bluuebunny/crossref_metadata_2025 huggingface dataset:
Necrophylactic periderm formation in the roots of western larch and Douglas‐fir trees infected with Armillaria ostoyae. II. The response to the pathogen
Authors: Robinson R. M. , Morrison D. J. , Jensen G. D.
Published: March 2004

Periderm formation was studied in bark samples collected from the roots of western larch (Larix occidentalis) and Douglas‐fir (Pseudotsuga menziesii) trees infected with Armillaria ostoyae. Necrophylactic periderms were formed in advance of infection and successfully restricted continued fungal spread in 68 and 45% of the samples collected from 10‐ and 27‐year‐old western larch, respectively. However, all periderms formed in 11‐ and 25‐year‐old Douglas‐fir had been breached by the advancing fungus. In both species, necrophylactic periderms were commonly breached at the junction of the periderm with the vascular cambium. In western larch, stone phellem often comprised the external phellem layer of necrophylactic periderms with multiple bands of phellem. In 27‐year‐old western larch, infection was often confined to discrete lesions bounded by multiple periderms with multiple bands of phellem. In both tree species, phellem production was greater in response to infection than in response to abiotic wounding.
The benefits and use of shock advisory defibrillators in hospitals
Authors: Dwyer Trudy , Mosel Williams Leonie , Jacobs Ian
Published: March 2004

Survival to discharge following a cardiac arrest is dependent on rapid and effective basic and advanced life support. Paramount to a rapid response is access to sufficiently trained health care providers, who have a duty to perform basic life support and initiate early defibrillation. In hospitals, defibrillation remains the domain of specially prepared staff and the type of defibrillator used might be crucial to rapid and effective defibrillation. The advent of automatic external defibrillators has increased the range of people who can use a defibrillator successfully. For nurses, arguably a lack of familiarity about the benefits of and the use of automatic external defibrillators are the greatest barriers to nurse‐initiated defibrillation programmes. This paper explores the use of automatic external defibrillators, their relationship to the associated defibrillator waveforms and the benefits of their use by registered nurses within the hospital setting.
Managing professionals: The emerging leadership role of Victorian Maternal and Child Health coordinators
Authors: Reiger Kerreen , Keleher Helen
Published: March 2004

Drawing on research into cultural and organizational change in the Victorian Maternal and Child Health Service during the 1990s, this paper examines implications for the nursing leadership provided by service coordinators. The project included a quantitative survey of nurses and semistructured interviews with managers and coordinators. Under a strongly neo‐liberal state government in Victoria, Australia, services were fundamentally restructured through tendering processes. A competitive, productivist culture was introduced that challenged the professional ethos of nurses and a primary health orientation to the care of mothers and infants. This paper focuses on the pressures that the entrepreneurial environment presented to maternal and child health nurses’ identity and collegial relations and to the coordination role. It argues that coordinators emerged as a significant nursing management group at the interface of administrative change and the management of professional practice. Although many nurses skilfully negotiated tensions with peers and management, their leadership role needs further clarification and support.
The search for insight: Clients’ psychological experiences of alcohol withdrawal in a voluntary, residential, health care setting
Authors: Smith Morgan
Published: March 2004

This study utilized a life history approach to describe clients’ psychological experiences of the alcohol withdrawal process while voluntarily residing in a specialist alcohol withdrawal facility. Reflection on the past and anticipation of the future frequently occupied the thoughts of participants as they sought insight in to their lives. These insights were associated with a range of emotions that included embarrassment, shame, optimism, feelings of support and a sense of loss of control. The findings provide additional information on the human experience of alcohol withdrawal and, thus, increase empathy, understanding and knowledge. This increased understanding can be utilized to improve the quality of nursing care provided to this complex client group.
Analysis of limited fertility in intracytoplasmic sperm injection of sperm obtained by electroejaculation
Authors: Nakamura Yoshihiro , Matsumiya Kiyomi , Kitamura Masaya , Nishimura Kenji , Tsujimura Akira , Takeyama Masami , Kondoh Nobuyuki , Miyazaki Kazunori , Okuyama Akihiko
Published: March 2004

Background and Aims:  We correlated findings in semen from patients with ejaculatory dysfunction with results of in vitro fertilization using their electroejaculated sperm.

Methods and Results:  Electroejaculation was carried out in six patients with the above‐mentioned criteria for a total of eight times. Sperm was obtained in six attempts. Intracytoplasmic injection of these sperm was performed in 156 eggs. Sixty‐seven eggs were fertilized; most of these were injected with motile sperm. Two women became pregnant, both after injection with motile sperm. As previously reported, electroejaculated sperm showed low motility and a low fertilization rate, but even motile sperm had a low fertilization rate.

Conclusion:  The results of the present study suggest the importance in fertilization of undetermined factors in addition to sperm motility. (Reprod Med Biol 2004; 3: 9–12)
Life‐table analysis of artificial insemination pregnancy rates for couples with male factor and idiopathic infertility
Authors: Suzuki Kohta , Kasai Tsuyoshi , Suzuki Mariko , Miyake Maki , Fujie Michiko , Mizuno Kaoruko , Hirata Shuji , Hoshi Kazuhiko
Published: March 2004

Background:  In the summer of 2002, standard guidelines for the application of assisted reproductive technology were reported by a research group of the Ministry of Health, Labor and Welfare. The present study aimed to examine the relationship between the number of cycles of artificial insemination and the cumulative pregnancy rates according to the cause of infertility.

