bluuebunny/crossref_metadata_2025 huggingface dataset:
A Temporal Association between Folic Acid Fortification and an Increase in Colorectal Cancer Rates May Be Illuminating Important Biological Principles: A Hypothesis
Authors: Mason Joel B. , Dickstein Aaron , Jacques Paul F. , Haggarty Paul , Selhub Jacob , Dallal Gerard , Rosenberg Irwin H.
Published: July 2007

Nationwide fortification of enriched uncooked cereal grains with folic acid began in the United States and Canada in 1996 and 1997, respectively, and became mandatory in 1998. The rationale was to reduce the number of births complicated by neural tube defects. Concurrently, the United States and Canada experienced abrupt reversals of the downward trend in colorectal cancer (CRC) incidence that the two countries had enjoyed in the preceding decade: absolute rates of CRC began to increase in 1996 (United States) and 1998 (Canada), peaked in 1998 (United States) and 2000 (Canada), and have continued to exceed the pre-1996/1997 trends by 4 to 6 additional cases per 100,000 individuals. In each country, the increase in CRC incidence from the prefortification trend falls significantly outside of the downward linear fit based on nonparametric 95% confidence intervals. The statistically significant increase in rates is also evident when the data for each country are analyzed separately for men and women. Changes in the rate of colorectal endoscopic procedures do not seem to account for this increase in CRC incidence. These observations alone do not prove causality but are consistent with the known effects of folate on existing neoplasms, as shown in both preclinical and clinical studies. We therefore hypothesize that the institution of folic acid fortification may have been wholly or partly responsible for the observed increase in CRC rates in the mid-1990s. Further work is needed to definitively establish the nature of this relationship. In the meantime, deliberations about the institution or enhancement of fortification programs should be undertaken with these considerations in mind. (Cancer Epidemiol Biomarkers Prev 2007;16(7):1325–9)
Interleukin-18, the Metabolic Syndrome, and Subclinical Atherosclerosis
Authors: Zirlik Andreas , Abdullah Shuaib M. , Gerdes Norbert , MacFarlane Lindsey , Schönbeck Uwe , Khera Amit , McGuire Darren K. , Vega Gloria L. , Grundy Scott , Libby Peter , de Lemos James A.
Published: July 2007

Objective—

Although IL-18 promotes atherogenesis in animal studies and predicts cardiovascular risk in humans, it is unknown whether elevated IL-18 levels are associated with coronary atherosclerosis in the general population.

Methods and Results—

IL-18 plasma levels were determined by ELISA in 2231 subjects from the Dallas Heart Study. In univariable analysis, IL-18 levels associated with traditional cardiovascular risk factors and particularly with components of the metabolic syndrome (MS,
P
<0.01 for trend across the number of MS components); IL-18 also associated with coronary artery calcium (CAC) scores measured by electron beam computed tomography and aortic plaque measured by MRI (
P
<0.01 for each). In multivariable analyses, IL-18 remained associated with multiple components of the MS but not with CAC or aortic plaque.

Conclusions—

In a large population-based sample, elevated IL-18 plasma levels associated with risk factors for atherosclerosis and with the metabolic syndrome. The association between IL-18 and atherosclerosis diminished after accounting for traditional cardiovascular risk factors. These data suggest that IL-18 does not add independently to detection of atherosclerotic burden in asymptomatic individuals.
Internal Carotid Artery Occlusion: Association With Atherosclerotic Disease in Other Arterial Beds and Vascular Risk Factors
Authors: Paraskevas Kosmas I. , Mikhailidis Dimitri P. , Liapis Christos D.
Published: July 2007

The aim of this article is to investigate the association between internal carotid artery occlusion (ICAO) and the presence of atherosclerotic disease and vascular risk factors. The clinical characteristics and risk factors of 120 patients presenting with ICAO were retrospectively reviewed. All patients (n = 120) had at least 1 of the 4 vascular risk factor (diabetes, smoking, hypercholesterolemia, and hypertension); 2, 3, or all 4 risk factors were present in 14 to 82 of the patients (11.7% to 68.3%), 10 to 39 of the patients (8.3% to 32.5%), and 9 of the patients (7.5%), respectively. A total of 84 patients (70%) with ICAO had disease in at least 1 additional vascular bed (aorta, coronary or lower limb arteries). In addition to ICAO, vascular disease was present in 2 and all 3 of these arterial beds in 42 (35%) and 9 (7.5%) patients, respectively. Furthermore, stenosis or occlusion of the ipsilateral or contralateral vertebral arteries was recorded in 19 of 120 patients (15.8%). Regarding the contralateral carotid artery, 1 patient had bilateral ICAO. One patient had contralateral common carotid artery occlusion, and 1 patient was excluded from the analysis because of surgery to the contralateral carotid artery. Of the remaining 117 patients, 34 (29.0%) had less than 50% contralateral carotid artery stenosis. Thirty-two patients (27.4%) had 50% to 69%, and 51 (43.6%) had 70% to 99% stenosis. Ultrasonographic imaging of the carotid plaque of the contralateral carotid artery revealed that 52 of the 120 arteries (43.3%) were uniformly or predominantly echolucent (types I and II, respectively). Fifty-nine (49.2%) were predominantly or uniformly echogenic (types III and IV), and 9 (7.5%) could not be classified. A similar distribution of echomorphology was observed on the occluded side. ICAO is associated with widespread atherosclerotic disease and a high prevalence of vascular risk factors. Detection of ICAO should prompt the investigation of other arterial beds and treatment of risk factors.
Home Therapy With LMWH in Deep Vein Thrombosis: Randomized Study Comparing Single and Double Daily Administrations
Authors: Bellosta Raffaello , Ferrari Patrizio , Luzzani Luca , Carugati Claudio , Cossu Luisa , Talarico Matteo , Sarcina Antonio
Published: July 2007

