bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatitis C virus replication kinetics in chimpanzees with self‐limited and chronic infections
Authors: Prince A. M. , Pawlotsky J.‐M. , Soulier A. , Tobler L. , Brotman B. , Pfahler W. , Lee D.‐H. , Li Liping , Shata M. T.
Published: April 2004

Summary.  The availability of molecular beacon‐based, real time polymerase chain reaction (PCR) and a semi‐automated sample extraction procedure have made it possible for us to retrospectively examine HCV replication kinetics in HCV naive chimpanzees infected during the past 20 years. We compared these in 17 animals that developed chronic infection, and in 21 that developed self‐limited infection. No differences were found in infecting dose, or replication kinetics in the acute phase between these two types of infection. An unanticipated finding was the fact that 10 of 17 animals developing chronic infection partially controlled virus replication for 48 ± 48 weeks after typical acute phase viraemia, and prior to development of chronic infection. Twenty‐nine out of 30 (29/30) sera, which were negative by quantitative PCR during the downregulated period, were, however, positive by the more sensitive Genprobe isothermal transcription‐mediated amplification (TMA) assay. Thus, downregulation was not complete. Ten animals showing self‐limited infection showed complete resolution of viraemia by TMA assay. Quasispecies analysis revealed that in all, except one case, the virus reappearing after downregulation was essentially identical to that of the originally infecting virus.
Serum immunoglobulins predict the extent of hepatic fibrosis in patients with chronic hepatitis C virus infection
Authors: Watt K. , Uhanova J. , Gong Y. , Kaita K. , Doucette K. , Pettigrew N. , Minuk G. Y.
Published: April 2004

Summary.  Recently, we documented that immunoglobulins stimulate the proliferative activity of rat hepatic stellate cells in vitro. The aim of the present study was to determine whether there is any association between serum immunoglobulin levels and hepatic fibrosis in patients with chronic hepatitis C virus (HCV) infection. Charts from 116 patients with biochemical, serologic, virologic and histologic evidence of chronic hepatitis C infection and serum immunoglobulin levels (IgA, IgG, IgM and total) were reviewed. The mean (±SD) age of the study population was 46 ± 11 years and 67 (58%) were male. There were significant correlations between serum IgA (r = 0.39, P = 0.00001), IgG (r = 0.49, P = 0.000002) and total (r = 0.51, P = 0.000003) immunoglobulin levels and the stage of hepatic fibrosis. When serum immunoglobulin levels were included into logistic regression analysis with variables known to be associated with advanced disease (male gender, age >40 years at onset of infection, duration of infection beyond 20 years and concurrent alcohol abuse) only IgA, IgG and total immunoglobulin levels (P < 0.05, <0.05 and <0.005, respectively) emerged as independent predictors of hepatic fibrosis. Our data indicate a strong association between serum immunoglobulin levels (IgA, IgG and total) and hepatic fibrosis in patients with HCV infection. This finding supports the need to further investigate whether immunoglobulins independently promote disease progression in patients with chronic HCV infection.
Single nucleotide polymorphism of the MxA gene promoter influences the response to interferon monotherapy in patients with hepatitis C viral infection
Authors: Suzuki F. , Arase Y. , Suzuki Y. , Tsubota A. , Akuta N. , Hosaka T. , Someya T. , Kobayashi M. , Saitoh S. , Ikeda K. , Kobayashi M. , Matsuda M. , Takagi K. , Satoh J. , Kumada H.
Published: April 2004

Summary. The biological activity of interferon (IFN) is mediated by the induction of intracellular antiviral proteins, such as 2′–5′ oligoadenylate synthetase, dsRNA‐activated protein kinase and MxA protein. Among these, MxA protein is assumed to be the most specific surrogate parameter for IFN action. This study was performed to elucidate whether a single nucleotide polymorphism (SNP) (G/T at nt‐88) in the promoter region of the MxA gene influences the response to IFN therapy in patients with chronic hepatitis C virus (HCV) infection. Polymorphisms of the MxA gene in 235 HCV patients were determined by polymerase chain reaction‐restriction fragment length polymorphism. The frequency of SNP was compared between sustained‐responders (n = 78) and nonresponders (n = 157), as determined by biochemical and virological responses to IFN. Multivariate analysis showed that among all patients, HCV genotype, HCV RNA level and the SNP of the MxA gene were independent and significant determinants of the outcome of IFN therapy [odds ratio 3.8 (95% confidence interval 2.0–7.0), P < 0.0001; 0.27 (0.15–0.50), P < 0.0001; 1.8 (1.0–3.4), P = 0.0464, respectively]. Furthermore, among patients with a low viral load (≤2.0 Meq/mL), MxA‐T‐positive patients were more likely to show a sustained response compared with MxA‐T‐negative patients [2.87 (1.3–6.3); 62%vs 36%; P = 0.0075]. Our findings suggested that the SNP of the MxA gene is one of the important host factors that independently influences the response to IFN in patients with chronic HCV infection, especially those with a low viral load.
Evidence for increased metabolism of chloroquine during the early third trimester of human pregnancy
Authors: Chukwuani Mercilina C. , Bolaji Oluseye O. , Onyeji Cyprian O. , Makinde O. N. , Ogunbona Festus A.
Published: April 2004

Objective  To examine the possibility of a different extent of chloroquine (CQ) metabolism in human pregnancy by determining blood level profiles of the drug and its major metabolite, desethylchloroquine (CQM).

