bluuebunny/crossref_metadata_2025 huggingface dataset:
Living donor liver transplant recipients achieve relatively higher immunosuppressant blood levels than cadaveric recipients
Authors: Trotter James F. , Stolpman Nancy , Wachs Michael , Bak Thomas , Kugelmas Marcelo , Kam Igal , Everson Gregory T.
Published: August 2002

Two recent brief reports suggest that recipients of living donor liver transplants achieve higher levels of immunosuppressive agents than cadaveric (CAD) liver transplant recipients administered the same dose. These results could have important implications regarding the dosing of immunosuppressives in living donor liver transplant recipients. We report our findings relative to immunosuppressive doses and levels in a cohort of 46 living donor liver transplant recipients. Immunosuppressive blood levels and doses were recorded weeks 1, 2, 3, and 4 and months 2, 3, 4, 5, and 6 for 46 living donor liver transplant recipients and 66 matched CAD liver transplant recipients who underwent transplantation between August 1997 and May 2001. The ratio of level to dose also was recorded at each interval. The mean overall cyclosporine A dose was similar in living donor liver transplant recipients (323 mg/d) compared with CAD recipients (344 mg/d; P = not significant [NS]). The mean overall tacrolimus dose was 15% lower in patients who underwent living donor liver transplantation (LDLT; 5.7 mg/d) than CAD transplantation (6.7 mg/d), although statistical significance was not achieved (P = .08). The mean overall cyclosporine A level was 18% higher in those undergoing LDLT (275 ng/mL) than CAD transplantation (234 ng/mL; P = .015). The mean overall tacrolimus level was the same in living donor liver transplant recipients (10.8 ng/mL) and CAD recipients (10.2 ng/mL; P = NS). The overall cyclosporine A level-dose ratio was 26% higher for those undergoing LDLT (0.83) than CAD transplantation (0.66; P = .01). The overall tacrolimus level-dose ratio was 26% higher for those undergoing LDLT (1.82) than CAD transplantation (1.44; P = .01). In conclusion, (1) living donor liver transplant recipients achieve higher blood levels of tacrolimus and cyclosporine A for a given dose compared with CAD recipients, and (2) this difference is observed up to 6 months after transplantation, when hepatic regeneration is completed.
Pathophysiology of renal disease associated with liver disorders: Implications for liver transplantation. Part I
Authors: Davis Connie L. , Gonwa Thomas A. , Wilkinson Alan H.
Published: August 2002

Renal and hepatic function are often intertwined through both the existence of associated primary organ diseases and hemodynamic interrelationships. This connection occasionally results in the chronic failure of both organs, necessitating combined liver-kidney transplantation (LKT). Since 1988, more than 850 patients in the United States have received such transplants, with patient survival somewhat less than that for patients receiving either organ alone. Patients with renal failure caused by acute injury or hepatorenal syndrome have classically not been included as candidates for combined transplantation because of the reversibility of renal dysfunction after liver transplantation. However, the rate and duration of renal failure before liver transplantation is increasing in association with prolonged waiting list times. Thus, the issue of acquired permanent renal damage in the setting of hepatic failure continues to confront the transplant community. The following article and its sequel (Part II, to be published in vol 8, no 3 of this journal) attempt to review the problem of primary and secondary renal disease in patients with end-stage liver disease, elements involved in renal disease progression and recovery, the impact of renal disease on liver transplant outcome, and results of combined LKT; outline the steps in the pretransplantation renal evaluation; and provide the beginnings of an algorithm for making the decision for combined LKT.
Predictors of mortality and stenosis after transjugular intrahepatic portosystemic shunt
Authors: Russo Mark W. , Jacques Paul F. , Mauro Matthew , Odell Pat , Brown Robert S.
Published: August 2002

Transjugular intrahepatic portosystemic shunts (TIPSs) are used to treat variceal hemorrhage and refractory ascites. We sought to determine factors associated with stenosis and mortality after TIPS placement in patients with end-stage liver disease. This is a retrospective review of 90 TIPSs placed over a 3-year period. Demographic, clinical, and biochemical parameters were analyzed in univariate analyses to determine their association with stenosis and death. Multivariate analyses were conducted using logistic regression and Cox proportional hazard modeling. Thirty-five TIPSs were placed for recurrent variceal bleeding; 14 TIPSs, for uncontrolled variceal bleeding; 34 TIPSs, for refractory ascites; and 7 TIPSs, for other causes. The overall mortality rate was 33%, and 18 patients died within 30 days of TIPS placement. The 1-year stenosis rate was 49%. Fourteen patients underwent liver transplantation a mean of 116 ± 143 days after TIPS placement. Prothrombin time greater than 17 seconds, serum creatinine level greater than 1.7 mg/dL, total bilirubin level greater than 3 mg/dL, and uncontrolled variceal bleeding as an indication for TIPS placement were significant predictors of 30-day mortality. Serum creatinine level was a predictor of 30-day mortality in individuals with recurrent variceal hemorrhage or ascites. Multivariate analyses showed that creatinine level greater than 1.7 mg/dL and uncontrolled variceal bleeding as an indication for TIPS placement were independently associated with 30-day mortality. Individuals with both coagulopathy and renal insufficiency had a 30-day mortality rate of 78%. Urgent placement of TIPS was associated with an increased risk for stenosis (hazard ratio = 4.5; 95% confidence interval, 1.9 to 10.1; P < .001), but no other clinical variables were associated with stenosis. Uncontrolled variceal bleeding as an indication for TIPS placement, coagulopathy, hyperbilirubinemia, and renal insufficiency were associated with increased mortality in patients with TIPSs. Individuals with both coagulopathy and renal insufficiency had high mortality. Urgent TIPS placement for uncontrolled variceal bleeding was associated with stenosis.
Markers of oxidative stress in cyclosporine-treated and tacrolimus-treated children after liver transplantation
Authors: Granot Esther , Elinav Hila , Kohen Ron
Published: August 2002

