bluuebunny/crossref_metadata_2025 huggingface dataset:
Real‐time endobronchial ultrasound‐guided transbronchial needle aspiration is useful for diagnosing sarcoidosis
Authors: OKI Masahide , SAKA Hideo , KITAGAWA Chiyoe , TANAKA Shigeru , SHIMOKATA Tomoya , KAWATA Yoshihiro , MORI Kouki , KAJIKAWA Shigehisa , ICHIHARA Shu , MORITANI Suzuko
Published: October 2007

Background and objective:  Several studies of real‐time endobronchial ultrasound (EBUS)‐guided transbronchial needle aspiration (TBNA) have reported a sensitivity of approximately 90% in the diagnosis of mediastinal and hilar malignancies. However, few studies have addressed its role in the diagnosis of sarcoidosis. The aim of the present study was to assess the utility of EBUS‐TBNA in confirming a pathological diagnosis of sarcoidosis.

Methods:  Fifteen consecutive patients with suspected sarcoidosis and mediastinal and/or hilar lymphadenopathy were investigated prospectively. EBUS‐TBNA with an echo‐bronchoscope and a dedicated echogenic 22‐gauge needle was carried out in patients under conscious sedation, followed by conventional TBNA of the same lesion using a 19‐gauge needle.

Results:  EBUS‐TBNA and/or TBNA demonstrated non‐caseating epithelioid cell granulomas in 14 of 15 patients (93%). All 14 patients with a pathological diagnosis of sarcoidosis were considered to have sarcoidosis based on subsequent clinical assessments. The single patient with a negative EBUS‐TBNA and TBNA had a malignant melanoma diagnosed following surgical biopsy. EBUS‐TBNA confirmed a diagnosis of sarcoidosis in 13 of the 14 patients (93%) by identifying non‐caseating epithelioid cell granulomas in 18 of 23 lymph nodes (78%) sampled. When two needle aspirates of one or two lymph nodes were carried out, the percentage positive pathological diagnosis for sarcoidosis for (i) EBUS‐TBNA; (ii) TBNA; and (iii) the combination of EBUS‐TBNA and TBNA were 93% (13 of 14 patients), 93% (13 of 14 patients) and 100% (14 of 14 patients), respectively. There were no complications associated with the procedures.

Conclusion:  EBUS‐TBNA is less invasive and acceptably sensitive as a method for obtaining pathological confirmation of sarcoidosis.
Diagnosis and management of malignant pleural effusions
Authors: HEFFNER John E.
Published: October 2007

Abstract: Malignant pleural effusions (MPEs) complicate the clinical course of patients with a broad array of malignancies, which are most often due to lymphomas or carcinomas of the breast, lung, gastrointestinal tract or ovaries. Patients may present with a MPE as the initial manifestation of a cancer or develop an effusion during the advanced phases of a known malignancy. In either circumstance, the median survival after presentation with a MPE is 4 months. Effusions may result from direct pleural invasion (MPE) or indirect effects (paraneoplastic effusions), such as impairment of fluid efflux from the pleural space by lymphatic obstruction or pleural effects of cancer radiation or drug therapy. Because only 50% of patients with cancer who develop a pleural effusion during their clinical course have a MPE, careful evaluation of the effusion to establish its aetiology is required to direct therapy. Management is palliative with interventions directed towards decreasing the volume of intrapleural fluid and the severity of associated symptoms.
Development and validation of diagnostic prediction model for solitary pulmonary nodules
Authors: YONEMORI Kan , TATEISHI Ukihide , UNO Hajime , YONEMORI Yoko , TSUTA Koji , TAKEUCHI Masahiro , MATSUNO Yoshihiro , FUJIWARA Yasuhiro , ASAMURA Hisao , KUSUMOTO Masahiko
Published: October 2007

Background and objective:  The aim of this study was to develop a simple prediction model for the underlying diagnosis of solitary pulmonary nodules (SPN) based on clinical characteristics and thin‐section CT findings.

Methods:  Retrospective analysis was carried out on 452 patients with SPN (113 benign and 339 malignant) smaller than 30 mm, who underwent thin‐section CT followed by surgical resection and histological diagnosis. The clinical characteristics were collected from medical records, and radiographic characteristics from thin‐section CT findings. The prediction model was determined using multivariate logistic analysis. The prediction model was validated in 148 consecutive patients with undiagnosed SPN, and the diagnostic accuracy of the model was compared with that of an experienced chest radiologist.

Results:  The prediction model comprised the level of serum CRP, the level of carcinoembryonic antigen, the presence or absence of calcification, spiculation and CT bronchus sign. The areas under the receiver‐operating characteristic curve in training and validation sets were 0.966 and 0.840, respectively. The diagnostic accuracies of the prediction model and the experienced chest radiologist for the validation set were 0.858 and 0.905, respectively.

Conclusion:  The simple prediction model consisted of two biochemical and three radiographic characteristics. The diagnostic accuracy of an experienced chest radiologist was higher compared with the prediction model.
Simultaneous bilateral primary spontaneous pneumothorax
Authors: LEE Shih‐Chun , CHENG Yeung‐Leung , HUANG Chi‐Wang , TZAO Ching , HSU Hsian‐He , CHANG Huang
Published: October 2007

Objective:  While primary spontaneous pneumothorax (PSP) is common in adolescents and young adults, simultaneous bilateral PSP (SBPSP) is rare and can be life‐threatening if it progresses to tension pneumothorax. This study reviewed cases of PSP to identify the clinical features of SBPSP.

Methods:  All patients with PSP diagnosed and treated between June 1996 and June 2006 were reviewed, and the clinicoradiological features and outcomes were evaluated.