The aim of this study was to assess the effectiveness of low-molecular-weight heparin (LMWH) treatment of deep vein thrombosis (DVT) in terms of the evolution of thrombosis, the incidence of adverse events, and compliance with heparin treatment using 2 types of LMWH available on the market administered in therapeutic doses throughout the period of treatment (Nadroparin) or at therapeutic doses only during the first month of treatment followed by a prophylactic phase at half dose (Parnaparin). A randomized prospective study was carried out on patients under observation with a recent diagnosis of DVT. The objectives of the study were to confirm the effectiveness of therapy with LMWH in terms of prevention of the risk of thromboembolism, of relapse of DVT, and of hemorrhagic complications, and to complete an evaluation of venous recanalization and residual valve competence in the 2 groups of patients. From December 2002 to June 2005, we randomized a total of 91 patients (51 in the Parnaparin group and 40 in the Nadroparin group). Overall, there was 1 case of nonfatal pulmonary embolism (1.1%) at 7 days into therapy with LMWH. There were 3 cases (3.3%) of progression of thrombosis despite therapy with LMWH, 2 cases (5%) in the Nadroparin group, and 1 case (2%) in the Parnaparin group (P = NS), and after suspension of the therapy, there was 1 case of relapse of thrombosis. Three of the 4 thrombotic events occurred in patients with active neoplasia. Moreover, only 1 major hemorrhagic event (1.1%) required blood transfusion. The Doppler ultrasound in the follow-up showed a complete resolution of 56% of the vein thromboses at an average of 6.1 ± 4.6 (mean ± SD) months. Valve competence recovered in 65.9% of cases with no significant difference between the 2 heparin groups. Home treatment of sural and femoral-popliteal DVT using LMWH represents a safe and effective method in the prevention of pulmonary embolism and encourages the process of recanalization of the thrombosed vessel, especially in cases of sural and/or popliteal DVT. Administration can be carried out with the same degree of safety at the therapeutic dose throughout the period of treatment or can be halved after the first month of treatment. In patients with active neoplasia, treatment with oral anticoagulant therapy must be considered.
Effect of Slow Coronary Flow on Electrocardiographic Parameters Reflecting Ventricular Heterogeneity
Authors: Sezgin Alpay Turan , Barutcu Irfan , Ozdemir Ramazan , Gullu Hakan , Topal Ergun , Esen Ali Metin , Tandogan Izzet , Acikgoz Nusret
Published: July 2007

QT interval dispersion reflects regional variations in ventricular repolarization and cardiac electrical instability. Previous studies have showed that QT interval dispersion changes during episodes of myocardial ischemia. Slow coronary flow (SCF) in epicardial coronary arteries is a rare and unique angiographic finding. Whether this pattern of flow is associated with electrocardiographic abnormalities is unknown. Therefore, this study was designed to investigate whether SCF results in electrocardiographic (ECG) changes compared to normal coronary flow. For this aim 24 patients with angiographically proven SCF who had no obstructive coronary lesion (group I) and 25 patients without coronary artery disease (group II) were included in the study. Both groups underwent a routine standard 12-lead surface electrocardiogram recorded at 50 mm/s during rest. QT dispersion (QTd), corrected QT (QTc), and corrected QT dispersion (QTcd) were calculated. Distributions of sex, age, body mass index (BMI), and cardiac risk factors were similar in the 2 groups. Mean heart rate was similar in the 2 groups (74 ±8 vs 77 ± 7 p > 0.05). Mean QRS interval durations were similar in the groups (92 ±7 vs 90 ±6 ms p > 0.005). In group I, QTd, QTcd, and QTc, were significantly higher than in group II (QTd: 73 ±14 vs 40 ±14; QTcd: 71 ±15 vs 42 ±9; QTc: 414 ±14 vs 388 ±13, respectively p <0.05). In conclusion, SCF was found to be associated with prolonged QT interval and increased QT dispersion. Ischemia in microvascular level and/or altered autonomic regulation of the heart may be responsible mechanisms.
Coronary-Subclavian Steal: Presentation and Management: Two Case Reports
Authors: Fergus Todd , Pacanowski John P. , Fasseas Panayotis , Nanjundappa A. , Habeeb Ahmed M. , Dieter Robert S.
Published: July 2007

Subclavian stenosis is a highly prevalent and underrecognized clinical entity. In patients with a history of coronary artery bypass grafting utilizing a left internal mammary artery, subclavian artery stenosis can cause coronary-subclavian steal, leading to myocardial ischemia. Traditionally, this has been treated surgically with a vascular bypass operation. Two cases of coronary-subclavian steal syndrome are presented, 1 treated percutaneously with angioplasty and stent, and 1 treated with a combined endovascular-surgical procedure.
Intravenous Leiomyomatosis With Extension to the Heart: Echocardiographic Features
Authors: Fang Ber-Ren , Ng Yuet-Tong , Yeh Chi-Hsiao
Published: July 2007