Methods:  Patients who experienced their first cycle of artificial insemination during the period of January 1999–December 2002 were included in the study and were divided into a male factor infertility group and an idiopathic infertility group. Cumulative pregnancy rates resulting from artificial insemination with the husband's semen were calculated by the life‐table approach.

Results:  During the study period, 139 couples entered the assisted reproduction program and underwent 581 cycles. Significant differences were observed in cumulative pregnancy rates between the two groups.

Conclusion:  It is recommended that couples with male factor infertility and who fail to conceive within six or seven cycles of intrauterine insemination, consider a modification of treatment strategy such as in vitro fertilization, because cumulative pregnancy rates of this group were reached at a plateau within six or seven cycles. In contrast, patients with idiopathic infertility, the cumulative pregnancy rates appeared to increase constantly with each subsequent cycle. It is important to consider modifications of treatment strategy in the light of the cause of infertility. (Reprod Med Biol 2004; 3: 27–31)
Elderly onset Parkinson's disease complicated by dropped head syndrome that responded favorably to therapy*
Authors: Horiuchi Masahiro , Uehara Kenji , Kamo Tsutomu , Sugihara Hiroshi , Takahashi Yoichi
Published: March 2004

An 86‐year‐old man presented with a 7‐year history of gait disturbance. He was admitted to hospital in April 2000, as he was experiencing difficulty eating due to progression of dropped head syndrome. Both standing and sitting, marked dropped head and kyphosis were observed. When supine, the patient was able to stretch his neck, and he could stand and walk with the aid of a walker. Rigidity and resting tremor were present predominantly in the lower limbs. Parkinson's disease was diagnosed, and L‐dopa and cabergoline were administered. Parkinsonism and dropped head syndrome improved in response to treatment. Cases involving Parkinson's disease are reportedly improved by L‐dopa, but exacerbated by dopamine agonists. Dropped head syndrome is thought to attributable to imbalances in the tonus of the anterior and posterior neck muscles. Dropped head in the present case may have been a complication of Parkinson's disease, since improvements occurred in response to L‐dopa.
Hyperostosis cranii in the elderly with various clinical symptoms
Authors: Sohmiya Makoto , Tanaka Makoto , Aihara Yoshiaki , Okamoto Koichi
Published: March 2004

We report three elderly patients with hyperostosis cranii. Patient 1 had two episodes of unconsciousness; Patient 2, headache; and Patient 3, dementia. On the basis of Moore's classification using skull films, Patients 1 and 2 showed hyperostosis frontoparietalis and Patient 3 had hyperostosis frontalis interna. Electroencephalography showed transient generalized spike and slow wave complexes over the frontal lobes in Patient 1. Magnetic resonance images showed frontal lobes compressed by the thickness of the frontal bones in all patients and the thickness of the parietal bones in Patients 1 and 2. Since the findings in the present cases and those in the literature suggest that hyperostosis cranii could show unexpected neuropsychiatric symptoms, hyperostosis cranii should be checked in elderly patients whose presenting symptoms include epilepsy, dementia, psychiatric disease, headache and so on. Magnetic resonance images should be helpful in examining the relationship between clinical symptoms and the deformation of the brain by the skull.
Bone lesions in elderly patients with multiple myeloma: a multicenter study by the Society for Geriatric Hematology
Authors: Umeda Masanori , Adachi Yamao , Tomiyama Junji , Takasaki Masaru , Shin Koichi , Mori Mayumi , Tsutsumi Hisashi , Murai Yoshirou , Mutoh Yoshitomo , Tomoyasu Shigeru , Kawato Masafumi , Nakamura Noriko , Metori Shouhei , Yamaguchi Hisomu
Published: March 2004

Background:  Bone lesions in multiple myeloma (MM) have a significant impact on the quality of life of elderly patients, but they have not been extensively investigated in the elderly.

Methods:  The subjects were 146 elderly MM patients (aged ≥ 65 years, median age 74) admitted to 11 institutions. Bone lesions were compared with those in 65 non‐elderly MM patients.

Results:  At the time of diagnosis, skeletal symptoms were present in 104 cases and bone pain in 75. Mixed type occurred more often in elderly patients (63.5%) than in controls (28.3%) (P < 0.0001). Lumbar vertebral lesions were more common in elderly than non‐elderly patients (P < 0.0001). Bone lesions restricted physical activity in 71 elderly patients (48.6%). There was a significant difference between elderly patients with and without bone lesions in the rate of detection of plasma cells in bone marrow. Significant differences were detected in serum calcium concentration, the rate of detection of plasma cells in bone marrow, and serum β2‐microglobulin concentration between patients with and without bone pain, and between those with and without fractures. No significant differences were detected in survival time between elderly patients with and without bone lesions, with and without bone pain, or with and without fractures, whereas a significant difference was seen between these subgroups of non‐elderly patients.

