bluuebunny/crossref_metadata_2025 huggingface dataset:
Lumboperitoneal Shunts in Children
Authors: Rekate Harold L. , Wallace Donna
Published: April 2003

Objective: To determine the safety and efficacy of lumboperitoneal (LP) shunts in carefully selected children with abnormalities of the absorption of cerebrospinal fluid. Methods: Magnetic resonance imaging studies, indications for treatment and pre- and postoperative symptoms of 25 patients (mean age 9.6 years) who had undergone LP shunting in the past 10 years in a single pediatric neurosurgical practice were analyzed retrospectively. Results: Indications for treatment included postoperative pseudomeningocele, pseudotumor cerebri and a severe form of slit ventricle syndrome. Preoperative symptoms resolved completely in all 25 patients as a result of the shunt, and no patient developed symptomatic or radiographic hindbrain herniation. Twenty-one shunts incorporated valve mechanisms. Conclusion: LP shunts may be used for specific indications without excessive risk of hindbrain herniation.
Rapid Uncoupling of Serotonin-1A Receptors in Rat Hippocampus by 17β-Estradiol in vitro Requires Protein Kinases A and C
Authors: Mize Amy L. , Alper Richard H.
Published: April 2003

17β-Estradiol decreases R(+)8-OH-DPAT-stimulated [35S]GTPγS binding [an index of serotonin-1A (5-HT1A) receptor coupling] through the activation of estrogen receptors. We hypothesize that this occurs as a result of activation of protein kinase A (PKA) and/or protein kinase C (PKC) and phosphorylation of 5-HT1A receptors. Hippocampus from ovariectomized rats was incubated with 17β-estradiol in HEPES buffer (37°C). Cytosolic and membrane fractions were prepared to assess PKA and PKC activities, respectively. In separate experiments, membranes were prepared to measure R(+)8-OH-DPAT-stimulated [35S]GTPγS binding. 17β-Estradiol (50 nM) increased PKA and PKC activities approximately 2- to 3-fold. PKC activity was elevated at 10, 30 and 60 min, whereas PKA activity was increased at 10 and 30 min. The ability of 17β-estradiol to increase PKA and PKC was blocked by the estrogen receptor antagonist ICI 182,780 (1 µM). A selective PKA inhibitor (KT 5720, 60 nM) blocked 17β-estradiol-stimulated PKA but not PKC activity. Conversely, the PKC inhibitor calphostin C (100 nM) blocked the increase in PKC activity produced by 17β-estradiol but not the PKA response. The protein kinase inhibitors individually blocked the effects of 17β-estradiol on R(+)8-OH-DPAT-stimulated [35S]GTPγS binding. By contrast, preincubation with the protein synthesis inhibitor cycloheximide (200 µM) or the mitogen activated protein (MAP) kinase kinase inhibitor PD 98059 (50 µM) was without effect. Incubation of hippocampus with 17β-estradiol (50 nM, 60 min) caused the phosphorylation of a protein consistent with the 5-HT1A receptor. These studies demonstrate that 17β-estradiol acts on estrogen receptors locally within the hippocampus through nongenomic mechanisms to activate PKA and PKC, phosphorylate 5-HT1A receptors and uncouple them from their G proteins.
Geometry of Compact Tubes and Protein Structures
Authors: Banavar Jayanth R. , Flammini Alessandro , Marenduzzo Davide , Maritan Amos , Trovato Antonio
Published: April 2003

Proteins form a very important class of polymers. In spite of major advances in the understanding of polymer science, the protein problem has remained largely unsolved. Here, we show that a polymer chain viewed as a tube not only captures the well-known characteristics of polymers and their phases, but also provides a natural explanation for many of the key features of protein behavior. There are two natural length scales associated with a tube subject to compaction – the thickness of the tube and the range of the attractive interactions. For short tubes, when these length scales become comparable, one obtains marginally compact structures, which are relatively few in number compared to those in the generic compact phase of polymers. The motifs associated with the structures in this new phase include helices, hairpins and sheets. We suggest that Nature has selected this phase for the structures of proteins because of its many advantages, including the few candidate structures, the ability to squeeze water out from the hydrophobic core and the flexibility and versatility associated with being marginally compact. Our results provide a framework for understanding the common features of all proteins.
Is Colonoscopic Screening of a Low-Risk (Normal) Population Ethically Justifiable?
Authors: Keighley M. , Arnold R.
Published: April 2003

This report summarizes the arguments for and against colonoscopic screening of a low-risk population for colorectal cancer. The strongest argument in favor of colonoscopy is that colonoscopy rarely misses an existing colorectal neoplasia and its precursor lesions and that procedural side effects are rare. In contrast, the combination of fecal occult blood test plus sigmoidoscopy leaves 10–15% of advanced neoplasms in the proximal colon undetected. However, colonoscopy is costly and the health care systems of only few European countries refund the respective costs. In addition, there is presently not sufficient manpower available to deliver colonoscopy to the public starting at the age of 50 in a 1:10 yearly frequency. Compliance to the procedure is very low even in countries which refund screening costs. Therefore, promotion of colonoscopy as the presently most effective screening procedure depends mainly on major educational efforts within the public to increase compliance as well as on the readiness of European health care systems to cover the respective costs.
Solitary Radial Head Metastasis with Wrist Drop: A Rare Presentation of Metastatic Prostate Carcinoma
Authors: Ansari M.S. , Nabi G. , Aron M.
Published: April 2003

