading cause of morbidity and mortality among hemodialysis patients. Staphylococcus aureus bacteremia accounts for 25% of these episodes. Nissenson et al., found that 20.7% of the patients developing S. aureus bacteremia had infectious complications as well as hospital readmissions related to the S. aureus bacteremia. This retrospective analysis did not determine whether the S. aureus bacteremia was access related, nor how each episode was treated. We have prospectively collected a database of all access‐related S. aureus bacteremia developing in our unit between 1/1/03 and 8/31/05, including the management of the access. Episodes of S. aureus bacteremia with an identifiable source other than the vascular access were excluded. Seventy‐two episodes of S. aureus bacteremia were identified; 54 developed in patients using a catheter and 18 developed in patients using an arteriovenous graft/fistula. The mean age was 64±15 years, and 56% of the patients were Caucasian. All patients were treated with 4 weeks of antibiotics. A total of 6 (8%) deaths and 15 (20.8%) infectious complications related to the S. aureus bacteremia were identified. Infectious complications included endocarditis (4), metastatic infection (7), discitis (3), and a myocardial abscess (1). Seventeen (23.6%) of the patients were readmitted within 30 days of the episode of S. aureus bacteremia; 4 readmissions were related to the S. aureus bacteremia. Five of the 54 catheter patients who developed S. aureus bacteremia expired and 14 developed infectious complications despite the catheter being removed/exchanged in all but one patient. One of the arteriovenous graft patients who developed S. aureus bacteremia expired. We conclude that infectious complications from S. aureus bacteremia are common, as 23.6% of the patients in our study developed an infectious complication. Eight percent of the patients who developed S. aureus bacteremia expired. Strategies to avoid S. aureus bacteremia are needed.
Prevalence of the metabolic syndrome in an incident dialysis population
Authors: YOUNG Daniel O. , LUND Richard J. , HAYNATZKI Gleb , DUNLAY Robert W.
Published: January 2007

The National Heart, Lung, and Blood Institute's National Cholesterol Education Program 2001 Adult Treatment Panel III report defined the metabolic syndrome as having at least 3 of the following 5 criteria: abdominal obesity, elevated triglyceride levels, low high‐density lipoprotein cholesterol levels, an elevated blood pressure, and an elevated fasting glucose. Evidence is accumulating to suggest that the metabolic syndrome predisposes to cardiovascular disease (CVD). End‐stage kidney disease (ESKD) patients requiring dialysis have a substantially elevated risk of CVD morbidity and mortality. Dialysis patients' increased risk can be partially explained by traditional and nontraditional risk factors. The prevalence of the metabolic syndrome in dialysis patients is unknown. This retrospective, cross‐sectional study of 202 incident dialysis patients examined the prevalence of the metabolic syndrome at the time of renal replacement therapy initiation. The study group was compared with all incident dialysis patients in 2002 on file with the U.S. Renal Data System. Females represented 39.1% of the study population. Blacks composed 34.7% of the study group. Diabetes was the etiology of ESKD in 44.6% of our patients. Surrogate criteria were used for the Adult Treatment Panel III risk factors of abdominal obesity and elevated fasting glucose levels. Overall, the prevalence of the metabolic syndrome was 69.3% in our population and was especially prevalent among diabetic, female, and white ESKD patients. Study limitations included the use of surrogate markers for 2 criteria of the metabolic syndrome and dependence on the Medical Evidence Report (Form 2728) for baseline characteristics. In summary, the metabolic syndrome is highly prevalent in incident dialysis patients.
Skin colour is associated with periodontal disease in Brazilian adults: a population‐based oral health survey
Authors: Peres Marco Aurélio , Antunes José Leopoldo Ferreira , Boing Antonio Fernando , Peres Karen Glazer , Bastos João Luiz Dornelles
Published: January 2007

Aim:To estimate the prevalence of periodontal disease in Brazilian adults and to test its association with skin colour after controlling for socio‐demographic variables.

Methods:The periodontal status of 11,342 Brazilian adults was informed by a nationwide oral health survey. Socio‐demographic variables included skin colour, gender, schooling, per capita income, age and geographical region. The association between periodontal disease and skin colour was tested by a logistic regression model, adjusting for covariates. Interactions between skin colour and socio‐demographic variables were tested.

Results:The prevalence of periodontal diseases was 9.0% [95% confidence interval (CI) 7.6–10.3]. Lighter‐skinned black people (pardos) and dark‐skinned black people (pretos) presented higher levels of periodontal disease when compared with white people [odds ratio (OR)=1.5; 95% CI 1.2; 1.8; OR=1.6; 95% CI 1.2; 2.1, respectively] even after controlling for age, gender, schooling, per capita income and geographic region. No interactions were statistically significant.

Conclusion:Skin colour was significantly associated with periodontal disease among Brazilian adults after adjustment for socio‐economic and demographic covariates.
Are statins associated with decreased tooth loss in chronic periodontitis?
Authors: Saver Barry G. , Hujoel Philippe P. , Cunha‐Cruz Joana , Maupomé Gerardo
Published: January 2007

Aim: To evaluate whether statin use was associated with decreased tooth loss among patients with chronic periodontitis.

Material and Methods: We evaluated administrative health plan data from 1996 to 2002 covering dental and periodontal treatment utilization, dental extractions, and prescription medication fills of 12,631 adults aged 48–64 in 2002. With tooth loss as the outcome, we evaluated a number of different patterns of statin prescription across time in multivariate generalized linear models.