Conclusion:  Although there were no significant differences in the incidence of bone lesions between elderly and non‐elderly patients, the mixed type of bone lesions occurred more often in the elderly than in controls. Lumbar vertebral lesions were more common in elderly than non‐elderly patients. There was no significant difference in prognosis between elderly patients with and those without bone lesions so the treatment strategy for bone lesions in the elderly should be aimed at improving quality of life through direct treatment of the bone lesions, with subsequent improvement of the related symptoms.
‘Alien Diplomatist’: Antisemitism and Anti‐Germanism in the Diplomatic Career of Sir Francis Oppenheimer
Authors: Otte T. G.
Published: March 2004

This article examines the interaction of antisemitic sentiments, bred by social exclusivity, and the conduct of diplomacy through the prism of the career of Sir Francis Oppenheimer, one of the few Jews in Britain's foreign service in the early part of the twentieth century. Oppenheimer filled consular and diplomatic posts between 1900 and 1920. Despite his distinguished services, his brilliant analyses of pre‐1914 German economics and politics, and his key role in Britain's wartime blockade efforts against the Central Powers, Oppenheimer found himself hampered in the execution of his duties, and thwarted in his hopes for advancement, by latent antisemitism amongst the senior ranks of Britain's diplomatic establishment. During the war years, the combination of such sentiments, the xenophobia of the super‐patriotic press, and Whitehall turf‐wars proved irresistible, bringing Oppenheimer's career to an early end.
Treatment of vascular and soft‐tissue sarcomas in dogs using an alternating protocol of ifosfamide and doxorubicin
Authors: Payne S. E. , Rassnick K. M. , Northrup N. C. , Kristal O. , Chretin J. D. , Cotter S. M. , Kintzer P. , Frimberger A. E. , Morrison‐Collister K. E. , Wood C. A. , Moore A. S.
Published: March 2004

A retrospective analysis was done to assess the toxicity and efficacy associated with an alternating chemotherapy protocol of ifosfamide (375 mg m−2) and doxorubicin (30 mg m−2) for adjuvant treatment of 39 dogs with sarcomas. Twelve dogs had various soft‐tissue sarcomas and 27 dogs had hemangiosarcoma (HSA). Complete blood counts were evaluated 7 days after the first dose of ifosfamide and doxorubicin. One dog had grade 4 neutropenia (<500 µL−1) after treatment with ifosfamide and one dog had grade 3 neutropenia (500–1000 µL−1) after treatment with doxorubicin. One dog treated with doxorubicin was hospitalized for 24 h due to vomiting. The median survival time (ST) for the 27 dogs with HSA treated by surgery and with doxorubicin/ifosfamide was 149 days (mean 366 days). Although the protocol of alternating ifosfamide and doxorubicin was well tolerated, it failed to result in a statistically significant improvement in the ST when compared to a historical population of dogs with stage 2 splenic HSA treated by surgery alone.
Breed incidence of lymphoma in a UK population of insured dogs
Authors: Edwards D. S. , Henley W. E. , Harding E. F. , Dobson J. M. , Wood J. L. N.
Published: March 2004

Canine lymphoma is one of the commonest forms of spontaneous canine neoplasia. Improved understanding of the genetic and environmental risk factors for canine lymphoma, including breed differences, may have comparative benefits for the study of non‐Hodgkin's lymphoma in humans. In this study, data from a pet insurance company were used to estimate the incidences of canine lymphoma for pedigree breeds in the UK. Out of a total of 130 684 insured dogs, 103 had a diagnosis of lymphoma recorded. A significant breed effect was found with the boxer, bulldog and bull mastiff breeds, all having a high incidence of lymphoma. The small number of lymphoma cases recorded may have limited our ability to detect other breeds with an elevated risk. Incidence of lymphoma was found to increase with age, peaking at 10 years of age.
The bisphosphonates alendronate and zoledronate are inhibitors of canine and human osteosarcoma cell growth in vitro
Authors: Poirier V. J. , Huelsmeyer M. K. , Kurzman I. D. , Thamm D. H. , Vail D. M.
Published: March 2004

Bisphosphonates (BPs) are a class of non‐hydrolysable analogues of pyrophosphate that have high affinity for bone mineral and are inhibitors of bone resorption. The in vitro effects of two nitrogen‐containing BPs, alendronate (ALE) and zoledronate (ZOL), on growth, induction of apoptosis and effects on cell‐cycle distribution in two canine and two human osteosarcoma (OSA) cell lines are investigated here. Both significantly (P < 0.001) reduced cell growth in all cell lines, as assessed by a colorimetric assay with IC50 values in the range of 7.3–61.4 µM and 7.9–36.3 µM for ALE and ZOL, respectively. Both BPs caused a significant (P < 0.001) dose‐dependent increase in the proportion of cells undergoing apoptosis, as assessed both by cell‐cycle analysis and by annexin‐V binding. Both ALE and ZOL altered the proportion of cells in each phase of the cell cycle, but the extent and proportion was both drug and cell line dependent. These data indicate that the nitrogen‐containing BPs have direct anti‐tumour activity against canine and human OSA cells.
A combination chemotherapy protocol with MOPP and CCNU consolidation (Tufts VELCAP‐SC) for the treatment of canine lymphoma
Authors: Morrison‐Collister K. E. , Rassnick K. M. , Northrup N. C. , Kristal O. , Chretin J. D. , Williams L. E. , Cotter S. M. , Moore A. S.
Published: March 2004

A chemotherapy protocol using a consolidation phase of alkylating agents was used for treating 94 dogs with lymphoma. Fifty‐seven percent of dogs were in stage V, 63% were ill and 38% had T‐cell lymphoma. The complete remission (CR) rate was 70% and is comparable to results achieved with previously published chemotherapy protocols. Anorexia predicted the remission; of the 40 dogs without anorexia, 35 (88%) achieved CR whereas of 52 dogs with anorexia, 30 (58%) achieved CR.

