bluuebunny/crossref_metadata_2025 huggingface dataset:
The Evolution of an Innovative Heart Disease Management Program for Older Women: Integrating Quantitative and Qualitative Methods in Practice
Authors: Dodge Julia A. , Janz Nancy K. , Clark Noreen M.
Published: April 2005

Few studies in the literature describe how to combine quantitative and qualitative methods to enhance the development of health education interventions. This article describes the evolution and refinement of an innovative disease management program “take PRIDE” for older adults with heart disease. Over 15 years, information obtained from data collection methods including telephone interviews, focus groups, face-to-face interviews, and program process data illuminated and guided subsequent refinement of the program and led to new iterations for different participants. Qualitative and quantitative data were incorporated into the two key areas of program development (theoretical framework, objectives, format, and content) and evaluation (evaluation design, sampling, and measurement). Combining both types of data enhanced the opportunity to detect needed program changes, to increase understanding of the mechanisms by which the program effects were produced, and to enhance the relevance of the program to different groups of program participants.
Assessing Hospital-Based Wellness Services using an Outcome Measurement System
Authors: Gibbs James , Kattapong Kristienne , St. John Julie , Kushner Robert F.
Published: April 2005

This article describes the process and results of an effort to develop an outcome measurement system for evaluating and improving hospital-based wellness programs and services. The authors defined a set of outcome measures for each of the wellness programs and services offered by the hospital and piloted health-related outcome and patient satisfaction measures in the following four different types of programs: (a) a disease screening program (osteoporosis), (b) an educational program (diabetes), (c) an instructional participatory program (yoga and tai chi), and (d) a behavioral intervention program (group weight loss). These programs were chosen to represent the array of wellness programs and services available at the hospital. Results are reported for each pilot test, and recommendations are offered for dealing with issues and challenges encountered in developing a system for measuring wellness program performance.
The Effects of Wellness Education on the Body Image of College Students
Authors: Burkett Lee N. , Rena Cynthia Gayle , Jones Kathy , Stone William J. , Klein Diane A.
Published: April 2005

The effects of a wellness education presentation on body image were investigated. Fifty-seven college men and women completed two questionnaires on body image; one before and one after undergoing skinfold measurement. The participants were divided into two groups: (a) receiving a wellness education program after being assessed, and (b) not receiving a wellness education program after being assessed. The data were analyzed with a multifactor randomized ANOVA. The body-image scores of noneducation group decreased significantly, with no difference between the sexes. The body-image scores of the education group did not decrease significantly for either gender. This study indicated that wellness education incorporated into body composition testing could minimize the negative effects of body composition knowledge on body image.
Defining and Assessing Organizational Competence in Serving Communities at Risk for Sexually Transmitted Diseases
Authors: Thach Sarah Brill , Eng Eugenia , Thomas James C.
Published: April 2005

This study sought to develop an assessment tool to help health agencies enhance their capacity to provide sexually transmitted disease (STD) care to communities at risk and close the gap of racial disparities in health. Specifically, the study sought to (a) define the organizational competence of agencies serving communities at risk for STDs, and (b) develop a method to assess an agency’s organizational competence. In a rural Southern county, qualitative action research methods including key informant interviews, observation, and document review were used to assess four health agencies’ competence in responding to the needs of high STD-risk communities. Nine dimensions of organizational competence were identified: community participation, assessment of community needs, ensured access to services, community outreach, cultural competence, interagency collaboration, policy development, resource acquisition, and organizational commitment to serve. A competent organization was conceived as one that (a) is committed to serve, (b) works with communities at risk, (c) understands and appropriately responds to their needs, and (d) advocates on their behalf.
Implementation and Long-Term Outcomes of Two HIV Intervention Programs for Latinas
Authors: Amaro Hortensia , Raj Anita , Reed Elizabeth , Cranston Kevin
Published: April 2005

Despite the disproportionate effect of HIV/AIDS on Latinas in the United States, only a few studies of HIV prevention programs have focused on this priority population. In the meantime, public health practitioners have needed to develop and implement programs that contribute to the reduction of HIV sexual risk among women in Latino communities. This article reports on a joint effort of a state health department, community advocates, and researchers to develop and test the effectiveness of two 12-week interventions, an Intensive HIV Prevention Program and a Women’s Health Program. The authors present the short-term and longer term outcomes of both programs, assess their strengths and weaknesses, and finally consider the broader implications of their findings for HIV prevention programs for Latinas nationwide.
Reducing Disparities in Hypertension Control: A Community-Based Hypertension Control Project (CHIP) for an Ethnically Diverse Population
Authors: Morisky Donald E. , Lees Nancy B. , Sharif Behjat A. , Liu Kenn Y. , Ward Harry J.
Published: April 2005