Results:  Of the 616 patients with 807 episodes of PSP, 13 had SBPSP (1.6%) at first presentation, and all were male (mean age 20.9 ± 4.7 years, range 16–25 years). Compared with the non‐SBPSP patients, SBPSP patients had significantly lower body weight and BMI (P = 0.018 and <0.001, respectively) and higher body height/body weight ratio (P = 0.004). There was no significant difference in their age, sex, smoking habits or body height. Patients with SBPSP had a significantly higher incidence of bleb/bullae seen in HRCT of the lung compared with non‐SBPSP (88.5% vs 63.5%, P = 0.016). In multiple logistic regression analysis, BMI and presence of blebs/bullae were independent risk factors for SBPSP. All patients with SBPSP received bilateral video‐assisted thoracoscopic surgery and recovered uneventfully. The mean follow‐up period was 3.7 years (range 10 months–7 years).

Conclusion:  Patients with PSP having a lower BMI, and bilateral bleb/bullae formation are at higher risk for the development of SBPSP. SBPSP needs urgent assessment and management, and bilateral video‐assisted thoracoscopic surgery is a safe and effective treatment.
Special report: Silent disasters
Authors: Eriksson Anneli
Published: October 2007

Abstract  Disasters occur not only in war and conflict or after natural events, such as earthquakes or floods. In fact, the death of hundreds of thousands of children in Niger every year, often for treatable conditions, could just as well qualify as a disaster situation. A lack of funding for health care and health‐care staff and user fee policies for health care in very poor or unstable settings challenge international agreements that make statements about the right to health and access to health care for all people. This paper argues that although sustainable development is important, today many are without essential health care and die in the silent disasters of hunger and poverty. In other words, the development of health care appears to be stalled for the sake of sustainability.
Integrating poverty and gender into health programs: A Sourcebook for health professionals
Authors: Coll‐Black Sarah , Bhushan Anjana , Fritsch Kathleen
Published: October 2007

Abstract  Evidence increasingly shows that poverty and gender inequalities are important determinants of health and influence the opportunity for timely and appropriate health care. These findings suggest that health professionals need to have a sound understanding of health inequalities and their causes, as well as of how they can be addressed. However, through surveys to health ministries and educational institutions in 2001, the World Health Organization Regional Office for the Western Pacific found that awareness of, and capacity to respond to, poverty and gender concerns in health was weak. In response, the Regional Office initiated a project to develop materials to support the integration of poverty and gender concerns into health professional education curricula. The multimodule publication, Integrating Poverty and Gender into Health Programmes: A Sourcebook for Health Professionals, supports evidence‐based and participatory learning. The experience to date suggests that the publication might be meeting a long‐felt need for such a response.
Life in Darwin's dust: intercontinental transport and survival of microbes in the nineteenth century
Authors: Gorbushina Anna A. , Kort Renate , Schulte Anette , Lazarus David , Schnetger Bernhard , Brumsack Hans‐Jürgen , Broughton William J. , Favet Jocelyne
Published: October 2007

Charles Darwin, like others before him, collected aeolian dust over the Atlantic Ocean and sent it to Christian Gottfried Ehrenberg in Berlin. Ehrenberg's collection is now housed in the Museum of Natural History and contains specimens that were gathered at the onset of the Industrial Revolution. Geochemical analyses of this resource indicated that dust collected over the Atlantic in 1838 originated from the Western Sahara, while molecular‐microbiological methods demonstrated the presence of many viable microbes. Older samples sent to Ehrenberg from Barbados almost two centuries ago also contained numbers of cultivable bacteria and fungi. Many diverse ascomycetes, and eubacteria were found. Scanning electron microscopy and cultivation suggested that Bacillus megaterium, a common soil bacterium, was attached to historic sand grains, and it was inoculated onto dry sand along with a non‐spore‐forming control, the Gram‐negative soil bacterium Rhizobium sp. NGR234. On sand B. megaterium quickly developed spores, which survived for extended periods and even though the numbers of NGR234 steadily declined, they were still considerable after months of incubation. Thus, microbes that adhere to Saharan dust can live for centuries and easily survive transport across the Atlantic.
Laparoscopic reversal of Hartmann's rectosigmoidectomy
Authors: Slawik S. , Dixon A. R.
Published: October 2007

Objective  The aim of this study was to analyse the outcome of laparoscopic restoration of bowel continuity post Hartmann's procedure.

Method  A prospectively electronic database of colorectal laparoscopic procedures between April 2001 and December 2006 has been used to identify surgical outcomes in 28 consecutive patients who have undergone laparoscopic reversal of an open Hartmann's procedure (LRH).

Results  Twenty‐eight patients (11 males), median age 66 (32–89), median body mass index 26 have undergone an attempted LRH over a 5‐year period. Twenty (71%) had undergone surgery for complicated diverticulitis, eight (29%) for cancer; two followed an anastomotic dehiscence post‐laparoscopic high anterior resection. The median operation time was 80 min (40–255 min). Twenty‐six procedures (93%) were completed laparoscopically. There was one late conversion (to release a small bowel loop from the pelvis). A small, fibrotic rectal stump split whilst attempting a stapled anastomosis – the procedure was abandoned. The median time to normal diet was 18 h and median hospital stay was 3 days (1–63). There were three (11%) readmissions; wound infection (two) and abdominal pain. There were two deaths (7%) – mesenteric emboli and anticoagulant induced upper gastrointestinal haemorrhage.

