bluuebunny/crossref_metadata_2025 huggingface dataset:
Pilot study to assess patient outcomes following endoscopic application of photodynamic therapy for advanced cholangiocarcinoma
Authors: HAREWOOD GAVIN C , BARON TODD H , RUMALLA ASHWIN , WANG KENNETH K , GORES GREGORY J , STADHEIM LINDA M , DE GROEN PIET C
Published: February 2005

Background: Photodynamic therapy (PDT) has demonstrated promise in the palliative treatment of advanced cholangiocarcinoma. The aim of this pilot study was to assess the outcome in patients with non‐resectable cholangiocarcinoma following endoscopic application of PDT directly into the biliary tract.

Methods: In patients with advanced cholangiocarcinoma, endoscopic retrograde cholangiopancreatography (ERCP) was performed to define the proximal and distal extent of intraductal tumor. Sodium porfimer was administered intravenously to all patients. Forty‐eight hours later, a commercially available cylindrical diffusing laser fiber (1–2.5 cm in length, OptiGuide) designed for esophageal use was advanced across the biliary strictures. Laser light was applied at a power of 400 mW/cm fiber for a total energy of 180 J/cm2 using an argon‐pumped tunable dye laser. Patients received endoscopic PDT every 3 months provided they maintained a favorable performance status. Plastic biliary stents were replaced immediately following light application and were maintained in all patients.

Results: Using a preloaded catheter, adequate positioning of the laser fiber was achieved in all patients. Eight patients with advanced cholangiocarcinoma received a total of 19 PDT treatments, range 1–5 treatments/patient. All eight patients were followed until death; mean follow‐up was 9.8 months. Median survival from the date of the first PDT treatment was 276 days, which compares favorably with published series that have reported median survival times between 45 and 127 days for patients with bismuth type III and IV tumors treated with stenting alone.

Conclusions: Endoscopic application of PDT demonstrates promise in prolonging survival in patients with advanced cholangiocarcinoma. Additional randomized clinical trials using commercially available fibers are needed to fully evaluate both the optimum frequency and treatment interval of endoscopic PDT in the management of advanced cholangiocarcinoma.
Effects of enhanced viscosity on canine gastric and intestinal motility
Authors: XU XIAOHONG , BRINING DOUG , RAFIQ ASAD , HAYES JAMES , CHEN JDZ
Published: February 2005

Background and Aim: The aim of this study was to investigate the effect of enhanced viscosity on gastric emptying and gastrointestinal motor and myoelectrical activities in dogs.

Method: The study was performed in eight healthy female hound dogs chronically implanted with four pairs of gastric and two pairs of intestinal serosal electrodes and a duodenal fistula. Each dog was studied in three sessions and fed with three test meals with different viscosity. Gastric emptying was monitored for 2 h simultaneously with gastric and intestinal myoelectrical recordings.

Results: The liquid test meal containing either 0.78% or 1.21% of galactomannan significantly delayed gastric emptying but had no effect on postprandial blood glucose levels in comparison with the meal containing no galactomannan. The liquid test meal containing either 0.78% or 1.21% of galactomannan significantly increased the frequency and strength of intestinal motility but had no effect on intestinal slow wave rhythms. The product with enhanced viscosity had no effect on gastric motor activity or gastric slow waves.

Conclusion: It was concluded that enhanced viscosity delays gastric emptying, increases postprandial intestinal but not gastric motility, and has no effects on gastric or intestinal slow waves.
Adverse drug reactions of intravesical bacillus Calmette–Guérin instillation and risk factors of the development of adverse drug reactions in superficial cancer and carcinoma in situ of the bladder
Authors: KOGA HIROFUMI , KURODA MASAO , KUDO SEIJI , YAMAGUCHI AKITO , USAMI MICHIYUKI , SUZUKI TADASHI , NAITO SEIJI
Published: February 2005

Background: We examined the incidence and severity of adverse drug reactions following intravesical bacillus Calmette–Guérin (BCG) instillation for superficial bladder cancer including carcinoma in situ. We investigated the relationship between adverse drug reactions and patient background to clarify risk factors for the development of adverse drug reactions.

Methods: A total of 123 patients who underwent intravesical BCG instillation for treatment and prophylaxis between April 1997 and June 2000 were included in this study. Adverse drug reactions were divided into local and systemic categories and the severity of reactions was classified according to the presence or absence of postponement or discontinuation of instillation, with or without treatment for the reaction itself.

Results: Of 123 patients, 95.9% showed adverse drug effects and 50.4% needed some sort of treatment. Discontinuation of instillation due to adverse drug reactions was observed in nine patients. Regarding the necessity of treatment for adverse drug effects, the purpose of instillation and BCG dose were independent significant factors on multivariate analysis.