A 40-year-old female was admitted to the hospital for an operation with a presumptive diagnosis of right atrial myxoma. She had had a hysterectomy for leiomyoma 8 months earlier and has since experienced progressive dyspnea on exertion, pedal edema, and two syncope episodes in the past 2 months. Cardiac murmur was detected and two-dimensional echocardiography was arranged. A mobile right atrial mass was discovered, which was thought to be a myxoma. The patient subsequently received open heart surgery. Histologic examination of the resected mass confirmed intravenous leiomyomatosis. Magnetic resonance imaging performed on the eighth postoperative day revealed an intravascular mass from the right common iliac vein to the upper abdominal inferior vena cava. The patient underwent a second operation one and half months after the first operation, with resection of the tumor mass in the inferior vena cava and resection of multiple uterine myoma. She recovered well. Repeat magnetic resonance imaging 6 months following the second operation showed that the inferior vena cava and right atrium were clear of tumor.
Plasma Levels of B-Type Natriuretic Peptide in Patients With Unstable Angina Pectoris or Acute Myocardial Infarction: Prognostic Significance and Therapeutic Implications
Authors: Ahmed Waqas , Zafar Saman , Alam Ali Y. , Ahktar Naveed , Shah Mumtaz A. , Alpert Martin A.
Published: July 2007

Plasma B-type natriuretic peptide (BNP) levels were obtained from 146 patients with unstable angina pectoris, non—ST-segment elevation myocardial infarction (MI), or ST-segment elevation MI to determine their value in predicting the presence of new heart failure, recurrent MI or ischemia, or death 1 month after the index event. Patients with elevated plasma BNP levels (>80 pg/mL) had a significantly higher incidence of new heart failure and all-cause mortality than those with a normal plasma BNP level (≤80 pg/mL). Early revascularization with percutaneous intervention or coronary artery bypass grafting significantly reduced the incidence of new heart failure and all-cause mortality in patients with an elevated plasma BNP level, but had no effect on individual outcomes in the normal plasma BNP subgroup.
Comparison of Doppler and Oscillometric Ankle Blood Pressure Measurement in Patients With Angiographically Documented Lower Extremity Arterial Occlusive Disease
Authors: Nukumizu Yoshihito , Matsushita Masahiro , Sakurai Tsunehisa , Kobayashi Masayoshi , Nishikimi Naomichi , Komori Kimihiro
Published: July 2007

To assess the reliability of the oscillometric method in patients with peripheral vascular disease, ankle blood pressure measurement by Doppler and oscillometry was compared. This study represents a prospective, non-blinded examination of pressure measurements in 168 patients. Twenty-two patients were included who had abdominal aortic aneurysms (AAA) and 146 had peripheral arterial occlusive disease (PAOD). Patients with PAOD were divided into 2 groups according to angiography results: a crural artery occlusion group (CAO, n = 32), and a no crural artery occlusion group (NCAO, n = 114). All subjects underwent pressure measurement by both Doppler and oscillometry. The correlation coefficient was 0.928 in AAA patients and 0.922 in PAOD patients. In CAO patients, there were significantly fewer patients whose oscillometric pressure was equivalent to the Doppler pressure (DP), as compared to NCAO patients, because the oscillometric pressure (OP) was 10% higher than DP in 44% of CAO patients. A high correlation exists between Doppler and oscillometric ankle pressure measurements irrespective of the type of vascular disease. However, the oscillometric method could not be substituted for the Doppler method completely, because there were several patients whose OP was greater than DP especially in those with crural artery occlusive disease.
Phenomenon and manifestation of the `Author's Effect of Showcasing' (AES): a literature science study, II. Very heterogeneous documentedness of historically synchronous conference communications of a single natural science
Authors: Száva-Kováts Endre
Published: July 2007

The `Author's Effect of Showcasing' (AES) is the activity of publishing authors who shape by their own free will the formal reference stock of their communications, placing this stock into the showcase of science. This paper reports the results of a decisive control test of the existence of the AES, processing 1175 historically synchronous physics conference communications. Applying methods of bibliometrics and science philology, the manifestation of the AES phenomenon is demonstrated and analysed in this theoretically most homogeneous domain of scientific literature. The widely differing documentedness in the communications of conferences held on particular topics of physics, especially the great differences in the size of the formal reference stocks in all extent categories of the communications depends solely on the person of the authors. This generally extremely heterogeneous documentedness is therefore valid evidence of the existence of the effect and its effective operation in the scientific literature. The correctness of the AES doctrine, including the correctness of two additional theses, has been demonstrated.
A uniform conceptual model for knowledge management of international copyright law
Authors: Wenhuan Lu  , Ikeda Mitsuru
Published: July 2007

Copyright issues are significant for worldwide information sharing, while mutual understanding about the commonalities and differences among international copyright law articles is difficult due to the diversity of legal knowledge representation. The goal of our research is to propose an appropriate methodology and capture a uniform conceptual model that will provide semantic level representation for processing and modelling international legal knowledge using ontological technology. This paper proposes a preliminary intention-oriented legal knowledge model as a pivotal model that, from the viewpoint of intention behind the law, manages and models legal knowledge derived from international law documents. We develop a domain ontology — international copyright law ontology, which is used as a fundamental conceptual framework to maintain consistency among diverse legal knowledge representations.
The application of cost—benefit and least effort theories in studies of information seeking behavior of humanities scholars: the case of Jewish studies scholars in Israel
Authors: Bronstein Jenny , Baruchson-Arbib Shifra
Published: July 2007

