bluuebunny/crossref_metadata_2025 huggingface dataset:
Loss of flower bud vigour in the Mediterranean shrub, Cistus albidus L. at advanced developmental stages
Authors: Oñate M. , Munné‐Bosch S.
Published: August 2009

To better understand aging in perennials, age‐related changes in the physiology of leaves and flower buds of the Mediterranean shrub, Cistus albidus L. were evaluated. Two groups of different ages (5 and 10 years old), both at advanced developmental stages but of similar size, were compared. Total plant biomass, biomass produced per apical meristem and levels of cytokinins, abscisic acid and jasmonic acid in leaves and flower buds, as well as flower production, were measured. No differences in plant size, vegetative growth rates and levels of phytohormones in leaves were observed between 5‐ and 10‐year‐old plants. However, they showed significant differences in flower bud development; the older plants having reduced vigour, with 29.6% of flowers reaching anthesis compared to 52.5% in the younger plants. Furthermore, endogenous concentrations of zeatin and abscisic acid in flower buds at stage I (start of flower organ formation) were 61% and 41%, respectively, smaller in 10‐ than in 5‐year‐old plants. At stage II (with all flower organs formed), zeatin and abscisic acid concentrations decreased by ca. 90% and 80%, respectively, but differences between age groups were still evident (60% and 29% for zeatin and abscisic acid, respectively). Jasmonic acid levels in flower buds decreased by 80% from stage I to II, but did not differ between age groups. Despite reductions in flower bud vigour, total number of flowers per individual was not significantly different between age groups, so that an age‐related loss in reproductive vigour at the organ level did not lead to a decrease in flower production at the whole plant level.
Gross Anatomy of the Intestine in the Giraffe (Giraffa camelopardalis)
Authors: Pérez W. , Lima M. , Clauss M.
Published: August 2009

We describe the macroscopic anatomy of the intestine of the giraffe (Giraffa camelopardalis). The small intestine was divided into duodenum, jejunum and ileum as usual. The caecum was attached to the ileum by a long ileocaecal fold, and to the proximal ansa of the ascending colon by a caecocolic fold. The ascending colon was the most developed portion of the gross intestine and had the most complex arrangement with three ansae: the proximal ansa, the spiral ansa and the distal ansa. The proximal ansa completely encircled the caecum, describing a 360° gyrus, and represented the widest portion of the intestine. The spiral ansa was formed by three and a half centripetal gyri, a central flexure and three centrifugal gyri. The last centrifugal gyrus left the spiral and described nine flexures of different form and direction over the left side of the mesentery. The two portions that formed each of these flexures ran parallel to each other. The last part of this gyrus ran parallel to the jejunum. When compared with domestic cattle, giraffe had a comparatively short small intestine and a comparatively long large intestine, with a resulting small ratio of small:large intestine. Reasons are presented why this should be considered a peculiarity of cattle‐like ruminants rather than a different representative of a browser–grazer dichotomy in general.
Towards Development of Eco‐Agriculture of Rainwater‐Harvesting for Supplemental Irrigation in the Semi‐Arid Loess Plateau of China
Authors: Zhao X. N. , Wu P. T. , Feng H. , Wang Y. K. , Shao H. B.
Published: August 2009

The semi‐arid Loess Plateau is a central zone of Chinese rain‐fed farming. Drought and soil erosion are the two major obstacles to restrict economic development in this semi‐arid Loess Plateau. The traditional conservation agriculture and runoff agriculture have been developed for several decades, which have reduced water and soil loss and improved rainwater utilization efficiency to a certain extent. However, its regulative role in rainwater is very much limited, and problems of agriculture production, such as severe seasonal drought and water shortage, low agriculture productivity, fragile ecological environment, and low yield‐invest ratio, are still going on. Supplemental irrigation of harvested rainwater is an important form of rainfall regulation and utilization on the basis of sophisticated technologies and theories of conservation agriculture and runoff agriculture, which not only promotes fulfilling rainfall harvesting in spatial location like the conservation agriculture and runoff agriculture measure but also gets at true rainfall harvesting in time distribution by principle of superposition and also decreases invalid evaporation for rainfall runoff. Agriculture productivity will be highly increased by using rainwater harvesting for supplemental irrigation. It not only brings about the integration of ecological reconstruction with economic development, but also provides a new approach to the agriculture sustainable development and overcomes two of the biggest obstacles (drought and soil erosion). It is suggested that this technology will become a strategic measure and comprehensive development model in semi‐arid Loess Plateau of China.
Molecular pathology of early stage chemically induced hepatocarcinogenesis
Authors: Ogawa Katsuhiro
Published: August 2009

In the early stage of chemically induced hepatocarcinogenesis, rare hepatocytes are transformed into preneoplastic hepatocytes, which progressively evolve into cells with increasing neoplastic phenotypes. Preneoplastic hepatocytes have gene expression different from normal hepatocytes, presumably from the outset. Some of these gene products are related to the growth and survival of the preneoplastic hepatocytes themselves, while others seem to involve the interaction of preneoplastic hepatocytes with non‐parenchymal cell components (paracrine mechanism). Carcinogen treatment, in contrast, usually causes chronic liver injury and continuous liver regeneration, which causes selective expansion of neoplastic hepatocytes due to the fact that the neoplastic hepatocytes are resistant to cellular stress, while proliferation of normal hepatocytes is suppressed by this stress. The formation of neoplastic lesions seems to create a new microenvironment within/around the lesions, which in turn may isolate the preneoplastic hepatocytes from the normal hepatic tissues, further favoring the survival and proliferation of the preneoplastic hepatocytes. Transformation of normal hepatocytes into preneoplastic hepatocytes, their selection for growth and their isolation from the normal hepatic environment are therefore considered the fundamental principles for hepatocarcinogenesis, and this unique gene expression in preneoplastic hepatocytes together with changes in the affected liver are thought to be related to these phenomena.
Increased cytoplasmic S100A6 expression is associated with pulmonary adenocarcinoma progression
Authors: Ishii Aya , Suzuki Meguri , Satomi Kaishi , Kobayashi Hiromi , Sakashita Shingo , Kano Junko , Pei Yihua , Minami Yuko , Ishikawa Shigemi , Noguchi Masayuki
Published: August 2009