Oxidative stress is presumed to have a major role in cyclosporine A (CsA)- and tacrolimus-induced tissue toxicity. The present study was performed to elucidate the degree of oxidative stress after liver transplantation in CsA- and tacrolimus-treated patients. Twenty-three patients (14 patients, CsA; 9 patients, tacrolimus) aged 2.5 to 18 years (mean, 9.8 years) who had undergone liver transplantation 1.5 to 12 years (mean, 5.4 years) before were studied. Eighteen healthy children aged 2 to 16.5 years (mean, 9.4 years) served as a control group. The following parameters were assessed: plasma lipoprotein levels; plasma carbonyl levels, as markers of oxidative damage to proteins; total plasma oxidizability, which evaluates plasma antioxidant capacity (lag phase) and lipoprotein susceptibility to oxidation; and plasma antioxidant capacity by cyclic voltammetry (CV), which measures antioxidant capacity stemming from hydrophilic low-molecular-weight antioxidant components. Carbonyl levels and rates of plasma oxidation did not differ between groups. The lag phase of plasma oxidation was significantly longer in CsA-treated children compared with tacrolimus-treated children or controls (mean, 54.4 ± 4.8 [SE] v 40.2 ± 2.2 v 46.5 ± 2.8 minutes, respectively; P < 0.05). Antioxidant capacity, assessed by CV, did not differ among CsA-treated patients, tacrolimus-treated patients, and healthy controls. Plasma α-tocopherol and β-carotene levels did not differ between CsA-treated and tacrolimus-treated patients. In children post-liver transplantation, oxidative damage assessed by markers of lipid and protein oxidation is not increased, and plasma antioxidant capacity is not diminished.
Costimulatory blockade prevents early rejection, promotes lymphocyte apoptosis, and inhibits the upregulation of intragraft interleukin-6 in an orthotopic liver transplant model in the rat
Authors: Bartlett Adam S. , McCall John L. , Ameratunga Rohan , Howden Brian , Yeong Mee-Ling , Benjamin Christopher D. , Hess Donna , Peach Robert , Munn Stephen R.
Published: August 2002

Costimulatory pathways have a pivotal role in the T-cell response to alloantigen. The role of costimulatory blockade with anti-CD154 in orthotopic liver transplantation (OLT) has not been examined previously. This study aims to investigate effects of anti-CD154 and CTLA4-immunoglobulin (Ig) in the early post-OLT period using a major histocompatibility complex-disparate fully arterialized OLT model in the rat. Lewis rats underwent OLT with Dark Agouti liver allografts. Recipients were randomized to receive (1) isotype control, (2) anti-CD154, (3) CTLA4-Ig, or (4) cyclosporine A (CyA). Rats were killed day 8, and specimens were obtained for histological examination, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling, immunohistochemistry, and quantitative reverse-transcriptase polymerase chain reaction. An additional five transplant recipients were treated with anti-CD154 for 14 days postoperatively to assess long-term allograft survival. All isotype control animals died on or before day 6 of acute rejection. Apart from four deaths caused by nonimmunologic causes, all treated recipients survived to day 8. The median survival of rats treated for 14 days with anti-CD154 was greater than 150 days. Serum aspartate aminotransferase and bilirubin levels normalized by day 3 in the CyA group and day 5 in transplant recipients treated with costimulatory blockade. Histologically, there was no difference between isotype controls and CTLA4-Ig-treated animals, whereas anti-CD154-treated transplant recipients had a lower Banff score. CD4+ and CD8+ T-cell infiltrates were prominent in transplant recipients treated with costimulatory blockade. Intragraft analysis showed an increase in lymphocyte apoptosis, Fas ligand messenger RNA expression, and reduction in interleukin-6 gene expression in transplant recipients treated with costimulatory blockade. Costimulatory blockade did not alter intragraft gene expression of other mediators of T-cell priming, differentiation, and effector function compared with isotype control animals. In conclusion, costimulatory blockade prevented acute rejection, enabled long-term survival, and increased intragraft lymphocyte apoptosis in a high-responding rat OLT model.
Effect of lamivudine treatment on survival of 309 North American patients awaiting liver transplantation for chronic hepatitis B
Authors: Fontana Robert J. , Keeffe Emmet B. , Carey William , Fried Michael , Reddy Rajender , Kowdley Kris V. , Soldevila-Pico Consuelo , McClure Leslie A. , Lok Anna S.F.
Published: August 2002