The study investigated the process of information channel selection of Jewish studies scholars in Israel according to two theoretical frameworks, the 'cost—benefit ratio' that focused on the quality of the information provided by the channel and the 'least effort principle' that focused on the accessibility of the channel. The study sought to identify which of the two parameters, quality of information or accessibility of the channel, was the decisive one when selecting an information channel. In order to further understand the underlying principle behind scholars' choice of information channels participants were asked about the obstacles they face when searching for information. Four obstacles were stipulated in the structured questionnaire: (1) cost; (2) distance, when the item can only be found at a distant location; (3) unfriendly interface; and (4) time that it takes to get hold of a copy of the desired item. Findings showed that, in general, participants' information channel use was not affected by the obstacles encountered in the information seeking process and that the quality of the information was the decisive factor in choosing an information channel.
Performance-Based Assessment in Schools
Authors: Smith Steven R.
Published: July 2007

This article addresses a 2006 article by Hojnoski, Morrison, Brown, and Matthews on the use of performance-based measurement among school-based practitioners. Their results suggest that many of their survey respondents favor the use of this form of measurement. This line of research is important and addresses an important issue in current clinical practice. However, they offer a critique of this form of assessment, in response to which the author raises four issues. First, there is a difference between tests and techniques. Second, assessment tools do not make decisions or diagnoses; clinicians do. Third, actuarial prediction and clinical expertise are mutually enhancing. Last, the relationship between science and practice should be bidirectional and integrative. These points are discussed in terms of the utility and appropriateness of performance-based measurement tools and techniques for helping psychologists answer diagnostic, placement, and treatment questions in the school setting.
Developing and Evaluating a Measure of Young Children's Attitudes Toward School and Learning
Authors: Henry Gary T. , Mashburn Andrew J. , Konold Timothy
Published: July 2007

High-stakes testing may potentially influence young children's attitudes toward school and learning. This study describes the development and evaluation of child and teacher versions of a measure called Children's Attitudes Toward School (CATS). Exploratory factor analyses of responses by 335 first graders and 130 first-grade teachers each identified the same underlying dimensions of attitudes related to three types of school activities—Academic, Early Literacy, and Child-Initiated. Confirmatory factor analyses of the three-factor model among a second split-half sample of 307 children and 129 teachers achieved acceptable fit. In general, children's self-reported attitudes were not associated with their achievement; teachers' judgments of children's attitudes had weak to moderate correlations with children's directly assessed skills and weak to moderately strong correlations with teachers' ratings of children's skills; children's self-reported attitudes and teachers' judgments of children's attitudes were not significantly correlated. Implications of these findings for assessing young children's attitudes are discussed.
Detecting Differential Item Functioning in the Japanese Version of the Multiple Affect Adjective Check List—Revised
Authors: Yasuda Tomoyuki , Lei Pui-Wa , Suen Hoi K.
Published: July 2007

This study examines the differential item functioning (DIF) of the English version and the Japanese-translated version of the Multiple Affect Adjective Check List—Revised (MAACL-R) using the logistic regression (LR) procedure. The results of the LR are supplemented by multiple group confirmatory factor analysis (MGCFA). A total of five items are consistently flagged as showing DIF by both methods and based on the effect size criteria set forth by Jodoin and Gierl. One item shows nonuniform DIF, whereas four items show uniform DIF. Elimination or modification of the items with DIF can facilitate the appropriate use of the Japanese MAACL-R, especially in cross-cultural studies.
An Independent Investigation of the Validity of the School Attitude Assessment Survey—Revised
Authors: Suldo Shannon M. , Shaffer Emily J. , Shaunessy Elizabeth
Published: July 2007

The psychometric properties of the School Attitude Assessment Survey—Revised (SAAS-R) are examined in a sample of 321 high school students. Students completed the SAAS-R along with measures of school climate, academic self-efficacy, and school satisfaction; school-related behaviors (i.e., attendance and discipline referrals) and academic achievement (i.e., grade point averages) were obtained from school records. Factor analysis procedures support the existence of five factors representing students' academic self-perceptions, attitudes toward teachers, attitudes toward school, motivation and self-regulation, and goal valuation. Criterion-related validity is supported by mean differences on the SAAS-R between groups of students with varying levels of achievement. Convergent validity is supported through correlations in the expected directions between the SAAS-R factors and students' related beliefs about school and indicators of school behavior. Results support the validity of the SAAS-R for use with high school students in general education and college preparatory curriculum programs.
Understanding the Link Between Childhood Maltreatment and Violent Delinquency: What Do Schools Have to Add?
Authors: Crooks Claire V. , Scott Katreena L. , Wolfe David A. , Chiodo Debbie , Killip Steve
Published: July 2007

Child maltreatment constitutes significant risk for adolescent delinquency. Although an ecological model has been proposed to explain this relationship, most studies focus on individual risk factors. Prospective data from 1,788 students attending 23 schools were used to examine the additive influence of childhood maltreatment, individual-level risk factors, and school-level variables assessed at the beginning of Grade 9 on delinquency 4 to 6 months later. Individual-level results indicated that being male, experiencing childhood maltreatment, and poor parental nurturing were predictors of violent delinquency. School climate also played a significant role: Given the same individual risk profile, a student attending a school that was perceived by students as safe was less likely to engage in violent delinquency than was a student attending a school perceived to be unsafe. Moreover, the impact of childhood maltreatment on risk for engaging in violent delinquency was somewhat mitigated by schools' participation in a comprehensive violence prevention program.
The Postmerger Financial Performance of Hotel Companies
Authors: Hsu Li-Tzang , Jang SooCheong
Published: July 2007