Median first CR duration was 168 days and 1‐ and 2‐year CR rates were 17.4 and 15.5%, respectively. Platelet count affected length of first CR, with a 53.2% reduced chance of coming out of remission with each log increase in platelet count. Median survival time was 302 days. One and 2‐year survival rates were 44 and 13%, respectively. Anorexia and no dose reduction of any drug were independent negative variables. Of 93 dogs with toxicity data, 65 dogs (70%) required a dose reduction. Cyclophosphamide was most commonly reduced with reductions in 31 (38%) of 82 dogs. A dose reduction was significantly more likely in dogs with B‐cell lymphoma than in those with T‐cell lymphoma.
Hypertrophic osteopathy secondary to pulmonary sarcoma in a cat
Authors: Grierson J. M. , Burton C. A. , Brearley M. J.
Published: March 2004

A case of hypertrophic osteopathy secondary to a pulmonary spindle cell sarcoma is described. The 9‐year‐old male cat presented with a 1‐month history of decreased appetite, decreased activity and progressive lameness with swelling and pain of all four limbs. Thoracic radiographs showed a soft tissue opaque mass in the left caudal lung lobe. Radiographs of all limbs showed extensive periosteal new bone formation of uniform opacity demonstrating a ‘palisading’ pattern. The lung mass was removed at exploratory thoracotomy; histopathological examination diagnosed a low‐grade spindle cell sarcoma. Prior to surgery, the cat had a non‐specific conjunctivitis that resolved spontaneously following lobectomy raising the possibility of a paraneoplastic association. The lameness also resolved; six months after surgery, the periosteal palisading of new bone on the long bones had remodelled, and there was no evidence of pulmonary metastases.
Net ecosystem carbon exchange in two experimental grassland ecosystems
Authors: Verburg Paul S. J. , Arnone John A. , Obrist Daniel , Schorran David E. , Evans R. David , Leroux‐swarthout Debbie , Johnson Dale W. , Luo Yiqi , Coleman James S.
Published: March 2004

Increases in net primary production (NPP) may not necessarily result in increased C sequestration since an increase in uptake can be negated by concurrent increases in ecosystem C losses via respiratory processes. Continuous measurements of net ecosystem C exchange between the atmosphere and two experimental cheatgrass (Bromus tectorum L.) ecosystems in large dynamic flux chambers (EcoCELLs) showed net ecosystem C losses to the atmosphere in excess of 300 g C m−2 over two growing cycles. Even a doubling of net ecosystem production (NEP) after N fertilization in the second growing season did not compensate for soil C losses incurred during the fallow period. Fertilization not only increased C uptake in biomass but also enhanced C losses through soil respiration from 287 to 469 g C m−2, mainly through an increase in rhizosphere respiration. Fertilization decreased dissolved inorganic C losses through leaching of from 45 to 10 g C m−2.

Unfertilized cheatgrass added 215 g C m−2 as root‐derived organic matter but the contribution of these inputs to long‐term C sequestration was limited as these deposits rapidly decomposed. Fertilization increased NEP but did not increase belowground C inputs most likely due to a concurrent increase in the production and decomposition of rhizodeposits. Decomposition of soil organic matter (SOM) was reduced by fertilizer additions. The results from our study show that, although annual grassland ecosystems can add considerable amounts of C to soils during the growing season, it is unlikely that they sequester large amounts of C because of high respiratory losses during dormancy periods. Although fertilization could increase NEP, fertilization might reduce soil C inputs as heterotrophic organisms favor root‐derived organic matter over native SOM.
Fall Prevention in Residential Care: A Cluster, Randomized, Controlled Trial
Authors: Kerse Ngaire , Butler Meg , Robinson Elizabeth , Todd Maree
Published: March 2004

Objectives: To establish the effectiveness of a fall‐prevention program in reducing falls and injurious falls in older residential care residents.

Design: Cluster, randomized, controlled trial.

Setting: Fourteen randomly selected residential care homes in Auckland, New Zealand.

Participants: All older residents (n=628, 95% participation rate).

Intervention: Residential care staff, using existing resources, implemented systematic individualized fall‐risk management for all residents using a fall‐risk assessment tool, high‐risk logo, and strategies to address identified risks.

Measurements: Number of residents sustaining a fall, falls, and injurious‐falls incidence rates.

Results: During 12 months of follow‐up, 103 (43%) residents in the control group and 173 (56%) residents in the intervention group fell (P<.018). There was a significantly higher incidence rate of falls in intervention homes than in control homes (incident rate ratio=1.34, 95% confidence interval=1.06–1.72) during the intervention period after adjusting for dependency level (type of home), baseline fall rate, and clustering. There was no difference in the injurious fall incidence rate or incidence of serious injuries.

Conclusion: This fall‐prevention intervention did not reduce falls or injury from falls. Low‐intensity intervention may be worse than usual care.
Alcohol Intake and Risk of Dementia
Authors: Luchsinger Jose A. , Tang Ming‐Xin , Siddiqui Maliha , Shea Steven , Mayeux Richard
Published: March 2004

Objectives: To examine the association between intake of alcoholic beverages and risk of Alzheimer's disease (AD) and dementia associated with stroke (DAS) in a cohort of elderly persons from New York City.

Design: Cohort study.

Setting: The Washington Heights Inwood–Columbia Aging Project.

Participants: Nine hundred eighty community‐dwelling individuals aged 65 and older without dementia at baseline and with data on alcohol intake recruited between 1991 and 1996 and followed annually.

