bluuebunny/crossref_metadata_2025 huggingface dataset:
Skin testing versus radioallergosorbent testing for indoor allergens
Authors: Chinoy Birjis , Yee Edgar , Bahna Sami L
Published: April 2005

Background

Skin testing (ST) is the most common screening method for allergy evaluation. Measurement of serum specific IgE is also commonly used, but less so by allergists than by other practitioners. The sensitivity and specificity of these testing methods may vary by type of causative allergen and type of allergic manifestation. We compared ST reactivity with serum specific IgE antibodies to common indoor allergens in patients with respiratory allergies.

Methods

118 patients (3 mo-58 yr, mean 12 yr) with allergic rhinitis and/or bronchial asthma had percutaneous skin testing (PST) supplemented by intradermal testing (ID) with those allergens suspected by history but showed negative PST. The sera were tested blindly for specific IgE antibodies by the radioallergosorbent test (Phadebas RAST). The allergens wereD. farinae(118), cockroach (60), cat epithelium (90), and dog epidermal (90). Test results were scored 0–4; ST ≥ 2 + and RAST ≥ 1 + were considered positive.

Results

The two tests were in agreement (i.e., either both positive or both negative) in 52.2% (dog epidermal) to 62.2% (cat epithelium). When RAST was positive, ST was positive in 80% (dog epidermal) to 100% (cockroach mix). When ST was positive, RAST was positive in 16.3% (dog epidermal) to 50.0%(D. farinae). When RAST was negative, ST was positive in 48.5% (cat epithelium) to 69.6% (D. farinae). When ST was negative, RAST was positive in 0% (cockroach) to 5.6% (cat epithelium). The scores of ST and RAST showed weak to moderate correlation (r = 0.24 to 0.54). Regardless of history of symptoms on exposure, ST was superior to RAST in detecting sensitization to cat epithelium and dog epidermal.

Conclusion

For all four indoor allergens tested, ST was more sensitive than RAST. When both tests were positive, their scores showed poor correlation. Sensitizations to cat epithelium and dog epidermal are common, even in subjects who claimed no direct exposure.
Educational and labor wastage of doctors in Mexico: towards the construction of a common methodology
Authors: Nigenda Gustavo , Ruiz José Arturo , Bejarano Rosa
Published: April 2005

Background

This paper addresses the problem of wastage of the qualified labor force, which takes place both during the education process and when trained personnel try to find jobs in the local market.

Methods

Secondary sources were used, mainly the Statistical yearbooks of the National Association of Universities and Higher Education Institutions (ANUIES in Spanish). Also, the 2000 Population Census was used to estimate the different sources of labor market wastage. The formulas were modified to estimate educational and labor wastage rates.

Results

Out of every 1000 students who started a medical training in 1996, over 20% were not able to finish the training by 2000. Furthermore, out of every 1000 graduates, 31% were not able to find a remunerated position in the labor market that would enable them to put into practice the abilities and capacities obtained at school. Important differences can be observed between generalists and specialists, as well as between men and women. In the case of specialists and men, lower wastage rates can be observed as compared to the wastage rates of generalists and women. A large percentage of women dedicate themselves exclusively to household duties, which in labor terms represents a wastage of their capacity to participate in the production of formal health services.

Conclusion

Women are becoming a majority in most medical schools, yet their participation in the labor market does not reflect the same trend. Among men, policies should be formulated to incorporate doctors in the specific health field for which they were trained. Regarding women, specific policies should target those who are dedicated full-time to household activities in order to create the possibility of having them occupy a remunerated job if they are willing to do so. Reducing wastage at both the educational and labor levels should improve the capacity of social investment, thereby increasing the capacity of the health system as a whole to provide services, particularly to those populations who are most in need.
Comparable response of ccn1 with ccn2 genes upon arthritis: An in vitro evaluation with a human chondrocytic cell line stimulated by a set of cytokines
Authors: Moritani Norifumi H , Kubota Satoshi , Sugahara Toshio , Takigawa Masaharu
Published: April 2005

Background

The chondrosarcoma-derived HCS-2/8 has been known to be an excellent model of human articular chondrocytes. By mimicking the arthritic conditions through the treatment of HCS-2/8 cells with cytokines, we estimated the gene expression response of ccn1 and ccn2 during the course of joint inflammation in vitro.

Results

In order to mimic the initiation of inflammation, HCS-2/8 cells were treated with tumor necrosis factor (TNF)-α. To induce pro-inflammatory or reparative responses, TGF-β was employed. Effects of an anti-inflammatory glucocorticoid were also evaluated. After stimulation, expression levels of ccn1 and ccn2 were quantitatively analyzed. Surprisingly, not only ccn2, but also ccn1 expression was repressed upon TNF-α stimulation, whereas both mRNAs were uniformly induced by transforming growth factor (TGF)-β and a glucocorticoid.