S100A6 is a calcium‐binding protein implicated in many cellular processes and frequently upregulated in cancer. Recently it was reported that S100A6 is one of the genes having higher expression in adenocarcinoma mixed subtype with a bronchioloalveolar carcinoma (BAC) component than in pure BAC. To clarify the association of S100A6 expression with stepwise progression of lung adenocarcinoma, S100A6 protein expression was examined on immunohistochemistry in 92 formalin‐fixed and paraffin‐embedded lung adenocarcinomas. Both the nucleus and cytoplasm of the tumor cells were stained, and the nuclear and cytoplasmic expression of S100A6 was assessed individually. In addition, six frozen surgical specimens were selected, and the expression of S100A6 was confirmed on western blotting. As a result, although it was not possible to detect any significant correlation between nuclear S100A6 immunoreactivity and tumor progression, advanced adenocarcinoma had significantly higher cytoplasmic S100A6 expression than non‐invasive lesions or normal lung tissue (P < 0.05). Moreover, the BAC component tended to have weaker staining than any of the other components. These findings indicate that S100A6 may be associated with the stepwise progression and/or invasion of lung adenocarcinoma, especially BAC‐type adenocarcinoma. The present results suggest the utility of S100A6 immunohistochemistry as a marker for estimation of malignancy in adenocarcinoma with a BAC component.
Immunohistochemistry of IgG4 can help subclassify Hashimoto's autoimmune thyroiditis
Authors: Li Yaqiong , Bai Yanhua , Liu Zhiyan , Ozaki Takashi , Taniguchi Emiko , Mori Ichiro , Nagayama Koji , Nakamura Hirotoshi , Kakudo Kennichi
Published: August 2009

IgG4‐related sclerosing disease has been recently recognized as a systemic disease entity characterized by an elevated serum IgG4 level, sclerosing fibrosis and diffuse lymphoplasmacytic infiltration by many IgG4‐positive plasma cells. Similar histopathological features have often been noted in the fibrous variant of Hashimoto's autoimmune thyroiditis, but thyroid gland involvement has been only briefly mentioned with regard to IgG4, and no immunohistochemistry for IgG4 has been reported in Hashimoto's autoimmune thyroiditis. Herein, the purpose of the present study was to investigate the infiltration of IgG‐ and IgG4‐positive plasma cells on immunohistochemistry for a panel of thyroiditis samples (Hashimoto's autoimmune thyroiditis, n= 13; subacute thyroiditis, n= 2; lymphocytic thyroiditis, n= 2). Cases of Hashimoto's thyroiditis could be classified into two groups based on immunostaining of IgG4: IgG4 thyroiditis (IgG4‐related, IgG4‐positive plasma cell‐rich thyroiditis) and non‐IgG4 thyroiditis (non‐IgG4‐related, IgG4‐positive plasma cell‐poor thyroiditis). IgG4 thyroiditis presents with severe lymphoplasmacytic infiltration, dense fibrosis, marked follicular cell degeneration, oxyphilic change and lymphoid follicle formation, while non‐IgG4 thyroiditis presents with relatively mild or absent histopathological characteristics. In conclusion, immunostaining of IgG4 can help subclassify Hashimoto's thyroiditis; and IgG4 thyroiditis may have a close relationship with IgG4‐related sclerosing disease.
Perivascular epithelioid cell tumor (PEComa) of the pancreas: Immunoelectron microscopy and review of the literature
Authors: Hirabayashi Kenichi , Nakamura Naoya , Kajiwara Hiroshi , Hori Sadaaki , Kawaguchi Yoshiaki , Yamashita Tomohiro , Dowaki Shoichi , Imaizumi Toshihide , Osamura Robert Y.
Published: August 2009

A perivascular epithelioid tumor (PEComa) is a rare tumor probably arising from the perivascular epithelioid cells. Only three cases of pancreatic PEComa have been reported in the English‐language literature. The present report describes an extremely rare case of pancreatic PEComa. A 47‐year‐old Japanese woman complained of lower abdominal pain and a well‐demarcated solid tumor was found in the pancreatic head. There was no history of tuberous sclerosis complexes. Pylorus‐preserving pancreaticoduodenectomy was thus performed. There was a well‐demarcated, solid tumor measuring 17 mm in the pancreatic head. The tumor was composed of a diffuse proliferation of epithelioid tumor cells with many blood vessels but no adipose tissue. The tumor cells expressed HMB45 and α‐smooth muscle actin. Ultrastructurally, the tumor cells possessed many membrane‐bound granules that were positive for HMB45 on immunoelectron microscopy. The results of immunoelectron microscopy show that some PEComas possess not only typical melanosomes or premelanosomes but also aberrant melanosomes.
Simple cysts of testis with immunohistochemical evidence of mesothelial origin
Authors: Kuwamoto Satoshi , Okuno Keisuke , Kato Masako , Hayashi Kazuhiko
Published: August 2009

