bluuebunny/crossref_metadata_2025 huggingface dataset:
The Search for Emerging Decolonizing Methodologies in Qualitative Research
Authors: Lincoln Yvonna S. , González y González Elsa M.
Published: June 2008

Many non-Western and non-English-speaking scholars express the need for supporting a methodological approach that foregrounds the voices of nationals and locals (or indigenous peoples). Supporting this stance, Western scholars will reach out in democratic and liberatory ways that effect research collaboration, helping to foster social justice and locally desired change. This article supports this search via presenting some methodological strategies culled from six different cases of cross-cultural and cross-language research in which both Western and non-Western scholars were involved and/or collaborated. A comparative study of the inquiries themselves, with follow-up interviews with their U.S.-based authors, is the strategy that has been chosen to respond to this search for additional, emerging methodological and narrative approaches to cross-cultural/cross-national research that is useful to both local and Western scholars equally.
Longitudinal Outcomes After Endovascular Repair of Abdominal Aortic Aneurysms
Authors: Vogel T.R. , Symons R.G. , Flum D.R.
Published: June 2008

Objective: Endovascular abdominal aneurysm repair (EVAR) is increasingly used, but there is insufficient evaluation of long-term outcomes. Method: Retrospective cohort study using the linked Washington State hospital discharge database. Result: 3,350 patients underwent elective repair of AAA (1181 EVAR) between 2000 and 2005. EVAR patients were older and had higher comorbidity scores. The 30-day readmission rate after EVAR was 11.6%. The 30-day readmissions included cardiac complications (18.5%) and device complications (10.4%). 46% of the 30-day readmissions after EVAR underwent procedures: abdominal/ iliac angiography (7.4%), angioplasty (8.9%), and device revision (8.2%). Mean time to late interventions was 611 days. Conclusion: Readmission, reintervention, and complication rates after EVAR occur more commonly than previously described. Cardiac complications were the most common readmission. Almost half of the 30-day readmissions required a secondary intervention. Long-term complications after EVAR occurred before two years. Population-based assessment may be more reflective of “real world” complication rates after EVAR.
Long-term Results of Femoro-Femoral Crossover Bypass After Endovascular Aortouniiliac Repair of Abdominal Aortic and Aortoiliac Aneurysms
Authors: Heredero Alvaro F. , Stefanov Stefan , del Moral L. Riera , Leblic Israel , Nistal Marta G. , Mendieta Covadonga , de Cubas L. Riera
Published: June 2008

Aortouniiliac stent grafts allow the endovascular treatment of complex anatomy aortoiliac aneurysms. The main drawback is the need for femoro-femoral crossover bypass, with its complications and its patency limitations. However, some authors have shown good results of femoro-femoral crossover bypass in aneurysmal disease. In this article, initial and long-term results of our experience in femoro-femoral crossover bypass revascularization after endovascular aortouniiliac stent grafts repair of aortoiliac aneurysms is reported. Prospective collection, intention-to-treat, and retrospective analysis maintained database. Femoro-femoral crossover bypass patency assessment of all patients treated between January 1999 and September 2002, compared patients with or without associated occlusive arterial disease. Urgent indications were excluded. In total of 52 patients, with a mean age 72.6 years, 30.8% of patients were identified with associated occlusive arterial disease. Initial systemic and local, access site, complications were 7.7% and 7.7%, respectively, no early thrombosis or death is reported. Primary patency was 90.9% at 54 months, 66 months assisted primary and secondary patency were 97.7% and 100%, respectively. The 48-month survival rate was 84.2%. No significant differences between patients with or without associated occlusive arterial disease were found. Femoro-femoral crossover bypass after aortouniiliac stent grafts treatment of aortoiliac aneurysms shows excellent initial and long-term patency and low complication rate.
Intraoperative Fluid Restriction Predicts Improved Outcomes in Major Vascular Surgery
Authors: Adesanya Adebola , Rosero Eric , Timaran Carlos , Clagett Patrick , Johnston William E.
Published: June 2008

Background: Traditional fluid resuscitation during general anesthesia has been questioned in recent studies. One study of patients undergoing abdominal surgery showed decreased postoperative weight gain, earlier return of bowel function, and shorter intensive care unit (ICU) and hospital length of stay (LOS) when intraoperative crystalloid infusion was restricted. The authors conducted a retrospective study of major vascular surgery patients (neo-aorto iliac system surgery) to correlate clinical outcomes with intraoperative crystalloid fluid administration. Methods: The charts of 41 patients who underwent major vascular surgery at our institution were reviewed. Patients were grouped according to the crystalloid volume infused intraoperatively into <3 L (group 1) and >3 L (group 2). Preoperative and postoperative weights, intraoperative crystalloid administration, intraoperative vasopressor use, preoperative and postoperative creatinine, number of days to clear liquid diet, and the time to discharge from the ICU (ICU LOS) and hospital (hospital LOS) were collected. Results: There were statistically significant differences in duration of mechanical ventilation (0.55 ± 0.934 vs 2.03 ± 2.735 days, P = .013) and ICU LOS (3.0 ± 1.48 vs 5.79 ± 3.938, P = .029) in favor of the fluid restriction group. Major postoperative complications, such as sepsis, acute myocardial infarction, and graft thrombosis, were less frequent in the fluid restriction group but not statistically significant (5 vs 9, P = .742). Intraoperative crystalloid volume was found to be an independent predictor of ICU LOS after adjusting for estimated blood loss and duration of surgery. There was no statistically significant difference in preoperative serum albumin in both groups. Conclusions: Restricted intraoperative administration of crystalloid fluids (<3 L) may be beneficial in major vascular surgery patients. These benefits are similar to those previously described in patients undergoing abdominal surgery.
Descending Thoracic Aortic Dissection: Evaluation and Management in the Era of Endovascular Technology
Authors: Lin Peter H. , Huynh Tam T. , Kougias Panagiotis , Huh Joseph , LeMaire Scott A. , Coselli Joseph S.
Published: June 2008