The primary aim of this study is to determine whether treatment with lamivudine improved pre-liver transplantation (pre-LT) and LT-free survival of patients awaiting LT for hepatitis B virus (HBV)-related cirrhosis. Data from 162 lamivudine-treated and 147 untreated transplant candidates managed at 20 North American transplant centers between 1996 and 1998 were collected and compared. Lamivudine-treated patients were more likely to be men, hepatitis B e antigen positive, HBV DNA positive, and have lower serum albumin levels at listing (P < .05). Actuarial pre-LT and LT-free survival were similar in lamivudine-treated and untreated patients. Using Cox regression analysis, the only significant predictor of pre-LT patient survival was the modified Child-Turcotte-Pugh (mCTP) score, whereas significant predictors of LT-free survival included ethnic background, lamivudine treatment, indication for LT, baseline serum alanine aminotransferase level, and baseline mCTP score. Lamivudine had no apparent effect on liver disease severity in patients undergoing LT, but appeared to improve disease severity in patients still awaiting LT. Breakthrough infection was noted in 11% of lamivudine-treated patients. We conclude that lamivudine therapy is not associated with improved pre-LT or LT-free survival in LT candidates with chronic hepatitis B. However, a subset of patients with less advanced liver failure may derive clinical benefit from lamivudine therapy, thus delaying the need for LT. In the absence of prospective, randomized, controlled trials of lamivudine in patients with decompensated cirrhosis, careful selection of patients and optimal timing of treatment are needed to balance the risk versus benefit of lamivudine therapy in LT candidates.
Comparison between two high-dose methylprednisolone schedules in the treatment of acute hepatic cellular rejection in liver transplant recipients: A controlled clinical trial
Authors: Volpin Roberta , Angeli Paolo , Galioto Alessandra , Fasolato Silvano , Neri Daniele , Barbazza Franco , Merenda Roberto , del Piccolo Franco , Strazzabosco Mario , Casagrande Fabio , Feltracco Paolo , Sticca Antonietta , Merkel Carlo , Gerunda Giorgio , Gatta Angelo
Published: August 2002

Intravenous methylprednisolone is used in most liver transplant centers as first-line therapy of acute hepatic cellular rejection in patients who undergo liver transplant. However, no controlled study has been performed to date to define the optimal dose and duration of the steroid regimen. The schedules that actually are used in most transplant centers are drawn from those that were developed empirically for the treatment of acute renal graft rejection. Thus, the aim of the study was to compare two schedules of steroid treatment of acute hepatic cellular rejection among those most widely used. Thirty-eight eligible patients with grade II or III acute hepatic cellular rejection were randomized to receive two different high-dose methylprednisolone schedules. Eighteen patients were randomized in group A (intravenous dose of 1,000 mg of methylprednisolone followed by a 6-day taper from 200 to 20 mg/d). Twenty patients were randomized in group B (intravenous dose of 1,000 mg of methylprednisolone for three consecutive days). The response to treatment was evaluated by means of a second liver biopsy. The treatment of group A proved to be more effective than treatment of group B. The resolution of acute hepatic cellular rejection was observed in 83.3% of cases in group A and 50.0% of cases in group B (P < .05). The treatment of group A proved to be safer also than treatment of group B. Patients randomized in group B showed a higher prevalence of infections (90.0% of cases versus 55.5% of cases; P < .01) mainly because of bacterial (80.0% versus 50.0%; P < .05) and viral (50.0% versus 16.6%; P < .05) agents. In conclusion, the study shows that intravenous administration of 1,000 mg of methylprednisolone followed by a 6-day taper from 200 to 20 mg/d is more effective and safer than intravenous dose of 1,000 mg of methylprednisolone for three consecutive days in the treatment of acute cellular rejection in patients with liver transplantation.
Volumetric analysis of liver segments in 155 living donors
Authors: Leelaudomlipi Surasak , Sugawara Yasuhiko , Kaneko Junichi , Matsui Yuichi , Ohkubo Takao , Makuuchi Masatoshi
Published: August 2002

Right-lobe graft has been used most frequently for living donor liver transplantation in adult patients; however, some donors cannot donate their right lobe (according to the Healey and Scroy’s terminology) because the remaining residual liver would be too small. A recent study suggested the possibility of right posterior segment graft in these donors. The purpose of this study was to evaluate the feasibility of right lobe or right posterior segment graft with a volumetric analysis. Liver volumetry by computed tomography was performed in 155 consecutive donors, and the volume of each liver segment was calculated. To confirm the reliability of volumetric examination, the estimated graft volume and the actual weight were compared. The average volume ratios of the left lateral segment, left medial segment, caudate lobe, right anterior segment, and right posterior segment were 17%, 14%, 2%, 37%, and 30%, respectively. In 39 donors (25%), the volume ratio of the right lobe was over 70%. Of these donors, 72% had a larger (difference in volume ratio greater than 5%) right posterior segment than left lobe with caudate lobe. The relationship between the estimated volume and actual weight was linear. The present results suggest that right lobectomy carries a potential risk and that the right posterior segment may be useful as an alternative graft from the point of donor’s safety.
Serial magnetic resonance imaging of central pontine myelinolysis
Authors: Buis Carlijn I. , Wijdicks Eelco F.M.
Published: August 2002

Central Pontine Myelinolysis (CPM) is a rare neurologic complication after liver transplantation. The true incidence of CPM after orthotopic liver tranplantation remains an estimate. However, with the introduction of magnetic resonance imaging, early recognition became feasible. In this report, we present a case of rapid resolution of CPM followed by serial magnetic resonance imaging scans.
Long-term survival and late graft loss in pediatric liver transplant recipients—a 15-year single-center experience
Authors: Wallot Michael A. , Mathot Michael , Janssen Magda , Hölter Tanja , Paul Kilic , Buts Jean Paul , Reding Raymond , Otte Jean Bernard , Sokal Etienne M.
Published: August 2002