Methods  Five women in the early third trimester of pregnancy and five non‐pregnant women received each a single 600 mg oral dose of CQ and blood samples were collected at pre‐determined intervals following drug administration. Plasma concentrations of CQ and CQM were analysed by an established HPLC method.

Results  The Cmax and AUC0‐‐48 h of CQM were significantly higher in the pregnant than the non‐pregnant group (P = 0.009). The ratio AUC(CQ)/AUC(CQM) ranged from 0.09 to 0.35 among pregnant women, and from 1.70 to 4.81 among non‐pregnant women.

Conclusion  Results from this preliminary study indicate an occurrence of induction of metabolism of CQ in the early third trimester of pregnancy. In view of toxicological importance of CQ metabolites, it is suggested that caution should be exercised in evaluation of higher dosage regimen of CQ in pregnant women.
A randomized trial on acceptability of voluntary HIV counselling and testing
Authors: Fylkesnes Knut , Siziya Seter
Published: April 2004

Objectives  To examine factors affecting readiness for and acceptability of voluntary HIV counselling and testing (VCT).

Methods  Participants in a population‐based HIV survey conducted in an urban population in Zambia in 1996 were offered VCT. Although 29% of them expressed interest in being tested (readiness), only 4% of this group used the services (i.e. acceptability). When the survey was repeated 3 years later, VCT was designed differently to assess acceptability. At the cluster level the participants were randomly allocated to VCT either at the local clinic (similar to 1996, n = 1102) or at an optional location (n = 1343).

Results  Readiness varied significantly by age group (47% in age group 20–24 years vs. 18% in age group 40–49 years). There were contrasts between young (15–24 years) and older age groups (25–49 years) regarding the main factors associated with readiness. Whereas self‐perceived risk of being HIV infected was the only significant factor among the young, poor self‐rated health and ever HIV tested were important factors among the older. The acceptability was 11.8% among the group allocated to VCT at the local clinic compared with 55.8% for the group allocated to an optional location (RR, 4.7).

Conclusions  Perceived risk of HIV infection had a major influence on VCT readiness among young people, whereas declining general health status, as indicated by self‐rated health, was most evident among those of older age. A strong effect of placement on acceptability of VCT was demonstrated, indicating this barrier to be important in explaining low demands for VCT in the past. Differences in perceptions of how confidentiality is handled at the two locations might be an important underlying factor.
Evaluation of an algorithm for integrated management of childhood illness in an area of Vietnam with dengue transmission
Authors: Phuong Cao Xuan Thanh , Nhan Ngo Thi , Kneen Rachel , Bethell Delia , Dep Le Thi , Nga Nguyen Thi Thuy , Thuy Pham Thi Thu , Luat Truong Dinh , Solomon Tom , Wills Bridget , Parry Christopher M. ,   The Dong Nai/WHO Study Team
Published: April 2004

Objectives  To determine whether nurses, using the WHO/UNICEF algorithm for integrated management of childhood illness (IMCI), modified to include dengue infection, satisfactorily classified children in an area endemic for dengue haemorrhagic fever (DHF).

Methods  Nurses assessed and classified, using the modified IMCI algorithm, a systematic sample of 1250 children aged 2 months to 10 years (n = 1250) presenting to a paediatric hospital in Dong Nai Province, Vietnam. Their classification was compared with that of a paediatrician, blind to the result of the nurses’ assessment, which could be modified in the light of simple investigations, e.g. dengue serology.

Results  In children aged 2–59 months (n = 859), the nurses were able to classify, using the modified chart, the presenting illness in >99% of children and found more than one classification in 70%. For the children with pneumonia, diarrhoea, dengue shock syndrome, severe DHF and severe disease requiring urgent admission, the nurse's classification was >60% sensitive and >85% specific compared with that of the paediatrician. For the nurse's classification of DHF the specificity was 50–55% for the children <5 years and in children with definitive dengue serology. Alterations in the DHF algorithm improved specificity at the expense of sensitivity.

Conclusion  Using the IMCI chart, nurses classified appropriately many of the major clinical problems in sick children <5 years in southern Vietnam. However, further modifications will be required in the fever section, particularly for dengue. The impact of using the IMCI chart in peripheral health stations remains to be evaluated.
Prevalence of Opisthorchis viverrini infection and incidence of cholangiocarcinoma in Khon Kaen, Northeast Thailand
Authors: Sriamporn S. , Pisani P. , Pipitgool V. , Suwanrungruang K. , Kamsa‐ard S. , Parkin D. M.
Published: April 2004

Liver cancer is the most common cancer in Khon Kaen, Northeast Thailand, because of the high incidence of cholangiocarcinoma (CHCA). Opisthorchis viverrini (OV), a liver fluke, is endemic in the area, and has been evaluated as a cause of CHCA by International Agency for Research on Cancer. Residents of 20 districts in the province were invited to attend a mobile screening programme between 1990 and 2001. Of 24 723 participants, 18 393 aged 35–69 years were tested for OV infection, by examining stools for the presence of eggs. Prevalence of infection in each district was estimated from the sample of the population who had been tested. The incidence of liver cancer in 1990–2001 was obtained for each district from the cancer registry. The average crude prevalence of OV infection in the sample subjects was 24.5%, ranging from 2.1% to 70.8% in different districts. Truncated age‐standardized incidence of CHCA at ages >35 years varied threefold between districts, from 93.8 to 317.6 per 100 000 person‐years. After adjustment for age group, sex and period of sampling, there was a positive association between prevalence of OV infection and incidence of CHCA at the population level. Associations between CHCA and active OV infection in individuals have become hard to demonstrate, because of effective anti‐OV treatment. The relationship may, however, be clear in comparisons between populations, which, for infectious diseases, take into account the contextual effects of group exposure in determining individual outcome. The cancer registry is an appropriate tool for disease monitoring in small areas.
Quality of sexually transmitted infections services for female sex workers in Abidjan, Côte d'Ivoire
Authors: Vuylsteke B. , Traore M. , Mah‐Bi G. , Konan Y. , Ghys P. , Diarra J. , Laga M.
Published: April 2004