This study investigates the postmerger financial performance of acquiring firms in the lodging industry between 1985 and 2000. Jensen Measure Model and Market Model are used to examine long-term and short-term market measure of performance. Additionally, return on assets (ROA) and return on equity (ROE) are used to assess the accounting measures for the financial performance of acquiring firms. The results indicate that the shareholders of acquiring hotel companies earned no abnormal equity returns over the short term, which indicates no significant relationship between merger announcement and the change in short-term equity value. As opposed to general expectations, the study reveals that merger has a negative effect on the acquiring firms' equity values over the long term. Similarly, the ROA and ROE are found to become significantly lower after mergers. Overall, this study provides evidence that shareholders of acquiring hotel companies did not benefit from the mergers.
How and How Much To Reveal? The Effects of Price Transparency On Consumers' Price Perceptions
Authors: Li Miao  , Mattila Anna S.
Published: July 2007

This study investigated the effects of price transparency on consumers' price perceptions. Our two-dimensional information transparency framework (sufficiency and diagnosticity of pricing information) is grounded in the Heuristic-Systematic Model of Persuasion. Real-life online hotel booking sites were used for hypothesis testing. Our results show that consumers' price fairness perceptions and willingness-to-pay are more susceptible to the influence of externally supplied pricing information when such information is presented in a high transparency context (i.e., information high in sufficiency and diagnosticity). Heightened judgmental confidence in consumers' price perceptions was also observed in the high information transparency condition. Managerial implications of these findings are briefly discussed.
STAT5 is required for long-term maintenance of normal and leukemic human stem/progenitor cells
Authors: Schepers Hein , van Gosliga Djoke , Wierenga Albertus T. J. , Eggen Bart J. L. , Schuringa Jan Jacob , Vellenga Edo
Published: July 2007

The transcription factor STAT5 fulfills a distinct role in the hematopoietic system, but its precise role in primitive human hematopoietic cells remains to be elucidated. Therefore, we performed STAT5 RNAi in sorted cord blood (CB) and acute myeloid leukemia (AML) CD34+ cells by lentiviral transduction and investigated effects of STAT5 downmodulation on the normal stem/progenitor cell compartment and the leukemic counterpart. STAT5 RNAi cells displayed growth impairment, without affecting their differentiation in CB and AML cultures on MS5 stroma. In CB, limiting-dilution assays demonstrated a 3.9-fold reduction in progenitor numbers. Stem cells were enumerated in long-term culture-initiating cell (LTC-IC) assays, and the average LTC-IC frequency was 3.25-fold reduced from 0.13% to 0.04% by STAT5 down-regulation. Single-cell sorting experiments of CB CD34+/CD38− cells demonstrated a 2-fold reduced cytokine-driven expansion, with a subsequent 2.3-fold reduction of progenitors. In sorted CD34+ AML cells with constitutive STAT5 phosphorylation (5/8), STAT5 RNAi demonstrated a reduction in cell number (72% ± 17%) and a decreased expansion (17 ± 15 vs 80 ± 58 in control cultures) at week 6 on MS5 stroma. Together, our data indicate that STAT5 expression is required for the maintenance and expansion of primitive hematopoietic stem and progenitor cells, both in normal as well as leukemic hematopoiesis.
Natural killer cells trigger differentiation of monocytes into dendritic cells
Authors: Zhang Angela L. , Colmenero Paula , Purath Ulrich , Teixeira de Matos Cristina , Hueber Wolfgang , Klareskog Lars , Tarner Ingo H. , Engleman Edgar G. , Söderström Kalle
Published: July 2007

Circulating monocytes can differentiate into dendritic cells (moDCs), which are potent inducers of adaptive immune responses. Previous reports show that granulocyte macrophage–colony-stimulating factor (GM-CSF) and interleukin-4 induce monocyte differentiation into moDCs in vitro, but little is known about the physiological requirements that initiate moDC differentiation in vivo. Here we show that a unique natural killer (NK) cell subset (CD3−CD56bright) that accumulates in lymph nodes and chronically inflamed tissues triggers CD14+ monocytes to differentiate into potent T-helper-1 (TH1) promoting DC. This process requires direct contact of monocytes with NK cells and is mediated by GM-CSF and CD154 derived from NK cells. It is noteworthy that synovial fluid (SF) from patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), but not osteoarthritis (OA), induces monocytes to differentiate into DC. However, this process occurs only in the presence of NK cells. We propose that NK cells play a role in the maintenance of TH1-mediated inflammatory diseases such as RA by providing a local milieu for monocytes to differentiate into DC.
Correlations of EGFR mutations and increases in EGFR and HER2 copy number to gefitinib response in a retrospective analysis of lung cancer patients
Authors: Pugh Trevor J , Bebb Gwyn , Barclay Lorena , Sutcliffe Margaret , Fee John , Salski Chris , O'Connor Robert , Ho Cheryl , Murray Nevin , Melosky Barbara , English John , Vielkind Jeurgen , Horsman Doug , Laskin Janessa J , Marra Marco A
Published: July 2007

Background

Gefitinib, a small molecule tyrosine kinase inhibitor of the Epidermal Growth Factor Receptor (EGFR), has shown limited efficacy in the treatment of lung cancer. Recognized clinical predictors of response to this drug, specifically female, non-smoker, Asian descent, and adenocarcinoma, together suggest a genetic basis for drug response. Recent studies have addressed the relationship between response and either sequence mutations or increased copy number of specific receptor tyrosine kinases. We set out to examine the relationship between response and the molecular status of two such kinases,EGFRandHER2, in 39 patients treated with gefitinib at the BC Cancer Agency.