Increasing numbers of children undergo successful liver transplantation. Limited data exist on long-term survival and late graft loss. Survival and graft loss were studied in 376 primary liver graft recipients who survived more than 3 months after transplantation (80.5% of all primary graft recipients). Patient records were reviewed retrospectively for causes of graft loss. Risk factors were identified by analyzing graft, recipient, and posttransplant variables using multivariate Cox regression. One-, 5-, and 10-year actuarial graft survival rates in the study population were 94.6%, 87.3%, and 86.3%, respectively. Corresponding patient survival rates were 95.7%, 91.4%, and 90.4%. Forty-seven (12.5%) grafts were lost subsequently, 15 by patient death with preserved graft function. Survival rate after late retransplantation was 63.3%. Causes of late graft loss were infection (21.2%), posttransplant lymphoproliferative disease (PTLD, 21.2%), chronic rejection (17%), biliary complications (14.8%), and recurrence of malignant disease (8.5%). Independent risk factors for late graft loss and patient death included liver malignancy as primary disease, steroid resistant rejection, and PTLD. Graft loss rate was significantly increased for reduced-size grafts. Patients undergoing transplantation after 1991 and recipients of full-size grafts were more likely to survive. In conclusion, the long-term outcome for pediatric primary liver graft recipients surviving the early postoperative period is excellent except for patients with liver malignancy. There is no increased risk of late graft loss with the use of split or living related donor grafts. Technical complications are only a minor factor in late graft loss, but complications related to immunosuppression and infection remain a major hazard and must be addressed.
Reduced use of intensive care after liver transplantation: Influence of early extubation
Authors: Mandell Susan M. , Lezotte Dennis , Kam Igal , Zamudio Stacy
Published: August 2002

Postoperative ventilation and admission to the intensive care unit (ICU) is the standard of care in liver transplantation and comprises a significant proportion of transplantation costs. Because immediate postoperative extubation has been reported previously in a selected group of liver transplant recipients, we questioned whether this protocol could be extended to a larger group of patients. We also sought to determine the proportion of patients extubated immediately after surgery that could be transferred to the surgical ward without intervening ICU care. Of 147 patients studied in a prospective trial of sequential liver transplant recipients (who were not second-transplant recipients, United Network for Organ Sharing status 1, living donor transplant recipients, or dead before the end of surgery), 13 patients did not meet postsurgical criteria for early extubation and 111 patients were successfully extubated. Eighty-three extubated patients were transferred to the surgical ward after a routine admission to the postoperative care unit. Only 3 patients who were transferred to the surgical ward experienced complications that required a greater intensity of nursing care. A learning curve detected during the 3-year study period showed that attempts to extubate increased from 73% to 96% and triage to the surgical ward increased from 52% to 82% without compromising patient safety. The use of this protocol in our institution resulted in a 1-day reduction in ICU use in 75.5% of study subjects. We therefore conclude that the majority of liver transplant recipients can be extubated safely and admitted to the surgical ward after liver transplantation surgery, thus decreasing the cost associated with ICU care.
Fast track anesthesia for liver transplantation reduces postoperative ventilation time but not intensive care unit stay
Authors: Findlay James Y. , Jankowski Christopher J. , Vasdev Gurinder M. , Chantigian Robert C. , Gali Bhargavi , Kamath Gerard S. , Keegan Mark T. , Hall Brian A. , Jones Keith A. , Burkle Christopher M. , Plevak David J.
Published: August 2002

Fast tracking is an approach to health care delivery that emphasizes the efficient use of resources. This investigation was designed to determine whether shorter-acting drugs and different drug administration practices reduce the length of time for which patients require mechanical ventilation and intensive care after liver transplantation. After obtaining Institutional Review Board approval and informed consent, we randomized 80 consecutive patients (>17 years) undergoing liver transplantation to receive either our traditional anesthetic (thiopental, pancuronium, 50 μg/kg fentanyl), or fast track anesthetic (propofol, cisatracurium, 20 μg/kg fentanyl). The patients were weaned to extubation in the intensive care unit after an established clinical protocol. Measured data included the occurrence of intraoperative hypotension, intraoperative hypertension, intraoperative tachycardia, the length of postoperative mechanical ventilation, length of intensive care unit stay, and episodes of reintubation. Seventy-eight patients remained in the study through the investigation (two died intraoperatively). Operating time; amount of intraoperative red blood cells transfused; lowest body temperature achieved; and minutes of intraoperative hypotension, hypertension, and tachycardia were not different between the traditional and fast track patient groups. Postoperative ventilation time was greater in the patients who received the traditional anesthetic; mean. 1,081 minutes (median, 855) versus mean, 553.5 minutes (median, 390) (P < .001). However, there was no difference in length of intensive care unit stay. Five patients required reintubation (two patients given the traditional anesthetic, three given the fast track anesthetic). We conclude that a fast track approach to anesthetic care reduces the requirement for postoperative mechanical ventilation, but does not reduce intensive care unit stay after liver transplantation.
A Typology of Fatigue in Children With Cancer
Authors: Davies Betty , Whitsett Stan F. , Bruce Anne , McCarthy Patricia
Published: August 2002