Conclusion: Although there was a high rate of adverse drug reactions after intravesical BCG instillation, the rate of discontinuation of instillation was not high and serious adverse reactions were rare. The scale of the present study was small, but these results suggest that BCG instillation was well tolerated. When instillation is being performed for the purpose of treatment, and the BCG dose is 80 mg, greater attention might be needed to monitor for the development of adverse drug effects.
Epithelioid angiomyolipoma of the kidney
Authors: ACIKALIN MUSTAFA FUAT , TEL NILÜFER , ÖNER ÜLKÜ , PASAOGLU ÖZGÜL , DÖNMEZ TURGUT
Published: February 2005

Abstract  Epithelioid angiomyolipoma is a recently recognized variant of angiomyolipoma, which is characterized by the presence of polygonal cells with densely eosinophilic cytoplasm and varying degrees of nuclear atypia. Only a relatively small number of cases of epithelioid angiomyolipoma of the kidney have been reported in the literature. We report a case of epithelioid angiomyolipoma of the kidney that occurred in a 38‐year‐old woman. The tumor was composed of diffuse sheets of epithelioid cells, adipocytes and only scattered thick‐walled blood vessels. The epithelioid cells had pleomorphic and hyperchromatic nuclei with densely eosinophilic cytoplasm. Hemorrhage, necrotic foci and clusters of foamy macrophages were present. HMB‐45, CD117 (c‐kit) and CD68 were detected in the epithelioid cells. There was no expression of cytokeratin, epithelial membrane antigen or desmin. The patient showed no evidence of recurrence or metastatic disease 9 months after nephrectomy.
Comparison of microvessel densities in rat prostate tissues treated with finasteride, bicalutamide and surgical castration: A preliminary study
Authors: KAYA CEVDET , OZYUREK MUSTAFA , TURKERI LEVENT N
Published: February 2005

Background: A group of anti‐androgens with different mechanisms of action and adverse effects have been investigated in patients with gross hematuria related to benign prostate hyperplasia; however, there is not yet any consensus about the standard management of these patients. The present study aims to identify if any one type of the hormonal intervention is superior in terms of the suppression of microvessel formation in the prostate.

Materials and methods: A total of 28 mature, healthy male Sprague–Dawley rats (300 ± 50 g) were used in this study. The rats were randomly assigned to one of four groups (n = 7 per group). The effects of three different hormonal therapies on angiogenesis and microvascularity in rat ventral prostate were compared. Groups 1 and 2 were treated for 28 days with finasteride and bicalutamide, respectively, and rats from Group 3 underwent surgical castration. Following treatment, all rats included in the study underwent dissection of the ventral prostate and immunohistochemical analysis of microvessel density by factor VIII‐related antigen.

Results: The mean number of microvessels in the finasteride and bicalutamide groups was 24.5 (±8.44 SE) and 27 (±9.89 SE) respectively. In contrast, the castration and control groups had microvessel numbers of 12.9 (±5.35 SE) and 40.3 (±5.03 SE) respectively. Differences were statistically significant between all three treatment groups and the controls (P < 0.005); the number of microvessels in rat prostate tissues of the control group was significantly higher than the treatment groups. Mean microvessel densities in the bicalutamide and finasteride groups were significantly higher than microvessel densities in the castration group (P < 0.005). There was no statistically significant difference between mean microvessel number in rat prostate tissue treated with finasteride or bicalutamide (P > 0.05).

Conclusions: Even though finasteride was not as effective as castration in reducing microvessel number, its effect was equal to that of bicalutamide in terms of suppressing the angiogenesis in prostatic tissue. Based on the findings of the present study, finasteride might offer a viable option in the management of macroscopic hematuria by inhibition of microvessel formation within the prostatic tissue. Further clinical studies are warranted.
Management of gestational nephrolithiasis in the presence of a bicornuate uterus and pelvic kidney
Authors: KAVANAGH DARA O , FANNING NIALL , HEFFERNAN ERIC , MALONE DERMOT E , MULVIN DAVID M , QUINLAN DAVID M
Published: February 2005

Abstract  A 39‐year‐old para 0+1 woman with known nephrolithiasis within a left‐sided pelvic kidney presented with left‐sided renal colic at 7 weeks gestation. She had a previous miscarriage due to a bicornuate uterus. Ultrasound and magnetic resonance urography confirmed an incomplete obstruction of the left upper renal tract which was relieved by percutaneous nephrostomy. She presented again at 14 weeks with renal colic and minimal output. An ultrasound confirmed recurrent hydronephrosis and a nephrostogram showed that the catheter had retracted almost completely from the collecting system. This was considered to be due to the upward pressure of the enlarging uterus on the catheter, which had been fixed externally to the skin. This problem was obviated by not securing the replacement nephrostomy tube to the skin. She developed pre‐eclamptic toxaemia and gave birth at 35 weeks gestation by caesarean section. The calculus was later dissolved using extra‐corporeal shockwave lithotripsy.
Sexual behavior survey and screening for chlamydia and gonorrhea in university students in South Korea
Authors: LEE SEUNG‐JU , CHO YONG‐HYUN , HA U‐SYN , KIM SAE WOONG , YOON MOON SOO , BAE KYUNGHEE
Published: February 2005

Background: The purpose of the present study was to define the prevalence of genital Chlamydia trachomatis and Neisseria gonorrhoeae infections and status of sexual risk behavior among university students (18–25 years old) in the capital region of South Korea.

Methods: Participants filled out a self‐administered questionnaire related to sexuality. First‐void urine was analyzed for chlamydial and gonococcal infection by strand displacement amplification (BDProbTecET, BD Diagnostic Systems, MD).

Results: A total of 622 students from 15 colleges in three universities took part in the study. The median age was 21 and 39.1% of them reported having sexual intercourse at least once. The prevalence of C. trachomatis among sexually active men and women was 8.4% and 10.6%, respectively. Gonococcal infection was noted in one symptomatic male. Factors significantly associated with infection were the number of sexual partners during past year and lifetime and condom use.