Methods

Archival patient material was reviewed by a pathologist and malignant cells were selectively isolated by laser microdissection or manual recovery of cells from microscope slides. Genomic DNA was extracted from 37 such patient samples and exons 18–24, coding for the tyrosine kinase domain ofEGFR, were amplified by PCR and sequenced.EGFRandHER2copy number status were also assessed using FISH in 26 samples. Correlations between molecular features and drug response were assessed using the two-sided Fisher's exact test.

Results

Mutations previously correlated with response were detected in five tumours, four with exon 19 deletions and one with an exon 21 missense L858R point mutation. Increased gene copy number was observed in thirteen tumours, seven withEGFRamplification, three withHER2amplification, and three with amplification of both genes. In our study cohort, a correlation was not observed between response andEGFRmutations (exon 19 deletion p = 0.0889, we observed a single exon 21 mutation in a non-responder) or increases inEGFRorHER2copy number (p = 0.552 and 0.437, respectively).

Conclusion

Neither mutation ofEGFRnor increased copy number ofEGFRorHER2was diagnostic of response to gefitinib in this cohort. However, validation of these features in a larger sample set is appropriate. Identification of additional predictive biomarkers beyondEGFRstatus may be necessary to accurately predict treatment outcome.
Mechanical ventilation with lower tidal volumes does not influence the prescription of opioids or sedatives
Authors: Wolthuis Esther K , Veelo Denise P , Choi Goda , Determann Rogier M , Korevaar Johanna C , Spronk Peter E , Kuiper Michael A , Schultz Marcus J
Published: July 2007

Introduction

We compared the effects of mechanical ventilation with a lower tidal volume (VT) strategy versus those of greater VT in patients with or without acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) on the use of opioids and sedatives.

Methods

This is a secondary analysis of a previously conducted before/after intervention study, which consisting of feedback and education on lung protective mechanical ventilation using lower VT. We evaluated the effects of this intervention on medication prescriptions from days 0 to 28 after admission to our multidisciplinary intensive care unit.

Results

Medication prescriptions in 23 patients before and 38 patients after intervention were studied. Of these patients, 10 (44%) and 15 (40%) suffered from ALI/ARDS. The VT of ALI/ARDS patients declined from 9.7 ml/kg predicted body weight (PBW) before to 7.8 ml/kg PBW after the intervention (P = 0.007). For patients who did not have ALI/ARDS there was a trend toward a decline from 10.2 ml/kg PBW to 8.6 ml/kg PBW (P = 0.073). Arterial carbon dioxide tension was significantly greater after the intervention in ALI/ARDS patients. Neither the proportion of patients receiving opioids or sedatives, or prescriptions at individual time points differed between pre-intervention and post-intervention. Also, there were no statistically significant differences in doses of sedatives and opioids. Findings were no different between non-ALI/ARDS patients and ALI/ARDS patients.

Conclusion

Concerns regarding sedation requirements with use of lower VT are unfounded and should not preclude its use in patients with ALI/ARDS.
Thyroid Function Disturbance and Type 3 Iodothyronine Deiodinase Induction after Myocardial Infarction in Rats—A Time Course Study
Authors: Olivares Emerson L. , Marassi Michelle P. , Fortunato Rodrigo S. , da Silva Alba C. M. , Costa-e-Sousa Ricardo H. , Araújo Iracema G. , Mattos Elisabete C. , Masuda Masako O. , Mulcahey Michelle A. , Huang Stephen A. , Bianco Antonio C. , Carvalho Denise P.
Published: July 2007

In humans, there is a significant decrease in serum T3 and increase in rT3 at different time points after myocardial infarction, whereas serum TSH and T4 remain unaltered. We report here a time course study of pituitary-thyroid function and thyroid hormone metabolism in rats subjected to myocardial infarction by left coronary ligation (INF). INF- and sham-operated animals were followed by serial deiodination assays and thyroid function tests, just before, and 1, 4, 8, and 12 wk after surgery. At 4 and 12 wk after INF, liver type 1 deiodinase activity was significantly lower, confirming tissue hypothyroidism. Type 3 deiodinase (D3) activity was robustly induced 1 wk after INF only in the infarcted myocardium. Reminiscent of the consumptive hypothyroidism observed in patients with large D3-expressing tumors, this induction of cardiac D3 activity was associated with a decrease in both serum T4 (∼50% decrease) and T3 (37% decrease), despite compensatory stimulation of the thyroid. Thyroid stimulation was documented by both hyperthyrotropinemia and radioiodine uptake. Serum TSH increased by 4.3-fold in the first and 3.1-fold in the fourth weeks (P < 0.01), returning to the basal levels thereafter. Thyroid sodium/iodide-symporter function increased 1 wk after INF, accompanying the increased serum TSH. We conclude that the acute decrease in serum T4 and T3 after INF is due to increased thyroid hormone catabolism from ectopic D3 expression in the heart.
Evolutionary Aspects in Evaluating Mutations in the Melanocortin 4 Receptor
Authors: Stäubert Claudia , Tarnow Patrick , Brumm Harald , Pitra Christian , Gudermann Thomas , Grüters Annette , Schöneberg Torsten , Biebermann Heike , Römpler Holger
Published: July 2007