Conclusions  We believe that in the hands of appropriately trained and experienced surgeons, laparoscopic ‘reversal’ of a Hartmann's procedure is a feasible, safe and largely predictive operation that allows for early return of gastrointestinal function and very early hospital discharge.
The role of interleukin‐6 in insulin resistance, body fat distribution and energy balance
Authors: Hoene M. , Weigert C.
Published: October 2007

Interleukin‐6 (IL‐6) is a central player in the regulation of inflammation, haematopoiesis, immune response and host defense mechanisms. During the last decade, an accumulating amount of data suggested a pivotal role for IL‐6 in metabolic processes, thus fortifying the picture of IL‐6 as a multifaceted, pleiotropic cytokine. Because of its secretion by adipose tissue and contracting skeletal muscle and its broad action on central and peripheral organs, IL‐6 has been termed an adipokine and a myokine. Its quantitative release from adipose tissue results in a subclinical, systemic elevation of IL‐6 plasma levels with increasing body fat content, which may be implicated in the proinflammatory state leading to insulin resistance. On the other hand, IL‐6 produced in the working muscle during physical activity could act as an energy sensor by activating AMP‐activated kinase and enhancing glucose disposal, lipolysis and fat oxidation. In addition, both impaired IL‐6 secretion and action are risk factors for weight gain. Thus, IL‐6 clearly has lipolytic effects and anti‐obesity potential. However, the application of IL‐6 itself is at least limited by a narrow therapeutic range and its important function for a balanced inflammatory response. Further studies on the molecular basis of the metabolic effects of IL‐6 could elucidate novel therapeutic strategies for custom‐designed, IL‐6‐related substances.
Central and peripheral neuroendocrine peptides and signalling in appetite regulation: considerations for obesity pharmacotherapy
Authors: Atkinson T. J.
Published: October 2007

Appetite and satiety are mediated by complex neuroendocrine signalling pathways involving over 40 hormones, neuropeptides, enzymes, other chemical messengers and their receptors. Research efforts continue to expand understanding of the role of signalling molecules between central hypothalamic nuclei and peripheral enteroendocrine cells; and discoveries of novel networks and messengers provide new biological insights on how to manipulate appetite–satiety pathways. Despite the vast array of peptides that are potentially useful for anti‐obesity drug development, only four classes of agents are approved: (i) catecholamine stimulants; (ii) serotonin and noradrenaline reuptake inhibitors; (iii) lipase inhibitors; and (iv) more recently cannabinoid‐1 receptor antagonists. Clinical effects of these drugs confer modest improvements, and side effects negatively impact long‐term treatment course. This paper suggests single target pharmacological interventions are possibly hampered by the myriad of alternate orexigenic peptidic signals that drive hyperphagia, hence a multiple target model or combination treatment approach is proposed to offer greater therapeutic potential in modulating appetite and managing weight.
Sibling Similarities and Differences in Time Use: A Pattern‐Analytic, Within‐Family Approach
Authors: Shanahan Lilly , Kim Ji‐Yeon , McHale Susan M. , Crouter Ann C.
Published: October 2007

Similarities and differences in adolescent siblings' free time activities were investigated. Firstborns and second‐borns from 181 predominantly White, working, and middle‐class families reported on their time use and sibling relationships. Their parents reported on their socioeconomic status and neighborhood characteristics. Cluster analysis identified three groups of sibling dyads: Cluster 1 differentiated in leisure and time with friends, Cluster 2 differentiated in instrumental activities and time alone, and Cluster 3 did not differentiate in time use. Multinomial logistic regressions revealed that the longitudinal links between sibling relationship qualities and cluster membership were moderated by firstborns' sex. Findings highlight the importance of person‐oriented analytic strategies for understanding sibling similarities and differences and of within‐family variability in youth's time use.
‘Best Practices’ in Regional Trading Agreements: An Application to Asia
Authors: Plummer Michael G.
Published: October 2007

Regionalism in Asia, particularly in the form of free‐trade areas (FTAs), is a recent trend that is becoming increasingly important. This has been disturbing to many, given the significance of trade and investment in Asian economic growth and development and the region's key role in global commerce. In light of this trend, the goal of this paper is to develop a blueprint, or a set of 10 ‘best practices’, that can be used as a guide to FTAs in order to ensure that they approximate first‐best outcomes to the greatest extent possible. Next, the paper applies this framework to the existing FTAs between Asian countries and their regional and extra‐regional partners. The results suggest that the more advanced regional accords generally receive high grades, with the notable exception of rules of origin, which tend to be even more problematic in the context of accords in which an OECD country is a party.
Neural connectivity in children with bipolar disorder: impairment in the face emotion processing circuit
Authors: Rich Brendan A. , Fromm Stephen J. , Berghorst Lisa H. , Dickstein Daniel P. , Brotman Melissa A. , Pine Daniel S. , Leibenluft Ellen
Published: October 2007

Background:  Pediatric bipolar disorder (BD), a highly debilitating illness, is characterized by amygdala abnormalities, i.e., volume reduction and hyperactivation during face processing. Evidence of perturbed amygdala functional connectivity with other brain regions would implicate a distributed neural circuit in the pathophysiology of BD, and would further elucidate the neural mechanisms associated with BD face emotion misinterpretation.

Methods:  Thirty‐three BD and 24 healthy age, gender, and IQ‐matched subjects completed a functional magnetic resonance imaging (fMRI) task of face emotion identification in which attention was directed to emotional (hostility, fearfulness) and nonemotional (nose width) aspects of faces. Voxel‐wise analyses examined whole brain functional connectivity with the left amygdala.

Results:  Compared to healthy subjects, BD subjects had significantly reduced connectivity between the left amygdala and two regions: right posterior cingulate/precuneus and right fusiform gyrus/parahippocampal gyrus. Deficits were evident regardless of mood state and comorbid diagnoses.