Measurements: Intake of alcohol was measured using a semiquantitative food frequency questionnaire at baseline. Subjects were followed annually, and incident dementia was diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and classified as AD or DAS.

Results: After 4 years of follow‐up, 260 individuals developed dementia (199 AD, 61 DAS). After adjusting for age, sex, apolipoprotein E (APOE)‐ɛ4 status, education, and other alcoholic beverages, only intake of up to three daily servings of wine was associated with a lower risk of AD (hazard ratio=0.55, 95% confidence interval=0.34–0.89). Intake of liquor, beer, and total alcohol was not associated with a lower risk of AD. Stratified analyses by the APOE‐ɛ4 allele revealed that the association between wine consumption and lower risk of AD was confined to individuals without the APOE‐ɛ4 allele.

Conclusion: Consumption of up to three servings of wine daily is associated with a lower risk of AD in elderly individuals without the APOEε‐4 allele.
Periodontal Disease and Weight Loss in Older Adults
Authors: Weyant Robert J. , Newman Anne B. , Kritchevsky Stephen B. , Bretz Walter A. , Corby Patricia M. , Ren Dianxu , Weissfeld Lisa , Rubin Susan M. , Harris Tamara
Published: March 2004

Objectives: To determine the association between periodontal disease and weight loss in an elderly cohort.

Design: A longitudinal design was used with participants from the Health, Aging and Body Composition (Health ABC) cohort study to determine the association between periodontal disease status and weight loss of at least 5% of baseline body weight over a period of 2 years.

Setting: Participants were examined in research clinics in Pittsburgh, Pennsylvania, and Memphis, Tennessee.

Participants: A randomly selected subset of 1,053 individuals from the Health ABC examination, aged 65 and older, ambulatory and community‐dwelling at baseline.

Measurements: Periodontal disease was measured as mean pocket depth and attachment loss, extent (percentage) of pockets with at least 6 mm probing depth, extent of bleeding on probing, and tissue inflammation.

Results: In logistic regression models adjusting for variables that may explain weight loss, extent of periodontal pockets with at least 6 mm probing depth showed a significant association with weight loss (odds ratio=1.53, 95% confidence interval=1.32–1.77).

Conclusion: Periodontal disease may be causally related to weight loss in the elderly and thus may increase risk of morbidity and mortality.
Arterial Stiffness Is Associated with Orthostatic Hypotension in Elderly Subjects with History of Falls
Authors: Boddaert Jacques , Tamim Hani , Verny Marc , Belmin Joël
Published: March 2004

Objectives: To test the hypothesis that impaired hemodynamic orthostatic changes commonly observed in the elderly may be related to age‐related increase in arterial wall stiffness.

Design: Convenience sample of consecutive patients admitted for falls.

Setting: Acute‐ and intermediate‐care geriatric ward of a French hospital.

Participants: Fifty‐seven elderly patients (46 women) consecutively admitted to a geriatric ward with a history of recent falls.

Measurements: Orthostatic hypotension (OH) was assessed using blood pressure measurements in the supine position and 1, 2, and 3 minutes after standing. Arterial wall stiffness was assessed using upper‐limb and aortic pulse‐wave velocities, measured with an external pressure transducer connected to a computer.

Results: OH was present in 18 patients with a mean age±standard deviation of 85.4±7.6 (5 men, 13 women) and absent in 39 patients aged 83.7±6.2 (6 men, 33 women). Upper‐limb pulse‐wave velocity was significantly higher, by 16%, in patients with OH than those without (9.91 vs 8.53 m/s; P<.02). Significant correlations were found between upper‐limb pulse‐wave velocity and systolic blood pressure changes after 1 minute of standing (r=0.263, P<.05) and maximal diastolic blood pressure change after standing (r=0.351, P<.01).

Conclusion: Upper‐limb arterial wall stiffness was significantly greater in elderly patients with OH than in patients without OH and was significantly related to blood pressure changes after standing. These results highlight the possible role of age‐related changes in the arterial tree in the hemodynamic response to orthostatic challenges.
Physical Functioning, Depression, and Preferences for Treatment at the End of Life: The Johns Hopkins Precursors Study
Authors: Straton Joseph B. , Wang Nae‐Yuh , Meoni Lucy A. , Ford Daniel E. , Klag Michael J. , Casarett David , Gallo Joseph J.
Published: March 2004

(See editorial comments by Dr. Linda Emanuel on pp 641–642.)

Objectives:  To examine the relationship between worsening physical function and depression and preferences for life‐sustaining treatment.

Design:  Mailed survey of older physicians.

Setting:  Longitudinal cohort study of medical students in the graduating classes from 1948 to 1964 at Johns Hopkins University.

Participants:  Physicians who completed the life‐sustaining treatment questionnaire in 1998 and provided information about health status in 1992 and 1998 (n=645, 83% of respondents to the 1998 questionnaire; mean age 68).

Measurements:  Preferences for life‐sustaining treatment, assessed using a checklist questionnaire in response to a standard vignette.

Results:  Of 645 physicians, 11% experienced clinically significant decline in physical functioning, and 18% experienced worsening depression over the 6‐year period. Physicians with clinically significant functional decline were more likely (adjusted odds ratio (AOR)=2.14, 95% confidence interval (CI)=1.18–3.88) to prefer high‐burden life‐sustaining treatment. Worsening depression substantially modified the association between declining functioning and treatment preferences. Physicians with declining functioning and worsening depression were more likely (AOR=5.33, 95% CI=1.60–17.8) to prefer high‐burden treatment than respondents without declining function or worsening depression.