The Community Hypertension Intervention Project (CHIP) is investigating medical, environmental, and psychosocial factors related to adherence to treatment for hypertension and examining the efficacy of three interventions designed to improve treatment adherence in a high-risk, underserved, ethnically diverse population. There were 1,367 Black (76%) and Hispanic (21%) adults who participated in a 4-year longitudinal study. Participants were randomized to either usual care or one of three interventions: (a) individualized counseling sessions with community health workers (CHWs), (b) a computerized appointment tracking system, or (c) home visits/focus group discussions with CHWs. At baseline, a total of 33% of the participants had one or more comorbidities in addition to hypertension; only 35% had their blood pressure under control. Participants assigned to the patient tracking intervention exhibited the most significant improvement in appointment keeping and blood pressure control status at 6 months; however, the 12-month follow-up assessments indicated that individualized counseling and home visits resulted in significant, sustained improvements in appointment keeping and blood pressure control status. These findings are now being integrated into the patient care delivery system of the participating outpatient clinics.
A Community-Based Physical Education and Activity Intervention for African American Preadolescent Girls: A Strategy to Reduce Racial Disparities in Health
Authors: Klebanoff Randi , Muramatsu Naoko
Published: April 2005

Physical activity habits fostered and developed early in life tend to persist into adulthood, reducing the incidence of chronic diseases associated with a sedentary lifestyle in later life. This is of particular importance for racial and ethnic minority populations who experience significant disparities in rates of chronic disease. Thus, promoting physical activity in minority children is an effective strategy for reducing these health disparities. Unfortunately, however, recommendations for effective implementation of such programs are sorely lacking. This article describes the development and implementation of Lively Ladies, a physical education and activity intervention targeted to low-income, preadolescent, African American girls in a community-based youth services organization. Low-income, minority girls face the catch-22 situation of being at higher risk for physical inactivity while having limited or no access to physical fitness programs. This article demonstrates that community-based youth organizations can play an important role in changing this situation. The authors’ experience with Lively Ladies indicates the effectiveness of a theory-based program addressing modifiable psychosocial and environmental determinants of behavior. They provide recommendations to guide future design and implementation of community-based physical education and activity interventions for a population group that tends to have increased risk for physical inactivity and limited access to fitness programs and facilities.
Reconceptualizing HIV Infection among Poor Black Adolescent Females: An Urban Poverty Paradigm
Authors: White Renée T.
Published: April 2005

Recent research of HIV infection has attributed high rates of infection among heterosexual Black adolescents to multiple sexual partners and inconsistent condom use. Social science explanations emphasize limited family support, poor access to information, and unwillingness to change. This article presents an analysis of the effects of economic inequality and changes in urban areas on sexual risk-taking among poor Black women. Data come from an ongoing ethnographic study involving 53 young women in New Haven, Connecticut. Theoretical frameworks of urban development, economic isolation, and opportunity structures inform the results. Findings show that structural, social, and individual characteristics influence how young Black women define and assess personal risk. The residual and cumulative effects of racial inequality, poverty, and destabilization of communities contribute to risk-taking. Teenagers are more likely to engage in risky behavior when they believe their life options are limited. Recommendations include focusing on the reduction of social inequality as a health-seeking strategy.
SOPHE’s Resolution to Eliminate Racial and Ethnic Health Disparities: Process and Recommendations for Accountability
Authors: Scharff Darcell P. , Haughton Lorna , Adams Brandie , Williams Charles , Parks Sharyn , Anwuri Victoria , Richard Roland
Published: April 2005

Health disparities are in the forefront of the public health agenda. Eliminating health disparities is one of two primary goals set for 2010. The Society for Public Health Education (SOPHE) has committed to working toward this effort in a variety of ways, including the development of a resolution to eliminate racial and ethnic disparities in health. This article describes the steps that were taken in the development of the resolution and offers recommendations to ensure that the action’s steps are conducted. Additionally, recommendations for other actions that can affect health disparities are offered. As a professional organization, SOPHE is in a prime position to lead the way on a number of activities designed to eliminate health disparities.
Integration of the Ecological Approach in Tobacco Programs for Youth: A Survey of Canadian Public Health Organizations
Authors: Richard Lucie , Potvin Louise , Denis Jean-Louis , Kishchuk Natalie
Published: April 2005

This study assessed the level of integration of the ecological approach in Canadian public health organizations’ tobacco control programs for youth. The study used a model that identified intervention settings, targets, and strategies as key dimensions of an ecological approach to programs. An inventory of the tobacco youth programs implemented by regional public health organizations identified 148 organizations conducting such programs, 129 of which agreed to participate. Program descriptions were obtained through telephone interviews. The mean number of settings in which programs were implemented was 3 (SD = 1.3), with schools and communities being the most often-used settings. The mean number of different intervention strategies was 3.6 (SD = 1.7). Most frequently, programs directly targeted youths themselves, followed by interpersonal and organizational environment. Overall, the level of integration of the ecological approach was deemed high. Canadian public health organizations’ tobacco control programs aimed at youth are evolving toward a more comprehensive agenda.
Health Correlates of Exercise Behavior and Stage Change in a Community-Based Exercise Intervention for the Elderly: A Pilot Study
Authors: Nigg Claudio , English Catherine , Owens Norma , Burbank Patricia , Connolly-Belanger Annie , Dufresne Robert , Fey-Yensan Nancy , Garber Carol Ewing , Luisi Andrea , Padula Cynthia , Saunders Sandra , Clark Phillip
Published: April 2005