Acute aortic dissection is a relatively uncommon but highly lethal condition. Without proper treatment, devastating consequences can occur due to aortic rupture, cardiac tamponade, or irreversible ischemia involving the spinal cord or the visceral organs. The treatment strategy of this condition is in part influenced by the location and the severity of aortic dissection as immediate surgical intervention is necessary in acute ascending aortic dissection, whereas medical therapy is the initial treatment approach in uncomplicated descending aortic dissection. Recent advances of endovascular technology have broadened the potential application of this catheter-based therapy in aortic pathologies, including descending thoracic aortic dissection. In this article, the etiology, pathogenesis, and classification of this condition are discussed. The diagnostic benefits of various imaging modalities for descending aortic dissection are also discussed. Current treatment strategies, including medical, surgical, and catheter-based interventions, are reviewed. Lastly, clinical experiences of endovascular treatment for descending aortic dissection and various endovascular devices potentially applicable for this condition are discussed.
Safety and Efficacy of Carotid Angioplasty/Stenting in 100 Consecutive High Surgical Risk Patients: Immediate and Long-Term Follow-up
Authors: AbuRahma Ali F. , Bates Mark C. , Eads Kris , Armistead Lauren , Flaherty Sarah K.
Published: June 2008

Background/purpose. This study analyzes the safety and efficacy of carotid angioplasty/stenting (CAS) with embolic protection devices in high surgical risk (HSR) patients. Patient population/methods. This study includes 100 consecutive HSR patients, who were followed prospectively, and had carotid duplex ultrasounds at 1 month and every 6 months thereafter. A Kaplan—Meier lifetable analysis was used to estimate survival rates, rates of freedom from stroke, and freedom from ≥50% in-stent restenosis. Results. Mean age was 69.6 years. There were 59 men and 41 women. Mean follow-up was 26.1 months (range, 1-50). Indications for CAS were symptomatic ≥50% stenosis in 47% and ≥80% asymptomatic stenosis in 53%. Procedure success rate was 100%. HSR includes 33% with restenosis and cardiac comorbidity, 21% with restenosis and cardiac/medical comorbidities, 13% with restenosis only, and 33% with cardiac/medical comorbidities. The 30-day perioperative stroke rate was 2% with no perioperative deaths or MI. Stroke-free survival rates were 95%, 91%, 83%, 79%, and 73% at 1, 2, 3, and 4 years, respectively. There were no late strokes. Stroke-free rate was 98% at 1, 2, 3, and 4 years, respectively. Freedom from ≥50% in-stent restenosis was 98%, 93%, 90%, and 79% at 1, 2, 3, and 4 years, respectively. Six patients had asymptomatic ≥80% in-stent restenosis; 3 underwent reintervention (percutaneous transluminal angioplasty). The incidence of in-stent restenosis was not statistically significant between patients who had restenosis after carotid endarterectomy and patients with primary stenting ( P = .21). Conclusions. CAS with embolic protection devices in HSR patients is safe and effective.
Endovascular Covered Stenting for Visceral Artery Pseudoaneurysm Rupture: Report of 2 Cases and a Summary of the Disease Process and Treatment Options
Authors: Pasklinsky Garri , Gasparis Antonios P. , Labropoulos Nicos , Pagan Jose , Tassiopoulos Apostolos K. , Ferretti John , Ricotta John J.
Published: June 2008

We present 2 cases of hemorrhage from a visceral artery pseudoaneurysm, managed successfully with endovascular covered stent placement. The first case was a 59-year-old man, 3 months after a laparoscopic distal pancreatectomy for adenoma, presenting with diffuse abdominal pain. The patient was evaluated with a computed tomography scan revealing a splenic artery pseudoaneurysm (PA) bleeding into a pancreatic pseudocyst. He was emergently taken to the angiography suite where a covered stent was deployed at the level of splenic artery PA. The second case was a 52-year-old woman with recurrent left retroperitoneal mass 5 years after distal pancreatectomy and splenectomy for a nonfunctional neuroendocrine tumor. She underwent resection of the mass in the left upper quadrant. Postoperative course was complicated by hematoma, abscess formation, reexploration, and repair of the duodenotomy and the portal vein. Subsequently, she was noted to have intermittent gastrointestinal hemorrhage, which prompted an angiogram revealing a hepatic artery PA that was repaired with a covered balloon-expandable stent. A completion angiogram was obtained in each case demonstrating exclusion of the PA. Our experience with these 2 cases supports the notion that endovascular covered stenting is a safe and effective therapy for exclusion of visceral artery aneurysm.
Integration of Patient Safety Technologies Into Sclerotherapy for Varicose Veins
Authors: Sibbitt Randy R. , Palmer Dennis J. , Sibbitt Wilmer L.
Published: June 2008