Conclusions: This is the first sexually transmitted infection (STI) screening in university students in South Korea. Urine‐based STI screening was both feasible and acceptable in university students in South Korea. It should be considered a routine part of programs to control STI nationally.
Giant retroperitoneal liposarcoma
Authors: INOUE KATSUKI , HIGAKI YOSHIO , YOSHIDA HIDEKI
Published: February 2005

Abstract  Liposarcomas are one of the most common soft tissue sarcomas of adulthood. Liposarcomas are remarkable because of their frequently large size. We report a case with an extremely large dedifferentiated liposarcoma that weighed 18 kg. Although it was capsulated and could be excised en bloc, the patient suffered a relapse 9 months later and died 1 year after the operation.
Infection‐induced urethral defect treated by urethral reconstruction with a radial forearm flap
Authors: KANNO TORU , SHIBASAKI NOBORU , ITO MASAAKI , TSUJI YUTAKA , TAKI YOJI , TAKEUCHI HIDEO , MIHARA HIROYA , IKEDA MIKA , YOSHIMOTO YUJI
Published: February 2005

Abstract  A 47‐year‐old man was admitted with the chief complaint of a urethral defect. An approximately 17‐cm defect of the urethra seemed to have been occurred by the infection of implanted foreign bodies in the penile skin. Reconstruction of the urethra and the ventral skin was performed with a free radial forearm flap. A fistula formed at the proximal anastomosis after the operation, but was controlled conservatively. Urethral stricture at the proximal anastomosis subsequently developed. A urethral stent made of shape memory alloy was placed with the preservation of voiding function.
SPACE–TIME MODELLING OF SYDNEY HARBOUR WINDS
Authors: Cripps Edward , Nott David , Dunsmuir William T.M. , Wikle Christopher
Published: February 2005

This paper develops a space‐time statistical model for local forecasting of surface‐level wind fields in a coastal region with complex topography. The statistical model makes use of output from deterministic numerical weather prediction models which are able to produce forecasts of surface wind fields on a spatial grid. When predicting surface winds at observing stations, errors can arise due to sub‐grid scale processes not adequately captured by the numerical weather prediction model, and the statistical model attempts to correct for these influences. In particular, it uses information from observing stations within the study region as well as topographic information to account for local bias. Bayesian methods for inference are used in the model, with computations carried out using Markov chain Monte Carlo algorithms. Empirical performance of the model is described, illustrating that a structured Bayesian approach to complicated space‐time models of the type considered in this paper can be readily implemented and can lead to improvements in forecasting over traditional methods.
DYNAMICAL AND STATISTICAL MODELS FOR EXPLOITED POPULATIONS†
Authors: Lebreton Jean‐Dominique
Published: February 2005

Human activities have indirectly modified the dynamics of many populations, accelerating considerably the natural rate of species extinction and raising strong concerns about biodiversity. In many such cases, the underlying ‘natural’ dynamics of the population has been modified by human‐induced increases in mortality, even if the populations are not exploited or harvested in the strict sense. Both dynamical and statistical models are needed to investigate the consequences of human‐induced mortality on the overall dynamics of a population. This paper reviews existing approaches and the potential of recent developments to help form a conceptual and practical framework for analysing the dynamics of exploited populations. It examines both the simple case of an extra source of mortality instantaneously in time, and the theory involved when both risks compete over a continuous time scale. This basic theory is expanded to structured populations, using matrix population models, with applications to the conservation biology of long‐lived vertebrates. The type and degree of compensation expected and approaches to detect it are reviewed, and ways of handling uncertainty are discussed.
Effects of glial cell line‐derived neurotrophic factor on isolated developing mouse Sertoli cells in vitro
Authors: Wu Zhenyu , Templeman Jenny L. , Smith Robert A. , Mackay Sarah
Published: February 2005

Cell proliferation is a key factor in sex determination where a size increase relative to the XX gonad is one of the first signs of testis differentiation. Moreover, proliferation of Sertoli cells during development is important in building up the stock of supporting cells necessary for subsequent successful fertility. Because proliferation is such an essential part of testis development, the hypothesis under long‐term investigation is that it is under fail‐safe control by multiple alternative growth factors. This study was undertaken to investigate the role of glial cell‐derived neurotrophic factor (GDNF) on developing mouse Sertoli cells in vitro. Sertoli cells, isolated from mouse embryos at three stages of testis development, were maintained for 2–7 days in vitro (div) in the presence or absence of GDNF at 1, 10 and 100 ng mL−1. Overall the presence of extracellular matrix gel had little effect on proliferative activity, but encouraged expression of the epithelial phenotype. A statistically significant difference in proliferation, assessed by immunocytochemical staining for proliferating cell nuclear antigen, was seen with GDNF at embryonic day (E)12.5 after 2 div (at both 10 and 100 ng mL−1, P < 0.001) and 7 div (at both 10 and 100 ng mL−1, P < 0.05); at E13.5 after 3 div (at both 10 and 100 ng mL−1, P < 0.05) and at E14.5 after 7 div (100 ng mL−1, P < 0.01), compared with controls cultured without growth factor. In conclusion, GDNF stimulates mitosis throughout this critical developmental window. The in vitro approach used here is a useful adjunct to the knockout mouse model and has been applied to show that GDNF exerts a proliferative effect on developing mouse Sertoli cells.
Morphogenesis of the juxtaoral organ in humans
Authors: Mérida‐Velasco J. R. , Rodríguez‐Vázquez J. F. , De La Cuadra‐Blanco C. , Salmerón J. I. , Sánchez‐Montesinos I. , Mérida‐Velasco J. A.
Published: February 2005