The effects of a community-based physical activity intervention grounded in the Transtheoretical Model were investigated in a sample of older adults. The residents (n = 48, mean age = 78.24 ± 6.69, 90% female) of an independent living complex completed pre-and postintervention assessments, including physical, mental, and general health; nutrition; bodily pain; and stages of exercise behavior change. The intervention included posters with stage-based pamphlets (for inactive stages) and in-house exercise sessions (for active participants). The intervention resulted in high exercise maintenance and more progression than regression in exercise stage. More maintainers and progressers improved on the measured variables compared to relapsers. The stage model is a promising framework on which to base and evaluate interventions for this population. The overall impact of the intervention was positive, whether by providing the actual opportunity to exercise or by motivating other physical activity. These results also support the potential quality-of-life impact for this type of intervention in older adults.
NK/iDC interaction results in IL-18 secretion by DCs at the synaptic cleft followed by NK cell activation and release of the DC maturation factor HMGB1
Authors: Semino Claudia , Angelini Giovanna , Poggi Alessandro , Rubartelli Anna
Published: April 2005

Interaction of natural killer (NK) cells with autologous immature dendritic cells (DCs) results in reciprocal activation; however, the underlying mechanisms are so far elusive. We show here that NK cells trigger immature DCs to polarize and secrete interleukin 18 (IL-18), a cytokine lacking a secretory leader sequence. This occurs through a Ca2+-dependent and tubulin-mediated recruitment of IL-18-containing secretory lysosomes toward the adhering NK cell. Lysosome exocytosis and IL-18 secretion are restricted at the synaptic cleft, thus allowing activation of the interacting NK cells without spreading of the cytokine. In turn, DC-activated NK cells secrete the proinflammatory cytokine high mobility group B1 (HMGB1), which induces DC maturation and protects DCs from lysis. Also HMGB1 is a leaderless cytokine that undergoes regulated secretion. Differently from IL-18, soluble HMGB1 is consistently detected in NK/DC supernatants. These data point to secretion of leaderless cytokines as a key event for the reciprocal activation of NK cells and DCs. DCs initiate NK cell activation by targeted delivery of IL-18, thus instructing NK cells in the absence of adaptive-type cytokines; in turn, activated NK cells release HMGB1, which promotes inflammation and induces DC maturation, thus favoring the onset of the adaptive immune response. (Blood. 2005;106:609-616)
Glucocorticoids inhibit activation-induced cell death (AICD) via direct DNA-dependent repression of the CD95 ligand gene by a glucocorticoid receptor dimer
Authors: Baumann Sven , Dostert Anja , Novac Natalia , Bauer Anton , Schmid Wolfgang , Fas Stefanie C. , Krueger Andreas , Heinzel Thorsten , Kirchhoff Sabine , Schütz Günther , Krammer Peter H.
Published: April 2005

Glucocorticoids (GCs) play an important role in the regulation of peripheral T-cell survival. Their molecular mechanism of action and the question of whether they have the ability to inhibit apoptosis in vivo, however, are not fully elucidated. Signal transduction through the glucocorticoid receptor (GR) is complex and involves different pathways. Therefore, we used mice with T-cell-specific inactivation of the GR as well as mice with a function-selective mutation in the GR to determine the signaling mechanism. Evidence is presented for a functional role of direct binding of the GR to 2 negative glucocorticoid regulatory elements (nGREs) in the CD95 (APO-1/Fas) ligand (L) promoter. Binding of GRs to these nGREs reduces activation-induced CD95L expression in T cells. These in vitro results are fully supported by data obtained in vivo. Administration of GCs to mice leads to inhibition of activation-induced cell death (AICD). Thus, GC-mediated inhibition of CD95L expression of activated T cells might contribute to the anti-inflammatory function of steroid drugs. (Blood. 2005;106:617-625)
CXCL9 inhibits eosinophil responses by a CCR3- and Rac2-dependent mechanism
Authors: Fulkerson Patricia C. , Zhu Hongyan , Williams David A. , Zimmermann Nives , Rothenberg Marc E.
Published: April 2005

Recently, inhibitory cytokine pathways for leukocyte chemoattraction and activation have been identified, but there is little insight into the operational mechanisms except for models that rely on simple receptor antagonism. We have previously identified the existence of a murine eosinophil inhibitory pathway mediated by the CXC chemokine ligand 9 (CXCL9, Mig [monokine induced by interferon-γ]) that impressively blocks eosinophil chemoattraction and function, but the mechanism has remained elusive. We now demonstrate that Mig's inhibitory action extends beyond receptor antagonism alone. Notably, in addition to inhibiting eotaxin-induced filamentous actin (F-actin) formation and chemoattraction, Mig potently blocks platelet activating factor (PAF)– and leukotriene B4 (LTB4)–induced responses. Remarkably, Mig-treated eosinophils display an abnormal F-actin assembly in the absence of agonist stimulation. Additionally, Mig pretreatment inhibits eotaxin-induced activation of the Rho–guanosine triphosphatase (GTPase) Rac, and Rac2-deficient eosinophils demonstrate an impaired transmigration and actin polymerization response to eotaxin stimulation. Furthermore, Mig was unable to inhibit eotaxin-induced responses in Rac2-deficient eosinophils. Finally, using CCR3 gene–targeted cells, Mig's inhibitory activity is demonstrated to be mediated by CC chemokine receptor 3 (CCR3). Thus, by altering agonist-induced signaling and abrogating cytoskeletal reorganization by a Rac2-dependent mechanism, Mig markedly inhibits eosinophil responses to diverse stimuli. These results establish evidence that distinct chemokines can use CCR3 to induce opposing signals in eosinophils.
Columba: an integrated database of proteins, structures, and annotations
Authors: Trißl Silke , Rother Kristian , Müller Heiko , Steinke Thomas , Koch Ina , Preissner Robert , Frömmel Cornelius , Leser Ulf
Published: April 2005