The American College of Surgeons, the Joint Commission, the Needlestick Safety and Prevention Act, and the Occupational Safety and Health Administration all direct surgical departments, including vascular surgeons who supply sclerotherapy services, to develop formal mechanisms to improve the safety of the patient and health care worker (HCW), including integration of new safety technologies. The purpose of the present study was to identify and evaluate new safety technologies for outpatient sclerotherapy for chronic venous disease. Using national resources for patient safety and literature review, the following safety technologies were identified: (1) a safety needle to reduce inadvertent needlesticks to workers, and (2) the reciprocating procedure device (RPD) to reduce iatrogenic injuries to patients. Both devices were evaluated in the clinic, and physician responses were determined. Although the safety sheath of the needle was somewhat bulky and could interfere with the ultrasound transducer, sclerotherapy could be performed with it. The RPD safety device required instruction to show how the RPD functioned (“push-push” to aspirate-inject with the RPD rather than the usual “push-pull” with the conventional syringe), but the RPD permitted better needle control and more precise injections. The RPD was well accepted by physicians who found it to be convenient, safer, and less painful. Subsequently, the involved services successfully integrated these safety technologies into their routine clinical practices. As recommended by the Joint Commission, safety technologies can be successfully evaluated and introduced into the clinic to improve patient and HCW safety during physician-performed syringe and needle procedures, including sclerotherapy.
Leadership Talent Identification and Development
Authors: Rhodes Christopher , Brundrett Mark , Nevill Alan
Published: June 2008

This article reports on outcomes from a study funded by the National College for School Leadership (NCSL) designed to explore leadership talent identification, development, succession and retention in contextually different primary and secondary schools in England. Focus groups and a questionnaire were used to secure perceptions of heads, middle leaders and classroom teachers about leadership talent identification and development. Twenty characteristics indicative of leadership talent were identified. Agreement and disjuncture were recorded concerning the importance of characteristics among respondent groups. The implications of these findings for leadership development and succession, in the face of a potential leadership crisis in the UK and internationally, are discussed. The longer-term career planning of staff, the place of needs analysis, self-disclosure and senior leadership decision-making are examined with respect to leadership talent identification and development. The article offers a basis upon which schools can reflect on their role in providing a good training ground for future leaders. School-based changes are recommended so that individual school's longer-term leadership requirements may be better addressed.
Principals' Performance Assessment
Authors: Gaziel Haim
Published: June 2008

Despite the current interest in many countries in assessing the principal's performance, stemming from the greater attention to educational reform and accountability, the empirical study of principal's appraisal has been slow to develop. This article was designed to fill partially this gap. Data was collected by semi-structured interviews of eight primary school supervisors and 24 primary school principals from four of the six educational districts in Israel. The subjects were asked to respond to the following questions related to the purposes of the principals' appraisal, political factors exerted on principals' appraisal, assessment usefulness and its impact upon principals' effectiveness. Results reveal that both groups had different perceptions regarding the principal appraisal purposes, processes, usefulness and effectiveness, which corroborate studies conducted in other countries. While most of the supervisors believed that the assessment process was helpful, 75 percent of the principals reported that the assessment was a waste of time. Regarding the improvement of the process, while the supervisors put emphasis on summative assessment and the need for more resources for supervision, school principals emphasized formative assessment, portfolios, being involved in the process and peer assessment.
Continuous positive airway pressure machines and the work of coordinating technologies at home
Authors: Moreira Tiago
Published: June 2008

Objectives: Research on the use of health technology at home has consistently reported that it is underpinned by users' evaluations of the technology in relation to their illness trajectory, their social network, and the place where it is used. Recent studies have also revealed that the efficacy of health technologies depends upon users' work that is largely invisible to professionals, managers and designers. This paper draws on the most widely used therapy for the management of sleep apnoea, continuous positive airway pressure (CPAP), to show how users maintain workable relationships between it and other technological elements of the domestic environment.

Methods: Qualitative analysis was performed of an archive of messages sent to a web-based support group for sleep disorders between 1994 and 2007.

Results: Users describe two related techniques: first, drawing on their embodied knowledge of using domestic technologies to imagine potential, alternative environments for CPAP; and second, using their body as an instrument to assess the `fit' of each of the attempted arrangements. The interaction between these two techniques entails frequent shifts in users' understandings of their illness and those involved in its management.

Conclusion: Strategies of implementation of health technologies at home should acknowledge and incorporate the embodied knowledge processes of users.
Integration of devices into long-term condition management: a synthesis of qualitative studies
Authors: Gately Claire , Rogers Anne , Kirk Susan , McNally Rosalind
Published: June 2008

Background: Understanding peoples' responses to and ability to incorporate technology for managing long-term conditions into their everyday lives is relevant for informing the development and implementation of new technologies as part of future long-term condition management in domestic environments. Future research and theory building can be facilitated by the synthesis of existing qualitative studies.

Methods: A systematic search for qualitative studies of health technologies at home was undertaken on OVID CINAHL, OVID Medline and CSA databases for the period 1996—2006. Studies ( n = 12) that met the inclusion criteria were synthesized and their analyses subjected to qualitative meta-synthesis.