The juxtaoral organ was studied using light microscopy in 55 human embryos and 90 fetuses at different stages of development. The juxtaoral organ arises from the epithelium at the bottom of the transverse opening of the primitive mouth during O’Rahilly stage 16 and becomes detached from the epithelium after O’Rahilly stage 18. The juxtaoral organ is innervated by the buccal nerve from O’Rahilly stage 20 onward, and its connective tissue capsule is clearly visible after week 11 of development. This study enabled us to describe three main periods of juxtaoral organ development: (1) the period of epithelial condensation and invagination, at O’Rahilly stages 16–17; (2) the period during which the juxtaoral organ becomes detached from the oral epithelium and is innervated, at O’Rahilly stages 18–23; and (3) the period during which the connective tissue capsule is formed, after week 11 of development. We also analysed the juxtaoral organ of five additional fetuses by immunohistochemistry with anti‐NF‐200 to verify their innervation. The results show that the juxtaoral organ may have a function in the mechanical activity of the region.
Anti‐müllerian hormone as a marker of ovarian reserve*
Authors: TREMELLEN Kelton P. , KOLO Michele , GILMORE Alan , LEKAMGE Dharmawijaya N.
Published: February 2005

Objective:  To analyse the usefulness of plasma anti‐müllerian hormone (AMH) measurement as a tool for assessing ovarian reserve in a general infertility population.

Materials and methods:  Plasma AMH levels were analysed in 238 women aged 18–46 years during day 3–5 of their menstrual cycle. All 238 patients had follicle stimulating hormone (FSH) levels less than 10 i.u./L, suggesting normal ovarian reserve on traditional FSH criteria. Eighty‐seven patients gave their consent to correlate their AMH levels with IVF oocyte retrieval outcome. Patients producing ≥ 8 oocytes were classified as having normal ovarian reserve, while those producing ≤ 4 oocytes were classified as having poor ovarian reserve.

Results:  Plasma AMH levels remained relatively static (20–25 pmol/L) from 18 to 29 years of age. By 30 years of age, plasma AMH levels start to drop rapidly, reaching only 10 pmol/L by 37 years. Despite this 50% fall in AMH levels between 29 and 37 years of age, minimal changes in FSH levels were observed. Using a cut off value of 8.1 pmol/L, plasma AMH assessment could predict poor ovarian reserve on a subsequent IVF cycle with a sensitivity of 80% and a specificity of 85%.

Conclusions:  Plasma AMH assessments are superior to FSH in identifying women with reduced ovarian reserve. Anti‐müllerian hormone assessment should be considered as a useful adjunct to FSH/oestradiol levels and antral follicle count when estimating ovarian reserve.
Coexistence of verrucous and squamous carcinoma of the vulva
Authors: HAIDOPOULOS Dimitrios , DIAKOMANOLIS Emmanuel , RODOLAKIS Alexandros , VOULGARIS Zannis , VLACHOS George , MICHALAS Stylianos
Published: February 2005

Aim:  To evaluate the coexistence of verrucous and squamous carcinoma of the vulva and to assess the clinical course, survival and rate of recurrent disease of these patients.

Methods:  The records of 17 patients who were diagnosed with verrucous carcinoma of the vulva over a 12‐year period were studied retrospectively. Presence of genuine verrucous carcinoma or coexistence of verrucous and squamous carcinoma of the vulva on vulvar biopsies, results of histopathological assessment of final vulva and inguino‐femoral node specimens and histological evaluation of recurrent disease specimens were the main outcome measures.

Results:  Five of the 17 patients (29.5%) initially underwent radical vulvectomy and inguino‐femoral lymphadenectomy. Histology of the specimens verified the coexistence of verrucous and squamous carcinomas in four of the five cases. Twelve women (70.5%) underwent simple vulvectomy for genuine verrucous carcinoma; in the final histology, 10 of these women (58.8%) were confirmed as having genuine verrucous carcinomas while two (11.7%) were found to have both verrucous and squamous carcinomas and were further managed by lymphadenectomy. None of our patients died of the disease. Three women (17.5%) presented with local relapse of the tumour, and were managed by wide local excision of the tumour.

Conclusions:  In the present study, 35% of patients with verrucous carcinomas of the vulva had coexistent squamous carcinoma. Separation of the cases of genuine verrucous carcinoma from coexistent verrucous and squamous tumours is based on the establishment of correct diagnosis by a large and deep vulvar biopsy as well as the meticulous assessment of the specimen by the pathologist. This will result in the decrease of the rate of over‐ and under‐treatment of these patients.
How useful are hospital morbidity data for monitoring conditions occurring in the perinatal period?
Authors: TAYLOR Lee K , TRAVIS Susan , PYM Margaret , OLIVE Emily , HENDERSON‐SMART David J
Published: February 2005

Background:  There is currently no published information on the full range of morbid conditions affecting mothers and newborns in Australia. Hospital morbidity data collections are a possible source of this information, but have not been widely utilised due to concerns about data quality.

Aims:  To assess the accuracy and reliability of perinatal morbidity reporting to the New South Wales Inpatient Statistics Collection (NSW ISC).