More than 70 missense mutations have been identified in the human melanocortin 4 receptor (MC4R), and many of them have been associated with obesity. In a number of cases, the causal link between mutations in MC4R and obesity is controversially discussed. Here, we mined evolution as an additional source of structural information that may help to evaluate the functional relevance of naturally occurring variations in MC4R. The sequence information of more than 60 MC4R orthologs enabled us to identify residues that are important for maintaining receptor function. More than 90% of all inactivating mutations found in obese patients were located at amino acid positions that are highly conserved during 450 million years of MC4R evolution in vertebrates. However, for a reasonable number of MC4R variants, we found no correlation between structural conservation of the mutated position and the reported functional consequence. By reevaluating selected mutations in the MC4R, we demonstrate the usefulness of combining functional and evolutionary approaches.
Liposarcoma of the larynx: A multicentric or a metastatic malignancy
Authors: Krausen Anthony S. , Gall Alan M. , Gaeza Raoul , Spector Gershon J. , Ansel David G.
Published: July 2007

The third case of liposarcoma of the larynx, this one arising from the preepiglottic space, is presented. The report is unique in so far as the patient previously had been treated for a liposarcoma in another anatomic region.

The diagnosis in this case was in doubt until electron microscopic studies were done. Since the histopathology of the laryngeal and the previous liposarcoma were different, the question of metastasis versus multi‐centricity was raised.

Other discussions of liposarcomas over the past three decades have not resolved this aspect of their behavior completely. In this instance, after considering avenues of metastatic spread in conjunction with the histopathology, it would appear that the laryngeal lesion was a second primary and not a metastasis.
Infratemporal fossa abscess unusual complication of maxillary sinus fracture
Authors: Weiss Barky R.
Published: July 2007

Infratemporal abscess is an unusual complication of maxillary sinus fracture. It can occur several years after the initial injury. Two case histories are presented in detail. The venous connections and the pathways of spread of infections, as well as the pathophysiology of osteomyelitis, are discussed. Treatment cf bony infection is wide removal of all necrotic tissue including a small amount of normal tissue.
Emphysema secondary to tonsillectomy
Authors: Malin Prupas H. , Fordham Stewart D.
Published: July 2007

An unusual complication of tonsillectomy is tissue emphysema and/or pneumomediastinitis. A patient is described with both of these conditions, which probably resulted directly from the introduction of air into the tonsillar bed either during the surgical procedure itself or in the postoperative recovery period. The possible etiologies and recognition of this problem are discussed.
The hypoglossal nerve. Its relationship to the temporal bone and jugular foramen
Authors: Shaia Fred T. , Graham Malcolm D.
Published: July 2007

The serpentine course of the hypoglossal nerve has been described and illustrated.

Clinical and surgical correlations are reviewed.
Squamous cell carcinoma of the soft palate
Authors: Russ Joseph E. , Applebaum Edward L. , Sisson George A.
Published: July 2007

Thirty‐eight patients with squamous cell carcinoma of the soft palate treated between 1960 and 1975 were reviewed. Males in the seventh decade predominated. All symptomatic patients complained of sore throat and/or odynophagia. Seventy‐eight percent were symptomatic less than three months. Approximately equal numbers of patients presented with Tl, T2, and T3 tumors. Twenty‐seven percent had cervical metastases when initially seen. The majority (89%) of patients were treated with radiation initially and the remainder (11%) received radiation therapy at the time of postsurgical recurrence with an absolute five year survival of 33%. Patients less than 60 years of age and those with small primary tumors and no neck metastases demonstrated better survival. Radiation therapy to the primary tumor and neck appears to be the preferred modality of initial treatment.
An unusual cause of cervical lymphadenitis
Authors: Ginsburg Charles M.
Published: July 2007

Histoplasmosis was incriminated as a cause of chronic cervical adenitis in a nine‐year‐old child. Spontaneous resolution of the infection occurred prior to the institution of specific antifungal therapy.
Clinical evaluation of TMJ arthroplasties with insertion of articular eminence prosthesis on ninety patients (an eight year study)
Authors: House Leland R. , Morgan Douglas H. , Hall William P.
Published: July 2007

This paper represents an analysis, accomplished over an eight‐year period, of 90 individuals who have been operated on for various arthritic diseases of their temporomandibular joints (TMJ).

In arthritic changes of the joint, several changes may occur: perforation of the disc, flattening of the articular eminence, asymmetrical condy‐lar movement, and chronic synovitis. This may result in increased synovial pressure on nerve fibers within the capsule of the joint, and a variety of referred pain symptoms.

Prior to operation, a careful differential diagnosis was made by an otolaryngologist and, frequently, by a neurologist/neurosurgeon and a psychologist. The prosthesis inserted during surgery was a metallic device which fits over the articular eminence in the upper portion of the joint. This prosthesis accomplishes primarily three functions: elimination of the crepitus; restoration of the contour of the eminence; separation of the articular surfaces of the joint.
Surgical management of vagal chemodectomas
Authors: Owen Black F. , Myers Eugene N. , Parnes Steven M.
Published: July 2007

Vagal chemodectomas (tumors of the vagal glomus body) are histologically benign and insensitive to radiation therapy. Unless properly managed, these tumors may become life‐threatening because of their eventual impingement on surrounding structures, particularly contents of the cranial vault.