Findings: Analyses clustered into five themes: (1) managing multiple uncertainties; (2) the reconstruction of identity; (3) the struggle to remain autonomous while allowing dependence; (4) coming to terms with living a technology-assisted life; and (5) the usability of devices. These translated into a line of argument synthesis in which technology takes on the status of a personified `other' around which a set of personal and relational attributions are subsequently constructed. These allow the extension of existing illness work to incorporate new technologies.

Conclusions: Ambivalence about the value of technologies that are designed to assist with the management of a long-term condition reflects experiences of the disruptive effects of health technologies on personal identities and strategies of managing illness. At the same time, they are highly valued because they provided new opportunities to complete aspects of illness work that were previously impossible.
The Use of a Combination of Cerclage and Unicortical Interosseous Loop Dental Wires For Long Oblique/Spiral Metacarpal Shaft Fractures
Authors: AL-QATTAN M. M.
Published: June 2008

A literature review of metacarpal fracture fixation techniques revealed that the use of a combination of interosseous and cerclage dental loop wires has not been previously described. In this report, we review the results of 24 patients with long oblique/spiral metacarpal shaft fractures of the fingers treated by this combined technique of internal fixation, followed by immediate postoperative finger mobilisation in a wrist splint.

The study included 20 men and four women with a mean age of 32 (range 20–48) years. After a mean follow-up of 10 weeks, 23 patients had regained full range of motion of the fingers. Complications included one case of CRPS Type 1 resulting in mild stiffness and all four women complained of the hyperpigmentation of the dorsal hand scars. The advantages of dental wire fixation were discussed and compared to those of lag screws.
STAT3 is required for IL-21–induced secretion of IgE from human naive B cells
Authors: Avery Danielle T. , Ma Cindy S. , Bryant Vanessa L. , Santner-Nanan Brigitte , Nanan Ralph , Wong Melanie , Fulcher David A. , Cook Matthew C. , Tangye Stuart G.
Published: June 2008

The production of immunoglobulin E (IgE) is tightly regulated. This is evidenced by the fact that it comprises less than 0.0001% of serum Ig, and aberrant production causes atopic conditions, including allergy, rhinitis, and anaphylaxis. Interleukin-4 (IL-4) is a well-characterized inducer of IgE by human and murine B cells, whereas interferon-γ can antagonize this effect. IL-21 has also been recognized for its ability to suppress IL-4–induced IgE production by murine B cells. Here, we identified IL-21 as an inducer of IgE production by CD40L-stimulated human naive B cells. Furthermore, there was a striking synergy between IL-4 and IL-21 on inducing IgE secretion by CD40L-stimulated human B cells, such that the levels detected under these conditions exceeded those induced by IL-4 or IL-21 alone by more than 10-fold. IL-21 induced activation of STAT3 and analysis of B cells from patients with loss-of-function STAT3 mutations revealed that the ability of IL-21 to induce IgE secretion, and augment that driven by IL-4, was STAT3-dependent. These findings highlight a fundamental difference between the regulation of IgE production by human and murine B cells and have implications for the dysregulated production of IgE in conditions characterized by extremely high levels of serum IgE.
Retention of Plasmodium falciparum ring-infected erythrocytes in the slow, open microcirculation of the human spleen
Authors: Safeukui Innocent , Correas Jean-Michel , Brousse Valentine , Hirt Déborah , Deplaine Guillaume , Mulé Sébastien , Lesurtel Mickael , Goasguen Nicolas , Sauvanet Alain , Couvelard Anne , Kerneis Sophie , Khun Huot , Vigan-Womas Inès , Ottone Catherine , Molina Thierry Jo , Tréluyer Jean-Marc , Mercereau-Puijalon Odile , Milon Geneviève , David Peter H. , Buffet Pierre A.
Published: June 2008

The current paradigm in Plasmodium falciparum malaria pathogenesis states that young, ring-infected erythrocytes (rings) circulate in peripheral blood and that mature stages are sequestered in the vasculature, avoiding clearance by the spleen. Through ex vivo perfusion of human spleens, we examined the interaction of this unique blood-filtering organ with P falciparum–infected erythrocytes. As predicted, mature stages were retained. However, more than 50% of rings were also retained and accumulated upstream from endothelial sinus wall slits of the open, slow red pulp microcirculation. Ten percent of rings were retained at each spleen passage, a rate matching the proportion of blood flowing through the slow circulatory compartment established in parallel using spleen contrast-enhanced ultrasonography in healthy volunteers. Rings displayed a mildly but significantly reduced elongation index, consistent with a retention process, due to their altered mechanical properties. This raises the new paradigm of a heterogeneous ring population, the less deformable subset being retained in the spleen, thereby reducing the parasite biomass that will sequester in vital organs, influencing the risk of severe complications, such as cerebral malaria or severe anemia. Cryptic ring retention uncovers a new role for the spleen in the control of parasite density, opening novel intervention opportunities.
Whole-body resting and exercise-induced lipolysis in sarcopaenic patients with COPD
Authors: Franssen F. M. E. , Sauerwein H. P. , Rutten E. P. A. , Wouters E. F. M. , Schols A. M. W. J.
Published: June 2008

Impaired β-adrenoceptor-mediated lipolysis has been reported in sarcopaenic chronic obstructive pulmonary disease (COPD) patients. This could play a role in the shift in body composition towards decreased fat-free mass (FFM) and relative maintenance of fat mass (FM). Lipolysis could be affected by chronic treatment with β2-agonists or disease-related factors. Therefore, whole-body resting and exercise-induced lipolysis were investigated in sarcopaenic COPD patients with moderate disease severity.