Fatigue in adults with cancer has received considerable attention as a trouble some symptom that requires nursing intervention. Fatigue in children with cancer, however, has received considerably less focus. The first phase of the present study used qualitative methods to generate a detailed description of fatigue in children with cancer. Thirteen children (ages 5 to 15) and 12 parents from the oncology service in two regional children's hospitals participated in the initial interviews; a validation sample comprised another 7 children and 6 parents from a third site. Transcribed interviews were subjected to grounded theory analysis. Energy, as an overriding phenomenon, was a core concept in the descriptions of fatigue. Findings suggest that children with cancer may experience three subjectively distinct types of fatigue that represent different levels of energy: typical tiredness, treatment fatigue, and shutdown fatigue. Children managed their dwindling energy and minimized further energy loss through strategies of replenishing, conserving, and preserving. Children's use of these strategies was influenced by temperament, lifestyle, environmental factors, and treatment modalities. Knowl edge of the specific types of fatigue in children can offer direction for optimal intervention and for further research.
Exploiting the Versatility of Human Cytochrome P450 Enzymes: The Promise of Blue Roses From Biotechnology
Authors: Gillam Elizabeth M. J. , Guengerich F. Peter
Published: August 2002

The cytochrome P450 (P450) enzymes involved in drug metabolism are among the most versatile biological catalysts known. A small number of discrete forms of human P450 are capable of catalyzing the monooxygenation of a practically unlimited variety of xenobiotic substrates, with each enzyme showing a more or less wide and overlapping substrate range. This versatility makes P450s ideally suited as starting materials for engineering designer catalysts for industrial applications. In the course of heterologous expression of P450s in bacteria, we observed the unexpected formation of blue pigments. Although this was initially assumed to be an artifact, subsequent work led to the discovery of a new function of P450s in intermediary metabolism and toxicology, new screens for protein engineering, and potential applications in the dye and horticulture industries.
Unit cell determination of 2,3,9,10,16,17,23,24- octapentoxyphthalocyanine and its nickel derivative using electron and X-ray powder diffraction
Authors: STEINBRECHER S. , ZHOU F. , PLIES E. , HANACK M.
Published: August 2002

2,3,9,10,16,17,23,24-Octapentoxyphthalocyanine and its nickel derivative have been studied by means of electron and X-ray powder diffraction. The results reveal that the metal-free compound forms monoclinic crystals (space group C2/c) with unit cell constants a = 4.202 nm , b = 0.4977 nm , c = 3.345 nm , β = 98.9 ° and Z = 4 molecules per unit cell. 2,3,9,10,16,17,23,24-Octapentoxyphthalocyaninatonickel(II) is likely to be isomorphous to its metal-free analogue, but occurs in a second phase which is also stable at room temperature. This is identified to be a crystalline primitive hexagonal phase with cell constants a = b = 2.50 nm and c = 0.33 nm . It is assumed that the molecules form a columnar structure along the c-axis, whereas the hexagonal cross-section in the ab-plane goes back to the molecular disc shape. Imaging of monoclinic crystals of 2,3,9,10,16,17,23,24-octapentoxyphthalocyanine in an energy-filtering transmission electron microscope (EFTEM) can be performed to resolve 2 nm structures only, owing to specimen damage. According to the diffraction pattern, the micrograph provides a view along [001] and shows directly that the structure can be described in terms of parallel columnar stacks of molecules along the b-axis, the distance between neighbouring stacks being [Formula: see text]. The results show that the structures of both the metal-free compound and its nickel analogue are dominated by π–π interactions between the macrocycles, which is a marked difference from the structures of 1,4,8,11,15,18,22,25-octasubstituted phthalocyanines.
Synthesis of meso-nitrophenylporphyrins covalently linked to a polyphenylene chain bearing methoxy groups
Authors: DURANTINI EDGARDO N.
Published: August 2002

A convenient procedure for the synthesis of polyphenylene porphyrin dyads is described. The dyads consist of a meso-nitrophenylporphyrin covalently linked to a polyphenylene chain by an amide bond. The final phenyl group in the chain bears electron donor methoxy groups. The π-conjugated chain was obtained in excellent yield via a Wittig–Horner reaction, which produces a new double bond (E isomer) incorporating either — COOCH 3 or E isomer) incorporating either — CON ( OCH 3)( CH 3) functional groups. Expansion of the conjugated chain involves the reduction of these groups to aldehydes followed by a second Wittig–Horner reaction. 5-(4-Aminophenyl)-10,15,20-tris(4-nitrophenyl)porphyrin was synthesized from meso-(4-nitrophenyl)dipyrromethane. The E isomer) incorporating either — NO 2 groups in para positions of the peripheral phenyl rings give extra electron-withdrawing character to the porphyrin macrocycles. Coupling of the polyphenylene acids with aminoporphyrin results in the desired dyads. These dyads have moieties with different electron donor–acceptor properties. This present strategy may be easily used for preparation of other similar dyad derivatives. These compounds can be suitable for photodynamic therapy.
Calming troubled waters: Peacemakers in a sports riot
Authors: Russell Gordon W. , Arms Robert L.
Published: August 2002

This investigation sought to identify a set of measures predictive of those who would intervene in a crowd disturbance with the intent of restoring order. Male participants (N = 74) completed a battery of social and personality measures. Men who had previously attempted to break up a fight(s), including those who had recently intervened and judged their efforts to have been successful, were most likely to step in. Additionally, peacemakers were subject to the false consensus effect and strongly believed in law and order. A multiple regression analysis yielded a solution that accounted for 40.3% of the variance, with previous experience as a peacemaker and attitudes toward law and order emerging as the best predictors. Aggr. Behav. 27:292–296, 2001. © 2001 Wiley‐Liss, Inc.
Multiple herpetic whitlow lesions in a patient with chronic lymphocytic leukemia
Authors: Smith Edward , Hallman James R. , Pardasani Asha , McMichael Amy
Published: August 2002