Conclusion

These results describing the same response during the course of inflammation suggest similar and co-operative roles of these 2 ccn family members in the course of arthritis.
Eco-epidemiological analysis of dengue infection during an outbreak of dengue fever, India
Authors: Chakravarti Anita , Kumaria Rajni
Published: April 2005

Background

This study was designed to find out a relationship of dengue infection with climatic factors such as rainfall, temperature and relative humidity during the dengue fever epidemic in the year 2003. Blood samples were collected from 1550 patients experiencing a febrile illness clinically consistent with dengue infection. Serological confirmation of Dengue Infection was done using Dengue Duo IgM and IgG Rapid Strip test (Pan Bio, Australia), which detected dengue-specific antibodies. Monthly data of total rainfall, temperature and relative humidity for the year 2003 was obtained from Meteorological Department of Delhi, New Delhi and retrospectively analyzed.

Results

Out of 1550 suspected cases, 893 cases (57.36%) were confirmed as serologically positive. The difference between numbers of serologically positive cases during different months was significant (p < 0.05). Larger proportions of serologically positive cases were observed among adults. Outbreak coincided mainly with the post monsoon period of subnormal rainfall. The difference between serologically positive cases as compared to serologically negative ones in post monsoon period was significantly higher (p < 0.001). The difference in the rainfall and temperature between three seasonal periods was significant (p < 0.05).

Conclusion

This prospective study highlighted rain, temperature and relative humidity as the major and important climatic factors, which could alone or collectively be responsible for an outbreak. More studies in this regard could further reveal the correlation between the climatic changes and dengue outbreaks, which would help in making the strategies and plans to forecast any outbreak in future well in advance.
Characterization of the protease domain of Rice tungro bacilliform virus responsible for the processing of the capsid protein from the polyprotein
Authors: Marmey Philippe , Rojas-Mendoza Ana , de Kochko Alexandre , Beachy Roger N , Fauquet Claude M
Published: April 2005

Background

Rice tungro bacilliform virus (RTBV) is a pararetrovirus, and a member of the family Caulimoviridae in the genus Badnavirus. RTBV has a long open reading frame that encodes a large polyprotein (P3). Pararetroviruses show similarities with retroviruses in molecular organization and replication. P3 contains a putative movement protein (MP), the capsid protein (CP), the aspartate protease (PR) and the reverse transcriptase (RT) with a ribonuclease H activity. PR is a member of the cluster of retroviral proteases and serves to proteolytically process P3. Previous work established the N- and C-terminal amino acid sequences of CP and RT, processing of RT by PR, and estimated the molecular mass of PR by western blot assays.

Results

A molecular mass of a protein that was associated with virions was determined by in-line HPLC electrospray ionization mass spectral analysis. Comparison with retroviral proteases amino acid sequences allowed the characterization of a putative protease domain in this protein. Structural modelling revealed strong resemblance with retroviral proteases, with overall folds surrounding the active site being well conserved. Expression in E. coli of putative domain was affected by the presence or absence of the active site in the construct. Analysis of processing of CP by PR, using pulse chase labelling experiments, demonstrated that the 37 kDa capsid protein was dependent on the presence of the protease in the constructs.

Conclusion

The findings suggest the characterization of the RTBV protease domain. Sequence analysis, structural modelling, in vitro expression studies are evidence to consider the putative domain as being the protease domain. Analysis of expression of different peptides corresponding to various domains of P3 suggests a processing of CP by PR. This work clarifies the organization of the RTBV polyprotein, and its processing by the RTBV protease.
Molecular advances in the cell biology of SARS-CoV and current disease prevention strategies
Authors: Stark Caren J , Atreya CD
Published: April 2005

In the aftermath of the SARS epidemic, there has been significant progress in understanding the molecular and cell biology of SARS-CoV. Some of the milestones are the availability of viral genome sequence, identification of the viral receptor, development of an infectious cDNA clone, and the identification of viral antigens that elicit neutralizing antibodies. However, there is still a large gap in our understanding of how SARS-CoV interacts with the host cell and the rapidly changing viral genome adds another variable to this equation. Now the SARS-CoV story has entered a new phase, a search for preventive strategies and a cure for the disease. This review highlights the progress made in identifying molecular aspects of SARS-CoV biology that is relevant in developing disease prevention strategies. Authors conclude that development of successful SARS-CoV vaccines and antivirals depends on the progress we make in these areas in the immediate future.
Characteristics of patients with organic brain syndromes : A cross-sectional 2-year follow-up study in Kuala Lumpur, Malaysia
Authors: Chandrasekaran Prem K , Jambunathan Stephen T , Zainal Nor Z
Published: April 2005

Background

Organic Brain Syndromes (OBS) are often missed in clinical practice. Determining their varied presentations may help in earlier detection, better management, and, assessing prognosis and outcome. We described the in-patient referrals of patients suffering from the psychiatric effects of organic states and compared the symptomatology and mortality between those with the Acute and Chronic varieties.

Methods

59 patients referred to our Consultation-Liaison (C-L) Psychiatry services and given a clinical diagnosis of OBS were selected over a 6-month period. Psychiatric and cognitive abnormalities and treatment regimes were recorded and fatality rates determined. Information regarding their condition 24 months after their index hospitalization was recorded. All data were entered into a proforma and analyzed after exclusion.