Simple cysts of the testis are an uncommon lesion found in adults as well as infants. Only a few histological and immunohistochemical studies for this lesion have been reported because the lesion have rarely undergone surgical excision or histological confirmation. Herein is reported an autopsy case of simple cysts of the right testis found incidentally in an 84‐year‐old man who died of hepatocellular carcinoma. The cysts were multilocular, 12 × 8 mm in size, separated from the tunica albuginea and filled with transparent and colorless serous fluid. Histology and immunohistochemistry showed that the cystic lesion had flattened or cuboidal single‐layered lining cells that were positive for cytokeratin AE1/AE3, calretinin, D2‐40, HBME‐1, mesothelin and thrombomodulin, indicating its mesothelial origin. To the authors' knowledge this is the first English‐language report describing the origin of simple cysts of the testis. Although the exact pathogenesis of simple cysts of the testis is as yet unknown and there seems to be more than one etiology, at least in the present case the cysts were confirmed to correspond to mesothelial inclusions.
A nomogram for predicting upgrading in patients with low‐ and intermediate‐grade prostate cancer in the era of extended prostate sampling
Authors: Moussa Ayman S. , Kattan Michael W. , Berglund Ryan , Yu Changhong , Fareed Khaled , Jones J. Stephen
Published: August 2009

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b

OBJECTIVE

To develop a nomogram to predict the probability that the pathological Gleason sum (GS) will be higher than that indicated by the biopsy, suggesting a higher risk for the patient presumed to be at low risk, as a substantial proportion of patients with low and intermediate grade on biopsy are upgraded on interpretation of the radical prostatectomy (RP) specimens, but a similar clarification of accurate Gleason scoring is not available in patients with no surgical histology.

PATIENTS AND METHODS

The study included 1017 patients who had RP after biopsy showing GS 6 and 7 (3 + 4) from 2000 to 2007. Nomogram predictor variables included age, race, digital rectal examination, prostate‐specific antigen (PSA) level, number of cores taken, number of positive cores, maximum percentage cancer in any core, number of previous biopsies, prostate volume, clinical stage, high‐grade prostatic intraepithelial neoplasia, atypical small acinar proliferation, inflammation and perineural invasion. We calculated the nomogram‐predicted probability in each patient. The area under the receiver operating characteristic curve was calculated as a measure of discrimination, and the calibration was assessed graphically.

RESULTS

The mean age of the patients was 60 years, the mean PSA level 6.62 ng/mL; 336 patients were upgraded (33%), 623 remained the same (61.3%) and 58 were downgraded (5.7%). A nomogram for predicting the possibility of upgrading was constructed that had a concordance index of 0.68. The nomogram was well calibrated.

CONCLUSIONS

Our nomogram for predicting upgrading provides important additional information for deciding on treatment to both the urologist and the patient with low‐ and intermediate‐grade prostate cancer. It might prove useful when the possibility of a more aggressive Gleason variant can change the management, and is especially meaningful when management options other than surgery are selected based on the inability to recognize the true pathological actual GS.
Factors associated with low and high voiding frequency in children with diurnal urinary incontinence
Authors: Von Gontard Alexander , Heron Jon , Joinson Carol
Published: August 2009

Study Type – Prognosis (cohort) Level of Evidence 2a

OBJECTIVE

To investigate, in a population‐based study, the association of urinary voiding frequency and daytime wetting or diurnal urinary incontinence (UI) in children aged 6.5 years, to test the hypothesis that children with high or low voiding frequency have increased somatic and psychological risks.

SUBJECTS AND METHODS

Participants were a cohort of >8000 children enrolled in the population‐based Avon Longitudinal Study of Parents and Children, a prospective longitudinal study of an original birth cohort of nearly 14 000 children. Parents completed postal questionnaires asking about diurnal UI, voiding frequency and associated somatic and behavioural signs and symptoms.

RESULTS

In all, 10.4% of children had diurnal UI. Children with diurnal UI had significantly more gastrointestinal, urinary and psychological symptoms than the controls. Of the children with diurnal UI, 35.7% had a voiding frequency of <5 voids/day, 61.5% 5–9 voids/day and 2.8%≥ 10 voids/day. High voiding frequency was more common in boys, children with frequent diurnal UI and those with combined diurnal and night‐time UI, and also in children with nocturia, urgency, hyperactivity and conduct problems. Children with a low voiding frequency needed to be reminded to go to the toilet more often. Fecal incontinence, constipation, stomach ‘aches’, ‘choosy’ eating and urinary tract infections were not associated with voiding frequency.

CONCLUSIONS

Voiding frequency is an important symptom in children with diurnal UI. The children with high voiding frequencies are especially at risk for associated somatic and behavioural problems.
Inhibition of bladder tumour growth by histone deacetylase inhibitor
Authors: Ozawa Akira , Tanji Nozomu , Kikugawa Tadahiko , Sasaki Toyokazu , Yanagihara Yutaka , Miura Noriyoshi , Yokoyama Masayoshi
Published: August 2009

OBJECTIVE

To examine the expression profile of histone deacetylase (HDAC)‐1 and explore its potential role in the development of bladder cancer, using valproic acid (VPA), a HDAC inhibitor, which reduces tumour growth and metastasis formation in animal models.