Methods:  A sample of 1000 records relating to 500 mothers and 500 newborns were randomly selected from the NSW ISC for the financial year 1999–2000 and compared with information obtained from medical records. Sensitivities and specificities were calculated for conditions of clinical relevance.

Results:  There was a wide range of sensitivities among the 41 conditions selected, indicating a variable level of under‐enumeration. Only 17 (41%) had a sensitivity of 80% or more. Sensitivities were more than 95% for gestational diabetes, prolonged pregnancy, perineal laceration, single live birth, low birth weight, and intracranial haemorrhage. However, numbers are small and confidence intervals wide for some of these conditions. Specificities were generally high. Neonatal conditions tended to be more accurately reported than maternal conditions. The pattern of results was similar to that reported for state perinatal data collections.

Conclusions:  While hospital administrative data are readily available, data quality is a valid concern. However, if the data are viewed critically and information on accuracy is available, they can be a useful resource for monitoring the health of mothers and babies.
Effects of tibolone on the quality of life, anxiety‐depression levels and cognitive functions in natural menopause: An observational follow‐up study
Authors: GÜLSEREN Leyla , KALAFAT Devrim , MANDACI Hatice , GÜLSEREN Şeref , ÇAMLI Lütfü
Published: February 2005

The effects of tibolone on the quality of life (QoL), depression‐anxiety levels and cognitive functions were investigated. Seventeen women received tibolone and 25 women did not receive any medication. At the end of the 6‐month follow‐up period, the QoL was better in the tibolone group in the area of mental health. Disability, anxiety symptoms, menopausal symptoms were significantly reduced in this group.
Alterations in levator ani morphology in elite nulliparous athletes: A pilot study
Authors: KRUGER Jennifer A. , MURPHY Bernadette A. , HEAP Stuart W.
Published: February 2005

Background:  A difficult vaginal birth is known to be one of the causes of damage to the pelvic floor muscles. Prolonged second stage of labour is thought to be one of the implicating factors in this damage. If the muscles of the pelvic floor were hypertrophied in response to repetitive high impact training, then the ‘suspected phenomenon’ of a more difficult childbirth for very athletic women might be related to these muscles reducing pelvic floor compliance.

Aim:  To document the muscle morphology of the pelvic floor using magnetic resonance imaging (MRI) in a group of nulliparous female athletes and to compare this to the findings in a similar group of age‐matched nulliparous nonathletic women.

Methods:  Static Magnetic Resonance (MR) imaging of the pelvic floor was performed with particular reference to the muscle morphology of levator ani and puborectalis. The cross‐sectional area of the urogenital hiatus and the diameter of the bony pelvic outlet were also assessed.

Results:  Significant differences in the cross‐sectional area and width of the pelvic floor muscles, measured in the line of the anal canal, were found between the athletic group and the controls. There were no differences found between the two groups in the cross‐sectional area of the urogenital hiatus, and the adequacy of the pelvic outlet was established with reference to normative data.

Conclusions:  The differences shown in the pelvic floor muscles in the athletes and nonathletes provide a focus for further research into this area. This change might influence the function of the pelvic floor muscles in this subgroup of women.
Total versus subtotal hysterectomy: An observational study with one‐year follow‐up
Authors: GIMBEL Helga , ZOBBE Vibeke , ANDERSEN Birthe M. , GLUUD Christian , OTTESEN Bent S. , TABOR Ann ,   the Danish Hysterectomy Group
Published: February 2005

The aim of this study was to compare total and subtotal abdominal hysterectomy for benign indications, with regard to urinary incontinence, postoperative complications, quality of life (SF‐36), constipation, prolapse, satisfaction with sexual life, and pelvic pain at 1‐year postoperative. Eighty women chose total and 105 women chose subtotal abdominal hysterectomy. No significant differences were found between the 2 operation methods in any of the outcome measures at 12 months. Fourteen women (15%) from the subtotal abdominal hysterectomy group experienced vaginal bleeding and three women had their cervix removed.
Pelvic floor trauma in childbirth – Myth or reality?
Authors: DIETZ H. P. , SCHIERLITZ Lore
Published: February 2005

The issue of traumatic damage to the pelvic floor in childbirth is attracting more and more attention amongst obstetric caregivers and laypersons alike. This is partly due to the fact that elective Caesarean section, as a potentially preventative intervention, is increasingly available and perceived as safe. As there are a multitude of emotive issues involved, including health economics and the relative roles of healthcare providers, the discussion surrounding pelvic floor trauma in childbirth has not always been completely rational. However, after 25 years of urogynaecological research in this field it should be possible to determine whether pelvic floor trauma in childbirth is myth or reality. On reviewing the available evidence, it appears that there are sufficient grounds to assume that vaginal delivery (or even the attempt at vaginal delivery) can cause damage to the pudendal nerve, the caudal aspects of the levator ani muscle, fascial pelvic organ supports and the external and internal anal sphincter. Risk factors for such damage have been defined and variously include operative vaginal delivery, a long second stage, and macrosomia. It is much less clear, however, whether such trauma is clinically relevant, and how important it is in the aetiology of pelvic floor morbidity later in life.
Change in Sensory Functioning Predicts Change in Cognitive Functioning: Results from a 6‐Year Follow‐Up in the Maastricht Aging Study
Authors: Valentijn Susanne A. M. , Van Boxtel Martin P. J. , Van Hooren Susan A. H. , Bosma Hans , Beckers Henny J. M. , Ponds Rudolf W. H. M. , Jolles Jelle
Published: February 2005

Objectives: To examine the longitudinal relationship between sensory functioning and a broad range of cognitive functions after 6 years follow‐up and whether cataract surgery or first‐time hearing aid use affected cognition.