The fact that a prostate carcinoma metastasizes to the skeleton is well known. The metastatic deposits are generally multiple and osteoblastic. Moreover, these involve the axial skeleton or the proximal part of long bones. A pure osteolytic metastasis from a prostate carcinoma is extremely rare. This is believed to be the 1st case report of a osteolytic solitary radial head metastasis from a prostate carcinoma in a 60-year-old male. The rare clinical presentation of wrist drop, the absence of metastases at any other site, and a significant decrease in the size of lesion on follow-up in response to hormonal therapy are of interest in this case. The rare clinical presentation of a common malignancy (prostate carcinoma) is reported with a brief review of the literature.
Irbesartan in Primary Hypertension in Thai Patients: A Multicentre, Non-Comparative Study
Authors: Tanomsup Supachai , Buranakitjaroen Peera , Koanantakul Banhan , Uboldejpracharak Yingnoi , Ngramukos Pungchai
Published: April 2003

Background: The angiotensin II receptor antagonist irbesartan is an effective and well-tolerated treatment for hypertension in Western societies. However, evidence of the therapeutic benefits of angiotensin II receptor antagonists is generally lacking in hypertensive Asian subjects. Objectives: This multicentre, non-comparative study assessed the efficacy and safety of once-daily irbesartan in the treatment of hypertension in a population of Thai patients. Methods: After a 3- to 4-week placebo run-in period, patients were treated with irbesartan for 12 weeks, initially with 150 mg/day for 4 weeks. At 4 weeks, patients are up-titrated from irbesartan 150 to 300 mg/day and, at 8 weeks from irbesartan 150 to 300 mg/day or from irbesartan 300 mg to irbesartan 300 mg plus hydrochlorothiazide (HCTZ)12.5 mg/day if their seated diastolic blood pressure (SeDBP) remained ≧90 mm Hg. Trough blood pressures and safety assessments were measured at intervals during the study. The primary end point was the comparison of the reduction in blood pressure at the end of the placebo run-in and irbesartan treatment periods. Safety assessments formed part of the secondary end points. Results: Significantly greater reductions in SeDBP (14.42 versus 0.11 mm Hg, p < 0.0001) and seated systolic blood pressure (SeSBP) (20.83 versus 3.15 mm Hg, p < 0.0001) were reported after 12 weeks of irbesartan compared with the placebo run-in period. After 12 weeks, the blood pressure of 56% of patients on irbesartan regimens was normalized and 77% responded to therapy. These results were similar to irbesartan treatment in the Western population. Reductions in blood pressure were recorded in all the irbesartan treatment groups. The safety profile was globally similar to that observed during the placebo run-in period. Conclusions: Once-daily irbesartan was an effective and well-tolerated agent for the treatment of hypertension in Thai patients, suggesting that dose recommendations for irbesartan in Thailand should follow those used in Western countries.
Heart Failure in the Elderly: Characteristics of a Swedish Primary Health Care Population
Authors: Alehagen U. , Eriksson H. , Nylander E. , Dahlström U.
Published: April 2003

Background: Heart failure (HF) is a challenge to diagnose and treat according to guidelines. Few studies have been performed in elderly subjects with symptoms that might be associated with HF in primary health care. Objective: To study elderly patients presenting with symptoms possibly associated with HF, with respect to systolic and diastolic function, B-type natriuretic peptide (BNP) levels and treatment. Methods: A cardiologist examined 415 elderly (65–82 years) patients with symptoms of dyspnoea, fatigue and/or peripheral oedema. All patients underwent echocardiography and plasma BNP determination. Systolic function was determined semiquantitatively, and ejection fraction (EF) <40% was considered to be reduced. Abnormal diastolic function was defined as a reduced ratio of peak early diastolic filling velocity to peak filling velocity at atrial contraction (E/A ratio; age adjusted) or an abnormal pattern of pulmonary venous flow. Results: Forty-eight percent of the patients showed abnormal systolic (26%) or diastolic function (22%). A majority of the patients with diastolic HF had relaxation abnormalities and neither pseudonormal nor restrictive filling patterns. Increased levels of BNP were found in the group with impaired systolic function. More than half of those with EF <40% were not receiving angiotensin-converting enzyme inhibitions at all, or were on a suboptimal dose, whereas others were on treatment for an HF diagnosis despite normal cardiac function. Conclusion: Diagnostic tools that are more objective than clinical examination are needed for the diagnosis of HF.
Prior Aspirin Therapy, Subsequent Stroke Severity and Mortality and Relationship with Cardiovascular Risk Factors in Patients Admitted to Hospital with Acute Stroke
Authors: Sharma Jagdish C. , Fletcher Sally , Vassallo Michael , Ross Ian
Published: April 2003

Objective: To investigate whether the prior use of aspirin has an association with the severity and mortality of subsequent stroke and its relationship with cardiovascular risk factors. Methods: This was a study of 296 patients, with a median age of 75 years, admitted to hospital with acute stroke. Data were collected on demography, risk factors, stroke syndromes, infarct size, parameters of stroke severity and acute-phase and 90-day mortality. Patients were categorised into aspirin (n = 95) and non-aspirin (n = 201) groups, depending on whether or not they had received prior aspirin therapy. Analysis was performed to study the relationship between prior aspirin therapy, cardiovascular risk factors, previous stroke and stroke mortality. Results: Patients in the aspirin group were more disabled prior to stroke (p < 0.001) and had a higher incidence of prior stroke (p < 0.001) and ischaemic heart disease (p < 0.001). There was insignificantly higher acute-phase and 90-day mortality in the aspirin group (p = 0.13 and 0.30, respectively) in all patients. There was significantly higher acute-phase mortality among patients with ischemic strokes in the aspirin group [p = 0.02; relative risk (RR) 2.26, 95% confidence interval (CI) 1.14–4.50] and non-significantly higher 90-day mortality (p = 0.08; RR 1.50, 95% CI 0.96–2.35). The significance did not persist when previous stroke was controlled for. Patients with pre-existing cardiac failure on aspirin had higher mortality (0.001) than did patients in the non-aspirin group. Conclusions: There was a trend for higher mortality in patients with ischaemic strokes on prior aspirin therapy. This may have been due to a higher incidence of cardiovascular disease in the aspirin group. Patients with cardiac failure on aspirin had higher mortality following a stroke.
Alcohol Problems and Treatment: The Patients’ Perceptions
Authors: Nielsen Anette Søgaard
Published: April 2003