Background

Structural and functional research often requires the computation of sets of protein structures based on certain properties of the proteins, such as sequence features, fold classification, or functional annotation. Compiling such sets using current web resources is tedious because the necessary data are spread over many different databases. To facilitate this task, we have created COLUMBA, an integrated database of annotations of protein structures.

Description

COLUMBA currently integrates twelve different databases, including PDB, KEGG, Swiss-Prot, CATH, SCOP, the Gene Ontology, and ENZYME. The database can be searched using either keyword search or data source-specific web forms. Users can thus quickly select and download PDB entries that, for instance, participate in a particular pathway, are classified as containing a certain CATH architecture, are annotated as having a certain molecular function in the Gene Ontology, and whose structures have a resolution under a defined threshold. The results of queries are provided in both machine-readable extensible markup language and human-readable format. The structures themselves can be viewed interactively on the web.

Conclusion

The COLUMBA database facilitates the creation of protein structure data sets for many structure-based studies. It allows to combine queries on a number of structure-related databases not covered by other projects at present. Thus, information on both many and few protein structures can be used efficiently. The web interface for COLUMBA is available at http://www.columba-db.de.
Epidermal growth factor mediates detachment from and invasion through collagen I and Matrigel in Capan-1 pancreatic cancer cells
Authors: Shirk Andrew J , Kuver Rahul
Published: April 2005

Background

Pancreatic adenocarcinoma is a highly invasive neoplasm. Epidermal growth factor (EGF) and its receptor are over expressed in pancreatic cancer, and expression correlates with invasion and metastasis. We hypothesized that EGF receptor and integrin signalling pathways interact in mediating cellular adhesion and invasion in pancreatic cancer, and that invasiveness correlates temporally with detachment from extracellular matrix.

Methods

We tested this hypothesis by investigating the role of EGF in mediating adhesion to and invasion through collagen I and Matrigel in the metastatic pancreatic adenocarcinoma cell line Capan-1. Adhesion and invasion were measured using in vitro assays of fluorescently-labeled cells. Adhesion and invasion assays were also performed in the primary pancreatic adenocarcinoma cell line MIA PaCa-2.

Results

EGF inhibited adhesion to collagen I and Matrigel in Capan-1 cells. The loss of adhesion was reversed by AG825, an inhibitor of erbB2 receptor signalling and by wortmannin, a PI3K inhibitor, but not by the protein synthesis inhibitor cycloheximide. EGF stimulated invasion through collagen I and Matrigel at concentrations and time courses similar to those mediating detachment from these extracellular matrix components. Adhesion to collagen I was different in MIA PaCa-2 cells, with no significant change elicited following EGF treatment, whereas treatment with the EGF family member heregulin-alpha elicited a marked increase in adhesion. Invasion through Matrigel in response to EGF, however, was similar to that observed in Capan-1 cells.

Conclusion

An inverse relationship exists between adhesion and invasion capabilities in Capan-1 cells but not in MIA PaCa-2 cells. EGF receptor signalling involving the erbB2 and PI3K pathways plays a role in mediating these events in Capan-1 cells.
Defining the timing of respiratory syncytial virus (RSV) outbreaks: an epidemiological study
Authors: Terletskaia-Ladwig Elena , Enders Gisela , Schalasta Gunnar , Enders Martin
Published: April 2005

Background

Seasonal RSV infections occur every year and affect particularly children under six months of age. Passive immunoprophylaxis with monoclonal antibody Palivizumab is recommended in the period with high risk of RSV infection. This study aims to define the period for the southern part of Germany (Stuttgart area).

Methods

Epidemiological analysis of the RSV situation in southern Germany from 1996 to 2004 and comparison of results with literature was made. The respiratory tract specimens were sent in for the detection of RSV mainly by paediatric clinics. Detection of RSV was carried out mainly by real-time RT-PCR or by ELISA "Pathfinder". RSV outbreaks were depicted as an absolute number and as a percentage of RSV diagnoses in a month. Onsets, offsets, peaks, duration and severity of RSV seasons were defined and analysed.