MATERIALS AND METHODS

The study comprised clinical samples from patients with urinary bladder cancer, mouse urinary bladder tissue specimens, and two human urinary bladder cancer cell lines (HT‐1376 and 5637). HDAC1 mRNA and protein expression were examined using real‐time reverse transcription‐polymerase chain reaction and immunohistochemical methods. Female C3H/He mice were given VPA (0, 250, 500 and 750 mg/kg body weight, intraperitoneal, every day) from the start or 4 weeks after 0.05%N‐butyl‐N‐(4‐hydroxybutyl)‐nitrosamine (BBN) treatment, and were humanely killed and sampled at 8 and 12 weeks.

RESULTS

A significantly higher level of HDAC1 mRNA was expressed in human urinary bladder cancer specimens. The immunohistochemical study showed that HDAC1 was expressed in the cytoplasm and nucleus in the specimens. BBN treatment increased HDAC1 mRNA expression in the urinary bladder. VPA administration seemed to delay the incidences of BBN‐induced mouse urinary bladder tumour, possibly through p21WAF1 protein expression.

CONCLUSION

These results indicate that HDAC might be an effective molecular target for cancer therapy.
Capsular involvement in patients undergoing partial nephrectomy for localized renal cell carcinoma: an adverse pathological finding?
Authors: Rouach Yannick , Delongchamps Nicolas , Timsit Marc‐Olivier , Verkarre Virginie , Fontaine Eric , Peyromaure Mickael , Mejean Arnaud
Published: August 2009

Study Type – Prognosis (case series) Level of Evidence 4

OBJECTIVE

To evaluate the prognostic impact of capsular involvement (CaI) in patients treated exclusively with partial nephrectomy (PN) for localized renal cell carcinoma (RCC), as in these patients CaI was recently reported as an adverse prognostic factor.

PATIENTS AND METHODS

We retrospectively reviewed the medical records of patients treated with PN for a sporadic and localized RCC (pT1‐pT2N0M0) in our institution between 1985 and 2005. Univariate and multivariate analysis using a Cox proportional‐hazards regression analysis were conducted to identify significant predictors of oncological outcome for several clinical and pathological factors, i.e. imperative indication, histological type, Fuhrman grade, tumour size, T stage, CaI, and surgical margins. Disease‐free and ‐specific survival rates of patients with CaI and no evidence of CaI were compared using the log‐rank test.

RESULTS

In all, 305 patients had a PN for localized RCC, of whom 22 (7.2%) had CaI in the PN specimen. The median (range) follow‐up was 6 (1.5–23) years. Multivariate statistical analysis showed that imperative indication for PN and high‐grade RCC were independently associated with worse disease‐free and ‐specific survival, whereas CaI had no prognostic value. Disease‐free and ‐specific survival in patients with and without CaI were not significantly different at 5 and 10 years.

CONCLUSIONS

In a contemporary series of patients exclusively treated with PN for localized RCC, CaI was not predictive of disease recurrence and disease‐specific mortality. These results do not support the use of any change in postoperative management in patients with CaI after PN.
Long‐term outcome of ureterosigmoidostomy: an analysis of patients with >10 years of follow‐up
Authors: Tollefson Matthew K. , Elliott Daniel S. , Zincke Horst , Frank Igor
Published: August 2009

Study Type – Therapy (case series)

Level of Evidence 4

OBJECTIVE

To examine our long‐term experience with ureterosigmoidostomy (USS) to evaluate its potential applicability in the treatment of benign and malignant conditions of the urinary bladder, as USS has been largely disregarded recently, secondary to concerns of long‐term complications, but has had a resurgence of interest due to its potential applicability to newer minimally invasive surgical techniques.

PATIENTS AND METHODS

We identified 51 patients who had USS from 1956 to 2006 at our institution and with >10 years of follow‐up. The patients were followed retrospectively by a chart review. Patient data were analysed in a multifaceted fashion, paying particular attention to metabolic abnormalities, early (≤30 days) and late (>30 days) complication rates, continence rates, imaging changes, and the rate of repeat surgical intervention.

RESULTS

The median (range) follow‐up was 15.7 (10.0–45.4) years and the median age at surgery was 58.8 (0.4–79.0) years; 40 (79%) patients had the procedure for malignancy and 11 (22%) for benign disease. Six patients (12%) had at least one early complication, including one wound dehiscence and one pulmonary embolus. In all, 22 patients (43%) had at least one late complication, with anastomotic stricture being the most common (11/51, 22%). This was followed by recurrent pyelonephritis in eight patients (16%), stones in five (10%), chronic renal insufficiency in three (6%) and severe intractable acidosis in two (4%). A repeat surgical intervention was required in 19 (37%) patients. In all, 94% (48) reported complete continence. No patient developed colonic malignancy during the course of this study.