The aim of this study is to investigate the patients’ perception of their own alcohol problems. It is based on semi-structured, audio-taped interviews with 27 randomly chosen patients at an Alcohol Treatment Centre. Four different ways how alcohol problems were perceived emerged: ‘cultural drinking’, ‘symptomatic drinking’, ‘pathological drinking’ and ‘incomprehensible drinking’. The ways of explaining the drinking problems were not related to the duration of the drinking problem, the actual amount of alcohol that the patients drank, or how or when it was drunk. Instead, the patients’ perceptions were grounded in the way the drinking pattern was interpreted in relation to concepts like ‘normality’ and ‘deviance’.
Alcohol Consumption in Alzheimer’s Disease
Authors: Müller-Thomsen Tomas , Haasen Christian
Published: April 2003

As late-onset alcohol consumption is rare, it often indicates a different underlying disorder. We present a case where late-onset alcohol drinking occurred during the onset of Alzheimer’s disease.
Metamodulation of the Crayfish Escape Circuit
Authors: Edwards Donald H. , Yeh Shih-Rung , Musolf Barbara E. , Antonsen Brian L. , Krasne Franklin B.
Published: April 2003

Neuromodulation provides a means of changing the excitability of neurons or the effect of synapses, and so extends the performance range of neural circuits. Metamodulation occurs when the neuromodulatory effect is itself modulated, often in response to a change in the behavioral state of the animal. The well-studied neural circuit that mediates escape in the crayfish is modulated by serotonin, and this modulation is subject to two forms of metamodulation. First, the serotonergic modulation of the Lateral Giant (LG) command neuron for escape depends on the pattern of exposure of the cell to serotonin. High and low concentrations, and rapid and slow exposures each produce opposite modulatory effects on sensory-evoked EPSPs in LG. In addition, brief exposures produce transient modulatory effects, whereas longer exposures produce long-term facilitation. These different patterns of exposure may result from serotonin neurotransmission, paracrine transmission, and hormonal release, all of which occur in the vicinity of LG. The second form of metamodulation enables serotonergic modulation to track slow changes in the social status of the crayfish. Slowly applied serotonin facilitates LG’s response in socially isolated crayfish and in new dominant and subordinate animals. Facilitation is retained in the dominant animal during two weeks of continuous pairing of the animals, but facilitation gradually changes to inhibition in the subordinate crayfish. These and related changes in serotonin modulation appear to result from changes in the population of serotonin receptors that mediate the modulatory effects in LG. Whereas the exposure-dependent metamodulation enables rapid changes in serotonergic modulation of LG to occur, the status-dependent metamodulation enables serotonergic modulation of LG to track the slow maturation of social relationships.
Antioxidant Enzyme and Malondialdehyde Levels in Patients with Panic Disorder
Authors: Kuloglu Murat , Atmaca Murad , Tezcan Ertan , Ustundag Bilal , Bulut Serpil
Published: April 2003

There is evidence of an etiopathogenetic role of free radicals (FRs) in some neuropsychiatric disorders. The aim of the present study was to determine whether the activity levels of some antioxidant enzymes [glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and catalase (CAT)] and malondialdehyde (MDA), a product of lipid peroxidation, were associated with panic disorder (PD). Twenty patients diagnosed with PD and 20 healthy controls were enrolled in this study. A clinical evaluation and measurements of GSH-Px SOD, CAT and MDA were performed. Additionally, all patients were assessed by the Panic Agoraphobia Scale (PAS). The mean GSH-Px, SOD and MDA levels of the patient group were significantly higher than those of the controls. There was a significant positive correlation between PAS scores and GSH-Px, SOD and MDA levels and between the duration of illness and SOD, CAT and MDA levels in the patient group. In conclusion, our results suggest that FRs may be involved in PD.
Effects of Imipramine on T Cell Subsets in Olfactory Bulbectomized Mice
Authors: Komori T. , Yamamoto M. , Matsumoto T. , Zhang K. , Okazaki Y.
Published: April 2003

To elucidate the immunological outcome in antidepressant therapy, the effects of acute or chronic imipramine (IMP) treatment on T cell subsets were examined in sham-operated (SO) and olfactory bulbectomized (OB) mice. Olfactory bulbectomy decreased the ratio of Lyt2-positive suppressor T cells to L3T4-positive T helper cells. Acute IMP treatment did not exert any effect on the ratio in SO nor in OB mice. Chronic IMP administration was found to significantly increase the ratio in SO and OB mice and, as a result, the ratio was significantly higher in SO mice compared with the control, while the ratio was normalized in OB mice. The present study may be suggestive of the immune activation in depression and of the immunosuppressive effects of antidepressants.
Affinity Hemodialysis for Antiviral Therapy
Authors: Tullis Richard H. , Duffin R. Paul , Zech Marvin , Ambrus Julian L.
Published: April 2003