Conclusion:  This study calls attention to the need for clinical reassessment of preferences for potentially life‐sustaining treatment when health has declined to prevent underestimating the preferences of older patients.
Dietary Patterns of Rural Older Adults Are Associated with Weight and Nutritional Status
Authors: Ledikwe Jenny H. , Smiciklas‐Wright Helen , Mitchell Diane C. , Miller Carla K. , Jensen Gordon L.
Published: March 2004

Objectives: To characterize dietary patterns of rural older adults and relate patterns to weight and nutritional status.

Design: Cross‐sectional.

Setting: Rural Pennsylvania.

Participants: One hundred seventy‐nine community‐dwelling adults aged 66 to 87 years.

Measurements: A home visit was conducted to collect demographic, health behavior, and anthropometric data and a blood sample. Five 24‐hour dietary recall were administered. Cluster analysis classified participants into dietary patterns using food subgroup servings. Chi‐square, analysis of covariance, and logistic regression were used to assess differences across clusters.

Results: A low‐nutrient‐dense cluster (n=107), with higher intake of breads, sweet breads/desserts, dairy desserts, processed meats, eggs, and fats/oils, and a high‐nutrient‐dense cluster (n=72) with higher intake of cereals, dark green/yellow vegetables, other vegetables, citrus/melons/berries, fruit juices, other fruits, milks, poultry, fish, and beans, were identified. Those in the high‐nutrient‐dense cluster had lower energy intake; higher energy‐adjusted intake of fiber, iron, zinc, folate, and vitamins B6, B12, and D; higher Healthy Eating Index scores; higher plasma vitamin B12 levels; and a lower waist circumference. Those with a low‐nutrient‐dense dietary pattern were twice as likely to be obese, twice as likely to have low plasma vitamin B12 levels, and three to 17 times more likely to have low nutrient intake.

Conclusion: This study provides support for recommending a high‐nutrient‐dense dietary pattern for older adults. Behavioral interventions encouraging diets characterized by high‐nutrient‐dense foods may improve weight and nutritional status of older adults.
Strengthening the Fellowship Training Experience: Findings from a National Survey of Fellowship Trained Geriatricians 1990–1998
Authors: Medina‐Walpole Annette , Barker William H. , Katz Paul R.
Published: March 2004

Geriatric fellowship training has significantly advanced in the past 2 decades in number, organization, and accreditation of formal fellowship programs. A recent survey examined career decision‐making, fellowship training, and current professional activities of fellowship trained geriatricians. This paper focuses upon further desired fellowship training identified by these individuals. The responses reflect skills relevant to four aspects of professional performance: administration, management, clinical geriatrics, research, and education.

More than half of the respondents documented the need for increased training in administration, including long‐term care medical directorship and Medicare/managed care. Regarding clinical training, 66% recommended additional subspecialty training, particularly in psychiatry, neurology, rehabilitation, and hospice/palliative care. Seventeen percent identified a need for training in research methodology, grant writing, and mentorship. Some 6% indicated a need for further training in education, citing teaching skills and program/faculty development.

This article provides examples of opportunities to strengthen each of the four defined areas, including formal training in medical administration by the American Medical Director's Association, model strategies for incorporating subspecialties, hospice/palliative care, programs to pursue graduate level training in research at many universities, and faculty development programs such as those offered by Harvard and Stanford.

Accredited geriatric fellowship programs as well as fellows should recognize potential gaps in training, and make available opportunities to strengthen these areas critical to preparing for future careers in geriatric medicine.
Aromatase Inhibitors: Current Indications and Future Prospects for Treatment of Postmenopausal Breast Cancer
Authors: Arora Amit , Potter Jane F.
Published: March 2004

This article provides a comprehensive review of aromatase inhibitors (AIs) for geriatricians, because it appears that more elderly women will be using these drugs in the near future.

Computerized literature searches of Medline were conducted through May 2003. Key words/phrases included in the literature searches were aromatase inhibitors, estrogen, and breast cancer. Limits included English language, age 65 and older, and female sex. All relevant articles were selected and reviewed. AIs suppress intratumoral and plasma estrogen levels significantly. Third‐generation AIs have excellent pharmacological profiles, with no significant drug interactions and better tolerability. These drugs have shown superiority compared with conventional therapies. The results of anastrozole, tamoxifen, and combination trials favors anastrozole over tamoxifen for adjuvant treatment, but further follow‐up is required. AIs are approved for the treatment of advanced metastatic breast cancer (BC) in postmenopausal women whose disease has progressed during tamoxifen therapy. Recent trials have shown that the highly selective third‐generation AIs are effective when used as first‐line therapy in metastatic BC. Their possible use in preventive, adjuvant, and neoadjuvant settings is also being explored.
Altered expression of syndecan‐1 in prostate cancer
Authors: KIVINIEMI JOHANNA , KALLAJOKI MARKKU , KUJALA IINA , MATIKAINEN MARJA‐TERTTU , ALANEN KALLE , JALKANEN MARKKU , SALMIVIRTA MARKKU
Published: March 2004