Herpetic whitlow, a herpes simplex virus infection involving the digits, most commonly presents as a vesicular eruption involving a single digit. Diagnosis of herpetic whitlow can usually be made with the history of exposure, the characteristic vesicular eruption, and a positive Tzank smear and/or viral culture. We describe a case of herpetic whitlow in a patient finishing 6 cycles of chemotherapy for refractory chronic lymphocytic leukemia that presented with a bilateral, multi‐digit, crusted eruption of the hands. This is an illustrative case of an immunocompromised host status altering appearance and course of cutaneous disease such that the history and physical exam alone may not help in diagnosing atypical presentations of herpetic infections. This case underscores the necessity for clinico‐histopathologic correlation. Am. J. Hematol. 69:285–288, 2002. © 2002 Wiley‐Liss, Inc.
Reticulocyte subpopulations and reticulocyte maturity index (RMI) rise as body iron status falls
Authors: Choi Jong Weon , Pai Soo Hwan
Published: August 2002

To investigate the influence of body iron status on reticulocyte subpopulations and reticulocyte maturity index (RMI), we measured serum iron markers, fluorescent intensity of reticulocytes, and serum transferrin receptor (sTfR) concentrations in 374 females aged 14–19 years. Reticulocyte subpopulations were analyzed by flow cytometry, and sTfR concentration was measured by enzyme immunoassay. There were no significant differences in the values of reticulocyte subpopulations and RMI between ferritin alone‐depleted group and healthy controls. However, middle‐ and high‐fluorescence reticulocytes and RMI were significantly higher in both the serum iron‐ and serum ferritin‐depleted groups than in the ferritin alone‐depleted group. Middle‐fluorescence reticulocytes and RMI increased gradually as the body iron store was depleted and were 3.4‐ and 3.6‐fold higher, respectively, than normal controls, when the subjects attained a frank iron‐deficiency anemia. There were no significant changes in the values of red blood cells or total reticulocyte counts during iron‐depleted states. The mean value of sTfR (3.98 mg/l) in the subjects with RMI ≥ 1.5% was significantly higher than that (2.26 mg/l) in the subjects with RMI < 1.5% (P < 0.01). The sTfR concentration correlated significantly with RMI (r = 0.61, P < 0.01) and middle‐fluorescence reticulocytes (r = 0.59, P < 0.01). In short, body iron depletion induces elevation of immature reticulocyte fractions and RMI. Am. J. Hematol. 67:130–135, 2001. © 2001 Wiley‐Liss, Inc.
Low adjusted‐dose acenocoumarol therapy in sickle cell disease: A pilot study
Authors: Schnog J.B. , Kater A.P. , Mac Gillavry M.R. , Duits A.J. , Lard L.R. , van der Dijs F.P.L. , Brandjes D.P.M. , ten Cate H. , Statius van Eps L.W. , Rojer R.A.
Published: August 2002

Vasoocclusion is a continuous process in sickle cell disease (SCD) and accumulates to significant end organ damage, mostly irrespective of the occurrence of manifest acute vasoocclusive events. As there are indications that reversing the hypercoagulable state may be of clinical benefit in sickle cell patients, we performed a randomized, double blind, placebo‐controlled, cross‐over pilot study to assess the efficacy and safety of low‐adjusted dose acenocoumarol therapy (International Normalized Ratio: 1.6–2.0) in SCD. Treatment consisted of either acenocoumarol or placebo for 14 weeks, after which treatment was discontinued for a period of five weeks. Then, patients initially on acenocoumarol received placebo (and vice versa) for 14 weeks. Therapy efficacy was assessed by comparing the frequency of vasoocclusive complications, the occurrence of bleeding, and clotting activation between acenocoumarol and placebo treatment of each individual patient. Twenty‐two patients (14 homozygous [HbSS] and 8 double heterozygous sickle‐C [HbSC]; aged 20–59 years) completed the entire study. Acenocoumarol treatment did not result in a significant reduction of acute vasoocclusive events (three painful crises during acenocoumarol, five painful crises during placebo). There was a marked reduction of the hypercoagulable state (depicted by a decrease in plasma levels of prothrombin F1.2 fragments [P = 0.002], thrombin‐antithrombin complexes [P = 0.003], and D‐dimer fragments [P = 0.001]) without the occurrence of major bleeding. Even though no clinical benefit (pertaining to the frequency of painful crises) was detected in this pilot study, the value of low adjusted‐dose acenocoumarol for preventing specific events (such as strokes) and as a long‐term treatment of sickle cell patients should be subject of further study. Am. J. Hematol. 68:179–183, 2001. © 2001 Wiley‐Liss, Inc.
Prediction of cross‐sectional geometry from metacarpal radiogrammetry: A validation study
Authors: Lazenby Richard A.
Published: August 2002

Regression models have been developed to adjust algebraic estimates of second metacarpal cortical bone geometry to actual values (as determined through invasive analysis). These models, derived from an archaeological sample of European origin, have high efficacy in predicting actual values but have not been validated on non‐European samples. This paper reports a validation study for these models applied to a historic/proto‐historic sample of Inuit from the central Canadian Arctic (n = 166; ages and sexes pooled as per the original study). In that the Inuit sample has been argued to exhibit distinct skeletal biology, this represents a robust test of the predictive models. The algebraic models again produced biased overestimates of actual values, whereas the predictive regression models were found to provide good estimates of actual values for measures of bone strength (Total Area, bending about the Ix and Iy axes), but not for estimates of mass (Cortical Area). This difference may exist in either functional or systemic differences in skeletal physiology and aging bone loss in the Inuit. Am. J. Hum. Biol. 14:74–80, 2002. © 2002 Wiley‐Liss, Inc.
Quantifying social consequences of occupational injuries and illnesses: State of the art and research agenda
Authors: Keller Susan D.
Published: August 2002

Background

Quantitative methods for describing the social effects of occupational injury and illness are evaluated including surveys of prevalence and ratings of severity of social role disability.