Seven sarcopaenic COPD patients (mean±semforced expiratory volume in one second (FEV1) 53±5% of the predicted value; body mass index (BMI) 27.5±0.9 kg·m−2) and seven controls matched for age, sex and BMI were studied. In addition, six underweight COPD patients (FEV151±5% pred; BMI 20.6±0.7 kg·m−2) matched for disease severity were recruited. Lipolysis and plasma levels of catecholamines were assessed during infusion of [2H5]glycerol at rest and during submaximal cycling exercise.

The proportional FM was comparable between sarcopaenic patients and controls, whereas the FFM index was significantly reduced in patients. At rest, the rate of appearance (Ra) of glycerol (4.1±0.6 and 3.3±0.2 μmol·kg FFM−1·min−1, respectively) did not differ significantly. In underweight patients, glycerolRa(4.3±0.5 μmol·kg FFM−1·min−1) was also comparable. End-of-exercise lipolytic rates did not differ significantly between groups. GlycerolRawas not related to FM. Resting adrenalin levels were significantly increased in underweight COPD patients and were related to resting lipolysis.

Sarcopaenia in chronic obstructive pulmonary disease patients with moderate disease severity is not characterised by an abnormal lipolytic rate. Altered regulation of muscle protein turnover seems to be the trigger in the body compositional shift observed in these patients.
Novel mutations in the folliculin gene associated with spontaneous pneumothorax
Authors: Fröhlich B. A. , Zeitz C. , Mátyás G. , Alkadhi H. , Tuor C. , Berger W. , Russi E. W.
Published: June 2008

Spontaneous pneumothorax is mostly sporadic but may also occur in families with genetic disorders, such as Birt–Hogg–Dubé syndrome, which is caused by mutations in the folliculin (FLCN) gene.

The aim of the present study was to investigate the presence and type of mutation in a Swiss pedigree and in a sporadic case. Clinical examination, lung function tests and high-resolution computed tomography were performed. All coding exons and flanking intronic regions ofFLCNwere amplified by PCR and directly sequenced. The amount ofFLCNtranscripts was determined by quantitative real-time RT-PCR.

Two novel mutations inFLCNwere identified. Three investigated family members with a history of at least one spontaneous pneumothorax were heterozygous for a single nucleotide substitution (c.779G>A) that leads to a premature stop codon (p.W260X). Quantitative real-time RT-PCR revealed a reduction ofFLCNtranscripts from the patient compared with an unaffected family member. DNA from the sporadic case carried a heterozygous missense mutation (c.394G>A). Lung function of this patient was normal and computed tomography showed similar bilateral cysts, as observed in the two members of the unrelated Swiss family.

Mutations in the folliculin gene are associated with cystic lung lesions in an otherwise morphological normal lung and predispose to spontaneous pneumothorax.
International variation in prevalence of rhinitis and its relationship with sensitisation to perennial and seasonal allergens
Authors: Weinmayr G. , Forastiere F. , Weiland S. K. , Rzehak P. , Abramidze T. , Annesi-Maesano I. , Björkstén B. , Brunekreef B. , Büchele G. , Cookson W. O. C. , von Mutius E. , Pistelli R. , Strachan D. P.
Published: June 2008

The relative importance of atopy in the aetiology of rhinitis is largely unknown. The present study investigated the geographical variations in rhinitis in relation to atopy.

The cross-sectional study involved 54,178 children (aged 8–12 yrs) from 30 study centres in 22 countries worldwide. Symptoms of rhinoconjunctivitis and rhinitis without conjunctivitis in the last 12 months were reported in parental questionnaires and children were skin-prick tested.

The prevalence of rhinoconjunctivitis and rhinitis without conjunctivitis varied widely (1.5–24.5% and 1.4–45.2%, respectively). For rhinoconjunctivitis, the population attributable fraction (PAF) varied 0–71% for a positive skin-prick test to one or more seasonal allergens and 0–41% for perennial allergens. The PAF for sensitisation to seasonal and perennial allergens was higher in affluent countries (36 and 25%, respectively) than nonaffluent countries (1.3 and 12.6%, respectively). For rhinitis without conjunctivitis, the PAF for perennial allergens was 8 and 4% for affluent and nonaffluent countries, respectively. No significant PAF was found for seasonal allergens.

Overall, atopy explained only a limited proportion of rhinitis symptoms, suggesting that the importance of other environmental factors has been under emphasised, particularly in less affluent countries. Atopy seems to be only marginally relevant for rhinitis without conjunctivitis, which seems mainly to reflect nonatopic rhinitis.
ParaHox gene expression in larval and postlarval development of the polychaete Nereis virens(Annelida, Lophotrochozoa)
Authors: Kulakova Milana A , Cook Charles E , Andreeva Tatiana F
Published: June 2008

Background

Transcription factors that encode ANTP-class homeobox genes play crucial roles in determining the body plan organization and specification of different organs and tissues in bilaterian animals. The three-gene ParaHox family descends from an ancestral gene cluster that existed before the evolution of the Bilateria. All three ParaHox genes are reported from deuterostomes and lophotrochozoans, but not to date from any ecdysozoan taxa, and there is evidence that the ParaHox genes, like the related Hox genes, were ancestrally a single chromosomal cluster. However, unlike the Hox genes, there is as yet no strong evidence that the ParaHox genes are expressed in spatial and temporal order during embryogenesis.