Syndecan‐1 is a cell surface heparan sulfate proteoglycan expressed by epithelial cells. It interacts with growth factors, matrix components, and other extracellular proteins, and is thought to be involved in processes such as cell growth, differentiation and adhesion. The expression of syndecan‐1 appears generally downregulated in human carcinomas and in experimental cancer models, whereas transfectional expression of syndecan‐1 in cultured cancer cells has been shown to inhibit their growth and other aspects of malignant behavior. These findings suggest that analysis of syndecan‐1 expression might be of prognostic value in cancer diagnosis, and studies on some carcinomas indeed point to an inverse correlation between syndecan‐1 expression and cancer prognosis. So far, little information has been available on the expression of syndecan‐1 in human prostate and prostate disease. We have generated and characterized novel antibodies against syndecan‐1 and applied them to immunohistochemical staining of specimens representing normal prostate as well as benign and malignant (n=23) prostate disease. The results indicate that syndecan‐1 expression is altered but not uniformly absent in prostate cancer, which is in contrast to the expression of high‐molecular‐weight cytokeratins. The data initially suggest an inverse correlation between syndecan‐1 expression and Gleason grade of the tumor, and warrant a larger study to assess the potential prognostic value of analysing syndecan‐1 expression in prostate carcinoma.
Perivascular epithelioid cell tumor (PEComa) of soft tissue: case report with ultrastructural study
Authors: FUKUNAGA MASAHARU
Published: March 2004

A perivascular epithelioid cell tumor (PEComa) arising in the abdominal wall of a 44‐year‐old female is described. The lesion was a well‐circumscribed but unencapsulated, rubbery, subcutaneous mass measuring 3.5×3.5×3.0 cm which was removed by simple excision. It was characterized by a nest‐ or sheet‐like arrangement of round to polygonal cells with round nuclei and abundant clear to slightly eosinophilic cytoplasm containing glycogen. There was mild to moderate nuclear pleomorphism with mitotic activity of 6 per 10 high power fields. A short fascicular proliferation of the tumor cells was observed focally. The stroma contained abundant small vascular channels with hyalinization. Immunohistochemically, the tumor cells were strongly positive for vimentin, epithelial membrane antigen, alpha‐smooth muscle actin, and HMB45. Ultrastructural examination showed poorly differentiated mesenchymal tumor cells without premelanosomes. There was local recurrence 6 years after excision. Pathologists and clinicians should be aware of the existence of PEComa in soft tissue and should differentiate it from other similar lesions.
Chromatic and spatial properties of parvocellular cells in the lateral geniculate nucleus of the marmoset (Callithrix jacchus)
Authors: Blessing Esther M. , Solomon Samuel G. , Maziar Hashemi‐Nezhad  , Morris Brian J. , Martin Paul R.
Published: March 2004

The parvocellular (PC) division of the afferent visual pathway is considered to carry neuronal signals which underlie the red–green dimension of colour vision as well as high‐resolution spatial vision. In order to understand the origin of these signals, and the way in which they are combined, the responses of PC cells in dichromatic (‘red–green colour‐blind’) and trichromatic marmosets were compared. Visual stimuli included coloured and achromatic gratings, and spatially uniform red and green lights presented at varying temporal phases and frequencies.

The sensitivity of PC cells to red–green chromatic modulation was found to depend primarily on the spectral separation between the medium‐ and long‐wavelength‐sensitive cone pigments (20 or 7 nm) in the two trichromatic marmoset phenotypes studied. The temporal frequency dependence of chromatic sensitivity was consistent with centre–surround interactions. Some evidence for chromatic selectivity was seen in peripheral PC cells. The receptive field dimensions of parvocellular cells were similar in dichromatic and trichromatic animals, but the achromatic contrast sensitivity of cells was slightly higher (by about 30%) in dichromats than in trichromats. These data support the hypothesis that the primary role of the PC is to transmit high‐acuity spatial signals, with red–green opponent signals appearing as an additional response dimension in trichromatic animals.
Feed‐forward and feedback regulation of bladder contractility by Barrington's nucleus in cats
Authors: Sasaki Mitsuyoshi
Published: March 2004

The purpose of the present study was to clarify how Barrington's nucleus regulates bladder contractility. Single neurones that discharge at higher rates during micturition contraction were recorded from Barrington's nucleus. Spinal‐projecting neurones were identified by antidromic stimulation of the spinal cord. Seventy‐six spinal‐projecting neurones were classified into four types based on the firing patterns displayed during the relaxation phase of the micturition contraction–relaxation rhythm: (1) ramp‐tonic neurones displayed a ramp increase in firing throughout the relaxation phase, (2) ramp‐silent neurones were silent initially during the relaxation phase and displayed a ramp increase later, (3) flat‐tonic neurones fired constantly, and (4) flat‐silent neurones displayed little firing, being virtually silent throughout relaxation. During the relaxation phase, discharge volleys from Barrington's nucleus to sacral neurones were estimated to increase exponentially as micturition contraction approached. Twenty‐two neurones increased firing even further within 3 s of micturition contraction, suggesting that they are involved in the final stages of initiation of micturition contraction. During micturition contraction, 18 neurones (of which 14 belonged to the ramp‐silent class) displayed maximal firing rates before maximal bladder pressures were reached; firing gradually decreased during micturition contraction. Thirty‐nine neurones (of which 25 belonged to the ramp‐tonic class) displayed constant firing during micturition contraction. This suggests that ramp‐silent neurones might be involved in increasing bladder pressure rapidly and strongly via feed‐forward regulation, while ramp‐tonic neurones might be involved in maintaining high bladder pressure via positive feedback from the bladder afferents. Sixty neurones continued to fire for 1–8 s after the onset of bladder relaxation, suggesting that Barrington's nucleus does not trigger bladder relaxation.
Exploring the connectivity between the cerebellum and motor cortex in humans
Authors: Daskalakis Zafiris J. , Paradiso Guillermo O. , Christensen Bruce K. , Fitzgerald Paul B. , Gunraj Carolyn , Chen Robert
Published: March 2004