Background: HIV-1 gp120 may play a role in the progression from HIV infection to AIDS. Aims: We investigated affinity hemodialysis for removing gp120 from cell culture and whole blood. Methods: Anti-gp120 antibodies covalently coupled to agarose beads were packed into columns or hollow-fiber hemodialysis cartridges. Supernatants from HIV-infected HL2/3 cells or gp120 containing whole blood were pumped over the columns and gp120 measured by ELISA. Results: Anti-gp120 agarose removed ∼90% of HIV-1 gp120 from HL2/3 cultures in 30–60 min. Capture was antibody-dependent (F105 > IDX 1121 > ABI 13-108). Affinity hemodialysis also efficiently captured gp120 from buffer in a first-order, flow-rate-dependent fashion (t½ = 13 min at 0.9 ml/min). Clearance was faster than calculated diffusion (t½ ∼2.5 h) suggesting significant convective transport. gp120 removal from blood was slower (t½ = 1.4 h). Conclusion: Affinity hemodialysis efficiently clears gp120 from cell culture fluids and blood and may be useful in slowing the progression to AIDS.
The ADEMEX Study and PD Adequacy
Authors: Burkart John M.
Published: April 2003

The ADEMEX study was a prospective, randomized, controlled, interventional trial that evaluated the effect of an increase in peritoneal clearance on the relative risk of death for patients on CAPD. The results suggest that over the range of solute clearance studied, increasing peritoneal solute clearance had no beneficial effect on survival. Residual renal function did predict outcome. The findings are clinically relevant, but there are some limitations of the study that may limit the generalizability of the results. First of all, exclusion criteria were likely to result in the exclusion of rapid transporters and small patients, the subgroup of patients found to have an increased relative risk of death on PD in other studies. Secondly, ADEMEX evaluated the effect of an increase in small solute, not middle molecular weight solute clearances on outcome. Lastly, ADEMEX did not evaluate outcomes for patients on cycler therapies, the most popular form of PD in use currently. The data confirms (a) that one size prescription does not fit all; (b) that many patients below current NKF-DOQI targets for small solute clearance may be adequately dialyzed, and (c) it provides us with evidence-based data that national societies can consider using when preparing for the next revisions of their guidelines.
High-Dose Oral Misoprostol for Mid-Trimester Pregnancy Interruption
Authors: Ramin Kirk D. , Ogburn Paul L. , Danilenko Diana R. , Ramsey Patrick S.
Published: April 2003

Objective: To evaluate the efficacy of high-dose oral misoprostol for mid-trimester pregnancy interruption. Methods: We reviewed our experience with high-dose oral misoprostol for mid-trimester pregnancy interruption from November 1995 to May 1999. Patients undergoing labor induction for intrauterine fetal demise or medically indicated pregnancy termination at 13–32 weeks of gestation with a non-dilated cervix were evaluated. Patients received 400 µg misoprostol orally every 4 h. Women undelivered within 24 h were considered failures and were treated with high-dose oxytocin as previously described. For comparison, a group of women treated with high-dose oxytocin were evaluated. Results: Forty-seven pregnancies were managed with misoprostol (n = 23) or high-dose oxytocin regimen (n = 24). Both groups were similar with respect to induction indication, gestational age, maternal age/parity, laminaria use, and initial cervical dilation. Induction-to-delivery interval (mean ± SD) was significantly shorter in the misoprostol cohort (15.2 ± 6.7 h) compared with those treated with oxytocin (21.7 ± 11.0 h; p = 0.02). Additionally, a significantly greater percentage of women treated with misoprostol delivered within 24 h (91.0%) compared with the oxytocin group (62.0%; p = 0.04). Adverse outcomes and side effects were not significantly different between the study groups. Conclusion: High-dose oral misoprostol is more effective than concentrated oxytocin infusion for mid-trimester pregnancy interruption.
Characterization of Expression of Puumala Virus Nucleocapsid Protein in Transgenic Plants
Authors: Khattak Shahryar , Darai Gholamreza , Süle Sandor , Rösen-Wolff Angela
Published: April 2003

Transgenic plants expressing a foreign gene are a suitable system for the production of relevant immunogens in high amounts that can be used for the development of a new generation of vaccines against a variety of infectious diseases. In the present study, the expression of the nucleocapsid (N) protein of hantavirus serotype Puumala in tobacco and potato plants was investigated. Transgenic tobacco and potato plants were generated and established. These transgenic plants expressed the N protein of Puumala virus strain CG-1820. No major differences were observed when the phenotype and growth rates of transgenic plants were compared to those of normal plants. However, it was found that the leaves of transgenic tobacco plants were more slender and the tubers of transgenic potato plants were smaller than those in normal plants. In order to investigate the distribution of the expression of the foreign gene in transgenic plants, the proteins of leaves and roots of the individual transgenic tobacco and potato plants were examined by Western blot analyses. It was found that all transgenic tobacco and potato plants expressed the N protein in the leaves, whereas transgenic potato plants are able to significantly express the viral proteins also in the tubers and roots. The antigens were expressed at a level of 1 ng of protein/5 µg of dried leaves. The hantaviral recombinant N proteins obtained from transgenic tobacco and potato plants were able to elicit specific humoral and mucosal immune responses when administered intraperitoneally or orally to rabbits and mice. The expression of viral proteins in plants has two major advantages compared to other expression systems: firstly, there is no risk of contamination with mammalian viruses or other pathogens, and secondly, the production of high amounts of antigens is cheap and therefore of great economic interest.
Erythropoietin Therapy in Pre-Dialysis Patients with Chronic Renal Failure: Lack of Need for Parenteral Iron
Authors: Trivedi Hariprasad S. , Brooks Blake J.
Published: April 2003