Results: Unadjusted, statin use was associated with increased tooth loss. After adjustment for potential confounders, there was no suggestion of either increased or decreased tooth loss associated with statin use.

Conclusions: Statin use was not associated with either a decreased or an increased risk of tooth loss.
A practical UV source to induce Herpes simplex labialis lesions in the clinic
Authors: Sayre Robert M. , Dowdy John C. , Harris Kelly A. , Berg Jeffrey E. , Trimble Mingyi W.
Published: January 2007

Background: Ultraviolet (UV) sources have been used to clinically induce herpes simplex lesions in the lips of susceptible individuals.

Methods: This study reports the optimization of a UV source for studies involving multiple clinical laboratory sites and subsequent clinical UV induction of cold sore lesions. We describe novel adaptations of a commercially available broadband UV phototherapy lamp that facilitate determination of individual's minimal erythemal dose (MED) and expose the lips with minimal risk of viral transmission to or between the volunteers and technicians.

Clinical Results: The source performed well in a clinical setting, with 171 of 386 subjects (44%) developing lesions, an induction rate similar to spectrally similar UV sources.

Conclusions: The advantages of consistent and reproducible exposure geometry, additional UV shielding and biological hygiene achieved by our method significantly enhance the execution of UV‐induced herpes simplex labialis studies.
A new targeted blue light phototherapy for the treatment of acne
Authors: Noborio Reiko , Nishida Emi , Kurokawa Mariko , Morita Akimichi
Published: January 2007

Background: The effects of blue light phototherapy on inflammatory acne lesions were recently investigated. Many reports have used high‐intensity, narrow‐band 420 nm UV‐free blue light delivery systems. The aim of this study was to evaluate a new blue light system (MultiClear™) for targeted blue light phototherapy.

Method: Ten Japanese patients with acne on the face or back were treated with targeted blue light once or twice a week. Acne severity was graded according to the acne severity score suggested by Allen and Smith (1982). If the acne was prevalent on the back or chest, the acne severity score of Burton et al. (1971) was adopted. The new targeting blue light system is equipped with a flexible optical light guide as a delivery system and the treatment device is placed directly only on the affected area.

Result: Of the 10 patients, eight had a significantly reduced acne severity score without any side effects. Although two patients discontinued the study because of unsatisfactory results, none of the patients showed any harmful side effects from the targeted blue light phototherapy.

Conclusion: Targeted blue light phototherapy with MultiClear™ is effective for the treatment of inflammatory acne lesions. This new irradiation device offers some advantages over previous blue light systems.
Acrodermatitis paraneoplastica responding to topical PUVA treatment
Authors: Abrou Ayad E. , Hope Jamie , Jackson‐Richards Diane , Lim Henry W. , Ozog David M.
Published: January 2007

Acrodermatitis paraneoplastica is a rare paraneoplastic entity that has been associated with multiple neoplasms, most commonly squamous cell carcinoma of the aerodigestive tract. Therapies have focused on treatment of the underlying carcinoma. We report a case of acrodermatitis paraneoplastica successfully treated with PUVA therapy.
Photoprotective activity of oral polypodium leucotomos extract in 25 patients with idiopathic photodermatoses
Authors: Caccialanza M. , Percivalle S. , Piccinno R. , Brambilla R.
Published: January 2007

Background: The incidences of idiopathic photodermatoses (IP) are increasing and the available therapeutic methods are often inadequate.

Aim: To evaluate whether, in subjects affected by IP not responding to the usual available therapies, the oral administration of an extract of Polypodium leucotomos (PL) could provide an effective photoprotective activity.

Methods: 26 patients with polymorphic light eruption and two with solar urticaria were recruited to enter the study. The protocol excluded the use of ultraviolet protection filters or other drugs that could in some way interfere with exposure to light. All patients exposed themselves to sunlight while consuming 480 mg/day of PL orally. The response of the skin to sunlight exposure of 25 evaluable patients was compared with that occurring previously without administration of PL.

Results: With PL, we observed a relevant and statistically significant reduction of skin reaction and subjective symptoms. The tolerance of the drug has been excellent.

Conclusion: PL extract administration has shown to be an effective and safe method, leading to a significant protection of skin in IP.
Effects of preceding sialadenitis on the development of autoimmunity against salivary gland
Authors: Ohno K , Hattori T , Kagami H , Ueda M
Published: January 2007

Objective:  The mechanism underlying the onset and development of autoimmune diseases such as Sjogren's syndrome is not well understood. Here, we examined the effects of preceding inflammation of the salivary gland at the onset of autoimmunity against the salivary gland.

Materials and methods:  One side of the submandibular gland duct was ligated in mice and the effect on the contralateral gland was investigated. After histological evaluation with hematoxylin and eosin staining, the presence of autoantibodies and immune compounds was examined.

Results:  In all five strains of mice that were used, the salivary gland of the ligated side showed severe inflammation and atrophic change. In two mouse strains (SJL/J and PL/J), mild sialadenitis was observed on the non‐ligated side 8 weeks after ligation. Autoantibodies reacting to the salivary gland were detected in three mouse strains (C3H/He, SJL/J, and PL/J). Immune complex was also detected in the duct basement membrane.

Conclusion:  The results indicate that the autoimmune mechanism is activated by the transient inflammation in the salivary gland under a specific genetic background.