Animal studies have shown that cerebellar projections influence both excitatory and inhibitory neurones in the motor cortex but this connectivity has yet to be demonstrated in human subjects. In human subjects, magnetic or electrical stimulation of the cerebellum 5–7 ms before transcranial magnetic stimulation (TMS) of the motor cortex decreases the TMS‐induced motor‐evoked potential (MEP), indicating a cerebellar inhibition of the motor cortex (CBI). TMS also reveals inhibitory and excitatory circuits of the motor cortex, including a short‐interval intracortical inhibition (SICI), long‐interval intracortical inhibition (LICI) and intracortical facilitation (ICF). This study used magnetic cerebellar stimulation to investigate connections between the cerebellum and these cortical circuits. Three experiments were performed on 11 subjects. The first experiment showed that with increasing test stimulus intensities, LICI, CBI and ICF decreased, while SICI increased. The second experiment showed that the presence of CBI reduced SICI and increased ICF. The third experiment showed that the interaction between CBI and LICI reduced CBI. Collectively, these findings suggest that cerebellar stimulation results in changes to both inhibitory and excitatory neurones in the human motor cortex.
Electrophysiological properties of BK channels in Xenopus motor nerve terminals
Authors: Sun Xiao‐Ping , Yazejian Bruce , Grinnell Alan D.
Published: March 2004

Single channel properties of Ca2+‐activated K+ (BK or Maxi‐K) channels have been investigated in presynaptic membranes in Xenopus motoneurone–muscle cell cultures. The occurrence and density of BK channels increased with maturation/synaptogenesis and was not uniform: highest at the release face of bouton‐like synaptic varicosities in contact with muscle cells, and lowest in varicosities that did not contact muscle cells. The Ca2+ affinity of the channel (Kd= 7.7 μm at a membrane potential of +20 mV) was lower than those of BK channels that have been characterized in other terminals. Hill coefficients varied between 1.5 and 2.8 at different potentials and open probability increased e‐fold per 16 mV change in membrane potential over a range of [Ca2+]i from 1 μm to 1 mm. The maximal activation rate of ensembled single BK channel currents was in the submillisecond range at ≥+20 mV. The activation rate increased ∼10‐fold in response to a [Ca2+]i increase from 1 to 100 μm, but increased only ∼2‐fold with a voltage change from +20 to +130 mV. The fastest activation kinetics of BK channels in cell‐attached patches resembled that in inside‐out patches with [Ca2+]i of 100 μm or more, suggesting that many BK channels are located very close to calcium channels. Given the low Ca2+ affinity and rapid Ca2+ binding/unbinding properties, we conclude that BK channels in this preparation are adapted to play an important role in regulation of neurotransmitter release, and they are ideal reporters of local [Ca2+] at the inner membrane surface.
Local inhibition of nitric oxide and prostaglandins independently reduces forearm exercise hyperaemia in humans
Authors: Schrage William G. , Joyner Michael J. , Dinenno Frank A.
Published: March 2004

We tested the hypothesis that inhibition of synthesis of either nitric oxide (NO) or vasodilating prostaglandins (PGs) would not alter exercise hyperaemia significantly, but combined inhibition would synergistically reduce the hyperaemia. Fourteen subjects performed 20 min of moderate rhythmic forearm exercise (10% maximal voluntary contraction). Forearm blood flow (FBF) was measured by Doppler ultrasound. Saline or study drugs were infused (2 ml min−1) into the forearm via a brachial artery catheter to locally inhibit synthesis of NO and PGs during steady state exercise (NG‐nitro‐L‐arginine methyl ester (L‐NAME), 25 mg over 5 min to inhibit NO synthase (NOS); and ketorolac, 3 mg over 5 min to inhibit cyclooxygenase (COX)). After achieving steady state exercise over 5 min (control), L‐NAME was infused for 5 min, followed by 2 min saline, then by a 5 min infusion of ketorolac, and finally by 3 min of saline (n= 7). Drug order was reversed in seven additional subjects, such that single inhibition of NOS or COX was followed by combined inhibition. FBF during exercise decreased to 83 ± 2% of control exercise (100%) with NOS inhibition, followed by a transient decrease to 68 ± 2% of control during COX inhibition. However, FBF returned to levels similar to those achieved during NOS inhibition within 2 min (80 ± 3% of control) and remained stable through the final 3 min of exercise. When COX inhibition was performed first, FBF decreased transiently to 88 ± 4% of control (P < 0.01), and returned to control saline levels by the end of ketorolac infusion. Addition of L‐NAME reduced FBF to 83 ± 3% of control, and it remained stable through to the end of exercise. Regardless of drug order, FBF was ∼80% of steady state control exercise (P < 0.01) during the last 30 s of exercise. We conclude that (1) NO provides a significant, consistent contribution to hyperaemia, (2) PGs contribute modestly and transiently, suggesting a redundant signal compensates for the loss of vasodilating PGs, and (3) NO and PG signals appear to contribute independently to forearm exercise hyperaemia.