Results

An early season with strong RSV activity (early-high phase) was followed by a weaker late season (late-low phase) in a regular biennial rhythm. However, onsets, offsets and durations of outbreaks varied significantly from year to year. RSV epidemics in southern Germany were found to oscillate in an antiphase with RSV epidemics in Finland and Sweden.

Conclusion

The long-term regular biennial rhythm allows predicting whether the next outbreak will be late or early and whether RSV activity will be strong or weak. Not foreseeable, however, is the precise time of increase and decrease of RSV activity. Moreover, the regular seasonal pattern may be disrupted by irregular outbreaks. Thus, activity of RSV has to be monitored every year to define the period with high risk of infection.
Public health education: A report from Mosul and a plan for change
Authors: Hughes Gail D , Mack Ally , Golden Kathie Stromile
Published: April 2005

Background

Today Iraq suffers from severe shortages of food, medicine, clean water and adequate sanitation. Malnutrition and communicable diseases are major factors in the rising morbidity and mortality rates. However, supplies and equipment are insufficient or outmoded, and public health training is outdated. The Universities have been unable to help because under-funding and isolation from their professional colleagues has limited their effectiveness.

Methods

To revitalize public health education, we describe a partnership between a US education consortium and the University of Mosul that will be carried out in the next several years. The plan is based on "three R's": Recovery from the past damage due to war and neglect; Retooling of key public health faculty to remedy the years of isolation and restriction of activity; and Reestablishment of the University as a resource for the its constituents, for the community and for other educational institutions. In all these activities, Iraqi minorities, especially women, will participate and contribute.

Conclusion

The work to repair the public health educational infrastructure has just begun. When completed, it will represent a small but necessary step in restoring normalcy to the people of Mosul, and of Iraq.
General practitioners' satisfaction with and attitudes to out-of-hours services
Authors: van Uden Caro JT , Nieman Fred HM , Voss Gemma BWE , Wesseling Geertjan , Winkens Ron AG , Crebolder Harry FJM
Published: April 2005

Background

In recent years, Dutch general practitioner (GP) out-of-hours service has been reorganised into large-scale GP cooperatives. Until now little is known about GPs' experiences with working at these cooperatives for out-of-hours care. The purpose of this study is to gain insight into GPs' satisfaction with working at GP cooperatives for out-of-hours care in separated and integrated cooperatives.

Methods

A GP cooperative separate from the hospital Accident and Emergency (A&E) department, and a GP cooperative integrated within the A&E department of another hospital. Both cooperatives are situated in adjacent geographic regions in the South of the Netherlands. One hundred GPs were interviewed by telephone; fifty GPs working at the separated GP cooperative and fifty GPs from the integrated GP cooperative. Opinions on different aspects of GP cooperatives for out-of-hours care were measured, and regression analysis was performed to investigate if these could be related to GP satisfaction with out-of-hours care organisation.

Results

GPs from the separated model were more satisfied with the organisation of out-of-hours care than GPs from the integrated model (70 vs. 60 on a scale score from 0 to 100; P = 0.020). Satisfaction about out-of-hours care organisation was related to opinions on workload, guarantee of gatekeeper function, and attitude towards out-of-hours care as being an essential part of general practice. Cooperation with medical specialists was much more appreciated at the integrated model (77 vs. 48; P < 0.001) versus the separated model.

Conclusion

GPs in this study appear to be generally satisfied with the organisation of GP cooperatives for out-of-hours care. Furthermore, GPs working at the separated cooperative seem to be more satisfied compared to GPs working at the integrated cooperative.
Downregulation of calcineurin activity in cervical carcinoma
Authors: Padma S , Sowjanya A Pavani , Poli Usha Rani , Jain Meenakshi , Rao BN , Ramakrishna Gayatri
Published: April 2005

Background

Calcineurin (CaN) is an important serine-threonine phosphatase (PP2B), which plays a crucial role in calcium-calmodulin mediated signal transduction events. Calcineurin has been implicated in pathogenesis of various diseases cardiac hypertrophy, diabetic neuropathy and Alzheimer's, however its role in neoplasia remains unclear.

Results

In view of this we evaluated the calcineurin activity in serum and biopsy samples collected from women diagnosed with invasive squamous cell carcinoma of cervix. A significant reduction was observed in the calcineurin activity in cancer cervix patients compared to the control group. However the calcineurin activity remained unaltered in the cervical scrapes obtained from patients diagnosed with low-grade squamous intra epithelial lesions (LSIL). Interestingly the downregulation of calcineurin activity in squamous cell carcinomas was not accompanied by any significant change in DNA-binding affinity of the transcriptional factor NFAT (Nuclear Factor of Activated T-cells). All the squamous cell carcinoma samples used in the present study were positive for high-risk human papillomavirus (HPV) types.