Results

We isolated fragments of the three Nereis virens ParaHox genes, then used these as probes for whole-mount in situ hybridization in larval and postlarval worms. In Nereis virens the ParaHox genes participate in antero-posterior patterning of ectodermal and endodermal regions of the digestive tract and are expressed in some cells in the segment ganglia. The expression of these genes occurs in larval development in accordance with the position of these cells along the main body axis and in postlarval development in accordance with the position of cells in ganglia along the antero-posterior axis of each segment. In none of these tissues does expression of the three ParaHox genes follow the rule of temporal collinearity.

Conclusion

In Nereis virens the ParaHox genes are expressed during antero-posterior patterning of the digestive system (ectodermal foregut and hindgut, and endodermal midgut) of Nereis virens. These genes are also expressed during axial specification of ventral neuroectodermal cell domains, where the expression domains of each gene are re-iterated in each neuromere except for the first parapodial segment. These expression domains are probably predetermined and may be directed on the antero-posterior axis by the Hox genes, whose expression starts much earlier during embryogenesis. Our results support the hypothesis that the ParaHox genes are involved in antero-posterior patterning of the developing embryo, but they do not support the notion that these genes function only in the patterning of endodermal tissues.
Expression of cell wall related genes in basal and ear internodes of silking brown-midrib-3, caffeic acid O-methyltransferase (COMT) down-regulated, and normal maize plants
Authors: Guillaumie Sabine , Goffner Deborah , Barbier Odile , Martinant Jean-Pierre , Pichon Magalie , Barrière Yves
Published: June 2008

Background

Silage maize is a major forage and energy resource for cattle feeding, and several studies have shown that lignin content and structure are the determining factors in forage maize feeding value. In maize, four natural brown-midrib mutants have modified lignin content, lignin structure and cell wall digestibility. The greatest lignin reduction and the highest cell wall digestibility were observed in the brown-midrib-3 (bm3) mutant, which is disrupted in the caffeic acid O-methyltransferase (COMT) gene.

Results

Expression of cell wall related genes was investigated in basal and ear internodes of normal, COMT antisens (AS225), and bm3 maize plants of the INRA F2 line. A cell wall macro-array was developed with 651 gene specific tags of genes specifically involved in cell wall biogenesis. When comparing basal (older lignifying) and ear (younger lignifying) internodes of the normal line, all genes known to be involved in constitutive monolignol biosynthesis had a higher expression in younger ear internodes. The expression of the COMT gene was heavily reduced, especially in the younger lignifying tissues of the ear internode. Despite the fact that AS225 transgene expression was driven only in sclerenchyma tissues, COMT expression was also heavily reduced in AS225 ear and basal internodes. COMT disruption or down-regulation led to differential expressions of a few lignin pathway genes, which were all over-expressed, except for a phenylalanine ammonia-lyase gene. More unexpectedly, several transcription factor genes, cell signaling genes, transport and detoxification genes, genes involved in cell wall carbohydrate metabolism and genes encoding cell wall proteins, were differentially expressed, and mostly over-expressed, in COMT-deficient plants.

Conclusion

Differential gene expressions in COMT-deficient plants highlighted a probable disturbance in cell wall assembly. In addition, the gene expressions suggested modified chronology of the different events leading to cell expansion and lignification with consequences far beyond the phenylpropanoid metabolism. The reduced availability of monolignols and S units in bm3 or AS225 plants led to plants also differing in cell wall carbohydrate, and probably protein, composition. Thus, the deficiency in a key-enzyme of the lignin pathway had correlative effects on the whole cell wall metabolism. Furthermore, the observed differential expression between bm3 and normal plants indicated the possible involvement in the maize lignin pathway of genes which up until now have not been considered to play this role.
Induction of beta defensin 2 by NTHi requires TLR2 mediated MyD88 and IRAK-TRAF6-p38MAPK signaling pathway in human middle ear epithelial cells
Authors: Lee Haa-Yung , Takeshita Tamotsu , Shimada Jun , Akopyan Arsen , Woo Jeong-Im , Pan Huiqi , Moon Sung K , Andalibi Ali , Park Rae-Kil , Kang Sung-Ho , Kang Shin-Seok , Gellibolian Robert , Lim David J
Published: June 2008

Background

All mucosal epithelia, including those of the tubotympanium, are secreting a variety of antimicrobial innate immune molecules (AIIMs). In our previous study, we showed the bactericidal/bacteriostatic functions of AIIMs against various otitis media pathogens. Among the AIIMs, human β-defensin 2 is the most potent molecule and is inducible by exposure to inflammatory stimuli such as bacterial components or proinflammatory cytokines. Even though the β-defensin 2 is an important AIIM, the induction mechanism of this molecule has not been clearly established. We believe that this report is the first attempt to elucidate NTHi induced β-defensin expression in airway mucosa, which includes the middle ear.

Methods

Monoclonal antibody blocking method was employed in monitoring the TLR-dependent NTHi response. Two gene knock down methods – dominant negative (DN) plasmid and small interfering RNA (siRNA) – were employed to detect and confirm the involvement of several key genes in the signaling cascade resulting from the NTHi stimulated β-defensin 2 expression in human middle ear epithelial cell (HMEEC-1). The student's t-test was used for the statistical analysis of the data.