Design: Hierarchical regression procedures were employed to determine whether sensory functioning was predictive of cognitive performance.

Setting: Maastricht University and the University Hospital Maastricht, the Netherlands.

Participants: Older Dutch adults (≥55) enrolled in the Maastricht Aging Study (N=418).

Measurements: Visual and auditory acuity, the Visual Verbal Learning Test (VVLT), the Stroop Color Word Test (SCWT), the Concept Shifting Task (CST), the Verbal Fluency Test, and the Letter‐Digit Substitution Test (LDST).

Results: A change in visual acuity was associated with change in most cognitive measures, including the total and recall scores of the VVLT, the mean score of the first two SCWT cards, the mean score of the first two CST cards and the LDST. In addition, a change in auditory acuity predicted change in memory performance (VVLT total and recall scores), and auditory acuity measured at baseline predicted change in the mean score of the first two SCWT cards and the LDST.

Conclusion: The findings support the notion of a strong connection between sensory acuity in auditory and visual domains and cognitive performance measures, both from a cross‐sectional and a longitudinal perspective. They also suggest that it is essential to screen older individuals in a clinical context for sensory functioning so that changes in visual or auditory acuity are not interpreted as changes in cognitive performance.
Accuracy of Self‐Reported Depression in Persons with Dementia
Authors: Snow A. Lynn , Kunik Mark E. , Molinari Victor A. , Orengo Claudia A. , Doody Rachelle , Graham David P. , Norris Margaret P.
Published: February 2005

Objectives: To investigate the reliability and validity of self‐reported depression in demented elderly patients.

Design: This is the first study to combine the use of multiple depression criteria with dementia and depression control groups.

Setting: Houston Veterans Affairs nursing home and geropsychiatric inpatient unit and outpatient clinic, Baylor College of Medicine's Alzheimer's Disease Research Center.

Participants: The total sample included 121 volunteer participants, their informants, and their clinicians, forming four diagnostic groups (27 controls, 37 dementia only, 28 depression only, 29 dementia and depression).

Measurements: Scales assessing depression, deficit awareness, physical illness, functional disability, caregiver burden, and severity of cognitive impairment were used.

Results: Analyses of variance using informant‐ and clinician‐rated depression categories found main effects on patient‐reported depression scores for deficit awareness and depression diagnosis but not for dementia diagnosis. Chi‐square analyses revealed that demented and depressed patients underreported depression at similarly high rates compared with clinician and informant reports. Regression analyses revealed that deficit awareness accounted for significant variance in self‐reported depression accuracy, whereas clinician‐ or informant‐rated depression, severity of cognitive impairment, physical disability, functional status, and caregiver burden were not significant.

Conclusion: The results of this investigation suggest that the presence of dementia per se does not predict inaccurate depression self‐reports. Deficit awareness, which covaries with dementia, appears to account for the majority of the variance in self‐report accuracy. These findings were stable across informant‐ and clinician‐rated depression criteria and multiple analyses.
Executive Function Correlates with Walking Speed in Older Persons: The InCHIANTI Study
Authors: Ble Alesandro , Volpato Stefano , Zuliani Giovanni , Guralnik Jack M. , Bandinelli Stefania , Lauretani Fulvio , Bartali Benedetta , Maraldi Cinzia , Fellin Renato , Ferrucci Luigi
Published: February 2005

Objectives: To study the association between performance on psychological tests of executive function and performance on lower extremity tasks with different attentional demands in a large sample of nondemented, older adults.

Design: Cross‐sectional study.

Setting: Community‐based.

Participants: Nine hundred twenty‐six persons aged 65 and older, without dementia, stroke, parkinsonism, visual impairment, or current treatment with neuroleptics, enrolled in a large epidemiological study.

Measurements: Trail Making Test (TMT) parts A and B and two performance‐based measures of lower extremity function that require different executive/attentional‐demanding skills: walking speed on a 4‐m course at usual pace and walking speed on a 7‐m obstacle course at fast pace. A difference score (Delta TMT), obtained by subtracting time to perform part A from time to perform part B of the TMT, was used as an indicator of executive function. Based on Delta TMT, subjects were divided into poor performance, intermediate performance, and good performance.

Results: After adjustment, no association between Delta TMT and 4‐m course usual‐pace walking speed was found. Participants with poor Delta TMT and with intermediate Delta TMT performance were more likely to be in the lowest tertile for 7‐m obstacle course walking speed.

Conclusion: In nondemented older persons, executive function is independently associated with tasks of lower extremity function that require high attentional demand.
Exercise Leads to Faster Postural Reflexes, Improved Balance and Mobility, and Fewer Falls in Older Persons with Chronic Stroke
Authors: Marigold Daniel S. , Eng Janice J. , Dawson Andrew S. , Inglis J. Timothy , Harris Jocelyn E. , Gylfadóttir Sif
Published: February 2005

Objectives: To determine the effect of two different community‐based group exercise programs on functional balance, mobility, postural reflexes, and falls in older adults with chronic stroke.

Design: A randomized, clinical trial.

Setting: Community center.

Participants: Sixty‐one community‐dwelling older adults with chronic stroke.