Background: During erythropoietin therapy, scant information exists regarding the optimal target percent saturation of transferrin (TSAT), ferritin and the mode and amount of iron supplementation in pre-dialysis patients with anemia due to chronic kidney disease (CKD). Hypothesis: Pre-dialysis CKD patients may have different needs for iron supplementation than end-stage renal disease subjects during erythropoietin therapy. Methods: Retrospective analysis of pre-dialysis CKD subjects (n = 31) treated with erythropoietin at our institution. Results: In this population our results showed that target hematocrit (33–36%) was achievable with erythropoietin (mean subcutaneous dose 86 ± 17 [SD] units/kg/week) without parenteral iron therapy. The hematocrit increased from a mean baseline value of 28.4 ± 2.7 to 33.6 ± 3.4% at time 1 (4–9 weeks, p < 0.0001), and to 37.7 ± 4.5% at time 2 (10–20 weeks, p < 0.0001). The hemoglobin concentration increased from 9 ± 0.9 g/dl at baseline to 10.7 ± 1.1 g/dl at time 1 (p < 0.0001) and to 12 ± 1.5 g/dl at time 2 (p < 0.0001). Subgroup analyses of patients prescribed <200 mg oral elemental iron per day (n = 10), those with TSAT <20% and/or ferritin <100 ng/ml (n = 19), and those prescribed erythropoietin <80 units/kg/week (n = 12), all showed a significant increase in hematocrit and hemoglobin. Conclusions: Our data show that pre-dialysis CKD subjects respond adequately to erythropoietin at or lower than recommended erythropoietin doses without parenteral iron. This response extends even to subgroups with TSAT and/or ferritin levels deemed to indicate iron deficiency in CKD subjects, and may be due to lack of existence of functional iron deficiency in this group of patients.
Treatment of Anemia with Darbepoetin Alfa Administered de novo Once Every Other Week in Chronic Kidney Disease
Authors: Suranyi Michael G. , Lindberg Jill S. , Navarro Jesus , Elias Chester , Brenner Robert M. , Walker Rowan
Published: April 2003

Background/Aims: Darbepoetin alfa is an erythropoiesis-stimulating protein that works via the same mechanism and has a threefold longer serum half-life than recombinant human erythropoietin (rHuEPO). The objective of this study was to evaluate extending the dosing interval of darbepoetin alfa to once every other week administration for the treatment of anemia in patients with chronic kidney disease (CKD) not requiring dialysis who were naive to rHuEPO therapy. Methods: This was a multi-center, open-label study. Seventy-six rHuEPO-naive patients were enrolled to receive darbepoetin alfa (0.75 µg/kg) once every other week for up to 24 weeks. Doses were titrated to achieve and maintain a hemoglobin target of 11.0 to 13.0 g/dl. Results: Ninety-seven percent (95% CI: 0.92, 1.00) of patients completing 24 weeks of treatment achieved a hemoglobin response. The median time to response was 5 weeks (range 1–25 weeks). The median darbepoetin alfa dose at the time of response was 60 µg (range 30–130 µg). Darbepoetin alfa was safe and well tolerated, and no antibodies to darbepoetin alfa were detected. Conclusion: These results demonstrate the utility of darbepoetin alfa administered once every other week in rHuEPO-naive CKD patients. This new treatment paradigm may allow for more widespread management of anemia in patients with CKD.
Stimmstörung und Lebensqualität: Die Münchner Lebensqualitätsdimensionen-Liste (MLDL) in der logopädischen Therapieforschung
Authors: Weichbold Viktor , Zorowka Patrick
Published: April 2003

Kosten-Nutzen-Analysen bilden zunehmend die Basis für die öffentliche Finanzierung des Gesundheitssystems, wodurch der Nachweis von Therapieeffekten an Bedeutung gewinnt. In der logopädischen Therapieforschung fehlen vielfach Instrumente zur Erhebung der Therapieeffekte. Ziel dieser Studie war es zu überprüfen, ob das Konzept «Lebensqualität», erhoben mit der Münchner Lebensqualitätsdimensionen-Liste (MLDL), dazu geeignet ist. 25 erwachsene Patienten mit Schlafstörung wurden zu Beginn und am Ende einer logopädischen Therapie (zirka 20 h) mit der MLDL befragt. Obwohl der Grossteil der Patienten mit der Therapie sehr zufrieden war, zeigten nur 2 der 19 MLDL-Items eine signifikante Verbesserung an («Entspannungsfähigkeit», p < 0,05; «Behandlung der Stimmstörung», p < 0,01). Die MLDL ist zu wenig sensitiv für Effekte der logopädischen Intervention. Die Entwicklung spezieller Skalen für die logopädische Therapieforschung wird angeregt.
Nonobstructive Dilatation of the Fetal Bowel in Twin Gestations
Authors: Achiron Reuwen , Seidman Daniel S. , Zalel Yaron , Orvieto Raoul , Sivan Eyal , Lipitz Shlomo
Published: April 2003

Objective: To assess the possible association of in-utero bowel dilatation and circulatory changes with fetal compromise. Methods: A retrospective survey of all ultrasound examinations was performed at the Chaim Sheba Medical Center (n ∼10,000) between 1995 and 1999. Cases with ultrasonographic evidence of bowel dilatation, but without evidence of obstruction, were recruited. In utero Doppler studies of umbilical, splenic, superior mesenteric arteries, and middle cerebral artery (MCA) were performed: systolic/diastolic ratio (S/D), pulsatility index (PI) and resistance index (RI) were calculated in the above arteries and compared with those of normal fetuses. Nonstress test and cord blood pH were also assessed. Neonatal medical records were procured. Results: Four fetuses, all of who were products of twin gestations, showed bowel dilatation without evidence for obstruction. Three of the four fetuses were small-for-gestation-age (SGA) and of bichorionic gestation, while one was of monochorionic twin gestation, with twin transfusion syndrome. In all three SGA fetuses, Doppler studies revealed increased peripheral resistance in the umbilical artery and adaptive peripheral vasodilatation in the fetal midcerebral, splenic and superior mesenteric arteries. In all cases, an abnormal nonstress test led to prompt delivery. Conclusions: Acute fetal bowel dilatation in a twin gestation is associated with abnormal splanchnic and gut perfusion that may lead to fetal compromise.
Deaths in Patients with Pulmonary Tuberculosis: An Analysis of a Chest Diseases Hospital in Istanbul, Turkey
Authors: Kartaloglu Zafer , Ilvan Ahmet , Kilic Erol , Okutan Oguzhan , Cerrahoglu Kamil , Ciftci Faruk
Published: April 2003