Conclusions:  BD youth exhibit deficient connectivity between the amygdala and temporal association cortical regions previously implicated in processing facial expressions and social stimuli. In conjunction with previously documented volumetric and functional perturbations in these brain regions, dysfunction in this distributed neural circuit may begin to clarify the pathophysiology of the face emotion misperceptions and social deficits seen in BD youth.
Personality‐targeted interventions delay the growth of adolescent drinking and binge drinking
Authors: Conrod Patricia J. , Castellanos Natalie , Mackie Clare
Published: October 2007

Background:  Personality factors are implicated in the vulnerability to adolescent alcohol misuse. This study examined whether providing personality‐targeted interventions in early adolescence can delay drinking and binge drinking in high‐risk youth.

Methods:  A randomised control trial was carried out with 368 adolescents recruited from years 9 and 10 (median age 14) with personality risk factors for substance misuse. Participants received either a personality‐targeted intervention or no intervention. Outcome data were collected on alcohol use through self‐reports at 6 and 12‐month post intervention and analyses were conducted on the full intent to treat sample.

Results:  Multi‐group analysis of a latent growth curve model showed a group difference in the growth of alcohol use between baseline and 6‐months follow‐up, with the control group showing a greater increase in drinking than the intervention group for this period. Interventions were particularly effective in preventing the growth of binge drinking in those students with a sensation seeking (SS) personality. SS drinkers in the intervention group were 45% and 50% less likely to binge drink at 6 (OR = .45) and 12 months (OR = .50) respectively, than SS drinkers in the control group, p = .001, phi = .49, Number Needed to Treat = 2.0.

Conclusions:  Considering the robust, inverse relationship between age of onset of alcohol use and later alcohol dependence, this intervention strategy may prove effective in preventing the onset of adult alcohol use disorders, by helping high‐risk youth delay the growth of their drinking to a later developmental stage.
Emotion regulation in preschoolers: the roles of behavioral inhibition, maternal affective behavior, and maternal depression
Authors: Feng Xin , Shaw Daniel S. , Kovacs Maria , Lane Tonya , O'Rourke Flannery E. , Alarcon Joseph H.
Published: October 2007

Background:  This study examined preschoolers’ emotion regulation (ER) strategies and the association with temperament, maternal interactive style, and maternal history of childhood‐onset depression (COD).

Methods:  Participants were 62 children and their mothers, 37 of whom had mothers with COD. Children's ER was assessed using a disappointment paradigm; temperament assessment also was laboratory‐based.

Results:  Maternal COD was inversely related to offspring's active ER and positive mood. Among children of COD mothers, behavioral inhibition was associated with passive regulation and sadness, and maternal positivity toward these children was associated with child active ER and positive mood.

Conclusion:  Behavioral inhibition may place children of COD mothers at risk for developing maladaptive ways of regulating negative emotion, whereas mothers’ positivity may serve as a protective factor for them.
Divergence in δ13C of dark respired CO2 and bulk organic matter occurs during the transition between heterotrophy and autotrophy in Phaseolus vulgaris plants
Authors: Bathellier Camille , Badeck Franz‐W. , Couzi Philippe , Harscoët Sébastien , Mauve Caroline , Ghashghaie Jaleh
Published: October 2007

DOI: 10.1111/j.1469-8137.2007.02336.x
Functional interactions between the SK2 channel and the nicotinic acetylcholine receptor in enteric neurons of the guinea pig ileum
Authors: Nakajima Hidemitsu , Goto Hiroto , Azuma Yasu‐Taka , Fujita Akikazu , Takeuchi Tadayoshi
Published: October 2007

The neurotransmitter acetylcholine (ACh) plays a critical role in gastrointestinal function. The role of the small conductance Ca2+‐activated K+(SK) channel in ACh release was examined using myenteric plexus preparations of guinea pig ileum. Apamin, an inhibitor of the SK channel, significantly enhanced nicotine‐induced ACh release, but neither electrical field stimulation‐ nor 5‐hydroxytryptamine‐induced ACh release, suggesting that SK channels might be selectively involved in the regulation of nicotine‐induced ACh release. Therefore, we investigated the distribution of SK2 and SK3 subunits and the interaction between SK2 channels and nicotinic ACh receptors (nAChRs) in the guinea pig ileum. The immunoreactivity of SK2 subunits was located in enteric neuronal cells. Furthermore, SK2‐immunoreactive cells stained with an antibody for choline acetyltransferase, a marker for cholinergic neurons, and with an antibody for the α3/5 subunits of nAChR. In contrast, immunoreactivity of SK3 subunits was not found in enteric neurons. A co‐immunoprecipitation assay with Triton X‐100‐soluble membrane fractions prepared from the ileum revealed an association of the SK2 subunit with the α3/5 subunits of nAChR. These results suggest that SK2 channels negatively regulate the excitation of enteric neurons via functional interactions with nAChRs.
Specificity in the crosstalk of TGFβ/GDNF family members is determined by distinct GFR alpha receptors
Authors: Peterziel Heike , Paech Tina , Strelau Jens , Unsicker Klaus , Krieglstein Kerstin
Published: October 2007