Results

The mean duration of detecting the symptoms by the physician was 3.52 days. The presence of a premorbid psychiatric illness had no influence on the clinical presentation but did on the mortality of patients with OBS (p = 0.029).

Patients with the Acute syndrome had significantly more symptom resolution as compared to those with the Chronic syndrome (p = 0.001) but mortalityrates did not differ. Elderly patients and those with symptom resolution upon discharge did not show statistically significant higher mortality rates. The most popular combination of treatment was that of a low-dose neuroleptic and a benzodiazepine (34.7%). The need for maintenance treatment was not significantly different in any group, even in those with a past history of a functional disorder.

Conclusion

Other than the Acute group having a significantly better outcome in terms of symptom resolution, our findings suggest that there was no significant difference in the clinical presentation between those with Acute or Chronic OBS. Mortality-wise, there was also no difference between the Acute and Chronic syndromes, nor was there any difference between the elderly and the younger group. There was also no significant difference in the need for continued treatment in both groups.
Consolidating the set of known human protein-protein interactions in preparation for large-scale mapping of the human interactome
Authors: Ramani Arun K , Bunescu Razvan C , Mooney Raymond J , Marcotte Edward M
Published: April 2005

Background

Extensive protein interaction maps are being constructed for yeast, worm, and fly to ask how the proteins organize into pathways and systems, but no such genome-wide interaction map yet exists for the set of human proteins. To prepare for studies in humans, we wished to establish tests for the accuracy of future interaction assays and to consolidate the known interactions among human proteins.

Results

We established two tests of the accuracy of human protein interaction datasets and measured the relative accuracy of the available data. We then developed and applied natural language processing and literature-mining algorithms to recover from Medline abstracts 6,580 interactions among 3,737 human proteins. A three-part algorithm was used: first, human protein names were identified in Medline abstracts using a discriminator based on conditional random fields, then interactions were identified by the co-occurrence of protein names across the set of Medline abstracts, filtering the interactions with a Bayesian classifier to enrich for legitimate physical interactions. These mined interactions were combined with existing interaction data to obtain a network of 31,609 interactions among 7,748 human proteins, accurate to the same degree as the existing datasets.

Conclusion

These interactions and the accuracy benchmarks will aid interpretation of current functional genomics data and provide a basis for determining the quality of future large-scale human protein interaction assays. Projecting from the approximately 15 interactions per protein in the best-sampled interaction set to the estimated 25,000 human genes implies more than 375,000 interactions in the complete human protein interaction network. This set therefore represents no more than 10% of the complete network.
Nanoarchaea: representatives of a novel archaeal phylum or a fast-evolving euryarchaeal lineage related to Thermococcales?
Authors: Brochier Celine , Gribaldo Simonetta , Zivanovic Yvan , Confalonieri Fabrice , Forterre Patrick
Published: April 2005

Background

Cultivable archaeal species are assigned to two phyla - the Crenarchaeota and the Euryarchaeota - by a number of important genetic differences, and this ancient split is strongly supported by phylogenetic analysis. The recently described hyperthermophile Nanoarchaeum equitans, harboring the smallest cellular genome ever sequenced (480 kb), has been suggested as the representative of a new phylum - the Nanoarchaeota - that would have diverged before the Crenarchaeota/Euryarchaeota split. Confirming the phylogenetic position of N. equitans is thus crucial for deciphering the history of the archaeal domain.

Results

We tested the placement of N. equitans in the archaeal phylogeny using a large dataset of concatenated ribosomal proteins from 25 archaeal genomes. We indicate that the placement of N. equitans in archaeal phylogenies on the basis of ribosomal protein concatenation may be strongly biased by the coupled effect of its above-average evolutionary rate and lateral gene transfers. Indeed, we show that different subsets of ribosomal proteins harbor a conflicting phylogenetic signal for the placement of N. equitans. A BLASTP-based survey of the phylogenetic pattern of all open reading frames (ORFs) in the genome of N. equitans revealed a surprisingly high fraction of close hits with Euryarchaeota, notably Thermococcales. Strikingly, a specific affinity of N. equitans and Thermococcales was strongly supported by phylogenies based on a subset of ribosomal proteins, and on a number of unrelated molecular markers.

Conclusion

We suggest that N. equitans may more probably be the representative of a fast-evolving euryarchaeal lineage (possibly related to Thermococcales) than the representative of a novel and early diverging archaeal phylum.
MIP-1α[CCL3] acting on the CCR1 receptor mediates neutrophil migration in immune inflammation via sequential release of TNF-α and LTB4
Authors: Ramos Cleber D L , Canetti Claudio , Souto Janeusa T , Silva João S , Hogaboam Cory M , Ferreira Sergio H , Cunha Fernando Q
Published: April 2005