Conclusion

The present study demonstrates the downregulation of calcineurin activity in squamous cell carcinoma of cervix with high risk HPV infection. We conclude that perturbations in calcineurin-mediated pathway may be involved in development of cervical neoplasia.
Increase in number of circulating disseminated epithelial cells after surgery for non-small cell lung cancer monitored by MAINTRAC® is a predictor for relapse: A preliminary report
Authors: Rolle Axel , Günzel Rainer , Pachmann Ulrich , Willen Babette , Höffken Klaus , Pachmann Katharina
Published: April 2005

Background

Lung cancer still remains one of the most commonly occurring solid tumors and even in stage Ia, surgery fails in 30% of patients who develop distant metastases. It is hypothesized that these must have developed from occult circulating tumor cells present at the time of surgery, or before. The aim of the present study was to detect such cells in the peripheral blood and to monitor these cells following surgery.

Methods

30 patients treated for lung cancer with surgery were monitored for circulating epithelial cells (CEC) by taking peripheral blood samples before, 2 weeks and 5 months after surgery and/or radiotherapy (RT) chemotherapy (CT) or combined RT/CT using magnetic bead enrichment and laser scanning cytometry (MAINTRAC®) for quantification of these cells.

Results

In 86% of the patients CEC were detected before surgery and in 100% at 2 weeks and 5 months after surgery. In the control group, which consisted of 100 normal donors without cancer, 97 % were negative for CEC. A significantly higher number of CEC was found preoperatively in patients with squamous cell carcinoma than in those with adenocarcinoma. In correlation to the extent of parenchymal manipulation 2 weeks after surgery, an increase in numbers of CEC was observed with limited resections (18/21) whereas pneumonectomy led to a decrease (5/8) of CEC, 2 weeks after surgery. The third analysis done 5 months after surgery identified 3 groups of patients. In the group of 5 patients who received neo- or adjuvant chemo/radiotherapy there was evidence that monitoring of CEC can evaluate the effects of therapy. Another group of 7 patients who underwent surgery only showed a decrease of CEC and no signs of relapse. A third group of 11 patients who had surgery only, showed an increase of CEC (4 with an initial decrease after surgery and 7 with continuous increase). In the group with a continuous increase during the following 24 months, 2 early relapses in patients with stage Ia adenocarcinoma were observed. The increase of CEC preceded clinical detection by six months.

Conclusion

We consider, therefore, that patients with adenocarcinoma and a continuous increase of CEC after complete resection for lung cancer are at an increased risk of early relapse.
Ultrastructural studies on dengue virus type 2 infection of cultured human monocytes
Authors: Mosquera Jesus A , Hernandez Juan Pablo , Valero Nereida , Espina Luz Marina , Añez German J
Published: April 2005

Background

Early interaction of dengue virus and monocyte/macrophages could be an important feature for virus dissemination after its initial entry via the mosquito vector. Since ultrastructural analysis of this interaction has not been reported, dengue type 2 (DEN2) virus-infected human monocyte cultures were studied at 1, 2, 4 and 6 hours after infection.

Results

Typical dengue particles and fuzzy coated viral particles were 35 to 42 nm and 74 to 85 nm respectively. Viruses were engulfed by phagocytosis and macropicnocytosis leading to huge vacuoles and phagosomes inside the monocytes. Interaction of monocytes with DEN2 virus induced apoptosis, characterized by nuclear condensation and fragmentation, cellular shrinkage, blebbing and budding phenomena and phagocytosis of apoptotic cells by neighboring monocytes. This finding was confirmed by TUNEL. Ultrastructural features associated to DEN2 virus replication were not observed.

Conclusion

These data suggest that clearance of the virus by monocytes and cellular death are the main features during the initial interaction of DEN2 virus and monocytes and this could be important in the rapid elimination of the virus after infection by mosquito vector.
Intra-articular injections of high-molecular-weight hyaluronic acid have biphasic effects on joint inflammation and destruction in rat antigen-induced arthritis
Authors: Roth Andreas , Mollenhauer Jürgen , Wagner Andreas , Fuhrmann Reneè , Straub Albrecht , Venbrocks Rudolf A , Petrow Peter , Bräuer Rolf , Schubert Harald , Ozegowski Jörg , Peschel Gundela , Müller Peter J , Kinne Raimund W
Published: April 2005

To assess the potential use of hyaluronic acid (HA) as adjuvant therapy in rheumatoid arthritis, the anti-inflammatory and chondroprotective effects of HA were analysed in experimental rat antigen-induced arthritis (AIA). Lewis rats with AIA were subjected to short-term (days 1 and 8, n = 10) or long-term (days 1, 8, 15 and 22, n = 10) intra-articular treatment with microbially manufactured, high-molecular-weight HA (molecular weight, 1.7 × 106 Da; 0.5 mg/dose). In both tests, 10 buffer-treated AIA rats served as arthritic controls and six healthy animals served as normal controls. Arthritis was monitored by weekly assessment of joint swelling and histological evaluation in the short-term test (day 8) and in the long-term test (day 29). Safranin O staining was employed to detect proteoglycan loss from the epiphyseal growth plate and the articular cartilage of the arthritic knee joint. Serum levels of IL-6, tumour necrosis factor alpha and glycosaminoglycans were measured by ELISA/kit systems (days 8 and 29). HA treatment did not significantly influence AIA in the short-term test (days 1 and 8) but did suppress early chronic AIA (day 15, P < 0.05); however, HA treatment tended to aggravate chronic AIA in the long-term test (day 29). HA completely prevented proteoglycan loss from the epiphyseal growth plate and articular cartilage on day 8, but induced proteoglycan loss from the epiphyseal growth plate on day 29. Similarly, HA inhibited the histological signs of acute inflammation and cartilage damage in the short-term test, but augmented acute and chronic inflammation as well as cartilage damage in the long-term test. Serum levels of IL-6, tumour necrosis factor alpha, and glycosaminoglycans were not influenced by HA. Local therapeutic effects of HA in AIA are clearly biphasic, with inhibition of inflammation and cartilage damage in the early chronic phase but with promotion of joint swelling, inflammation and cartilage damage in the late chronic phase.
Effect of ventilator-associated tracheobronchitis on outcome in patients without chronic respiratory failure: a case–control study
Authors: Nseir Saad , Di Pompeo Christophe , Soubrier Stéphane , Lenci Hélène , Delour Pierre , Onimus Thierry , Saulnier Fabienne , Mathieu Daniel , Durocher Alain
Published: April 2005