Glial cell line‐derived neurotrophic factor (GDNF) and neurturin (NRTN) are neurotrophic factors for parasympathetic neurons including ciliary ganglion (CG) neurons. Recently, we have shown that survival and signaling mediated by GDNF in CG neurons essentially requires transforming growth factor β (TGFβ). We have provided evidence that TGFβ regulates the availability of the glycosyl phosphatidylinositol (GPI)‐anchored GDNF receptor alpha 1 (GFRα1) by promoting the recruitment of the receptor to the plasma membrane. We report now that in addition to GDNF, NRTN, but not persephin (PSPN) or artemin (ARTN), is able to promote survival of CG neurons. Interestingly, in contrast to GDNF, NRTN is not dependent on cooperation with TGFβ, but efficiently promotes neuronal survival and intracellular signaling in the absence of TGFβ. Additional treatment with TGFβ does not further increase the NRTN response. Both NRTN and GDNF exclusively bind to and activate their cognate receptors, GFRα2 and GFRα1, respectively, as shown by the use of receptor‐specific neutralizing antibodies. Immunocytochemical staining for the two receptors on the surface of CG neurons reveals that, in contrast to the effect on GFRα1, TGFβ is not required for recruitment of GFRα2 to the plasma membrane. Moreover, binding of radioactively labeled GDNF but not NRTN is increased upon treatment of CG neurons with TGFβ. Disruption of TGFβ signaling does interfere with GDNF‐, but not NRTN‐mediated signaling and survival. We propose a model taking into account data from GFRα1 crystallization and ontogenetic development of the CG that may explain the differences in TGFβ‐dependence of GDNF and NRTN.
Congo red and thioflavin‐T analogs detect Aβ oligomers
Authors: Maezawa Izumi , Hong Hyun‐Seok , Liu Ruiwu , Wu Chun‐Yi , Cheng R. Holland , Kung Mei‐Ping , Kung Hank F. , Lam Kit S. , Oddo Salvatore , LaFerla Frank M. , Jin Lee‐Way
Published: October 2007

Several small molecule ligands for amyloid‐β (Aβ) fibrils deposited in brain have been developed to facilitate radiological diagnosis of Alzheimer’s disease (AD). Recently, the build‐up of Aβ oligomers (AβO) in brain has been recognized as an additional hallmark of AD and may play a more significant role in early stages. Evidence suggests that quantitative assessment of AβO would provide a more accurate index of therapeutic effect of drug trials. Therefore, there is an urgent need to develop methods for efficient identification as well as structural analysis of AβO. We found that some well established amyloid ligands, analogs of Congo red and thioflavin‐T (ThT), bind AβO with high affinity and detect AβO in vitro and in vivo. Binding studies revealed the presence of binding sites for Congo red‐ and thioflavin‐T‐analogs on AβO. Furthermore, these ligands can be used for imaging intracellular AβO in living cells and animals and as positive contrast agent for ultrastructural imaging of AβO, two applications useful for structural analysis of AβO in cells. We propose that by improving the binding affinity of current ligands, in vivo imaging of AβO is feasible by a ‘signal subtraction’ procedure. This approach may facilitate the identification of individuals with early AD.
Variscan relicts in Alpine high‐P pelitic rocks from Samos (Greece): evidence from multi‐stage garnet and its included minerals
Authors: FEENSTRA A. , PETRAKAKIS K. , RHEDE D.
Published: October 2007

Porphyroblastic garnet schists from northern Samos contain in their matrix the assemblage Ca‐rich garnet + phengite + paragonite ± chloritoid equilibrated at ∼530 °C and ∼19 kbar during early Tertiary metamorphism. These high‐pressure/low‐temperature (HP‐LT) metapelitic rocks also exhibit mineralogical and microstructural evidence of an older, higher temperature metamorphism. Large, centimetre‐sized Fe‐rich garnet showing growth zoning developed discontinuous, <0.5 mm thick, Ca‐rich and Mn‐poor overgrowths, compositionally matching small (<1 mm) high‐P matrix garnet. Because the discontinuous garnet rims are in textural and chemical equilibrium with Alpine high‐P minerals, the central parts of the garnet porphyroblasts were found to have formed prior to the Tertiary metamorphism. This is supported by electron microprobe U‐Th‐Pb dating of monazite inclusions yielding partly reset Variscan ages between 360 and 160 Ma. Monazite‐xenotime and garnet‐muscovite thermometry applied to inclusions in the pre‐Alpine garnet yielded temperatures of 600–625 °C (at 3–8 kbar). Prismatic Al‐rich pseudomorphs, possibly after kyanite/sillimanite, and inclusions in garnet composed of white K‐Na mica + quartz ± albite ± K feldspar, interpreted as possible replacements of an intermediate K‐Na feldspar, further support Variscan amphibolite facies conditions. The Samos metapelites thus experienced higher temperatures during the Variscan than during Alpine metamorphism. Diffusional relaxation was very limited between pre‐Alpine garnet and Alpine garnet; both were filled with Alpine garnet along overgrowths and fractures. Fluid‐mediated intergranular element transport, enhanced by deformation, appears crucial in transforming the Variscan garnet into a grossular richer composition during Alpine subduction‐zone metamorphism. At such conditions, dissolution–reprecipitation appears to be a much more effective mechanism for modifying garnet compositions than diffusion. Amphibolite facies conditions are typical for Variscan basement relics exposed in central Cycladic and Dodecanese islands as well as in eastern Crete. The Samos metapelites studied comprise a north‐eastern extension of these basement occurrences.
Accuracy of Physical Examination in the Detection of Arteriovenous Graft Stenosis
Authors: Leon Carlos , Orozco‐Vargas Luis Carlos , Krishnamurthy Gururaj , Choi Kenneth L. , Mercado Carlos , Merrill Donna , Thomas Ian , Salman Loay , Artikov Shukhrat , Bourgoignie Jacques J. , Asif Arif
Published: October 2007