In the present study, we investigated the involvement of macrophage-inflammatory protein-1α (MIP-1α)[CC chemokine ligand 3 (CCL3)], MIP-1β[CCL4], regulated on activation, normal T expressed and secreted (RANTES)[CCL5], and CC chemokine receptors (CCRs) on neutrophil migration in murine immune inflammation. Previously, we showed that ovalbumin (OVA)-triggered neutrophil migration in immunized mice depends on the sequential release of tumor necrosis factor α (TNF-α) and leukotriene B4(LTB4). Herein, we show increased mRNA expression for MIP-1α[CCL3], MIP-1β[CCL4], RANTES[CCL5], and CCR1 in peritoneal cells harvested from OVA-challenged, immunized mice, as well as MIP-1α[CCL3] and RANTES[CCL5] but not MIP-1β[CCL4] proteins in the peritoneal exudates. OVA-induced neutrophil migration response was muted in immunized MIP-1α[CCL3]−/− mice, but it was not inhibited by treatment with antibodies against RANTES[CCL5] or MIP-1β[CCL4]. MIP-1α[CCL3] mediated neutrophil migration in immunized mice through induction of TNF-α and LTB4 synthesis, as these mediators were detected in the exudates harvested from OVA-challenged immunized wild-type but not MIP-1α[CCL3]−/− mice; administration of MIP-1α[CCL3] induced a dose-dependent neutrophil migration, which was inhibited by treatment with an anti-TNF-α antibody in TNF receptor 1 (p55−/−)-deficient mice or by MK 886 (a 5-lipoxygenase inhibitor); and MIP-1α[CCL3] failed to induce LTB4 production in p55−/− mice. MIP-1α[CCL3] used CCR1 to promote neutrophil recruitment, as OVA or MIP-1α[CCL3] failed to induce neutrophil migration in CCR1−/− mice, in contrast to CCR5−/− mice. In summary, we have demonstrated that neutrophil migration observed in this model of immune inflammation is mediated by MIP-1α[CCL3], which via CCR1, induces the sequential release of TNF-α and LTB4. Therefore, whether a similar pathway mediates neutrophil migration in human immune-inflammatory diseases, the development of specific CCR1 antagonists might have a therapeutic potential.
Regulation of matrix metalloproteinase-9 release from IL-8-stimulated human neutrophils
Authors: Chakrabarti Subhadeep , Patel Kamala D
Published: April 2005

Matrix metalloproteinase-9 (MMP-9) is present in the tertiary granules of neutrophils and can be released following stimulation. We examined the signaling mechanisms that regulate interleukin-8 (IL-8)-mediated MMP-9 release from neutrophils. IL-8 activates neutrophils by interacting with two receptors: CXC chemokine receptor 1 (CXCR1) and CXCR2. Blocking CXCR1 had no effect on IL-8-mediated MMP-9 release, whereas blocking CXCR2 significantly reduced MMP-9 release. We also found that stimulating CXCR2 alone was sufficient to induce MMP-9 release. This process was independent of changes in the intracellular calcium concentration. Src-family kinases and protein kinase C (PKC) were involved in two mutually exclusive pathways regulating IL-8-mediated MMP-9 release. Inhibition of extracellular signal-regulated kinase (ERK)1/2 blocked IL-8-mediated MMP-9 release; however, inhibition of p38 mitogen-activated protein kinase had no effect on MMP-9 release. We found ERK1/2 was activated downstream of PKC, but not Src-family kinases, in this system. These data suggest that IL-8-induced MMP-9 release from neutrophils is mediated through CXCR2 and involves two distinct pathways, one involving PKC and ERK1/2 and the other involving Src-family kinases. Furthermore, our data show that the mechanisms that regulate MMP-9 release from tertiary granules are different from those that regulate primary granule release.
Reading-time studies of second language ambiguity resolution
Authors: Papadopoulou Despina
Published: April 2005

This article provides a review of studies that have examined the ambiguity resolution strategies employed when processing a second language (L2). The way second language learners parse the L2 input has not yet been thoroughly investigated, although recently there has been an increasing interest in this area. The exploration of the mechanisms L2 learners use to parse ambiguous constructions allows us to examine not only aspects of L2 acquisition that still remain obscure, but also the validity of existing theories of parsing. The studies reported in this article look at three different types of ambiguous construction in the L2, and their results are discussed in relation to the L2 performance pattern. Most of the findings show that even advanced L2 learners are slower readers than native speakers and apply processing routines that depart from those best suited for processing the target language input. In addition, although L2 learners show sensitivity to lexical cues such as verb argument structure when processing the L2 input, they are less likely to rapidly employ structural information on line. The issues of the transfer of processing mechanisms from the first language (L1) to the second as well as the impact of L2 exposure on the adoption of the L2 processing routines are still unresolved and need to be further investigated.
Electrophysiological correlates of second language processing
Authors: Mueller Jutta L.
Published: April 2005

The aim of this article is to provide a selective review of event-related potential (ERP) research on second language processing. As ERPs have been used in the investigation of a variety of linguistic domains, the reported studies cover different paradigms assessing processing mechanisms in the second language at various levels, ranging from phoneme discrimination to complex sentence processing. Differences between ERP patterns of first language (L1) and second language (L2) speakers can help to specify and to test predictions derived from models of L2 processing or hypotheses concerning critical periods for some aspects of second language acquisition. The studies currently available suggest that ERPs are indeed sensitive to qualitative and quantitative differences in L2 speakers with regard to on-line processing.
Eye-movement recording as a tool for studying syntactic processing in a second language: a review of methodologies and experimental findings
Authors: Frenck-Mestre Cheryl
Published: April 2005