Results

The experimental results showed that the major NTHi-specific receptor in HMEEC-1 is the Toll-like receptor 2 (TLR2). Furthermore, recognition of NTHi component(s)/ligand(s) by TLR2, activated the Toll/IL-1 receptor (TIR)-MyD88-IRAK1-TRAF6-MKK3/6-p38 MAPK signal transduction pathway, ultimately leading to the induction of β-defensin 2.

Conclusion

This study found that the induction of β-defensin 2 is highest in whole cell lysate (WCL) preparations of NTHi, suggesting that the ligand(s) responsible for this up-regulation may be soluble macromolecule(s). We also found that this induction takes place through the TLR2 dependent MyD88-IRAK1-TRAF6-p38 MAPK pathway, with the primary response occurring within the first hour of stimulation. In combination with our previous studies showing that IL-1α-induced β-defensin 2 expression takes place through a MyD88-independent Raf-MEK1/2-ERK MAPK pathway, we found that both signaling cascades act synergistically to up-regulate β-defensin 2 levels. We propose that this confers an essential evolutionary advantage to the cells in coping with infections and may serve to amplify the innate immune response through paracrine signaling.
Deferiprone targets aconitase: Implication for Friedreich's ataxia treatment
Authors: Goncalves Sergio , Paupe Vincent , Dassa Emmanuel P , Rustin Pierre
Published: June 2008

Background

Friedreich ataxia is a neurological disease originating from an iron-sulfur cluster enzyme deficiency due to impaired iron handling in the mitochondrion, aconitase being particularly affected. As a mean to counteract disease progression, it has been suggested to chelate free mitochondrial iron. Recent years have witnessed a renewed interest in this strategy because of availability of deferiprone, a chelator preferentially targeting mitochondrial iron.

Method

Control and Friedreich's ataxia patient cultured skin fibroblasts, frataxin-depleted neuroblastoma-derived cells (SK-N-AS) were studied for their response to iron chelation, with a particular attention paid to iron-sensitive aconitase activity.

Results

We found that a direct consequence of chelating mitochondrial free iron in various cell systems is a concentration and time dependent loss of aconitase activity. Impairing aconitase activity was shown to precede decreased cell proliferation.

Conclusion

We conclude that, if chelating excessive mitochondrial iron may be beneficial at some stage of the disease, great attention should be paid to not fully deplete mitochondrial iron store in order to avoid undesirable consequences.
ADAM9 is highly expressed in renal cell cancer and is associated with tumour progression
Authors: Fritzsche Florian R , Wassermann Kirsten , Jung Monika , Tölle Angelika , Kristiansen Ilka , Lein Michael , Johannsen Manfred , Dietel Manfred , Jung Klaus , Kristiansen Glen
Published: June 2008

Background

A DisintegrinAndMetalloprotease (ADAM) 9 has been implicated in tumour progression of various solid tumours, however, little is known about its role in renal cell carcinoma. We evaluated the expression of ADAM9 on protein and transcript level in a clinico-pathologically characterized renal cell cancer cohort.

Methods

108 renal cancer cases were immunostained for ADAM9 on a tissue-micro-array. For 30 additional cases, ADAM9 mRNA of microdissected tumour and normal tissue was analyzed via quantitative RT-PCR. SPSS 14.0 was used to apply crosstables (Fisher's exact test and χ2-test), correlations and univariate as well as multivariate survival analyses.

Results

ADAM9 was significantly up-regulated in renal cancer in comparison to the adjacent normal tissue on mRNA level. On protein level, ADAM9 was significantly associated with higher tumour grade, positive nodal status and distant metastasis. Furthermore, ADAM9 protein expression was significantly associated with shortened patient survival in the univariate analysis.

Conclusion

ADAM9 is strongly expressed in a large proportion of renal cell cancers, concordant with findings in other tumour entities. Additionally, ADAM9 expression is significantly associated with markers of unfavourable prognosis. Whether the demonstrated prognostic value of ADAM9 is independent from other tumour parameters will have to be verified in larger study cohorts.
Physician and patient attitudes towards complementary and alternative medicine in obstetrics and gynecology
Authors: Furlow Mandi L , Patel Divya A , Sen Ananda , Liu J Rebecca
Published: June 2008

Background

In the U.S., complementary and alternative medicine (CAM) use is most prevalent among reproductive age, educated women. We sought to determine general attitudes and approaches to CAM among obstetric and gynecology patients and physicians.

Methods

Obstetrician-gynecologist members of the American Medical Association in the state of Michigan and obstetric-gynecology patients at the University of Michigan were surveyed. Physician and patient attitudes and practices regarding CAM were characterized.

Results

Surveys were obtained from 401 physicians and 483 patients. Physicians appeared to have a more positive attitude towards CAM as compared to patients, and most reported routinely endorsing, providing or referring patients for at least one CAM modality. The most commonly used CAM interventions by patients were divergent from those rated highest among physicians, and most patients did not consult with a health care provider prior to starting CAM.