Objectives  To assess the quality of sexually transmitted infections (STI) care in health care facilities in Abidjan attended by female sex workers.

Methods  A cross‐sectional study was conducted in June 2000 in the 29 health care facilities and 10 pharmacies, which were reported as points of first encounter for STI care by female sex workers in a previous study on health seeking behaviour. Evaluation components included: (1) checklists of equipment and STI drugs in the facilities; (2) interviews with health care providers and pharmacists; (3) direct observation of the provider/client interaction; (4) exit interviews with women attending with STI or genital problems.

Results  Private health care facilities were more expensive, had fewer clients, and had less equipment and medical staff than public facilities, with the exception of the special female sex worker clinic. A total of 60 health care providers and 29 pharmacists were interviewed. There was no difference in their scoring on syndromic approach case studies, with the exception of the nurse assistants, who scored less. Overall scores for correct treatment were lowest for the pharmacists. We observed 513 provider–client interactions, of which 161 related to STIs or genital problems in women. Questions about recent sexual contacts were asked in only 20% and preventive messages were given in only 9% of the cases with STI/genital problems. Of 161 clients interviewed, 44% complained about a long waiting time, and 39% thought the health care provider had adequately explained the problem to them.

Conclusions  The opportunity for improvement of STI case management in health care facilities in Abidjan where female sex workers go for STI care is enormous. Public and private health care facilities should be made more accessible for sex workers, and their services should be upgraded to better respond to the sexual health needs of high risk women.
Short communication: Misleading microscopy in amoebiasis
Authors: Kebede Amha , Verweij Jaco J. , Petros Beyene , Polderman Anton M.
Published: April 2004

High prevalences of intestinal amoebiasis are commonly reported by microscopy in Ethiopia. In order to confirm the actual occurrence of Entamoeba histolytica we collected 108 stool specimens from different hospitals & health centers from patients in whom haematophagous trophozoites were believed to be found. We detected only a single E. histolytica case while 77 (71.3%) were E. dispar and the remaining 30 samples were negative for both species by real‐time PCR based on the small subunit ribosomal RNA gene sequence of E. histolytica and E. dispar. The tradition of microscopy in a routine diagnostic set‐up appears unsatisfactory to reliably differentiate rbc‐engulfing amoeba from non‐invasive amoeba in wet smears.
Maternal perceptions of acute respiratory infections in children under 5 in rural South Africa
Authors: Kauchali Shuaib , Rollins Nigel , Bland Ruth , Van den Broeck Jan ,   on behalf of the Child Health Group
Published: April 2004

Objectives  To assess maternal ability to recognize respiratory distress and to identify local beliefs and practices around respiratory infections in rural KwaZulu/Natal, South Africa.

Methods  A descriptive study: 15 knowledgeable mothers were shown a video of 10 children with respiratory distress and four normal children. Mothers were asked to describe perceived types, signs, symptoms, causes of and actions taken for each child. Sensitivity and specificity were calculated for maternal recognition of respiratory distress (chest indrawing, fast breathing) shown on the video. A focus group discussion with six mothers was held to corroborate and refine individually reported local concepts.

Findings  Maternal recognition of respiratory distress was good (sensitivity 91.3%, 95% CI: 86.8–95.8%; specificity 95%, 95%CI: 89.5–100%), with little variation between mothers (kappa = 0.704). Mothers described 12 ‘local types of respiratory illness’, each with its own name and its own well‐defined set of signs and symptoms. They were classifiable into five causative categories: supernatural, natural, tuberculosis, cold weather and unknown, indicating that perceptions of causation differed greatly from biomedical concepts. For illnesses of perceived supernatural causation, mothers were reluctant to seek medical care and antibiotics were deemed inappropriate. Traditional remedies were preferred instead.

Conclusion  Knowledge of local vocabulary and concepts about respiratory infections is essential to design strategies for health care workers to communicate with mothers about respiratory disease, so that mothers will seek timely medical care, provide continued safe, supportive home care and comply with antibiotic treatment.
Relationship between age, molecular markers, and response to sulphadoxine–pyrimethamine treatment in Kampala, Uganda
Authors: Staedke Sarah G. , Sendagire Hakim , Lamola Steven , Kamya Moses R. , Dorsey Grant , Rosenthal Philip J.
Published: April 2004