The complex trace of saccades, fixations and regressions that the eyes make while taking in a line of text is unquestionably one of the richest accounts available as concerns the process of reading. Recording these jumps, stops and re-takes provides a to-the-letter, millisecond-precise report of the readers’ immediate syntactic processing as well as revisions thereof. In addition, the influence of innumerable factors -from low-level visual conditions to high-level pragmatic cues - on the reading process can be measured via this method, thereby rendering possible the testing of various psycholinguistic models of parsing and comprehension. For all of these reasons, eye-movement recording has become an invaluable tool in the study of how readers process text. Interestingly, however, only a handful of eye-movement studies have been published as concerns reading in the second language. The goal of the present article is to outline the findings of these second language studies and, hopefully, to encourage future work in the field using this tool.
Symptom distress as rated by advanced cancer patients, caregivers and physicians in the last week of life
Authors: Oi-Ling Kwok , Man-Wah Doris TSE , Kam-Hung Daniel NG
Published: April 2005

Objectives: To study the symptom distress as rated by patients with advanced cancer during their last week of life, and to compare patients' ratings with those perceived by caregivers and physicians. Method: This was a prospective study on all patients admitted to the Hospice Unit of the Caritas Medical Centre with an estimated life expectancy of two weeks or less from May 2002 to September 2002. A questionnaire with a list of 13 symptoms, including pain, dyspnoea, nausea, vomiting, dry mouth, cough, fatigue, cachexia, anorexia, constipation, diarrhoea, insomnia and haemoptysis, was administered to assess the distress. Distress was rated by a verbal rating scale consisting of five grades (grade 0 to grade 4). Patients, caregivers and physicians completed the questionnaire weekly until the patient died. Only the questionnaires completed in the last week of life were included for analysis. Results: Of 82 patients who were recruited in the study, 30 patients were able to complete the questionnaire within the last week of life. Their median age was 69 years and the gender ratio was 1:1. Lung cancer was the most common primary tumour. Fatigue, cachexia and anorexia caused distress of all grades in nearly all 30 patients and caused significant distress of grade 3 and above in two-thirds of patients. Neither the caregivers nor the physicians gave congruent distress scores for these three symptoms ( k < 0.4). Caregivers' ratings agreed well with those of patients for five symptoms ( k > 0.4, P < 0.005), including dyspnoea, cough, dry mouth, constipation and insomnia. For physicians, good agreement was found for three symptoms only, including pain, dyspnoea and cough. Moreover, physicians tended to underrate the distress. Conclusion: Fatigue, cachexia and anorexia were the three most distressful symptoms in the last week of life in this group of patients, but caregivers and physicians failed to rate them in agreement with patients.
The level of and relation between hope, hopelessness and fatigue in patients and family members in palliative care
Authors: Benzein Eva G , Berg Agneta C
Published: April 2005

Hope, hopelessness and fatigue are important experiences for patients and family members in palliative care. The aim of the study was to describe the level of and relation between hope, hopelessness and fatigue in patients and family members in palliative care. Eighty-five participants completed the Herth Hope Index, Beck's Hopelessness Scale and rated their level of fatigue from none to severe. The level of hope proved to be significantly lower among the family members than among the patients. For the family members, correlations were found between hope and age (–0.358*), fatigue and hope (–0.439*), hopelessness and age (0.484**), age and fatigue (0.403**) and between hope and hopelessness (–0.723**). For the patients, correlations were found between age and hopelessness (0.555**) and between hopelessness and hope (–0.580**). Efforts to increase the experience of hope and decrease hopelessness and fatigue must include not only the patient but also the family members. (*=P<0.5, **=P<0.01)
Measurements of plasma oxycodone, noroxycodone and oxymorphone levels in a patient with bilateral nephrectomy who is undergoing haemodialysis
Authors: Lee M A , Leng M E F , Cooper R M
Published: April 2005

The use of opioid analgesics in renal dysfunction is potentially problematic and many patients with end stage renal disease are unable to tolerate these medications. A greater understanding of the pharmacokinetics of opioid analgesics is vital in informing safe and effective practice.

Using pharmacokinetic analysis, this case study demonstrates for the first time that oxycodone and its metabolites are removed by haemodialysis. As such, care should be taken when using oxycodone in patients undergoing haemodialysis.
Is long-term low-molecular-weight heparin acceptable to palliative care patients in the treatment of cancer related venous thromboembolism? A qualitative study
Authors: Noble Simon IR , Finlay I G
Published: April 2005