Methods

The reliability and validity for the injured worker population of the most commonly used general and condition‐specific role disability measures is reviewed and summarized. This review is used to support the development of a prototype strategy for quantifying the social consequences of occupational injuries and to identify areas of need for further research and development

Conclusions

Research is needed to: (a) determine which of existing measures is most precise in describing the severity of dysfunction due to a specific illness or injury, (b) expand the development of measures of specific role functioning (including paid work), and (c) develop item banks to support the construction of computer adaptive assessments of role functioning. Am. J. Ind. Med. 40:438–451, 2001. © 2001 Wiley‐Liss, Inc.
Mortality patterns by occupation in a cohort of electric utility workers
Authors: van Wijngaarden Edwin , Savitz David A. , Kleckner Robert C. , Kavet Robert , Loomis Dana
Published: August 2002

Background

Mortality patterns were examined in a United States cohort of 138,905 male electric utility workers from five companies to help interpret previous studies of health effects in this industry.

Methods

Using Poisson regression techniques, internal cohort analyses examined total mortality, cardiovascular disease, and cancer in relation to duration of employment in each of nineteen occupational categories which comprise utility operations.

Results

Relative to workers who were never involved in utility operations (e.g., administrative workers), mortality rate ratios among operations workers were higher for total mortality, cardiovascular disease, and total cancer. Lung cancer risk was consistently elevated, whereas increased mortality for other cancers was less consistent.

Conclusions

The results of this study indicate excess risk of total mortality, cardiovascular disease, and some cancers among electric utility workers, which could be related to both occupational and non‐occupational risk factors. Am. J. Ind. Med. 40:667–673, 2001. © 2001 Wiley‐Liss, Inc
Risk of shoulder tendinitis in relation to shoulder loads in monotonous repetitive work
Authors: Frost Poul , Bonde Jens Peter E. , Mikkelsen Sigurd , Andersen Johan H. , Fallentin Nils , Kaergaard Anette , Thomsen Jane F.
Published: August 2002

Background

Few studies relate the occurrence of shoulder disorders to quantified ergonomic exposures. This study evaluates the hypothesis that shoulder loads in repetitive work might contribute to the occurrence of shoulder tendinitis.

Methods

This is a cross‐sectional study of 1961 workers in repetitive work and 782 referents. Shoulder loads were quantified at task level and measures of exposures were assigned based on task distribution. Symptoms in combination with clinical criteria defined shoulder tendinitis.

Results

The prevalence of shoulder tendinitis was higher among exposed workers (adjusted OR 3.1, 95% CI 1.3–3). Neither frequency of movements (ranging 1–36/min) nor lack of micro‐pauses in shoulder flexion (ranging 0–100% of cyclus time) was related to disease prevalence. Increasing force requirements (categorized as light = 1, somewhat hard = 2, hard = 3 or very hard = 4) increased risk slightly (OR 1.6, 95% CI 1.0–2.6 per unit).

Conclusions

The results indicate that workers with repetitive tasks have increased risk of shoulder tendinitis, which partially can be attributed to force requirements. Am. J. Ind. Med. 41:11–18, 2002. © 2002 Wiley‐Liss, Inc.
Hospitalizations among female home‐helpers in Denmark, 1981–1997
Authors: Hannerz Harald , Tüchsen Finn
Published: August 2002

Background

Occupational health problems among home‐helpers have been reported in a series of studies, and the need for intervention has been pointed out. To facilitate decisions regarding interventions and to establish baseline values for future evaluation of preventive efforts, the present study aimed to elucidate the disease pattern among female home‐helpers in Denmark.

Methods

Cohorts of all 20–59‐year‐old Danish female home‐helpers in the years 1981, 1986, 1991, and 1994 were formed, to calculate age standardized hospitalization ratios (SHR) and time trends (1981–1997) for a large variety of diagnostic aggregations.

Results

Significantly high SHRs were found for injuries, infectious and parasitic diseases, and for diseases of the nervous system, circulatory system, the respiratory organs, digestive system, and the musculoskeletal system. When adjusting for social group the SHRs for varicose veins, ischemic heart diseases (IHD), and musculoskeletal disorders were still significantly high while the SHR for malignant neoplasm of respiratory organs became significantly low. The time trends revealed increased relative risks for IHD and asthma, and a decreasing relative risk for duodenal ulcer.