Sulphadoxine/pyrimethamine (SP) has become the first‐line treatment of uncomplicated malaria in a number of African countries. Molecular surveillance of resistance‐mediating mutations in Plasmodium falciparum dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) has been proposed as a means of predicting SP treatment outcomes, but optimal methods of surveillance in different populations have not been well established. To investigate the relationship between molecular markers of SP resistance, host immunity, and response to therapy, we evaluated the association between the presence of five key dhfr and dhps mutations at enrollment and clinical outcome in children and adults treated with SP for uncomplicated malaria in Kampala, Uganda. Clinical treatment failure was 11% at 14 days, increasing to 30% at 28 days, after excluding new infections. Outcomes varied markedly based on the number of dhfr and dhps mutations and on the age of treated subjects. All infections with less than two dhfr/dhps mutations were successfully treated. Treatment failure associated with any two, three, or four dhfr/dhps mutations occurred in nine of 24 (38%) children up to 5 years, but not in older patients (0/20). In the presence of all five mutations, treatment failure occurred equally in children aged 5 years or younger [7/16 (44%)] and in older patients [8/16 (50%)]. Our results showed that age, a surrogate marker of antimalarial immunity, had a major impact on the relationship between polymorphisms in SP target enzymes and treatment outcomes. The use of molecular markers of SP resistance to predict treatment failure rates should take age into account.
Implementation of intermittent preventive treatment with sulphadoxine–pyrimethamine for control of malaria in pregnancy in Kisumu, western Kenya
Authors: van Eijk Anna M. , Ayisi John G. , ter Kuile Feiko O. , Slutsker L. , Otieno Juliana A. , Misore Ambrose O. , Odondi J. O. , Rosen Daniel H. , Kager Piet A. , Steketee Rick W. , Nahlen Bernard L.
Published: April 2004

Objective In 1998, the Kenyan Ministry of Health introduced intermittent preventive treatment (IPT) with sulphadoxine–pyrimethamine (SP), one treatment dose in the second trimester (16–27 weeks) and one treatment dose between 28 and 34 weeks of gestational age, for the control of malaria in pregnancy. We evaluated the coverage and determinants of receipt of IPT after its introduction in the Provincial Hospital in Kisumu, western Kenya.

Methods Information on the use of IPT in pregnancy was collected from women who attended the antenatal clinic (ANC) and delivered in the same hospital. In exit interviews, we assessed patterns of IPT use in the ANC.

Results Of 1498 women who delivered between June 1999 and June 2000, 23.7%, 43.4% and 32.9% received ≥2, 1 or no dose of SP, respectively. Late first ANC attendance was the most important factor contributing to incomplete IPT; 45% of the women started attending ANC in the third trimester. More women received at least one tetanus toxoid immunization than at least one dose of IPT (94%vs. 67%, P < 0.05). In exit interviews, 74% correctly associated IPT with treatment of malaria; however, knowledge on the need for the second dose was poor. Three per cent of the administrations were given despite contraindications. The agreement between gestational age by date of last menstrual period and by palpation was low (κ = 0.1).

Conclusions Education of pregnant women and ANC staff to increase earlier attendance for ANC has the potential to substantially increase the proportion of women receiving two doses of IPT with SP.
IgG class antibodies from psoriasis patients recognize the 60‐KDa heat‐shock protein of Streptococcus pyogenes
Authors: Cancino‐Díaz Mario E. , Ruiz‐González Verónica , Ramírez‐Reséndiz Luis , Ortiz Blanca , Domínguez‐López María Lilia , Paredes‐Cabrera Giovanna C. , León‐Dorantes Gladys , Blancas‐González Fernando , Jiménez‐Zamudio Luis , García‐Latorre Ethel
Published: April 2004

Background  We have previously found that psoriatic patients have IgG autoantibodies that recognize lesions but not autologous normal skin. The reactivity of the autoantibodies can be adsorbed with streptococcal antigens.

Methods  IgG antibodies were determined by immunoblot and ELISA to streptococcal antigens and by ELISA to the recombinants HSP60Sp, HSP70Sp, HSP60Ec and HSP60Hu, in plaque (PP) and guttate (GP) psoriasis patients, in healthy subjects (HC) and in individuals with streptococcal throat infections and high ASO titers, but without history of dermatological disease (ISp).

Results  We found by immunoblot that the IgG response to 71‐, 60‐, and 14‐kDa protein fractions of Streptococcus pyogenes is important in psoriasis. We also found by ELISA that the response to the rHSP60Sp in PP was higher than in all the other three groups studied (P < 0.05) with an odds ratio of 11.11 (CI95% of 4.33–28.49). The PP infected with S. pyogenes had higher titers of the antirHSP60Sp, high ASO, and high PASI. The PP patients did not significantly recognize the HSP60Ec or the HSP60Hu. The GP patients had a higher response to the rHSP60Sp than the healthy controls or ISp patients (P < 0.05) but showed no association with the disease. The response of the ISp patients to the HSP60Sp was similar to the healthy controls. The response to the rHSP70Sp was similar in the PP patients and the healthy controls.

Conclusion  Results suggest that a high response to the HSP60Sp could be associated with the chronic form of psoriasis.
A comparative study of antibody titers of blister fluid and serum in patients with subepidermal immunobullous diseases
Authors: Daneshpazhooh Maryam , Shahdi Majid , Aghaeepoor Mahnaz , Hasiri Gholamreza , Chams Cheida
Published: April 2004

Background  Subepidermal autoimmune bullous diseases (SABD) comprise several disorders, such as bullous pemphigoid (BP), cicatricial pemphigoid (CP), epidermolysis bullosa acquisita (EBA), herpes gestationis (HG), and linear immunoglobulin A (IgA) dermatosis (LAD), and are characterized by antibody production against the basement membrane structures of the skin and mucosa. Although indirect immunofluorescence (IIF) on serum is a routine test for the detection of basement membrane zone antibodies, there have only been a few studies related to IIF on blister fluid.