Objective: To evaluate the medical records of patients with pulmonary tuberculosis in order to determine the inhospital mortality rate. Materials and Methods: Medical records of 22,651 patients with pulmonary tuberculosis admitted to Gulhane Military Medical Academia, Camlica Chest Diseases Hospital, Istanbul, Turkey from 1977 to 1999 were examined. Results: Of the 22,651 patients, 133 (0.58%) died: 117 male and 16 female, mean age 41.5 ± 20.7 years. The mean length of hospital stay was 15.8 ± 25.9 days and it increased yearly (p = 0.004). There was no significant difference in hospital mortality rate of tuberculosis within years. Forty-nine patients had chronic and/or far advanced tuberculosis, 36 of them had concomitant diseases. Thirteen patients had miliary and/or tuberculous meningitis, 3 multi drug-resistant tuberculosis, another 3 had pneumothorax, and 2 empyema. These patients had significantly lower prognostic nutritional index than those patients who recovered from pulmonary tuberculosis (p = 0.025). Conclusion: Inhospital mortality rate of tuberculosis did not change in the last 23 years. We suggest that pulmonary tuberculosis will continue to be a significant cause of death and therefore important health care problem for Turkey in the 21st century.
Transcription of a Single Mannose Receptor Gene by Macrophage and Retinal Pigment Epithelium
Authors: Greaton Cynthia J. , Lane Kirk B. , Shepherd Virginia L. , McLaughlin Barbara J.
Published: April 2003

To determine if the macrophage mannose receptor transcript is present in mouse, rat, pig, and human retinal pigment epithelium (RPE), primary cultures and/or freshly dissected retinal pigment epithelium from four different species were used to isolate total RNA. RT-PCR was used to amplify segments of the macrophage mannose receptor from each sample. Amplified products were sequenced and compared with known sequences of the macrophage mannose receptor. Macrophage mannose receptor transcripts were identified in all RPE samples. Comparison between sequences identified in RPE with macrophage sequences from the same species revealed 100% identity. Sequence homology between the different species was 74% or greater. These data are consistent with the transcription of a single mannose receptor gene by these two phagocytic cell types.
Influence of Short-Term Sucrose Exposure on Plaque Acidogenicity and Cariogenic Microflora in Individuals with Different Levels of Mutans Streptococci
Authors: Aranibar Quiroz E.M. , Lingström P. , Birkhed D.
Published: April 2003

The aim was to study the short-term effect of a varying sucrose exposure on plaque acidogenicity and cariogenic microflora in two groups of subjects with different levels of mutans streptococci (MS). Eight subjects with low (<104) and 8 with high (>106) numbers of MS per millilitre saliva participated. Three 7-day test periods were conducted. During two of these, the subjects rinsed either 5 or 10 times daily with 10% sucrose; the third period without any mouth rinses served as control. The subjects refrained from oral hygiene during the last 3 days of each test period. On day 7, the following parameters were measured: plaque pH after a sucrose rinse, numbers of MS, Streptococcus sanguis and lactobacilli in saliva, percent MS in plaque and plaque index. The results revealed that plaque acidogenicity was more pronounced for the high-MS group compared to the low-MS group after all three test periods, i.e. lower resting pH, deeper pH falls and a lower final pH. For both groups, the greatest pH-lowering capacity of plaque was found after the period with 10 sucrose rinses/day. An increase in bacterial counts was noted for both groups during the test periods with the 5- and 10-time rinse regimen; this increase was larger for the high-MS group compared to the group with low MS counts. The highest plaque index was, irrespective of the test period, found for the high-MS group.
Die dichotischen Diskriminationstests von Feldmann und Uttenweiler: Welcher Test sollte bei 8- bis 10-jährigen Kindern verwendet werden?
Authors: de Maddalena H. , Watzlawick-Schumacher M. , Schmitz-Salue C. , Arold R.
Published: April 2003

Fragestellung: Anhand von wichtigen Testkriterien wurde ermittelt, ob bei 8- bis 10-jährigen Kindern der dichotische Diskriminationstest (dD) von Uttenweiler oder der dD von Feldmann geeigneter ist. Patienten: Es wurden 48 Kinder mit Lese- und Rechtschreibstörungen sowie 48 gleichaltrige Kontrollkinder getestet. Ergebnisse und Schlussfolgerungen: In der Aufgabenanalyse zeigte sich, dass Reliabilität, Aufgabenschwierigkeit und Trennschärfe des dD von Feldmann in der Altersgruppe der 8- bis 10-jährigen Kinder deutlich besser ausfallen als beim dD von Uttenweiler. Es wird empfohlen, bei älteren Grundschulkindern den dD von Feldmann zu verwenden und den dD von Uttenweiler ausschliesslich jüngeren Kindern vorzubehalten.
Role and Mechanisms of Interleukin-1 in the Modulation of Neurotoxicity
Authors: Ma Xiaoling C. , Gottschall Paul E. , Chen Li T. , Wiranowska Marzenna , Phelps Christopher P.
Published: April 2003