Introduction

Our objective was to determine the effect of ventilator-associated tracheobronchitis (VAT) on outcome in patients without chronic respiratory failure.

Methods

This was a retrospective observational matched study, conducted in a 30-bed intensive care unit (ICU). All immunocompetent, nontrauma, ventilated patients without chronic respiratory failure admitted over a 6.5-year period were included. Data were collected prospectively. Patients with nosocomial pneumonia, either before or after VAT, were excluded. Only first episodes of VAT occurring more than 48 hours after initiation of mechanical ventilation were studied. Six criteria were used to match cases with controls, including duration of mechanical ventilation before VAT. Cases were compared with controls using McNemar's test and Wilcoxon signed-rank test for qualitative and quantitative variables, respectively. Variables associated with a duration of mechanical ventilation longer than median were identified using univariate and multivariate analyses.

Results

Using the six criteria, it was possible to match 55 (87%) of the VAT patients (cases) with non-VAT patients (controls). Pseudomonas aeruginosa was the most frequently isolated bacteria (34%). Although mortality rates were similar between cases and controls (29% versus 36%; P = 0.29), the median duration of mechanical ventilation (17 days [range 3–95 days] versus 8 [3–61 days]; P < 0.001) and ICU stay (24 days [range 5–95 days] versus 12 [4–74] days; P < 0.001) were longer in cases than in controls. Renal failure (odds ratio [OR] = 4.9, 95% confidence interval [CI] = 1.6–14.6; P = 0.004), tracheostomy (OR = 4, 95% CI = 1.1–14.5; P = 0.032), and VAT (OR = 3.5, 95% CI = 1.5–8.3; P = 0.004) were independently associated with duration of mechanical ventilation longer than median.

Conclusion

VAT is associated with longer durations of mechanical ventilation and ICU stay in patients not suffering from chronic respiratory failure.
Influence of support on intra-abdominal pressure, hepatic kinetics of indocyanine green and extravascular lung water during prone positioning in patients with ARDS: a randomized crossover study
Authors: Michelet Pierre , Roch Antoine , Gainnier Marc , Sainty Jean-Marie , Auffray Jean-Pierre , Papazian Laurent
Published: April 2005

Introduction

Prone positioning (PP) on an air-cushioned mattress is associated with a limited increase in intra-abdominal pressure (IAP) and an absence of organ dysfunction. The respective influence of posture by itself and the type of mattress on these limited modifications during the PP procedure remains unclear. The aim of this study was to evaluate whether the type of support modifies IAP, extravascular lung water (EVLW) and the plasma disappearance rate of indocyanine green (PDRICG) during PP.

Methods

A prospective, randomized, crossover study of 20 patients with acute respiratory distress syndrome (ARDS) was conducted in a medical intensive care unit in a teaching hospital. Measurements were made at baseline and repeated after 1 and 6 hours of two randomized periods of 6 hours of PP with one of two support types: conventional foam mattress or air-cushioned mattress.

Results

After logarithmic transformation of the data, an analysis of variance (ANOVA) showed that IAP and PDRICG were significantly influenced by the type of support during PP with an increase in IAP (P < 0.05 by ANOVA) and a decrease in PDRICG on the foam mattress (P < 0.05 by ANOVA). Conversely, the measurements of EVLW did not show significant modification between the two supports whatever the posture. The ratio of the arterial oxygen tension to the fraction of inspired oxygen significantly increased in PP (P < 0.0001 by ANOVA) without any influence of the support.