Aim  To perform IIF on blister fluid and to compare the results with those of serum.

Methods  IIF on salt‐split skin was performed on the serum and blister fluid of 35 patients with SABD (25 bp, three EBA, three HG, three LAD, and one bullous systemic lupus erythematosus) with conjugated IgG, IgA, and C3.

Results  Twenty‐eight of the 35 patients showed IIF‐positive blister fluid with a titer similar or less than that of serum. In 25 patients with BP, the most common disease in this study, 23 cases (92%) had positive IIF on serum, 23 cases (92%) on blister fluid, and 24 cases (96%) on either serum or blister fluid. Immunoreactant titers in BP blister fluid and serum did not show significant differences (P > 0.05). Epidermal binding of immunoreactants was the most prevalent staining pattern of IIF on salt‐split skin (92%) in BP.

Conclusions  From the findings of this study, the blister fluid of patients with SABD can be used for IIF. Although IIF sensitivity on blister fluid is no more than that on serum, the performance of this test on blister fluid in addition to serum may reduce the number of false negative results of IIF found using either of these two substrates alone.
A matter of trust – patient's views on decision‐making in colorectal cancer
Authors: Salkeld Glenn , Solomon Michael , Short Leonie , Butow Phyllis N
Published: April 2004

Objectives To determine which aspects of the treatment decision process, therapy and outcomes are most important to patients with colorectal cancer (CRC).

Design Cross‐sectional survey.

Participants A total of 102 men and 73 women who had completed primary treatment for CRC in two teaching hospitals in Central Sydney, Australia.

Main outcomes measures Patient's rating of the importance of the decision‐making aspects and outcomes of treatment for CRC.

Results Trust in their surgeon and confidence of specialty training are of paramount importance to CRC patients. Patients also have a strong desire to get on with treatment quickly and rate the risk of disease recurrence and quality of life as being very important in their treatment decisions. Gender, age and whether the patient had undergone adjuvant radiotherapy were all significant predictors of preferred mode of treatment decision‐making. Fifty‐eight per cent of women preferred a shared decision‐making role compared with 36% of men, whilst older patients and those who had undergone adjuvant radiotherapy were significantly more likely to prefer that their surgeon decide upon treatment when compared with younger patients and respondents who have not had radiotherapy.

Conclusions Regardless of whether a patient prefers an active or more passive role in decision‐making, having a surgeon explain treatment options in a clear, unhurried and open manner is vital to how patients feel about their treatment. Whilst acknowledging that individual patients will have different needs for information and preferences for treatment, there are several factors amongst many in the process of decision‐making which are considered very important by patients with CRC. A surgeon who adopts a consultation style that is open and informative, that offers patients the chance to participate in the process of decision‐making and clearly explain treatment options and outcomes will engender trust with their patient.
Evaluating decision aids – where next?
Authors: O'Cathain Alicia , Thomas Kate J
Published: April 2004

Decision aids have been developed to help patients become involved in decision‐making about their individual health care. During the evaluation of a particular decision aid in maternity care – a set of 10 ‘Informed Choice’ leaflets – we considered the lessons learnt for evaluation of decision aids in the future. Decision aids have been tested mainly in explanatory trials and have been found to be effective. We argue that existing decision aids should be subjected to more pragmatic trials to test their effectiveness in the real world. The small amount of evidence on their use in the real world shows that they face challenges, resulting in poor implementation. Therefore, we propose that implementation strategies are developed which take heed of the findings of research on getting evidence into practice, and in particular address structural barriers such as the lack of time available to health professionals. We recommend that these ‘decision aid implementation packages’ are developed in conjunction with both health professionals and patients, and identify and address potential barriers to both the delivery of patient involvement in decision‐making, and the use of decision aids, in the real world. These ‘packages’ can then be submitted to pragmatic evaluation.
Patient‐focussed decision‐making in early‐stage prostate cancer: insights from a cognitively based decision aid
Authors: Feldman‐Stewart Deb , Brundage Michael D , Manen Lori Van , Svenson Ola
Published: April 2004

Purpose  To study the cognitive processes of early‐stage prostate cancer patients as they determined which treatment they preferred, using our cognitively based decision aid.

Method  The aid was a one‐to‐one interview that included the structured presentation of information, listing exercises in which the patient identified attributes important to his decision, and trade‐off exercises to help him weigh and integrate those attributes together. At various points of the interview, patients identified the attributes they felt were important to their decision, rated their treatment options and completed standardized assessments relating to their decision. In addition, patients participated in a follow‐up interview at the time they made their actual treatment decision and again 3 months later.

Results  Sixty of 70 (86%) of the invited patients participated in the study. Participating patients identified a median of four important attributes (range 1–10); 36 different attributes were identified at some point in the interview by the group. During the interview, 78% of patients changed which attributes they considered important, and 72% changed their treatment ratings. Stability of treatment choice after the interview and lack of regret after the decision were each positively associated with increasing differentiation between treatment options over time.