Objective: Recent studies on cerebral ischemia in the rat have demonstrated that administration of interleukin-1 receptor antagonist (IL-1ra) markedly reduces the volumes of infarcts which are associated with N-methyl-D-aspartate (NMDA)-mediated neurotoxicity. These observations suggested that endogenous interleukin-1 (IL-1) may be involved in the mediation of excitotoxic neuronal injury following ischemia. Method: In the present studies, we examined the role of interleukin-1β (IL-1β) in NMDA-related and microglia-induced excitotoxicity in cocultures of mixed neurons and microglia. Results: Our observations in these mixed cultures indicated that addition of IL-1β exaggerated NMDA and glutamate-evoked hippocampal neuron death. Addition of microglia, activated by lipopolysaccharide (LPS) and interferon-γ (IFN-γ), to cocultures of cortical neurons and glia induced significantly greater neurotoxicity when compared with cocultures of cortical neurons and untreated microglia. This neurotoxicity did not require that activated glia be in cell-to-cell contact with neurons. Addition of either IL-1ra or the NMDA receptor antagonist MK-801 to cocultures of cortical neurons and activated glia partially reversed the neuronal damage mediated by activated microglia. Finally, IL-1β concentrations in the supernatant of cocultures of cortical neurons and microglia treated by LPS and IFN-γ were markedly increased when compared with coculture of neurons with untreated microglia. Conclusion: These results suggest that both the NMDA receptor and the IL-1 receptor are involved in microglia-mediated neurotoxicity.
The Exacerbation of Hippocampal Excitotoxicity by Glucocorticoids Is Not Mediated by Apoptosis
Authors: Roy Madhuri , Sapolsky Robert M.
Published: April 2003

Both endogenous and exogenous glucocorticoids (GCs) are known to cause apoptosis in a number of peripheral tissues and in some cases in the CNS. Additionally, GCs can exacerbate the neuron loss associated with such acute neurological insults as hypoxia-ischemia, excitotoxicity, and metabolic disruption. This exacerbation is accompanied by increased accumulation of glutamate in the synapse, excessive cytosolic calcium, and increased oxygen radical activity, markers usually attributed to pathways of necrotic cell death. It is also known that acute insults can involve apoptotic mediators. In this context, one outstanding question that has received little attention is whether the exacerbation of insult-mediated cell death in neurons is apoptotic in mechanism. In this study we investigate whether the GC-mediated exacerbation of hippocampal excitotoxicity in culture involves apoptosis. Specifically, we show that while the magnitude of hippocampal neuron death caused by the excitotoxin kainic acid is indeed worsened in the presence of GCs, there is no evidence of increased markers of apoptosis. Specifically, we show that neither kainic acid nor GCs alone, or in combination, cause activation of caspase 3, a critical executor of insult-induced apoptosis. Furthermore, while kainic acid causes a significant incidence of apoptotic nuclear condensation, the incidence of this morphological indicator of apoptosis is not worsened by GCs. Thus, GCs appear to augment excitotoxic death in hippocampal neurons without augmenting the occurrence of apoptosis. We suggest that this finding is to be expected, given some energetic features of GC action and the energetic demands of apoptosis.
Effects of Speaking Rate on Temporal Patterns of English
Authors: Smith Bruce L.
Published: April 2003

Individual subjects have been found to show considerable variation in the extent to which they manifest certain temporal patterns of English in their speech. Because at least some differences across speakers appear to be related to the fact that some subjects typically talk faster/slower than others, the present investigation examined variability in temporal patterns by having subjects produce target stimuli in sentences spoken at normal and fast rates. The results from these manipulations of speaking rate generally supported previous findings related to temporal patterns as a function of ‘natural’ variations in rate of speech. That is, there was considerable variability among the 15 subjects in the normal speaking rate condition in the extent to which temporal parameters such as final-syllable vowel lengthening occurred. In addition, there was substantial variation in these parameters in the fast speaking rate condition, and some systematic changes in certain patterns also occurred as a function of the rate change. For example, vowel lengthening preceding voiced obstruents tended to decrease when subjects spoke at a fast versus a normal rate, whereas phrase-final vowel lengthening was typically greater when they spoke at a faster rate.
Cyclooxygenase-2 Expression Is Associated with Well-Differentiated and Intestinal-Type Pathways in Gastric Carcinogenesis
Authors: Joo Young-Eun , Oh Won-Tae , Rew Jong-Sun , Park Chang-Soo , Choi Sung-Kyu , Kim Sei-Jong
Published: April 2003

Background/Aims: Cyclooxygenase-2 (COX-2) expression appears to be increased in several different types of human cancers, suggesting that the presence of COX-2 is associated with carcinogenesis. Recently, increased expression of COX-2 has been frequently detected in gastric cancer, and this may have prognostic significance. In the present study, we aimed to analyze the expression of COX-2 in a much larger sample to determine whether COX-2 expression is related to the clinicopathological features and survival rates of patients with gastric cancer. Methods: We investigated 140 patients with gastric cancer who underwent surgery between January 1992 and December 1993 and examined the expression of COX-2 in human gastric cancer tissue by immunohistochemistry. Results: COX-2 expression was present in the cytoplasm of tumor cells but not in normal gastric epithelia. Positive expression of COX-2 was detected in 86 of 140 gastric cancers analyzed (61.4%). Positive expression of COX-2 correlated with the depth of tumor invasion (p = 0.015). However, there was no association between COX-2 expression and tumor stage or status of lymph node or distant metastasis. Furthermore, COX-2 expression was not associated with patient survival (p = 0.816). Positive expression of COX-2 occurred more frequently in intestinal than in diffuse or mixed types of cancer and correlated with tumor differentiation (p < 0.001, p = 0.001, respectively). Conclusion: These results suggest that COX-2 may play an important role in the evolution of gastric carcinogenesis and be associated with well-differentiated and intestinal type pathways in gastric carcinogenesis. However, COX-2 expression seems to be less useful for establishing prognosis for gastric cancer.
Profound, Non-Opioid Analgesia Produced by the High-Efficacy 5-HT1A Agonist F 13640 in the Formalin Model of Tonic Nociceptive Pain
Authors: Bardin L. , Tarayre J.P. , Malfetes N. , Koek W. , Colpaert F.C.
Published: April 2003