CONCLUSIONS

USS is associated with long‐term complications. While this complication rate might not be acceptable for all patients, some might be willing to undergo the procedure as the primary method of urinary diversion. When designing newer minimally invasive techniques for the treatment of benign and malignant conditions of the bladder, consideration could be given to USS as a form of urinary diversion in highly selected patients.
Will Sub‐Prime be a Twin Crisis for the United States?
Authors: Dooley Michael P. , Folkerts‐Landau David , Garber Peter M.
Published: August 2009

We identify incentives generated by the Bretton Woods II system that may have contributed to the sub‐prime liquidity crisis now working its way through the international monetary system. We then evaluate the persistent conjecture that the liquidity crisis is or will become a balance of payments crisis for the United States. Given that it happens, the additional costs associated with a sudden stop of net capital flows to the United States could be quite substantial. But we observe that emerging market governments have continued to acquire US assets even as yields have fallen, and the incentives for continuing to do so remain strong. Moreover, the Bretton Woods II system, which has clearly been the most resilient of the forces driving current markets, continues to generate low real interest rates in industrial countries and growth in emerging markets that will help limit the damage from the liquidity crisis.
What is Driving Reserve Accumulation? A Dynamic Panel Data Approach
Authors: Bastourre Diego , Carrera Jorge , Ibarlucia Javier
Published: August 2009

Foreign reserve accumulation is a widespread phenomenon of recent years, particularly among emerging economies. Using a panel of 136 countries for the period 1973–2003, we demonstrate the need of using both a dynamic specification of the reserve demand equation and the system GMM estimator. These improvements change the results found by previous studies. Openness, regional imitation, persistence, an inverted U‐shaped relationship between reserves and income level, and financial deregulation are the factors driving reserve hoardings. In contrast, reserves yield, and both trade and financial volatility are not statistically significant. Surprisingly, we find that countries with flexible exchange rate regimes have higher ratios of reserves to GDP. This result is robust to alternative exchange rate regime classifications.
Can International Productivity Differences Alone Account for the US Current Account Deficits?
Authors: Chakraborty Suparna , Dekle Robert
Published: August 2009

An influential explanation for the recent rise in the US current account deficit is the boom in US productivity. As US productivity surged in the mid‐1990s, capital was attracted to the US to take advantage of the higher real returns. Using a two‐country general‐equilibrium model, this paper quantitatively shows that the gap in productivity growth between the US and the “rest of the world” cannot explain the US current account deficits, especially in the 1980s and the 2000s. This is because on a GDP‐weighted basis, the “rest of the world” actually had higher productivity growth during these periods, and standard macroeconomic models would predict an outflow of funds from the US to the rest of the world, and a consequent US current account surplus. We show that changes in global financial integration can help explain this anomaly in US current account behavior.
Hoarding of International Reserves: Mrs Machlup's Wardrobe and the Joneses
Authors: Cheung Yin‐Wong , Qian Xingwang
Published: August 2009

Motivated by the observed international reserve hoarding behavior in the post‐1997 crisis period, we explore the Mrs Machlup's Wardrobe hypothesis and the related keeping up with the Joneses argument. It is conceived that, in addition to psychological reasons, holding a relatively high level of international reserves reduces the vulnerability to speculative attacks and promotes growth. A stylized model is constructed to illustrate this type of hoarding behavior. The relevance of the keeping up with the Joneses effect is examined using a few plausible empirical specifications and data from 10 East Asian economies. Panel‐based regression results are suggestive of the presence of the Joneses effect, especially in the post‐1997 crisis period.
Emergency department utilization among HIV‐infected patients in a multisite multistate study*
Authors: Josephs JS , Fleishman JA , Korthuis PT , Moore RD , Gebo KA ,   for the HIV Research Network
Published: August 2009

Objective

The aim of this study was to examine Emergency Department (ED) utilization and clinical and sociodemographic correlates of ED use among HIV‐infected patients.

Methods

During 2003, 951 patients participated in face‐to‐face interviews at 14 HIV clinics in the HIV Research Network. Respondents reported the number of ED visits in the preceding 6 months. Using logistic regression, we identified factors associated with visiting the ED in the last 6 months and admission to the hospital from the ED.

Results

Thirty‐two per cent of respondents reported at least one ED visit in the last 6 months. In multivariate analysis, any ED use was associated with Medicaid insurance, high levels of pain (the third or fourth quartile), more than seven primary care visits in the last 6 months, current or former illicit drug use, social alcohol use and female gender.

Of those who used ED services, 39% reported at least one admission to the hospital. Patients with pain in the highest quartile reported increased admission rates from the ED as did those who made six or seven primary care visits, or more than seven primary care visits vs. three or fewer.

Conclusions

The likelihood of visiting the ED has not diminished since the advent of highly active antiretroviral therapy (HAART). More ED visits are to treat illnesses not related to HIV or injuries than to treat direct sequelae of HIV infection. With the growing prevalence of people living with HIV infection, the numbers of HIV‐infected patients visiting the ED may increase, and ED providers need to understand potential complications produced by HIV disease.
The Failure of Organizational Learning from Crisis – A Matter of Life and Death?
Authors: Elliott Dominic
Published: August 2009

The continuing failure of organizations to learn from crisis has many costs, social, political, financial and individual and may be attributable to a misunderstanding of learning processes. This paper maps out contributions to learning from crisis from a number of fields. Central to the paper's argument is that the separation of policy development from practice, in theory and action, has contributed to a failure to learn. The paper considers two cases where the failure of child protection services resulted in the deaths of the children concerned. These two cases, separated by seven years, were connected by the failure of the same local authorities and agencies. The paper concludes with a number of observations concerning the public inquiry process.
Kaempferol protects against rat striatal degeneration induced by 3‐nitropropionic acid
Authors: Lagoa Ricardo , Lopez‐Sanchez Carmen , Samhan‐Arias Alejandro K. , Gañan Carlos M. , Garcia‐Martinez Virginio , Gutierrez‐Merino Carlos
Published: August 2009