Physical examination has recently been demonstrated to detect vascular access stenosis in patients with arteriovenous fistulae. However, its accuracy in the identification of stenoses when compared with the gold standard (angiography) in patients with arteriovenous grafts has not been studied in a systematic fashion. We conducted a prospective study to examine the accuracy of physical examination in the detection of stenotic lesions when compared with angiography. Forty‐three consecutive cases referred for an arteriovenous graft dysfunction were included in this analysis. Preprocedure physical examination was performed. The findings of the examination and diagnosis were recorded and secured in a sealed envelope. Angiography from the feeding artery to the right atrium was performed. The images were reviewed by an independent interventionalist with expertise in endovascular dialysis access procedures and the diagnosis was rendered. The reviewer was blinded to the physical examination. Cohen’s Kappa was used as a measurement of the level of agreement beyond chance between the diagnosis made by physical examination and angiography. There was a strong agreement between the physical examination and the angiography in the diagnosis of vein‐graft anastomotic stenosis (kappa = 0.52). The sensitivity and specificity for this lesion was 57% and 89%, respectively. There was a moderate agreement beyond chance regarding the diagnosis of intragraft (kappa = 0.43) and inflow stenoses (kappa = 0.40). The sensitivity and specificity for the intragraft and inflow stenosis was 100%, 73% and 33%, 73%; respectively. The findings of this study demonstrate that physical examination can assist in the detection and localization of stenoses in arteriovenous grafts.
Review: Cognitive Function in Chronic Kidney Disease
Authors: Madero Magdalena , Gul Ambreen , Sarnak Mark J.
Published: October 2007

Chronic kidney disease (CKD) is a growing public health problem. The incidence of kidney failure is rising in all age groups but particularly in older adults. Individuals in all stages of CKD are at higher risk for development of cognitive impairment and this may be a major determinant in their quality of life. Furthermore, cognitive impairment is associated with an increased risk of death in dialysis patients. Cerebrovascular disease is a strong risk factor for development of cognitive impairment and vascular disease is a more likely cause of cognitive impairment than Alzheimer’s disease in patients with CKD. Both traditional and nontraditional vascular risk factors are more common in CKD and dialysis patients may also be at risk for cognitive impairment via nonvascular risk factors and the hemodialysis procedure itself. Unfortunately, because risk factors for cognitive impairment in CKD have not been thoroughly ascertained, evaluation of potential treatments has been limited. Given the high prevalence of cognitive impairment in all stages of CKD, additional studies are needed to evaluate potential risk factors and treatments in this vulnerable population.
Clinical Experience of StarClose Vascular Closure Device in Patients with First and Recurrent Femoral Punctures
Authors: TAY EDGAR LIK‐WUI , CO MELISSA , TAI BEE‐CHOO , LEE YIAN PING , LOW ADRIAN , LIM YEAN‐TENG , TAN HUAY‐CHEEM , LEE CHI‐HANG
Published: October 2007

Objective:

We present our clinical experience of StarClose in patients undergoing coronary interventions, including its use in patients after repeated puncture of the same femoral access site.

Background:

The StarClose is a novel vascular closure device that deploys a small, flexible, circumferential nitinol clip onto the femoral artery surface.

Methods:

In this study, 103 consecutive patients (24% with repeated punctures) who underwent percutaneous coronary intervention and received a StarClose were followed up prospectively. The patients were assessed for vascular complications prior to hospital discharge. Device success, based on time‐to‐hemostasis, was divided into (1) immediate success: hemostasis achieved immediately after StarClose deployment without the need for adjunctive manual compression, (2) partial success: occurrence of minor oozing after StarClose deployment and hemostasis achieved after <3 minutes of manual compression, and (3) device failure: need for adjunctive manual compression for >3 minutes.

Results:

Immediate success, partial success, and device failure rates were 74% (n = 68), 16% (n = 15), and 10% (n = 9), respectively. There were no major complications attributable to the StarClose device. There were 10 (9.7%) cases of minor complications; all were recurrent wound bleeding requiring manual compression in the wards. Among these 10 cases of recurrent bleeding, 5 (50%) had initial device success (immediate success, n = 2, partial success, n = 3) in the catheterization laboratory. The risk for recurrent bleeding was 2.9% after immediate device success and 20.0% after partial device success.

Conclusion:

Our study found no major complications but a 10% failure rate and a 9.7% rate of minor complications. Close surveillance is important as there is a risk for recurrent bleeding, especially in patients with partial device success as defined in this report.
The Retrograde Coronary Approach for Chronic Total Occlusions: Mid‐Term Results and Technical Tips & Tricks
Authors: SHEIBAN IMAD , MORETTI CLAUDIO , OMEDÉ PIERLUIGI , SCIUTO FILIPPO , BOLLATI MARIO , LAUDITO ANTONIO , TREVI GIAN PAOLO , BIONDI‐ZOCCAI GIUSEPPE G.L.
Published: October 2007

Background: Coronary chronic total occlusions (CTO) remain a challenging lesion subset for interventional cardiologists. The retrograde approach is a novel but still incompletely described technique. We report our 5‐year‐long experience in retrograde percutaneous coronary intervention (PCI) for CTOs.

Methods: We abstracted patient and procedural data on all cases with attempted retrograde approach by means of a native septal or epicardial collateral pathway. End‐points were wiring, angiographic and procedural success, plus long‐term major adverse cardiovascular events (MACE).