Venous thromboembolism (VTE) is common in patients with terminal cancer. Current treatment practice with warfarin has a high incidence of complications, including bleeding, poor control and recurrent VTE. Long-term low-molecular-weight heparin (LMWH) therapy is safer and more efficacious in this patient group, but there are concerns that daily therapy may have a negative impact on quality of life. A qualitative study was carried out to determine whether LMWH was acceptable in palliative care patients, both in the community and in-patient units. Forty palliative care patients receiving LMWH for VTE were interviewed. Participants found LMWH to be an acceptable intervention, allowing them freedom from blood tests and optimism regarding their care. It was considered a preferable therapy to warfarin, which had a negative impact on participant's quality of life. The findings of this study support the use of LMWH, first line in the treatment of established VTE in the palliative care setting.
The management of xerostomia in patients on haemodialysis: comparison of artificial saliva and chewing gum
Authors: Bots Casper P , Brand Henk S , Veerman Enno CI , Valentijn-Benz Marianne , Amerongen Barbara M Van , Amerongen Arie V Nieuw , Valentijn Robert M , Vos Pieter F , Bijlsma Joost A , Bezemer Pieter D , Wee Piet M ter
Published: April 2005

Many patients on haemodialysis (HD) therapy suffer from a dry mouth and xerostomia. This can be relieved by mechanical and gustatory stimulation or palliative care. The aim of this crossover study was to investigate the effect and preferences of a sugar-free chewing gum (Freedent WhiteTM) and a xanthan gum-based artificial saliva (XialineTM) in the management of xerostomia in chronic HD patients. Sixty-five HD patients participated in a 6-week crossover trial. The artificial saliva was rated significantly lower than the chewing gum for effectiveness, taste and a global assessment. No preference differences were found for gender and age, although older subjects rated the artificial saliva with a higher mark. Thirty-nine subjects (60%) preferred chewing gum, 15% ( n = 10) preferred the artificial saliva. Therefore, both chewing gum and artificial saliva could play an important role in the palliative care of xerostomia in HD patients.
A survey of methicillin-resistant Staphylococcus aureus (MRSA) management in hospices/palliative care units
Authors: Dand Pauline , Fyvie Joan , Yee Alethea , Sykes Nigel
Published: April 2005

A questionnaire-based survey was performed of the protocols adopted by specialist palliative care in-patient units in southern England for the management of methicillin-resistant Staphylococcus aureus(MRSA). An 87% response rate was obtained from a total of 63 units. Ninety-five percent of the responding units had a protocol for MRSA management, but staff training in its contents was provided in only 59%. Some form of screening for MRSA was carried out by 13% of units. Infection control precautions taken varied between units and according to whether a patient was colonized or infected with MRSA. Although 86% carried out some form of isolation of patients with known or suspected MRSA infection, only 46% restricted their activity within the unit. However, 41% of respondents felt that protocols to eradicate MRSA colonization were not relevant to hospices. The impact of MRSA infection or colonization on a palliative care population in terms of quality of life and morbidity remains unknown.
Historical geography in China
Authors: Chiang Tao-Chang
Published: April 2005

Traditional Chinese historical geography is closely related to yange dili. Concepts relating to man-land relations are the underlying theories. The Yugong Society played a key role in the transformation of the Chinese historical geography from yange dili to modern historical geography. In the second half of the twentieth century, Chinese historical geographers made substantial contributions. Two main themes are the geographical change through time and the reconstruction of past geographies. Major research topics include changes of national territories and administrative divisions, changes of physical environments, urban geography, population, agricultural geography, social and cultural aspects, general and regional geographies, historical cartographics, and other aspects. Chinese historical geography is indigenous, but with western influence. Nevertheless, the Chinese historical geography is still very much descriptive and lags behind the west in theoretical research. Most Chinese historical geographers are originally trained historians. Hence they are more interested in studies of changes through time than in researches of spatial variations. Chinese historical geography is maturing as a respected field of study.
The role of geography in public debate
Authors: Murphy Alexander B. , de Blij H. J. , Turner B. L. , Gilmore Ruth Wilson , Gregory Derek
Published: April 2005

Many geographers work on matters of great relevance for the issues facing society, but geography is rarely invoked in public debates over matters of contemporary concern. As a result, geographical perspectives are often missing from public discourse, and outmoded conceptions of geography are reinforced. This forum considers the importance and challenge of addressing this state of affairs. Four distinguished geographers who have been involved in different ways with the effort to raise geography's profile consider the possibilities and limitations of enhancing geography's public profile. Consideration is given to the prospects for raising the discipline's visibility in high-profile public venues, the role of geography in organized international research endeavors, the challenge of linking what geographers do to social activism, and the importance of questioning the unproblematized geographical ideas and discursive norms that already circulate in the public arena.
Treprostinil for the treatment of severe digital necrosis in systemic sclerosis
Authors: Engel Gregory , Rockson Stanley G
Published: April 2005

We report a case of severe digital ulcerations associated with systemic sclerosis, successfully treated with treprostinil (Remodulin®). There was improvement within days of the treatment initiation; complete healing was accomplished after 16 weeks of therapy. Patients with systemic sclerosis and peripheral small vessel disease have limited therapeutic options. Treprostinil is a prostacyclin analogue that can be delivered by subcutaneous infusion and is approved in the USA only for treatment of primary pulmonary hypertension. This report provides an impressive example of an alternative, complementary indication for the use of treprostinil.
ADMA regulates angiogenesis: genetic and metabolic evidence
Authors: Achan V , Ho HK , Heeschen C , Stuehlinger M , Jang JJ , Kimoto M , Vallance P , Cooke JP
Published: April 2005