Conclusions

Employment in the Danish home‐help sector is associated with an elevated hospitalization risk due to many work‐related diseases. Am. J. Ind. Med. 41:1–10, 2002. © 2002 Wiley‐Liss, Inc.
Relationship between stress and pain in work‐related upper extremity disorders: The hidden role of chronic multisymptom illnesses*
Authors: Clauw Daniel J. , Williams David A.
Published: August 2002

Background

Pain and fatigue are commonly associated with work‐related upper extremity disorders. Occasionally these symptoms persist beyond a reasonable healing period. One potential explanation for prolonged symptom expression is the concurrent development of a stress‐mediated illness or CMI (Chronic Multi‐Symptom Illness). In such a scenario, the chronic regional pain and other symptoms that the individual is experiencing would be attributable to the CMI rather than to tissue damage or a biomechanical dysfunction of the upper‐extremity.

Methods

This article critically reviews the case definitions of the new class of CMI disorders and evaluates the existing evidence supporting centrally mediated physiological changes (e.g., sensory hypervigilance, dysautonomia) that manifest as symptoms of pain and fatigue in some individuals experiencing chronic stressors.

Results

While explanations for prolonged pain and fatigue have historically focused on mechanisms involving peripheral pathology or psychiatric explanations, ample evidences support the role of altered Central Nervous System function in accounting for symptom manifestation in CMI.

Conclusions

A model is presented that unites seemingly disparate findings across numerous investigations and provides a framework for understanding how genetics, triggering events, stressors, and early life events can affect CNS activity. Resultant symptom expression (e.g., pain and fatigue) from central dysregulation would be expected to occur in a subset of individuals in the population, including a subset of individuals with work‐related upper extremity disorders. Thus when symptoms such as pain and fatigue persist beyond a reasonable period, consideration of CMI and associated assessment and interventions focused on central mechanisms may be worthwhile. Am. J. Ind. Med. 41:370–382, 2002. © 2002 Wiley‐Liss, Inc.
Nested case‐control study of lung cancer among pulp and paper workers in relation to exposure to dusts
Authors: Szadkowska‐Stańczyk Irena , Szymczak Wiełsaw
Published: August 2002

Background

Numerous studies have indicated an increased risk of lung cancer in pulp and paper industry workers. In a 1990 survey, standardized mortality ratio (SMR) was found to be 122 (95% CI:96–153) for lung cancer in Polish male workers in the pulp and paper industry, and 166 (95% CI:95–270) among workers engaged in paper production.

Methods

A nested case‐control design within a cohort of pulp and paper workers was applied. Seventy‐nine lung cancer cases and 237 “healthy” controls were selected from the cohort of 10,460 workers employed during the years 1968–1990, and observed until the end of 1995. Based on personnel files, occupational exposure was reconstructed by experts. Using a questionnaire, data on smoking habits were collected. ORs unadjusted and adjusted for smoking were calculated applying the model of conditional logistic regression.

Results

Occupational exposure to inorganic dusts (kaolin, lime, cement, brick, grindstone) adjusted for smoking was a significant lung cancer risk factor, with a 4.0‐fold risk (95% CI:1.3–12.6), and a dose‐response by cumulative dose index. Among organic dusts only wood dust increased albeit insignificantly the risk for those exposed (adjusted for smoking OR = 2.1, 95% CI:0.9–4.9), but without dose‐response relationship.

Conclusions

Exposure to occupational dust with relatively low content of silica, but at high concentrations may be considered as a factor increasing lung cancer risk. However, the observation made in this study should be viewed with caution as it was based on a small number of cases, and further evidence is needed to confirm or refute the authors' hypothesis. Am. J. Ind. Med. 39:547–556, 2001. © 2001 Wiley‐Liss, Inc.
Subclinical immunologic and physiologic responses in hexamethylene diisocyanate‐exposed auto body shop workers
Authors: Redlich Carrie A. , Stowe Meredith H. , Wisnewski Adam V. , Eisen Ellen A. , Karol Meryl H. , Lemus Ranulfo , Holm Carole T. , Chung Joyce S. , Sparer Judy , Liu Youcheng , Woskie Susan R. , Appiah‐Pippim James , Gore Rebecca , Cullen Mark R.
Published: August 2002

Background

Diisocyanates are potent sensitizing agents and currently the most commonly identified cause of occupational asthma in industrialized countries. However, diisocyanate asthma is difficult to diagnose and exposure and host risk factors are unclear. Auto body shops, one of the most common hexamethylene diisocyanate (HDI) exposure settings, are particularly difficult to study due to their small size and episodic exposures. Surveillance studies of such workers are limited.

Objectives

We have initiated a cross‐sectional field epidemiologic study, Survey of Painters and Repairers of Auto bodies by Yale (SPRAY), to characterize the effects of diisocyanate exposures on actively employed auto body shop workers.

Methods and Results

We present here questionnaire, physiologic, immunologic, and exposure data on 75 subjects enrolled in the study. No overt cases of clinically apparent diisocyanate asthma were identified based on spirometry, methacholine challenge, peak flows, and symptoms. HDI‐specific lymphocyte proliferation was present in 30% of HDI‐exposed workers and HDI‐specific IgG in 34% of HDI‐exposed workers, but they were not associated. HDI‐specific IgE was detected in two workers. HDI‐specific lymphocyte proliferation, increased methacholine responsiveness, and symptoms of chest tightness and shortness of breath were more common in the most heavily HDI‐exposed workers, the painters. More long‐term follow‐up of this cohort should clarify the significance of these HDI‐specific immunologic responses, physiologic changes, and symptoms.

Conclusions

These findings demonstrate the presence of HDI‐specific immune responses in a large proportion of healthy HDI‐exposed workers. Am. J. Ind. Med. 39:587–597, 2001. © 2001 Wiley‐Liss, Inc.