Conclusions  The decision process appears to be dynamic for the patients with great variability across patients in what is important to the decision. Increasing stability of choice and lack of regret appear to be related positively to increasing difference over time in how attractive the preferred option is over its closest competitor, rather than to the size of the difference at any one point in time.
Developing consumer involvement in rural HIV primary care programmes
Authors: Mamary Edward M , Toevs Kim , Burnworth Karla B , Becker Lin
Published: April 2004

Objectives  As part of a broader medical and psychosocial needs assessment in a rural region of northern California, USA, five focus groups were conducted to explore innovative approaches to creating a system of consumer involvement in the delivery of HIV primary care services in the region.

Design  A total of five focus groups (n = 30) were conducted with clients from three of five counties in the region with the highest number of HIV patients receiving primary care.

Setting and participants  Participants were recruited by their HIV case managers. They were adults living with HIV, who were receiving health care, and who resided in a rural mountain region of northern California.

Variables studied  Group discussions explored ideas for new strategies and examined traditional methods of consumer involvement, considering ways they could be adapted for a rural environment.

Results  Recommendations for consumer involvement included a multi‐method approach consisting of traditional written surveys, a formal advisory group, and monthly consumer led social support/informal input groups. Specific challenges discussed included winter weather conditions, transportation barriers, physical limitations, confidentiality concerns, and needs for social support and education.

Conclusions  A multiple‐method approach would ensure more comprehensive consumer involvement in the programme planning process. It is also evident that methods for incorporating consumer involvement must be adapted to the specific context and circumstances of a given programme.
Requirement for the Rac GTPase in Chlamydia trachomatis Invasion of Non‐phagocytic Cells
Authors: Carabeo Rey A. , Grieshaber Scott S. , Hasenkrug Aaron , Dooley Cheryl , Hackstadt Ted
Published: April 2004

Chlamydiae are gram‐negative obligate intracellular pathogens to which access to an intracellular environment is paramount to their survival and replication. To this end, chlamydiae have evolved extremely efficient means of invading nonphagocytic cells. To elucidate the host cell machinery utilized by Chlamydia trachomatis in invasion, we examined the roles of the Rho GTPase family members in the internalization of chlamydial elementary bodies. Upon binding of elementary bodies on the cell surface, actin is rapidly recruited to the sites of internalization. Members of the Rho GTPase family are frequently involved in localized recruitment of actin. Clostridial Toxin B, which is a known enzymatic inhibitor of Rac, Cdc42 and Rho GTPases, significantly reduced chlamydial invasion of HeLa cells. Expression of dominant negative constructs in HeLa cells revealed that chlamydial uptake was dependent on Rac, but not on Cdc42 or RhoA. Rac but not Cdc42 was found to be activated by chlamydial attachment. The effect of dominant negative Rac expression on chlamydial uptake is manifested through the inhibition of actin recruitment to the sites of chlamydial entry. Studies utilizing Green Fluorescent Protein fusion constructs of Rac, Cdc42 and RhoA, showed Rac to be the sole member of the Rho GTPase family recruited to the site of chlamydial entry.
Sorting of H,K‐ATPase β‐Subunit in MDCK and LLC‐PK1 Cells is Independent of μ1B Adaptin Expression
Authors: Duffield Amy , Fölsch Heike , Mellman Ira , Caplan Michael J.
Published: April 2004

The cytoplasmic tail of the H,K‐ATPase β‐subunit contains a putative tyrosine‐based motif that directs the β‐subunit's basolateral sorting when it is expressed in Madin‐Darby Canine Kidney (MDCK) cells. When expressed in LLC‐PK1 cells, however, the β‐subunit is localized to the apical membrane. Several proteins that contain tyrosine‐based motifs, including the low‐density lipoprotein and transferrin receptors, show a similar sorting ‘defect’ when expressed in LLC‐PK1 cells. For low‐density lipoprotein and transferrin receptors, this behavior is due to the differential expression of the μ1B subunit of the AP‐1B clathrin adaptor complex. μ1B is expressed by MDCK cells, but not LLC‐PK1 cells, and transfection of μ1B into LLC‐PK1 cells restores basolateral localization of low‐density lipoprotein and transferrin receptors. For the β‐subunit, however, μ1B expression in LLC‐PK1 cells does not induce its basolateral expression. We found that the β‐subunit interacts with both μ1B and μ1A in vitro and in vivo. The capacity to participate in a μ1B interaction therefore is not sufficient to program the β‐subunit's basolateral localization in MDCK cells. Our data suggest that the H,K‐ATPase β‐subunit's basolateral sorting signal is either masked in certain epithelial cells, or requires an interaction with sorting machinery other than AP‐1B for delivery to the basolateral plasma membrane.
Resistant bipolar disorder precipitated by Behcet's syndrome
Authors: Alevizos B , Anagnostara C , Christodoulou GN
Published: April 2004

Objective:  To report a case of a patient with Behcet's syndrome who developed treatment resistant bipolar disorder (BD) several years after the onset of Behcet's syndrome.

Methods:  A 62‐year‐old woman suffering from Behcet's syndrome since the age of 38, who developed a typical BD 6 years after the first manifestations of the syndrome was described.

Results:  Once BD occurred, Behcet's syndrome became milder, while BD deteriorated and evolved into a rapid cycling illness. Lithium and carbamazepine were ineffective in controlling the affective symptoms, while sodium valproate combined with low doses of carbamazepine and olanzapine resulted in sufficient stabilization of her mood state.