Intervention: Participants were randomly assigned to an agility (n=30) or stretching/weight‐shifting (n=31) exercise group. Both groups exercised three times a week for 10 weeks.

Measurements: Participants were assessed before, immediately after, and 1 month after the intervention for Berg Balance, Timed Up and Go, step reaction time, Activities‐specific Balance Confidence, and Nottingham Health Profile. Testing of standing postural reflexes and induced falls evoked by a translating platform was also performed. In addition, falls in the community were tracked for 1 year from the start of the interventions.

Results: Although exercise led to improvements in all clinical outcome measures for both groups, the agility group demonstrated greater improvement in step reaction time and paretic rectus femoris postural reflex onset latency than the stretching/weight‐shifting group. In addition, the agility group experienced fewer induced falls on the platform.

Conclusion: Group exercise programs that include agility or stretching/weight shifting exercises improve postural reflexes, functional balance, and mobility and may lead to a reduction of falls in older adults with stroke.
Surgical Outcomes for Patients Aged 80 and Older: Morbidity and Mortality from Major Noncardiac Surgery
Authors: Hamel Mary Beth , Henderson William G. , Khuri Shukri F. , Daley Jennifer
Published: February 2005

Objectives: To gather information about surgical outcomes for patients in their 80s and 90s.

Design: Prospective cohort study.

Setting: Veterans Affairs Medical Centers.

Participants: Patients (26,648 aged ≥80; 568,263 aged <80) enrolled in the Veterans Affairs National Surgical Quality Improvement Project (NSQIP) who had noncardiac surgery between 1991 and 1999.

Methods: Data were collected prospectively from medical records and healthcare providers. Detailed information was collected about patients' preoperative status, intraoperative experience, and postoperative outcomes. Postoperative outcomes were survival status at 30 days (deaths from any cause occurring during hospitalization and after hospital discharge were captured) and the occurrence of 21 selected surgical complications within 30 days postoperatively: wound complications (3 types), respiratory complications (4), urinary tract complications (3), nervous system complications (3), cardiac complications (3), and other complications (5).

Measurements: Mortality and the occurrence of 21 surgical complications within 30 days of surgery.

Results: Thirty‐day all‐cause mortality rates varied widely across operations and were higher for patients aged 80 and older than for younger patients (8% vs 3%, P<.001). Mortality rates for those aged 80 and older were less than 2% for many commonly performed operations (e.g., transurethral prostatectomy, hernia repair, knee replacement, carotid endarterectomy). Of patients aged 80 and older, 20% had one or more postoperative complications, and patients who suffered complications had higher 30‐day mortality than those who did not (26% vs 4%, P<.001). For 11 of the 21 complications, mortality for patients aged 80 and older was greater than 33%. The risk factors for poor outcomes were the same for older and younger patients, and the NSQIP Mortality Risk model performed well on patients aged 80 and older (C statistic=0.83).

Conclusion: A substantial minority of patients aged 80 and older died or suffered a complication within 30 days of surgery, but for many operations mortality rates were extremely low. Postoperative complications were associated with high 30‐day mortality in patients aged 80 and older.
Cognitive Deficits 3 to 6 Years Before Dementia Onset in a Population Sample: The Honolulu‐Asia Aging Study
Authors: Jorm Anthony F. , Masaki Kamal H. , Petrovitch Helen , Ross G. Webster , White Lon R.
Published: February 2005

Objective: To determine the type of cognitive deficits occurring 3 to 6 years before onset of dementia in a population sample.

Design: A prospective study in which cognitive deficits in participants who had incident dementia at the 6‐year follow‐up were examined at baseline and 3 years.

Setting: Honolulu, Hawaii.

Participants: Three thousand seven hundred thirty‐four Japanese‐American men aged 71 to 93 at baseline. At the 6‐year follow‐up, there were 52 incident cases of dementia, and 1,559 controls.

Measurements: The Cognitive Abilities Screening Instrument (CASI) and a questionnaire on subjective memory problems were administered at baseline. Dementia was assessed at baseline and at 3‐year and 6‐year follow‐ups.

Results: Subjects who had incident dementia at 6‐year follow‐up, had showed deficits 3 to 6 years earlier in the CASI domain of episodic memory and in the questionnaire covering subjective memory problems. Up to 3 years before onset, there was worsening of the episodic memory deficit from baseline and new deficits in language, verbal fluency, and orientation.

Conclusion: Cognitive deficits and awareness of memory problems are frequently present several years before dementia onset. The predictive value of these deficits is not large enough to allow earlier diagnosis of dementia, but information about such deficits may be useful as criteria for mild cognitive impairment.
Atherosclerosis Is Associated with Delirium After Coronary Artery Bypass Graft Surgery
Authors: Rudolph James L. , Babikian Viken L. , Birjiniuk Vladimir , Crittenden Michael D. , Treanor Patrick R. , Pochay Val E. , Khuri Shukri F. , Marcantonio Edward R.
Published: February 2005

Objectives: To investigate whether atherosclerosis of the ascending aorta, internal carotid arteries, and coronary arteries is predictive of postoperative delirium in subjects undergoing coronary artery bypass graft (CABG) surgery.

Design: Prospective cohort study.

Setting: Boston Veterans Affairs Healthcare System.

Participants: Thirty‐six male veterans undergoing primary CABG surgery.