3‐Nitropropionic acid (NPA) produces degeneration of striatum and some neurological disturbances characteristic of Huntington’s disease in rodents and primates. We have shown that the flavonoid kaempferol largely reduced striatal damage induced by cerebral ischaemia‐reperfusion in rats (Lopez‐Sanchez et al. 2007). In this work, we report that intraperitoneal (i.p.) administration of kaempferol affords an efficient protection against NPA‐induced neurodegeneration in Wistar rats. We studied the effects of daily i.p. injections of 7, 14 and 21 mg of kaempferol/kg body weight during the NPA‐treatment (25 mg/kg body weight/12 h i.p., for 5 days) on the neurological deficits, degeneration of rat striatum and oxidative stress markers. Intraperitoneal injections of 14–21 mg of kaempferol/kg body weight largely attenuated motor deficit and delayed mortality. The higher dose of kaempferol prevented the appearance of NPA‐induced striatal lesions up to the end of treatment, as revealed by haematoxylin‐eosin and TUNEL staining, and also NPA‐induced oxidative stress, because it blocked the fall of reduced glutathione and the increase of protein nitrotyrosines in NPA‐treated rats. It was found that striatal degeneration was associated with calpains activation and a large inactivation of creatine kinase, which were also prevented when the higher doses of kaempferol were administered.
Involvement of glutamate in retinal protection against ischemia/reperfusion damage induced by post‐conditioning
Authors: Fernandez Diego C. , Chianelli Mónica S. , Rosenstein Ruth E.
Published: August 2009

Retinal ischemia could provoke blindness and there is no effective treatment against retinal ischemic damage. Brief intermittent ischemia applied during the onset of reperfusion (i.e., post‐conditioning) protects the retina from ischemia/reperfusion injury. Multiple evidences support that glutamate is implicated in retinal ischemic damage. We investigated the involvement of glutamate clearance in post‐conditioning‐induced protection. For this purpose, ischemia was induced by increasing intra‐ocular pressure for 40 min, and 5 min after reperfusion, animals underwent seven cycles of 1 min/1 min ischemia/reperfusion. One, three, or seven days after ischemia, animals were subjected to electroretinography and histological analysis. The functional and histological protection induced by post‐conditioning was evident at 7 (but not 1 or 3) days post‐ischemia. An increase in Müller cell glial fibrillary acidic protein (GFAP) levels was observed at 1, 3, and 7 days after ischemia, whereas post‐conditioning reduced GFAP levels of Müller cells at 3 and 7 days post‐ischemia. Three days after ischemia, a significant decrease in glutamate uptake and glutamine synthetase activity was observed, whereas post‐conditioning reversed the effect of ischemia. The intravitreal injection of supraphysiological levels of glutamate mimicked electroretinographic and histological alterations provoked by ischemia, which were abrogated by post‐conditioning. These results support the involvement of glutamate in retinal protection against ischemia/reperfusion damage induced by post‐conditioning.
Docosahexaenoic acid promotes hippocampal neuronal development and synaptic function
Authors: Cao Dehua , Kevala Karl , Kim Jeffrey , Moon Hyun‐Seuk , Jun Sang Beom , Lovinger David , Kim Hee‐Yong
Published: August 2009

Docosahexaenoic acid (DHA, 22:6n‐3), the major polyunsaturated fatty acid accumulated in the brain during development, has been implicated in learning and memory, but underlying cellular mechanisms are not clearly understood. Here, we demonstrate that DHA significantly affects hippocampal neuronal development and synaptic function in developing hippocampi. In embryonic neuronal cultures, DHA supplementation uniquely promoted neurite growth, synapsin puncta formation and synaptic protein expression, particularly synapsins and glutamate receptors. In DHA‐supplemented neurons, spontaneous synaptic activity was significantly increased, mostly because of enhanced glutamatergic synaptic activity. Conversely, hippocampal neurons from DHA‐depleted fetuses showed inhibited neurite growth and synaptogenesis. Furthermore, n‐3 fatty acid deprivation during development resulted in marked decreases of synapsins and glutamate receptor subunits in the hippocampi of 18‐day‐old pups with concomitant impairment of long‐term potentiation, a cellular mechanism underlying learning and memory. While levels of synapsins and NMDA receptor subunit NR2A were decreased in most hippocampal regions, NR2A expression was particularly reduced in CA3, suggesting possible role of DHA in CA3‐NMDA receptor‐dependent learning and memory processes. The DHA‐induced neurite growth, synaptogenesis, synapsin, and glutamate receptor expression, and glutamatergic synaptic function may represent important cellular aspects supporting the hippocampus‐related cognitive function improved by DHA.
Combined therapy in the treatment of hypertension
Authors: Escobar Carlos , Barrios Vivencio
Published: August 2009

The majority of patients with hypertension need at least two antihypertensive agents to achieve blood pressure (BP) objectives. As current European guidelines for the treatment of arterial hypertension recommend, combined therapy is required when monotherapy fails and as a first‐line treatment in certain situations, such as subjects at high or very high cardiovascular risk, markedly elevated BP values, or when lower targets are required (<130/80 mmHg). The advantages of combined therapy are well known and include an earlier and higher antihypertensive efficacy because of complementary mechanisms of action, and a lower incidence of side effects due to the possible compensatory responses and, in many cases, the lower doses used. In the present study, available evidence about the efficacy and tolerability of combined therapy for the treatment of hypertension is updated.
Mossy fiber sprouting interacts with sodium channel mutations to increase dentate gyrus excitability
Authors: Thomas Evan A. , Reid Christopher A. , Petrou Steven
Published: August 2009

Purpose:  Idiopathic epilepsy is caused by the complex interaction of genetic and environmental factors. The purpose of this study was to use computational approaches to explore the interaction between changes in sodium channel availability caused by mutations and mossy fiber sprouting.