Conclusions:  Behcet's syndrome may have been the organic substrate for BD in this case. The appearance of BD in the setting of an organic‐immune disorder, like Behcet's syndrome, suggests that such disorders may be the neurobiologic substrate or contributor for BD, at least in certain cases.
Quetiapine with lithium or divalproex for the treatment of bipolar mania: a randomized, double‐blind, placebo‐controlled study
Authors: Sachs G , Chengappa KNR , Suppes T , Mullen JA , Brecher M , Devine NA , Sweitzer DE
Published: April 2004

Objective:  Evaluate the efficacy and tolerability of quetiapine (QTP) combined with lithium (Li) or divalproex (DVP) in the treatment of acute mania.

Methods:  Patients were randomized to 21 days of double‐blind treatment with QTP plus Li/DVP, or placebo (PBO) plus Li/DVP. QTP was rapidly dosed up to a maximum of 800 mg/day; Li was dosed to 0.7–1.0 mEq/L; or DVP to 50–100 μg/mL.

Results:  Fifty‐six of 91 (61.5%) individuals in the QTP + Li/DVP group compared with 49 of 100 (49%) taking PBO + Li/DVP completed the study. A significantly greater mean reduction in total Young Mania Rating Scale (YMRS) score was observed at end‐point in patients receiving QTP + Li/DVP compared with those in the PBO + Li/DVP group (−13.76 versus −9.93; p = 0.021). The response rate (≥50% YMRS improvement) was significantly higher in the QTP + Li/DVP group than in PBO + Li/DVP‐treated patients (54.3% versus 32.6%; p = 0.005), as was the proportion of patients achieving clinical remission (YMRS < 12) (45.7% versus 25.8%; p = 0.007). Patients receiving QTP + Li/DVP also had a significantly greater improvement in Clinical Global Impressions‐Bipolar (CGI‐BP) Severity of Illness scores (−1.38 versus −0.78; p = 0.001). The mean last‐week dose of QTP was 584 mg/day in patients meeting response criteria. Common adverse events (at least 10% and twice the rate of Li/DVP) in the QTP + Li/DVP group included somnolence, dry mouth, asthenia, and postural hypotension.

Conclusions:  Quetiapine combined with either Li or DVP has superior efficacy compared with Li or DVP monotherapy for treating patients with bipolar mania. Combination therapy was well‐tolerated and most adverse events were mild, withdrawal because of adverse events being only 5% compared with 6% on Li or DVP monotherapy.
Collective Consultation and Industrial Relations in China
Authors: Clarke Simon , Lee Chang‐Hee , Li Qi
Published: April 2004

Economic reform in China has seen the replacement of the administrative regulation of labour relations by their contractual regulation, with an increasing emphasis on the role of the collective contract system. Studies of the introduction of the system emphasized the determining role of the state. In this paper we examine the more recent development of the collective contract system and conclude that it is primarily the continued integration of the trade union into management at the workplace that prevents collective consultation from providing an adequate framework for the regulation of labour relations.
Shaping Union and Gender Identities: A Case Study of Women‐Only Trade Union Courses
Authors: Kirton Gill , Healy Geraldine
Published: April 2004

In the context of efforts to revitalize unions and the acknowledged need to widen participation within trade unions, this paper argues that women‐only trade union education acts as a vehicle for increasing women's participation and for improving their experiences of unions. Drawing on a qualitative research study of women‐only courses in two large male‐dominated British trade unions, the findings indicate that such courses provide the conditions for women to question, reinforce or transform their social identities and thereby can lead to greater union identification and participation.
Protest or Partnership? The Voluntary and Community Sectors in the Policy Process
Authors: Craig Gary , Taylor Marilyn , Parkes Tessa
Published: April 2004

The growing emphasis on partnership is opening up new opportunities for voluntary and community organizations, many of which have felt themselves hitherto to be “outsiders” in the policy process. But it is also generating new dilemmas as they strive to maintain their autonomy while increasingly operating as insiders. This article examines the strategic choices that such organizations make in seeking to influence policy and the challenges that they face. It rejects the simple categorizations made between “insiders” and “outsiders” in the policy process, arguing that strategic choices are more complex and dynamic than this, with insider strategies dependent on outsider strategies and vice versa, and many organizations operating from both arenas.
A Bound on Synchronically Interpretable Structure
Authors: Slack Jon M.
Published: April 2004

Abstract: Multiple explanatory frameworks may be required to provide an adequate account of human cognition. This paper embeds the classical account within a neural network framework, exploring the encoding of syntactically‐structured objects over the synchronic‐diachronic characteristics of networks. Synchronic structure is defined in terms of temporal binding and the superposition of states. To accommodate asymmetric relations, synchronic structure is subject to the type uniqueness constraint (TUC). The nature of synchronic structure is shown to underlie X‐bar theory that characterizes the phrasal structure of human languages. The derivation differentiates core X‐bar properties from language‐specific properties.
Surgical Correction of Periocular Fat Pad Hypertrophy in Pot‐Bellied Pigs
Authors: Andrea C. Renee , George Lisle W.
Published: April 2004

Objective To report surgical correction of hypertrophic periocular fat pads that cause loss of vision and behavioral changes in pot‐bellied pigs.

Study Design A retrospective study.

Animals or Sample Population Nine Vietnamese pot‐bellied pigs.

Methods Medical records of nine pot‐bellied pigs admitted between 1994 and 1997 for loss of vision associated with hypertrophied periocular fat accumulations were reviewed. Outcome was assessed by contacting owners 4 months to 5 years after surgery.