Measurements: Subjects underwent Duplex ultrasound to assess stenosis in the internal carotid arteries. Information on the ascending aortic plaque, as assessed by transesophageal echocardiogram, and the number of coronary vessels bypassed was collected. To create an atherosclerosis score, the number of atherosclerotic areas was added. A validated delirium battery was administered to the subjects preoperatively and on postoperative Days 2 and 5.

Results: Fifteen subjects (41.7%) developed delirium postoperatively. In bivariate analysis, carotid stenosis of 50% or more (relative risk (RR)=3.5, 95% confidence interval (CI)=1.5–8.1) and moderate‐severe ascending aortic plaque (RR=2.9, 95% CI=1.0–8.5) were significantly associated with the development of delirium. There was a trend toward a significant association for three or more vessels bypassed (RR=9.6, 95% CI=0.6–145.3). After controlling for age, baseline cognition, and medical comorbidity, the atherosclerosis score was significantly associated with postoperative delirium (adjusted RR=2.7, 95% CI=1.1–6.8).

Conclusion: In this preliminary report, atherosclerosis in the carotid arteries, aorta, and coronary circulation is associated with the development of delirium after CABG surgery. Further investigation into atherosclerosis as a risk factor for delirium is warranted.
Effect of Leg Muscle Contraction Velocity on Functional Performance in Older Men and Women
Authors: Sayers Stephen P. , Guralnik Jack M. , Thombs Lori A. , Fielding Roger A.
Published: February 2005

Objectives: To explore the relationship between impairment (skeletal muscle strength and contraction velocity) and function in community‐dwelling older adults.

Design: Cross‐sectional.

Setting: University‐based human physiology laboratory.

Participants: One hundred one men and women (aged 75–90).

Measurements: Muscle strength and contraction velocity during bilateral leg press (LP) were calculated during one‐repetition maximum (1RM) and 40% 1RM. A short physical performance battery (SPPB) and gait speed (GS) from a 400‐m self‐paced walk assessed function. Sex differences in LP strength and contraction velocity (at 40% 1RM) were assessed. The relationship between these variables and function was also examined.

Results: Lower extremity strength and contraction velocity were significantly associated with GS (P=.02 and P=.005, respectively) and SPPB (P<.001 and P=.009, respectively) in men only. Contraction velocity, but not muscle strength, was significantly associated with GS (P<.001) and SPPB (P=.02) in women.

Conclusion: Sex differences exist in the relationship between impairment (muscle strength and contraction velocity) and function. Older men and women may employ different strategies to achieve success on different functional tasks. These findings may have important implications for clinicians practicing geriatric rehabilitation.
Measuring the Psychological Outcomes of Falling: A Systematic Review
Authors: Jørstad Ellen C. , Hauer Klaus , Becker Clemens , Lamb Sarah E. ,   on behalf of the ProFaNE Group
Published: February 2005

The objectives were to identify fall‐related psychological outcome measures and to undertake a systematic quality assessment of their key measurement properties. A Cochrane review of fall‐prevention interventions in older adults was used to identify fall‐related psychological measurements. PubMed, CINAHL, and PsycINFO were systematically searched to identify instruments not used in trials and papers reporting the methodological quality of relevant measures. Reference lists of articles were searched for additional literature, and researchers were contacted. Two reviewers undertook quality extraction relating to content, population, reliability, validity, responsiveness, practicality, and feasibility. Twenty‐five relevant papers were identified. Twenty‐three measures met the inclusion criteria: six single‐item questions, Falls Efficacy Scale (FES), revised FES, modified FES, FES‐UK, Activities‐specific Balance and Confidence Scale (ABC), ABC‐UK, Confidence in maintaining Balance Scale, Mobility Efficacy Scale, adapted FES, amended FES, Survey of Activities and Fear of Falling in the Elderly (SAFFE), University of Illinois at Chicago Fear of Falling Measure, Concern about Falling Scale, Falls Handicap Inventory, modified SAFFE, Consequences of Falling Scale, and Concern about the Consequences of Falling Scale. There is limited evidence about the measurement properties of single‐item measures. Several multiitem measures obtained acceptable reliability and validity, but there is less evidence regarding responsiveness, practicality, and feasibility. Researchers should select measures based on the constructs they intend to study. Further research is needed to establish and compare the instruments' measurement properties.
Geriatrics for Residents in the Surgical and Medical Specialties: Implementation of Curricula and Training Experiences
Authors: Potter Jane F. , Burton John R. , Drach George W. , Eisner Janis , Lundebjerg Nancy E. , Solomon David H.
Published: February 2005

In 1994, under the leadership of the late Dennis Jahnigen, the American Geriatrics Society, with support of the John A. Hartford Foundation, began a project to improve the amount and quality of geriatrics education that surgical and related medical specialty residents receive. The targeted disciplines initially were general surgery, emergency medicine, gynecology, orthopedic surgery, and urology and, later, anesthesiology, ophthalmology, otolaryngology, physical medicine and rehabilitation, and thoracic surgery. A key element of this project was to develop model programs within surgical and related specialty residency education. The Geriatrics Education for Specialty Residents (GESR) program has supported 29 residencies to pilot methods for integration of geriatrics within residency programs, encouraged and inspired development of curricular content, and helped to develop faculty leaders to support these efforts in the long term and at a national level. This paper describes the GESR program, the status of curriculum development, steps for other programs to use in developing a geriatrics education program, and some of the common barriers likely to be encountered during implementation along with solutions to those barriers.