Endothelium-derived nitric oxide (NO) plays an important role in transducing the effects of angiogenic factors. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthase (NOS). We used a murine model of hindlimb ischemia to investigate whether genetic or metabolic changes in ADMA levels could impair angiogenic response in vivo. Hindlimb ischemia was surgically induced in C57BL/6J mice, apo E-deficient mice, or transgenic mice overexpressing dimethylarginine dimethylaminohydrolase (DDAH). Some animals were also treated with the NOS antagonist L-nitro-arginine, or the NO precursor L-arginine. Angiogenesis was quantified in the hindlimb skeletal muscle by capillary/myocyte ratio. Plasma or tissue ADMA levels were measured by HPLC. In normal mice, hindlimb ischemia increased tissue ADMA twofold, and reduced DDAH and NOS expression. This was associated with a reduced NOS activity (by over 80%) three days following surgery. On day seven, a threefold increase in DDAH expression and a fall in tissue ADMA levels were associated with a sevenfold increase in NOS activity, whereas NOS expression did not increase above baseline. In DDAH transgenic mice, the elevation of ADMA and decrement in NOS activity was blunted during hindlimb ischemia. Plasma ADMA levels were increased in apo E-mice (1.79 ± 0.45 versus 1.07 ± 0.08 μmol/l; p = 0.008). Capillary index was significantly reduced in apo E-mice up to seven weeks after surgery (0.25 ± 0.05 versus 0.62 ± 0.08; p < 0.001). The effect of hypercholesterolemia on capillary index was reversed by L-arginine, and (in wild-type mice) mimicked by administration of the NOS antagonist L-nitro-arginine. In conclusion, metabolic or genetic changes in plasma and tissue ADMA levels affect tissue NO production and angiogenic response to ischemia.
Plasma levels and zymographic activities of matrix metalloproteinases 2 and 9 in type II diabetics with peripheral arterial disease
Authors: Signorelli Salvatore Santo , Malaponte Grazia , Libra Massimo , Pino Luigi Di , Celotta Gabriella , Bevelacqua Valentina , Petrina Marcello , Nicotra Giuseppina S , Indelicato Manuela , Navolanic Patrick M , Pennisi Giuseppe , Mazzarino Maria Clorinda
Published: April 2005

Deregulation of matrix metalloproteinases (MMPs) is an important factor contributing to the development of vascular lesions. Plasma levels and zymographic activities of MMP-2 and MMP-9 were investigated in type II diabetics with ( n = 51) or without ( n = 42) peripheral artery disease (PAD) and in normal volunteers ( n = 23). Plasma MMP-2 levels were higher in type II diabetics with ( p < 0.01) or without ( p < 0.05) PAD in comparison with normal volunteers. Similarly, type II diabetics with ( p < 0.0001) or without ( p > 0.05) PAD had higher plasma MMP-9 levels than normal volunteers. Plasma zymographic activities of both MMP-2 and MMP-9 were positively correlated with their plasma levels. Plasma MMP-2 zymographic activity was higher in type II diabetics with PAD than type II diabetics without PAD ( p > 0.05). Plasma MMP-9 zymographic activity was higher in type II diabetics with ( p < 0.0001) or without ( p < 0.0001) PAD in comparision with normal volunteers. Together, these results indicate that increased plasma levels and zymographic activities of MMP-2 and MMP-9 may contribute to PAD in type II diabetics. In particular, plasma MMP-9 may be a useful marker for the development of vascular disease in type II diabetics.
Cellular and molecular mechanisms of coronary vessel development
Authors: Mu Hong , Ohashi Ryuji , Lin Peter , Yao Qizhi , Chen Changyi
Published: April 2005

Development of coronary vessels is a complex process in developmental biology and it may have clinical implications. Although coronary vessels develop as a form of vasculogenesis followed by angiogenesis, the cells of the entire coronary system do not arise from the developing heart. The key events of the coronary system formation include the generation of primordium and proepicardial organ; formation of epicardium; generation of subepicardial mesenchymal cells, and the formation, remodeling and maturation of the final vascular plexus. These events represent a complex regulation of the cell fate determination, cellular migration, epicardial/mesenchymal transformation, and patterning of vasculatures. Recent studies suggest that several transcription factors, adhesion molecules, growth factors and signaling molecules play essential roles in these events. This article reviews the literature on the development of coronary vessels, and discusses current advances and controversies of molecular and cellular mechanisms, thereby directing future investigations.
Vascular viewpoint
Authors: Mohammed Naufal , Anand Sonia S
Published: April 2005

Question: Is carotid endarterectomy (CEA) an effective and safe treatment for the prevention of stroke among patients with >60% internal carotid artery stenosis who had no neurologic symptoms in the previous 6 months.

Population: Men and women with severe (>60%) unilateral or bilateral carotid artery stenosis not associated with neurologic symptoms in the past 6 months, where both doctor and patient were uncertain whether to choose or to defer immediate CEA. Design and methods: During 1993-2003, 3120 asymptomatic patients with >60% carotid stenosis were randomized equally to immediate CEAversus indefinite deferral of CEA, and were followed for up to 5 years. The primary end point was risk of stroke or death at 5 years. Analysis was by intention to treat. The treatment of patients with antiplatelet agents, antihypertensive and lipid-lowering therapies was left to the discretion of the clinician.