Results The most common clinical signs were related to impaired vision and included periocular dermatitis, lethargy, and aggressive behavior. Surgical removal of redundant periorbital fat and skin resulted in marked improvement in vision and behavior in all pigs. Overall client satisfaction was excellent.

Clinical Relevance A novel method for removal of redundant fat and skin can be used to alleviate clinical signs associated with periocular fat pad hypertrophy of pot‐bellied pigs. A small percentage of Vietnamese pot‐bellied pigs are prone to abnormal fat accumulations in the facial region, particularly the periorbital region, that results in a mechanically narrowed palpebral fissure and impaired vision. This report describes a technique for surgically removing redundant fat and skin to improve vision and reports outcome in nine pigs.
Microvascular Transplantation of a Free Omental Graft to the Distal Extremity in Dogs
Authors: Roa Daren M. , Bright Ronald M. , Daniel Gregory B. , McEntee Michael F. , Sackman Jill E. , Moyers Tammy D.
Published: April 2004

ObjectiveTo assess the survival of a free omental graft applied to an experimentally created wound on the distal extremity in dogs.

Study DesignA free omental graft was evaluated as a primary method of treatment for dogs with distal extremity wounds in an experimental model.

Animals or Sample PopulationFive adult intact female mixed breed dogs weighing 21.8 kg to 25.0 kg.

MethodsA free omental graft was harvested from the abdomen and transferred to a wound bed overlying the medial aspect of the tibia. A microvascular anastomosis was performed between the graft vessels and vessels at the recipient site. Daily clinical assessment of graft viability was performed. Angiography and99mTechnetium labeled macroaggregated albumin (99mTc MAA) scintigraphic perfusion scans were performed on either day 4, 5, or 7. Postmortem collection of tissues for histopathologic analysis was performed immediately after imaging. Total operative time and graft ischemia time were evaluated for effects on graft survival.

ResultsTwo of seven grafts survived to the end of the study, three of seven grafts failed because of ischemia, and two of seven grafts failed because of self‐trauma. There was no clinically significant morbidity associated with the abdominal portion of the procedure. Because of the small number of surviving grafts, the effects of operative time and graft ischemia time could not be statistically evaluated.

ConclusionsMicrovascular transplantation of a free omental graft can result in a viable tissue covering of a distal extremity wound, however, the failure rate is unacceptably high.

Clinical RelevanceA free omental graft may not have sufficient durability to be an acceptable wound covering by itself. Further studies combining omentum with a skin graft or other tissues may result in a clinically useful technique.
Investigation Into the Use of the Laryngeal Mask Airway in Pentobarbital Anesthetized Dogs
Authors: Braz José R.C. , Martins R.H.G. , Mori A.R. , Luna Stelio P.L.
Published: April 2004

Objective To investigate the use of the laryngeal mask airway (LMA) in dogs.

Study Design Prospective experimental study.

Animals Eight healthy adult mixed breed dogs weighing from 15 to 20 kg.

Methods The dogs were anesthetized with intravenous pentobarbital. An LMA was introduced after the induction of anesthesia and 1 L/min O2 plus 1 L/min air was delivered using a circle anesthetic system. Respiratory rate, tidal volume, arterial O2 saturation (pulse oximetry), end tidal CO2, inspired fraction of O2, pulse rate, and mean arterial blood pressure were measured after the insertion of the LMA and 30, 60, 90, and 120 minutes afterwards.

Results There were no changes in respiratory rate, tidal volume, arterial O2 saturation, and pulse rate during anesthesia. End tidal CO2 decreased significantly by the end of anesthesia and ventilation appeared satisfactory.

Conclusions An LMA appeared to be an alternative option to maintain the patency of the airway in dogs.

Clinical Relevance This device may allow safe maintenance of an airway in dogs when intubation is difficult or when it interferes with the procedure (eg, cervical myelography).
The Effect of Compacted Cancellous Bone Grafting on the Healing of Subchondral Bone Defects of the Medial Femoral Condyle in Horses
Authors: Jackson W.A. , Stick J.A. , S.P. Arnoczky , Nickels F.A.
Published: April 2004

Objective—To compare the quality of second‐intention healing and that of compacting sternally harvested cancellous bone into subchondral bone defects of the medial femoral condyle in horses.

Study Design—A controlled experiment using a surgical technique that minimizes soft tissue trauma, customized for consistency among horses.

Animals or Sample Population—Ten horses, aged 2 to 5 years, free of hindlimb lameness and with radiographically normal stifles.

Methods—After a 12.7‐mm‐diameter × 19‐mm‐deep defect was created into randomly selected medial femoral condyles, bone and cartilage healing was evaluated over a 6‐month period in control horses (n = 5) and horses receiving a compacted cancellous bone graft (n = 5). Healing was evaluated using lameness assessment, radiographic and microradiographic interpretation, arthroscopic appearance, percent bone fill, proteoglycan content, and histology.

Results—Six months after surgery, there was no significant difference between grafted and ungrafted defects with respect to lameness, radiographic score, or percent bone fill. Histologically, grafted defects were characterized by the presence of dead graft and secondary cyst formation in four defects. Ungrafted defects filled with fibrous tissue and no cyst formation were identified.

Conclusions—Grafted defects do not heal better than ungrafted defects, and lameness was not affected by surgical technique.

Clinical Significance—Cartilage healing is similar in grafted and ungrafted defects in the equine medial femoral condyle at 6 months, suggesting that surgical debridement alone of cystic structures remains the treatment of choice.