Previously, we have reported that in rat models of chronic pain, in particular, the very-high-efficacy 5-HT1A agonist F 13640 induces unprecedented pain relief by novel neuroadaptative mechanisms that involve inverse tolerance and cooperation with nociceptive stimulation in producing analgesia. The present studies detailed the actions of F 13640 and other compounds in the formalin model of tonic nociceptive pain. Intraperitoneal injection of F 13640 (0.01–2.5 mg/kg; t –15 min) caused a dose-dependent and complete inhibition of the paw elevation and paw licking that occurred both early (0–5 min) and late (22.5–27.5 min) after the intraplantar injection of diluted formaldehyde (2.5%) in the rat. The extent to which F 13640 and other 5-HT1A receptor ligands inhibited these pain behaviors correlated (p < 0.05) with the extent to which they activated 5-HT1A receptors. Under similar conditions, some inhibitory effects were also observed with various agents that are known to produce analgesia by different peripheral and/or central mechanisms (e.g., opioids, NA/5-HT reuptake inhibitors, COX-2 inhibitors and other nonsteroidal anti-inflammatory drugs, gabapentin, and ABT-594). However, with the possible exception of morphine, the effects of all of these agents at nontoxic doses were lower than those of F 13640, in particular in inhibition of early paw elevation. The 5-HT1A antagonist WAY 100635, but not naloxone, antagonized the actions of F 13640. These results help to establish large-magnitude 5-HT1A receptor activation as a new molecular mechanism of profound, central analgesia and suggest that F 13640 may be particularly effective against pain arising from severe tonic nociceptive stimulation.
Immune Cells in Bronchoalveolar Lavage in Peripheral Lung Cancer – Analysis of 140 Cases
Authors: Domagała-Kulawik Joanna , Guzman Josune , Costabel Ulrich
Published: April 2003

Background: Changes in the bronchoalveolar lavage fluid (BALF) cell profile may reflect immunologic reactions of the lung in pulmonary malignancies. Objective: Our aim was to analyse the BALF cell profile in peripheral lung cancer. Methods: This study was a retrospective analysis of BALF samples containing tumor cells from patients with confirmed peripheral lung cancer (140 cases). Routine analysis and lymphocyte phenotyping by an immunoperoxidase technique with the monoclonal antibodies CD3, CD20, CD4, CD8, CD57, CD1, CD25, CD71 and HLA-DR were performed. The data were compared with those from healthy persons. Results: We found a significantly lower proportion of macrophages (60%), and significantly elevated proportions of lymphocytes (24%) and neutrophils (13%) in cases with cancer when compared with controls. The proportion of eosinophils was higher in the cancer patients (2.4%), though not significantly. Regarding the lymphocyte phenotypes, we found a significantly elevated proportion of T cells (86%), a relatively low CD4/CD8 ratio (1.7 ± 1.3), and a relatively higher percentage of HLA-DR+ lymphocytes (6.6%) in patients with cancer. There were no significant differences between smokers and nonsmokers in the cancer patients. In more than half of the cases, a positive staining for epithelial membrane antigen was found. Conclusion: Our observations confirm the possible participation of lymphocytes (activated and suppressor subtypes) and eosinophils in the response against tumor in peripheral airways.
Papular Xanthoma Associated with Angiokeratoma of Fordyce: Considerations on the Nosography of This Rare Non-Langerhans Cell Histiocytoxanthomatosis
Authors: Caputo Ruggero , Passoni Emanuela , Cavicchini Stefano
Published: April 2003

Background: Papular xanthoma (PX) is a rare normolipidemic non-Langerhans cell histiocytoxanthomatosis affecting both children and adults. Objective: We describe an adult case of PX associated with angiokeratoma of Fordyce and review the literature in order to compare and discuss previous reports. Methods: We studied the clinical, histopathological, immunocytochemical and ultrastructural findings. Results: We report the findings of our case and compare our case with those described in the literature. Conclusions: Three clinical patterns of PX appeared to emerge in the review of the literature: a self-healing form, a persistent form and a progressive form. The progressive form of PX can be considered the same clinical entity that is also described as progressive nodular histiocytosis.
A Case of Chronic Myeloid Leukemia Complicated with Minimal Change Nephrotic Syndrome
Authors: Talwar Rashmi , Dash S.C. , Kucheria Kiran
Published: April 2003

We present a 28-year-old patient with chronic myeloid leukemia (CML) in chronic phase complicated with nephrotic syndrome. The bone marrow cells revealed the presence of Philadelphia chromosome, the cytogenetic hallmark of CML, that results from a balanced, reciprocal translocation between the long arms of chromosomes 9 and 22, t(9;22)(q34;q11). This reciprocal translocation leads to the formation of the bcr/abl fusion gene, the presence of which was confirmed using the highly sensitive fluorescence in situ hybridization technique. The renal biopsy was compatible with minimal change nephrotic syndrome. To the best of our knowledge, this is the first case of minimal change nephrotic syndrome associated with CML before the administration of any therapy.