Patients with chemodectomas of the skull base may be surgically treated without significant functional or cosmetic loss, provided the surgeon possesses the following surgical abilities: 1. temporal bone dissection capabilities; 2. microsurgical skills, including techniques of middle ear reconstruction and neurovascular anastomosis; 3. implementation of simultaneous multiple approaches to the skull base and infratemporal fossa; and 4. the capability of managing technically inherent intraoperative and postoperative problems.

Experience from nine patients, all successfully treated surgically, will be summarized.
Correction of congenital choanal atresia in children and adults
Authors: Carpenter Robert J. , Bryan Neel H.
Published: July 2007

Congenital choanal atresia occurs once in 7,000 to 8,000 births. The atresia is bony in most cases, more common in females, and more often right‐sided in patients with unilateral atresia. The incidence of associated congenital anomalies is relatively high. During the 25‐year period 1951 to 1976, 36 patients with choanal atresia were treated at the Mayo Clinic; 19 were females and 17 were males. The ages at the time of surgical treatment ranged from 1 day to 58 years. Twenty‐four patients had unilateral obstruction, and 12 had bilateral obstruction. Six patients (17%) had other associated congenital anomalies. Intranasal perforation and transpalatal correction were most commonly employed in children who were less than 8 years old, and transseptal correction was most often carried out in older patients. The nature of the stenting material and the age of the patient have important bearing on the outcome of the operation.

Congenital choanal atresia is a bony or membranous closure of the posterior choana. It may be complete or incomplete and unilateral or bilateral. We wish to report on a series of children and adults who were treated for congenital choanal atresia at the Mayo Clinic during a 25‐year period and to describe a transseptal method of correction that may be performed concurrently with septal reconstruction and external nasal surgery in older children and adults.
Rhinocerebral phycomycosis
Authors: Yanagisawa Eiji , Friedman Stanley , Kundargi Ronald S. , Smith Howard W.
Published: July 2007

Rhinocerebral phycomycosis is an uncommon but important pathologie entity with a rapidly fatal course if treatment is delayed. Successful therapy demands early diagnosis and institution of adequate treatment if complications are to be avoided.

Two cases of rhinocerebral phycomycosis which demonstrate the rapidly progressive and devastating nature of this disease are presented.

The first case is that of a rapidly progressive rhinocerebral phycomycosis with the classical syndrome of diabetic acidosis, unilateral blindness, ophthalmoplegia and proptosis. Early diagnosis, immediate surgical de‐bridement and Amphotericin B therapy resulted in a long‐term (five years) survival.

This case is also unique in that a large fungal mass was found within the sphenoid sinus, which was removed via sphenoidotomy. If the sphenoid sinus had not been opened and the mass not removed at surgery, this could have been the source of continued infection in spite of Amphotericin B treatment. If preoperative X‐rays show cloudiness of the sphenoid sinus, sphenoidotomy is recommended.

The second case illustrates a fatal course of rhinocerebral phycomycosis in which surgical treatment was refused. This leukemie patient died within one week from the onset of the disease. Autopsy showed extensive fungal involvement of the posterior orbital contents, ethmoid sinuses, leptome‐ninges and cerebrum with thrombosis of the right internal carotid artery and meningoencephalitis. Histological sections showed nonseptate hyphae in the wall and lumen of vessels, occular muscles, optic nerve sheath, leptomeninges, and cerebrum. No leukemie infiltrates were observed in either the brain or orbit.

Clinicopathological features of phycomycosis are discussed and the need for early diagnosis is stressed.

The most frequent manifestations of rhinocerebral phycomycosis are: 1. diabetic ketoacidosis; 2. blepharoptosis; 3. ophthalmoplegia; i. “black” turbinate (may appear “pale” when seen early); 5. X‐ray evidence of cloudiness of the involved sinuses without fluid level; and 6. signs of cerebrovascular thrombosis (CVA) with meningoencephalitis.

Treatment consists of: 1. control of systemic disease; 2. debridement of involved tissues; and 3. Amphotericin B.
Motivation in hearing aid acceptance
Authors: Vernon Sally M. , Pratt Lindsay L.
Published: July 2007

Patient case histories are presented in an attempt to pinpoint possible motivational factors affecting the acceptance of a hearing aid. Personality profiles were constructed on three representative patients through the use of an in‐depth interview as well as three personality scales: the 16 Multiphasic Personality Scale; the Crowne‐Marlowe Social Desirability Scale; and the Attitude Toward Disabled Persons Scale. The very preliminary results indicate at least some face validity to the assertion that unsuccessful hearing aid wearers are measurably different from successful wearers and that these differences may be used to predict success or failure for future patients.
Secondary phase nystagmus—revisited
Authors: Kameker Donald B. , Rood Stewart R. , Thompson James N.
Published: July 2007

A prospective clinical study of secondary phase nystagmus (SPN) is presented. The tracings of 200 patients referred for ENG evaluation and eight normal control subjects were analyzed under all caloric conditions, within a prolonged postirrigation tracing time frame. The spontaneous direction reversal (SPN) was observed in a majority of the control subjects under all four conditions. The occurrence of post‐caloric SPN in the patient group varied considerably among various diagnostic categories. However, SPN was observed far less frequently in the total patient group as compared to the control group. Thus, the absence of SPN may be taken to be a general indication of vestibular pathology.