Methods:  We used a previously published biophysically realistic computer model of dentate gyrus neurons and networks. A sensitivity analysis probed the effects of typical mutation‐like changes in either single‐ or multiple‐gating parameters. Isolated neuron models were stimulated with current injections, and networks were stimulated with perforant path synaptic input. The gene–environment interaction was studied by including mossy fiber sprouting into these networks.

Results:  Single neuron responses to current injections were complex, with increased sodium channel availability paradoxically reducing firing rates. In the absence of mossy fiber sprouting, control networks showed strong accommodation supporting the role of the dentate gyrus as a gate. Availability changes alone were not able to drive the networks into ictal states, even though they reduced the effectiveness of the dentate gyrus gate. Interestingly, the presence of electrophysiologic changes substantially increased the ability of mossy fiber sprouting to induce ictal activity.

Conclusion:  (1) Increased sodium channel availability does not necessarily lead to increased firing rates, (2) network excitability is most sensitive to changes in steady state activation of sodium channels, (3) mutation‐induced changes in availability reduce the effectiveness of the dentate gyrus gate, and (4) mutations interact strongly with structural network changes to allow ictal‐like activity in the dentate gyrus.
Hippocampal volume assessment in temporal lobe epilepsy: How good is automated segmentation?
Authors: Pardoe Heath R. , Pell Gaby S. , Abbott David F. , Jackson Graeme D.
Published: August 2009

Purpose:  Quantitative measurement of hippocampal volume using structural magnetic resonance imaging (MRI) is a valuable tool for detection and lateralization of mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE). We compare two automated hippocampal volume methodologies and manual hippocampal volumetry to determine which technique is most sensitive for the detection of hippocampal atrophy in mTLE.

Methods:  We acquired a three‐dimensional (3D) volumetric sequence in 10 patients with left‐lateralized mTLE and 10 age‐matched controls. Hippocampal volumes were measured manually, and using the software packages Freesurfer and FSL‐FIRST. The sensitivities of the techniques were compared by determining the effect size for average volume reduction in patients with mTLE compared to controls. The volumes and spatial overlap of the automated and manual segmentations were also compared.

Results:  Significant volume reduction in affected hippocampi in mTLE compared to controls was detected by manual hippocampal volume measurement (p < 0.01, effect size 33.2%), Freesurfer (p < 0.01, effect size 20.8%), and FSL‐FIRST (p < 0.01, effect size 13.6%) after correction for brain volume. Freesurfer correlated reasonably (r = 0.74, p << 0.01) with this manual segmentation and FSL‐FIRST relatively poorly (r = 0.47, p << 0.01). The spatial overlap between manual and automated segmentation was reduced in affected hippocampi, suggesting the accuracy of automated segmentation is reduced in pathologic brains.

Discussion:  Expert manual hippocampal volumetry is more sensitive than both automated methods for the detection of hippocampal atrophy associated with mTLE. In our study Freesurfer was the most sensitive to hippocampal atrophy in mTLE and could be used if expert manual segmentation is not available.
Ictal apnea linked to contralateral spread of temporal lobe seizures: Intracranial EEG recordings in refractory temporal lobe epilepsy
Authors: Seyal Masud , Bateman Lisa M.
Published: August 2009

Purpose:  Respiratory mechanisms are implicated in sudden unexpected death in epilepsy (SUDEP). We previously demonstrated a high incidence of ictal hypoxemia in temporal lobe seizures. We now report on the temporal relationship between ictal apnea and seizure onset and spread in patients undergoing video‐EEG (electroencephalography) telemetry (VET) with intracranial electrodes.

Methods:  Ten patients with medically refractory temporal lobe epilepsy (TLE) undergoing VET were studied. Data from synchronously recorded digital pulse oximetry (SaO2), end‐tidal CO2 (ETCO2), nasal airflow, abdominal excursions, and electrocardiography were obtained.

Results:  Sixty‐one seizures were captured. SaO2 in the ictal/postictal period was available for 52 seizures, apnea onset times for 27 seizures, and ETCO2 for 16 seizures. Apneas occurred only when seizures spread to the contralateral temporal lobe. The mean delay to apnea onset was significantly shorter after contralateral seizure spread (2.87 s) than after seizure onset (58.4 s); p < 0.001. The mean SaO2 nadir with partial seizures or partial seizures prior to secondary generalization was 89.4 ± 8.6% (91.5, 69–100). Following generalized convulsions the mean oxygen saturation nadir was 75.8 ± 10.6% (78.5, 58–90). ETCO2 elevations occurred with each ictal desaturation below 85%.