Conclusion

In comparison with a conventional foam mattress, the use of an air-cushioned mattress limited the increase in IAP and prevented the decrease in PDRICG related to PP in patients with ARDS. Conversely, the type of support did not influence EVLW or oxygenation.
Derivation of genetic interaction networks from quantitative phenotype data
Authors: Drees Becky L , Thorsson Vesteinn , Carter Gregory W , Rives Alexander W , Raymond Marisa Z , Avila-Campillo Iliana , Shannon Paul , Galitski Timothy
Published: April 2005

We have generalized the derivation of genetic-interaction networks from quantitative phenotype data. Familiar and unfamiliar modes of genetic interaction were identified and defined. A network was derived from agar-invasion phenotypes of mutant yeast. Mutations showed specific modes of genetic interaction with specific biological processes. Mutations formed cliques of significant mutual information in their large-scale patterns of genetic interaction. These local and global interaction patterns reflect the effects of gene perturbations on biological processes and pathways.
Procedure Documentation in Emergency Medicine Residencies: A Time of Change
Authors: Stromski Christopher J. , Jeffers Tabatha , Bean Eric
Published: April 2005

Objectives: The purpose of this study was to identify the methods of procedure documentation (PD) used by emergency medicine residency programs and to ascertain the number of programs that are transitioning to a more advanced system. Methods: All 122 ACGME‐approved allopathic emergency medicine programs were contacted by telephone in December 2001. Survey information was obtained from the program director, an attending physician, a resident, or the residency coordinator. Results: The response rate was 92.6%. Seventeen programs (15%) reported using multiple methods of PD, with only 8% utilizing a formal database. Fifty‐five percent reported that PD was manual. One third of all programs utilized a Web‐based system for PD, while 13% required the use of personal digital assistants (PDAs). Nearly one fifth of programs stated they were changing to another form of PD, with the majority of those changing to a PDA format. Fifteen percent of programs purchased PDAs for their residents, and a similar proportion reported that the PDA was used by “most or all” of their residents to document procedures. Nearly four times as many programs (64%) reported that “most or all” of their residents utilized PDAs for clinical purposes. Conclusions: PDAs are used by a majority of residents for clinical purposes, although fewer utilize this resource for PD. Although most emergency medicine residency programs still utilize a manual system for PD, many programs are in transition to a more technologically advanced method.
Complement C5 and Early Oxygen Kinetics during Murine Sepsis
Authors: Valencia Gabriel , Sarma J. Vidya , Younger John G.
Published: April 2005

Objectives: Changes in oxygen consumption (VO2) and carbon dioxide production (VCO2) are common but poorly understood features of sepsis. The authors studied the role of complement C5 in the development of abnormal oxygen kinetics during sepsis in mice, arguing that as a pro‐inflammatory event, complement activation might exacerbate disturbances in oxygen use during abdominal sepsis. Methods: An open‐circuit indirect calorimeter was used to measure VO2, VCO2, and respiratory exchange ratio during a seven‐day median lethal dose (LD50) murine cecal ligation and puncture (CLP) model. Results: CLP produced significant changes in oxygen kinetics within three hours of onset, although when the animals were stratified by seven‐day survival, no difference in these abnormalities was seen between the survivors and the nonsurvivors. Genetic deficiency of C5 did not ameliorate the changes in oxygen utilization. Rather, the C5‐deficient mice experienced more severe abnormalities in oxygen kinetics and greater mortality. Treating animals with anti‐C5a antibodies at the time of injury had little effect on oxygen kinetics, indicating that C5b, rather than C5a, was predominantly acting to protect the mice during the first 24 hours of illness. Conclusions: These findings indicate that the primary contribution of C5 to oxygen kinetics during sepsis is salutary through the host defense conveyed by generation of C5b, rather than detrimental by worsening oxygen utilization via pro‐inflammatory mechanisms.
Ultrasound with Topical Anesthetic Rapidly Decreases Pain of Intravenous Cannulation
Authors: Becker Bruce M. , Helfrich Sara , Baker Elizabeth , Lovgren Kirsten , Minugh P. Allison , Machan Jason T.
Published: April 2005

Objectives: Physicians and nurses in the emergency department rarely use topical anesthesia when starting intravenous (IV) lines because of time constraints and lack of data on patients' perception of the pain associated with this procedure. Ultrasound pretreatment of skin increases permeation rates of hydrophobic topical medications, including topical lidocaine. The objective of this study was to demonstrate that ultrasound treatment followed by brief application of topical anesthetic decreases the patients' perception of the pain of IV cannulation. Methods: This was a randomized, controlled, prospective trial performed in a university hospital emergency department. Eighty‐seven consecutive English‐speaking, subcritically injured or ill adult patients able to give consent who were receiving an IV line as part of their care were enrolled. The intervention was a brief ultrasound treatment using the SonoPrep (Sontra Medical Corp., Franklin, MA) therapeutic ultrasound device (frequency, 53–56 kHz) followed by 5 minutes of 4% liposomal lidocaine cream and standard‐care IV cannulation, or standard care alone. Participants rated their pain on a visual analog scale. Researchers assessed the site after IV insertion and 20–36 hours later. The primary outcome was participants' subjective pain score, and the secondary outcome was site skin irritation. Results: The ultrasound group reported significantly less pain (p<0.001), with 80% of treated participants reporting pain scores ≤3 versus only 37% of controls (p <0.001). Conclusions: The SonoPrep ultrasound device applied to skin for 15 seconds followed by 5 minutes of 4% liposomal lidocaine cream significantly reduced patients' perception of the pain of an IV start when compared with standard care. There were no adverse side effects noted in any participant during the 36 hours of the follow‐up period.