Conclusion

Although obstetrics/gynecology physicians and patients have a positive attitude towards CAM, physician and patients' view of the most effective CAM therapies were incongruent. Obstetrician/gynecologists should routinely ask their patients about their use of CAM with the goal of providing responsible, evidence-based advice to optimize patient care.
Factors associated with the subspecialty choices of internal medicine residents in Canada
Authors: Horn Leora , Tzanetos Katina , Thorpe Kevin , Straus Sharon E
Published: June 2008

Background

Currently, there are more residents enrolled in cardiology training programs in Canada than in immunology, pharmacology, rheumatology, infectious diseases, geriatrics and endocrinology combined. There is no published data regarding the proportion of Canadian internal medicine residents applying to the various subspecialties, or the factors that residents consider important when deciding which subspecialty to pursue. To address the concern about physician imbalances in internal medicine subspecialties, we need to examine the factors that motivate residents when making career decisions.

Methods

In this two-phase study, Canadian internal medicine residents participating in the post graduate year 4 (PGY4) subspecialty match were invited to participate in a web-based survey and focus group discussions. The focus group discussions were based on issues identified from the survey results. Analysis of focus group transcripts grew on grounded theory.

Results

110 PGY3 residents participating in the PGY4 subspecialty match from 10 participating Canadian universities participated in the web-based survey (54% response rate). 22 residents from 3 different training programs participated in 4 focus groups held across Canada. Our study found that residents are choosing careers that provide intellectual stimulation, are consistent with their personality, and that provide a challenge in diagnosis. From our focus group discussions it appears that lifestyle, role models, mentorship and the experience of the resident with the specialty appear to be equally important in career decisions. Males are more likely to choose procedure based specialties and are more concerned with the reputation of the specialty as well as the anticipated salary. In contrast, residents choosing non-procedure based specialties are more concerned with issues related to lifestyle, including work-related stress, work hours and time for leisure as well as the patient populations they are treating.

Conclusion

This study suggests that internal medicine trainees, and particularly males, are increasingly choosing procedure-based specialties while non-procedure based specialties, and in particular general internal medicine, are losing appeal. We need to implement strategies to ensure positive rotation experiences, exposure to role models, improved lifestyle and job satisfaction as well as payment schedules that are equitable between disciplines in order to attract residents to less popular career choices.
Polymorphism patterns in Duffy-binding protein among Thai Plasmodium vivax isolates
Authors: Gosi Panita , Khusmith Srisin , Khalambaheti Thareerat , Lanar David E , Schaecher Kurt E , Fukuda Mark M , Miller Scott R
Published: June 2008

Background

The Duffy-binding protein II of Plasmodium vivax (PvDBPII) has been considered as an attractive target for vaccine-mediated immunity despite a possible highly polymorphic nature. Among seven PvDBP domains, domain II has been shown to exhibit a high rate of nonsynonymous polymorphism, which has been suggested to be a potential immune (antibody binding) evasion mechanism. This study aimed to determine the extent of genetic polymorphisms and positive natural selection at domain II of the PvDBP gene among a sampling of Thai P. vivax isolates.

Methods

The PvDBPII gene was PCR amplified and the patterns of polymorphisms were characterized from 30 Thai P. vivax isolates using DNA cloning and sequencing. Phylogenetic analysis of the sequences and positive selection were done using DnaSP ver 4.0 and MEGA ver 4.0 packages.

Results

This study demonstrated a high rate of nonsynonymous polymorphism. Using Sal I as the reference strain, a total of 30 point-mutations were observed in the PvDBPII gene among the set of Thai P. vivax isolates, of which 25 nonsynonymous and five synonymous were found. The highest frequency of polymorphism was found in five variant amino acids (residues D384G, R390H, L424I, W437R, I503K) with the variant L424I having the highest frequency. The difference between the rates of nonsynonymous and synonymous mutations estimated by the Nei and Gojobori's method suggested that PvDBPII antigen appears to be under selective pressure. Phylogenetic analysis of PvDBPII Thai P. vivax isolates to others found internationally demonstrated six distinct allele groups. Allele groups 4 and 6 were unique to Thailand.

Conclusion

Polymorphisms within PvDBPII indicated that Thai vivax malaria parasites are genetically diverse. Phylogenetic analysis of DNA sequences using the Neighbour-Joining method demonstrated that Thai isolates shared distinct alleles with P. vivax isolates from different geographical areas. The study reported here will be valuable for the development of PvDBPII-based malaria vaccine.
Laugh syncope as a rare sub-type of the situational syncopes: a case report
Authors: Nishida Katsufumi , Hirota Sean K , Tokeshi Jinichi
Published: June 2008

Introduction

Laughter is a good medicine; it enhances cardiovascular health and the immune system. What happens, however, if a person laughs too much or the laughter becomes out of control? Laughter-induced syncope is rare and likely goes unrecognized by many health care providers. It is thought to be another form of Valsalva-induced syncope.

Case presentation

We report the case of a 56-year-old, moderately obese (body mass index of 35) man with a past medical history of sleep apnea, hypertension and hyperlipidemia who suffered from syncope secondary to intense laughter. The patient also had a history of syncope in the distant past when he collapsed on the floor for several seconds. Treadmill stress testing after the incident revealed no arrhythmia or ischemic disease, although he complained of dizziness after the test and a sudden drop in blood pressure was noted.

Conclusion

Laughter-induced or gelastic syncope is extremely rare. It is thought to be a sub-type of the situational syncopes.