Conclusions:  There is a close temporal relationship between spread of seizures to the contralateral hemisphere and the onset of seizure‐associated apnea. Apnea onsets are more tightly linked to time of contralateral spread than to time of seizure onset. Patients with TLE in whom there is evidence of contralateral seizure spread may be at higher risk for ictal‐related respiratory dysfunction than those in whom seizures remain unilateral.
Description and Students' Perceptions of a Required Geriatric Clerkship in Postacute Rehabilitative Care
Authors: Bautista Miho K. , Meuleman John R. , Shorr Ron I. , Beyth Rebecca J.
Published: August 2009

This article describes medical students' evaluation of a geriatric clerkship in postacute rehabilitative care settings. This was a cross‐sectional study of fourth‐year medical students who completed a mandatory 2‐week rotation at a postacute care facility. Students were provided with three instructional methods: Web‐based interactive learning modules; small‐group sessions with geriatric faculty; and Geriatric Interdisciplinary Care Summary (GICS), a grid that students used to formulate comprehensive interdisciplinary care plans for their own patients. After the rotation, students evaluated the overall clerkship, patient care activities, and usefulness of the three instructional methods using a 5‐point Likert scale (1=poor to 5=excellent) and listed their area of future specialty. Of 156 students who completed the rotation, 117 (75%) completed the evaluation. Thirty (26%) chose specialties providing chronic disease management such as family, internal medicine, and psychiatry; 34 (29%) chose specialties providing primarily procedural services such as surgery, radiology, anesthesiology, pathology, and radiation oncology. Students rated the usefulness of the GICS as good to very good (mean±standard deviation 3.3±1.0). Similarly, they rated overall clerkship as good to excellent (3.8±1.0). Analysis of variance revealed no significant group difference in any of the responses from students with the overall clerkship (F(112, 4)=1.7, P=.20). Students rated the geriatric clerkship favorably and found the multimodal instruction to be useful. Even for students whose career choice was not primary care, geriatrics was a good model for interdisciplinary care training and could serve as a model for other disciplines.
Use of Medicare and Department of Veterans Affairs Health Care by Veterans with Dementia: A Longitudinal Analysis
Authors: Zhu Carolyn W. , Penrod Joan D. , Ross Joseph S. , Dellenbaugh Cornelia , Sano Mary
Published: August 2009

The objectives of this study were to examine longitudinal patterns of Department of Veterans Affairs (VA)–only use, dual VA and Medicare use, and Medicare‐only use by veterans with dementia. Data on VA and Medicare use were obtained from VA administrative datasets and Medicare claims (1998–2001) for 2,137 male veterans who, in 1997, used some VA services, had a formal diagnosis of Alzheimer's disease or vascular dementia in the VA, and were aged 65 and older. Generalized ordered logit models were used to estimate the effects of patient characteristics on use group over time. In 1998, 41.7% of the sample were VA‐only users, 55.4% were dual users, and 2.9% were Medicare‐only users. By 2001, 30.4% were VA‐only users, 51.5% were dual users, and 18.1% were Medicare‐only users. Multivariate results show that greater likelihood of Medicare use was associated with older age, being white, being married, having higher education, having private insurance or Medicaid, having low VA priority level, and living in a nursing home or dying during the year. Higher comorbidities were associated with greater likelihood of dual use as opposed to any single system use. Alternatively, number of functional limitations was associated with greater likelihood of Medicare‐only use and less likelihood of VA‐only use. These results imply that different aspects of veterans' needs have differential effects on where they seek care. Efforts to coordinate care between VA and Medicare providers are necessary to ensure that patients receive high‐quality care, especially patients with multiple comorbidities.
Effect of Light‐Emitting Diode (LED) Curing Modes on Resin/Dentin Bond Strength
Authors: Fahmy Nadia , Naguib Hanan , Guindy Jylan El
Published: August 2009

Purpose: This study aimed to compare the effect of three curing modes of a high‐powered curing‐light source on the shear bond strength and marginal gap of light‐ and dual‐cured adhesive resin cements to dentin.

Materials and Methods: Twelve freshly extracted intact human mandibular molars were selected for this study and stored in the saline solution. Three of the axial surfaces of the teeth were prepared to obtain flat dentinal surfaces. Thirty‐six ceramic disks (4‐mm diameter, 2‐ mm thick) were constructed from a pressable glass‐ceramic (Vision). The discs were etched with hydrofluoric acid and primed, and then divided into two equal groups, groups I and II (n = 18 each). Two adhesive systems were used following manufacturer's instructions. The discs of group I were bonded to the conditioned dentin surface using adhesive resin (Rely X Veneer), and group II discs were bonded to dentin using Rely X ARC. For each group, the resin was cured using three modes (fast, ramp, pulse). Interfacial gap at the dentin/resin interface was measured at eight predetermined sites for each specimen using a stereomicroscope, and shear bond strength of the bonded specimens was carried out using a universal testing machine.

Results: Ramp‐cured specimens recorded significantly higher mean shear bond strengths for both dual‐ and light‐polymerized resins than those with fast and pulse modes. Moreover, fewer interfacial gaps were found at the resin/dentin interface in association with ramp cure modes of both resins. Most failures were adhesive failures at the dentin–resin luting agent (RLA) interface in specimens polymerized using high‐powered LED fast or pulse modes, while a cohesive failure pattern within the resin was associated with the ramp‐curing mode.

Conclusion: Within the limitations of this study, the shear bond strength of an RLA to dentin was found to be enhanced with light‐ or dual‐polymerized adhesive resin using an LED light in ramp mode, whereas shear bond strength was significantly lower when polymerized using LED in fast or pulse modes.
Palatal Anchorage for the Retention of Interim Removable Prostheses
Authors: Ambard Alberto J.
Published: August 2009

This paper describes a technique that involves the use of palatal implants to retain a maxillary interim prosthesis when extensive bone graft procedures are performed. The rationale is that some bone graft procedures require the removal of the denture flanges for graft success. Once the denture flanges are removed, the denture loses all its retention capabilities, making this lengthy interim phase difficult for the patient. While the use of palatal implants has been documented extensively, limited information is available to describe the use of palatal implants for prosthetic reasons.