Results: Among patients randomized to immediate CEA (50% had CEA by 1 month, 88% by 1 year) versus deferred, the incidence of stroke or death at 5 years was 6.4% versus 11.8% (95% CI: 3.0-7.7, p < 0.0001); 3.5% versus 6.1% for fatal or disabling strokes (95% CI: 0.8-4.3, p = 0.004), and 2.1% versus 4.2% for fatal strokes (95% CI: 0.6-3.6, p = 0.006). The perioperative stroke incidence was marginally higher in the delayed group versus the immediate group (4.5% versus 2.8%) and overall the risk per CEA of perioperative stroke or death was 3.1%. After excluding the perioperative events from the analysis, the 5-year stroke risks were 3.8% versus 11% (95% CI: 5.0-9.4], p < 0.0001). Surgery primarily prevented carotid territory ischemic strokes (2.7% vs 9.5%; gain 6.8% [4.8-8.8], p < 0.0001). The impact of immediate surgery was consistent in all age groups, among men and women, and across the spectrum of carotid stenosis (i.e. 70%, 80% and 90% carotid stenosis).

Conclusion: In asymptomatic patients younger than 75 years of age with carotid stenosis of 70% or more on ultrasound, immediate CEA reduces the 5-year incidence of stroke and death.
The role of inflammation in atherothrombosis: implications for clinical practice
Authors: Tedgui Alain
Published: April 2005

Inflammation plays a key role in atherothrombosis: in the development of plaques, plaque rupture and thrombus formation. Various biochemical substances have been shown to be involved in the inflammatory process, some with pro-inflammatory activity and others with anti-inflammatory activity. Increased expression of many inflammatory mediators (e.g. C-reactive protein, CD40 ligand, P-selectin and IL-6) has been shown to correlate with increased risk of atherothrombotic events. One possible strategy for primary and secondary prevention is likely to focus on minimizing the inflammatory response and tipping the balance in favour of anti-inflammatory mediators and, therefore, plaque stability.
Nebulized antibiotic therapy: the evidence
Authors: Conway S P
Published: April 2005

The main indications for nebulized antibiotic use are as maintenance therapy for patients with chronic Pseudomonas aeruginosa infection and in treatment protocols aimed at eradicating early P. aeruginosa infection. Daily nebulized antibiotic therapy has been used extensively in Europe for the last 25 years and recently in North America following the introduction of tobramycin solution for inhalation (TSI). The antibiotic is delivered directly to the site of infection, maximizing its efficacy and reducing its potential for toxicity. The efficacy of nebulized antibiotic therapy has been confirmed by meta–analyses of early studies which usually involved only small numbers of patients, and recently by large scale randomized control trials. These studies have shown that regular aerosolized antibiotic treatment results in improved respiratory function, less hospital admissions and respiratory exacerbations, and a significant reduction in the load of P. aeruginosa respiratory tract infection. Concerns about increasing bacterial resistance do not yet seem to have had any clinical impact. Successful eradication of early P. aeruginosa infection has been reported with nebulized colistin (in combination with oral ciprofloxacin), tobramycin and TSI. No advantage has been shown in studies comparing nebulized and intravenous antibiotics versus intravenous antibiotics alone in the treatment of acute respiratory exacerbations. Inhalation of antibiotics may provoke bronchospasm and patients should be assessed before and after treatment prior to continuing long–term therapy at home.
Osteoporosis screening in people with airways disease
Authors: Smith B J , McElroy H J , Laslett L L , Pile K D , Phillips P J , Phillipov G , Evans S M , Weekley J S , Pilotto L S
Published: April 2005

We tested associations between risk factors and bone mineral density in airways disease subjects, and developed a clinical screening tool to identify people who could benefit from bone mineral density testing. Subjects were recruited through hospital outpatients and pharmacies (Newcastle, n = 172). With survey refinement, we then tested a revised tool in a second sample (Adelaide, n = 317). Study factors included oral/inhaled corticosteroid use, asthma severity, respiratory admissions, physical activity, percent predicted forced expiratory volume in one second (FEVI), body mass index, and smoking history. Outcomes were bone mineral density of lumbar vertebra (L2–4) and total (or neck of) femur. Analysis was logistic regression with generation of a simple screening algorithm based upon coefficients. Scoring algorithm risk factors for T–score of – 2.0: age 68 = 10 points, bone mineral density <20 = 25, weight <60 kg = 20, 60–69 kg = 10, > 80 cigarette pack years = 15, low–level leisure activity = 5, area under receiver operator curve 0.83. For a cut–off score of 10, sensitivity was 91.2%, specificity 53.9%, positive and negative predictive values 52.3 and 91.7%, and 67.2% were correctly classified. In conclusions, our model has acceptable sensitivity, although limited specificity. Use of this tool may reduce unnecessary referrals for bone mineral density measurement.