Results: The retrograde approach was used in 18 patients, including 11 CTOs of right coronary artery (RCA), 3 of left circumflex (LCX), and 4 of left anterior descending (LAD), with procedural success in 12 (67%). Conversely, two cases of wiring failures, three angiographic failures despite successful retrograde wiring, and one postprocedural myocardial infarction in an otherwise angiographically successful procedure were found. Causes of wiring failure were inability to retrogradely cross the distal (1) or the proximal stump (1) with the wire, while angiographic failures were due to interruption of the procedure due to rupture of a minor septal collateral branch during attempts at advancing the noninflated balloon (1) or persistent inability to deliver the balloon through the chosen collateral (2). Follow‐up at a mean of 15 months showed MACE had occurred in five (28%) subjects.

Conclusions: The retrograde approach appears feasible and safe in the percutaneous management of coronary occlusions, and its application can be envisioned as a promising alternative in selected patients in whom antegrade approaches fail or are unsafe.
Patients with multiple contact allergies: a review
Authors: Carlsen Berit Christina , Andersen Klaus Ejner , Menné Torkil , Johansen Jeanne Duus
Published: October 2007

Patients with multiple contact allergies, also referred to as polysensitized, are more frequent than predicted from prevalence of single sensitivities. The understanding of why some people develop multiple contact allergies, and characterization of patients with multiple contact allergies is limited. This review presents the current knowledge on the topic and discusses the evidence and characteristics of an increased susceptibility factor, possible causes to and genetic markers for the increased susceptibility, composition of the patient group and identification of patients at risk of developing multiple contact allergies. Evidence of allergen clusters among polysensitized individuals is also reviewed. The literature supports the idea that patients with multiple contact allergies constitute a special entity within the field of contact allergy. There is no generally accepted definition of patients with multiple contact allergies. We suggest that contact allergy to 3 or more allergens are defined as multiple contact allergies.
Production of anti‐epithelial antibodies and acantholysis by vaccination with an anti‐idiotypic antibody, mimicking desmoglein 1
Authors: Avalos‐Díaz Esperanza , López‐Robles Eréndira , Alvarado‐Flores Ernesto , Herrera‐Esparza Rafael
Published: October 2007

Abstract:  Theoretically, the immunization of experimental animals with an anti‐idiotype antibody may elicit antibodies that recognize epitopes like the original idiotype; this is archived via internal images. Using this strategy, we attempted to produce anti‐epithelial antibodies in Balb/c mice immunized with a pemphigus anti‐idiotypic determinant. First, when an anti‐idiotype antibody was produced in rabbits by immunization with pemphigus immunoglobulin G (IgG), the anti‐idiotypic activity was tested successfully. The anti‐idiotype IgG was digested with pepsin and purified by gel filtration chromatography to obtain F(ab’)2 fragments, which were used to immunize Balb/c mice. A control group was immunized with normal IgG. The experimental animals immunized with anti‐idiotype F(ab’)2 fragments developed anti‐epithelial antibodies in the following two months. The elicited antibodies had anti‐desmoglein 1 specificity. Additionally, the skin biopsies of these animals exhibited antibody deposition along intercellular spaces of epidermis, and 25% of them developed blisters. Sera and skin biopsies of control Balb/c mice group were negative. In conclusion, the immunization with pemphigus anti‐idiotype antibody may elicit anti‐epithelial antibodies via internal images. This experimental approach can be used to understand the pathogenic mechanisms of pemphigus.
Molecular determination of laminin‐5 degradation: a biomarker for mustard gas exposure diagnosis and its mechanism of action
Authors: Jin Xiannu , Ray Radharaman , Leng Yan , Ray Prabhati
Published: October 2007

Abstract:  Laminin‐5, a heterotrimer of laminin α3, β3 and γ2 subunits, is a component of epithelial cell basement membranes. Laminin‐5 functions as a ligand of the α3β1 and α6β4 integrins to regulate cell adhesion, migration and morphogenesis. In the skin, laminin‐5 facilitates the assembly of basement membranes; thus it is essential for a stable attachment of the epidermis to the dermis and recovery of damaged skin. Sulphur mustard (SM), also known as mustard gas, is a vesicant that has been employed as a chemical weapon in various conflicts during the twentieth century. Skin exposure to SM results in fluid‐filled blisters; proposed mechanisms are inflammation, protease stimulation, basal cell death and separation of the epidermis from the dermis apparently because of the degradation of attachment proteins like laminin‐5. Therefore, we investigated the effects of SM exposure on the degradation of laminin‐5 and its three subunits, α3, β3 and γ2 by exposing normal human epidermal keratinocytes (NHEK) to SM (0–300 μm, 1–24 h). We found that SM degraded laminin‐5 and its two subunits β3 and γ2, but not α3. Preincubation of cells with a serine protease inhibitor (PMSF), or a metalloprotease inhibitor (1,10‐phenanthroline) prior to SM exposure partially prevented SM‐induced degradation of laminin‐5 subunits, β3 and γ2. Specificity studies showed that the degradation of laminin‐5 γ2 was due to a bifunctional mustard compound such as SM, but not due to the other alkylating agents tested. Our results support that laminin‐5 degradation is an important mechanism of SM injury as well as a useful biomarker of SM exposure. The knowledge of the mechanisms of laminin‐5 degradation in SM‐exposed NHEK has potential application in developing cutaneous therapeutics against SM.
Prevalence of gestational exposure to cannabis in a Mediterranean city by meconium analysis
Authors: Lozano Jaime , García‐Algar Oscar , Marchei Emilia , Vall Oriol , Monleon Toni , Giovannandrea Rita Di , Pichini Simona
Published: October 2007

Aim: To investigate the prevalence of in utero exposure to cannabis in a cohort of 974 mother‐infants dyads from Barcelona (Spain).

Methods: A validated gas chromatographic‐mass spectrometric assay was used for meconium analysis.

Results: Prenatal exposure to cannabis was detected in 5.3% newborns; however, only 1.7% of the participating mothers disclosed gestational drug use. Ethnicity was not associated with cannabis use, nor were the maternal features or newborns somatometry. A significantly higher percentage of cannabis using mothers had a managerial professional job versus nonusers.

Conclusions: Meconium analysis is especially important to identify neonates who have been exposed to cannabis in utero, which appear normal at birth and therefore may not be recognized. Timely detection of these newborns at risk provides the basis for appropriate treatment and adequate medical and social follow‐up.
Growth and neurodevelopment outcome of very low birth weight infants delivered by preeclamptic mothers
Authors: Silveira Rita C , Procianoy Renato S , Koch Maike S , Benjamin Ana Cláudia W , Schlindwein Carolina F
Published: October 2007

Aim: To investigate growth and neurodevelopment outcome of very low birth weight (VLBW) infants delivered by preeclamptic mothers.

Methods: A cohort including all VLBW infants delivered between December 2003 and May 2005 was followed up to 12 and 18 months corrected age (CA). Exclusion criteria: death before 1 year corrected age, major malformations, deafness and blindness. Weight, length and head circumference were plotted on NCHS curves. Bayley Scales were performed at 12 and 18 months CA.

Results: 40 infants in preeclamptic and 46 in control groups were studied. Birth weight and gestational age were 1148 g ± 236 and 1195 g ± 240, and 31.3 weeks ± 1 and 30.6 weeks ± 2 for preeclamptic and control groups, respectively. At 12 and 18 months, CA, weight for age (Z score) was significantly higher in control than in preeclamptic. PDI scores were higher in preeclamptic than in controls at 18 months CA.

Conclusions: Catch‐up of body weight did not occur in the first 18 months CA in preeclamptic infants. Neurodevelopment outcome was better in infants delivered by preeclamptic mothers than in controls at 18 months CA.
COMPARISON OF MAGNETIC RESONANCE CONTRAST ARTHROGRAPHY AND ARTHROSCOPIC ANATOMY OF THE EQUINE PALMAR LATERAL OUTPOUCHING OF THE MIDDLE CARPAL JOINT
Authors: GETMAN LIBERTY M. , McKNIGHT ALEXIA L. , RICHARDSON DEAN W.
Published: October 2007

The objective of this report was to provide an anatomic description of the equine palmar lateral outpouching of the middle carpal joint by comparing its arthroscopic and magnetic resonance (MR) contrast arthrography appearance and to define the structures within the palmar lateral outpouching of the middle carpal joint that can be assessed arthroscopically. MR contrast arthrography was performed on seven cadaveric limbs; images were compared with those obtained during arthroscopic exploration of the palmar lateral outpouching of the middle carpal joint. Gross dissection was performed to confirm identification of intra‐articular structures. The MR images compared well with the arthroscopic and gross appearance of the palmar lateral outpouching of the middle carpal joint. Portions of the ulnar carpal bone, fourth carpal bone, fourth metacarpal bone, lateral palmar intercarpal ligament, and lateral collateral ligament of the carpus were identified within the palmar lateral outpouching of the middle carpal joint in all limbs. In addition, in three limbs areas of the third carpal bone and intermediate carpal bone could be seen. MR arthrography was a useful tool for helping to define the anatomy of the palmar lateral outpouching of the middle carpal joint. The arthroscopic approach to the palmar lateral outpouching of the middle carpal joint is technically easy, but the intra‐articular anatomy can be confusing. Use of a motorized arthroscopic blade to remove excess synovial tissue is necessary to view all of the structures within the palmar lateral outpouching of the middle carpal joint. Arthroscopic removal of osteochondral fragments from this location may be facilitated by the information obtained from this study.
MAGNETIC RESONANCE IMAGING FEATURES OF PROXIMAL METACARPAL AND METATARSAL INJURIES IN THE HORSE
Authors: BROKKEN MATTHEW T. , SCHNEIDER ROBERT K. , SAMPSON SARAH N. , TUCKER RUSSELL L. , GAVIN PATRICK R. , HO CHARLES P.
Published: October 2007

Magnetic resonance (MR) imaging abnormalities in horses with lameness localized to the proximal metacarpal or metatarsal region have not been described. To accomplish that, the medical records of 45 horses evaluated with MR imaging that had lameness localized to either the proximal metacarpal or metatarsal region were reviewed. Abnormalities observed in the proximal suspensory ligament or the accessory ligament of the deep digital flexor tendon included abnormal high signal, enlargement, or alteration in shape. Twenty‐three horses had proximal suspensory ligament desmitis (13 hindlimb, 10 forelimb). Sixteen horses had desmitis of the accessory ligament of the deep digital flexor tendon. One horse had desmitis of the proximal suspensory ligament and the accessory ligament of the deep digital flexor tendon on the same limb and one horse had desmitis of the proximal suspensory ligament on one forelimb and desmitis of the accessory ligament of the deep digital flexor tendon on the other forelimb. Four horses did not have abnormalities in the proximal suspensory ligament or accessory ligament of the deep digital flexor tendon. Eighty percent of horses with forelimb proximal suspensory ligament desmitis and 69% of horses with hindlimb proximal suspensory ligament desmitis returned to their intended use. Sixty‐three percent of horses with desmitis of the accessory ligament of the deep digital flexor tendon were able to return to their intended use. MR imaging is a valuable diagnostic modality that allows diagnosis of injury in horses with lameness localized to the proximal metacarpal and metatarsal regions. The ability to accurately diagnose the source of lameness is important in selecting treatment that will maximize the chance to return to performance.