bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness and satisfaction with imiquimod for the treatment of superficial basal cell carcinoma in daily dermatological practice
Authors: Daudén E. ,   on behalf of the BASALE Study Group
Published: February 2011

Background  The use of imiquimod for the treatment of superficial basal cell carcinoma (sBCC) in actual conditions of the daily practice has been poorly studied.

Objective  A prospective, observational and multicentre study was designed to gather information on the effectiveness and safety of imiquimod therapy in patients with sBCC in daily practice. Patient’s satisfaction with imiquimod was also assessed.

Methods  A total of 370 adult patients with sBCC were included in the study. Patients were treated with imiquimod 5% cream five times per week for 6 weeks. A maximum of three lesions per patient were treated. Patients were requested to complete diary cards to register treatment‐related events and had a final visit within 16 weeks after the end of treatment.

Results  Target sBCCs included 471 tumours, with a mean (SD) 1.3 (0.6) lesions per patient. Most sBCC were primary tumours (92.6%). Tumours were clinically diagnosed in 63.2% of cases and histologically confirmed in 36.8%. Previous sBCC had occurred in 42% of the patients. The mean number of daily applications of imiquimod was 1.0 (0.1) for a mean of 4.9 (0.5) days per week. The mean duration of treatment was 6.0 (1.0) weeks. In 13 patients (14 target sBCCs), rest periods were indicated with a mean of 5.0 (2.8) rest days. The clearance rate was 83.2%. Clearance rate was independent of the tumour size. Local skin reactions (mostly erythema) occurred in 85% of cases (mild 37%, moderate 39% and severe 24%). Nine patients discontinued imiquimod treatment because of severity of application site reactions. Most patients (82.1%) were very satisfied or satisfied with imiquimod.

Conclusions  The present data from a prospective study carried out in a community setting adds evidence of the usefulness and favourable clinical profile of imiquimod 5% cream when administered for treating sBCC.
Comparison of the clinical efficacy of NBUVB and NBUVB with benzoyl peroxide/clindamycin in progressive macular hypomelanosis
Authors: Sim J.H. , Lee D.J. , Lee J.S. , Kim Y.C.
Published: February 2011

Background  Progressive macular hypomelanosis (PMH) is a skin disorder characterized by multiple hypopigmented patches symmetrically distributed on the trunk. Several treatment modalities have been attempted; however, a standard treatment modality has not been agreed to.

Objectives  The aim of this study was to compare the effectiveness of antimicrobial therapy combined with narrow band ultraviolet B (NBUVB) with NBUVB monotherapy.

Methods  A randomized left–right comparison study was conducted in a total of 10 patients. Patients received NBUVB therapy with daily application of antimicrobial gel on one side of the trunk (comb‐NBUVB) and without it (mono‐NBUVB) for 8 weeks. The clinical efficacy was determined by objective measurements using a colour analyser and subjective assessment by evaluating pictures taken with a digital camera at baseline, at the time of treatment cessation and 6 months after treatment.

Results  Significant repigmentation was observed in all 10 patients during the 8 weeks of treatment. The mean difference in L values between lesional and non‐lesional skin was reduced in the comb‐NBUVB area (from 4.52 ± 1.65 to 0.94 ± 0.65), and in the mono‐NBUVB area, (from 4.34 ± 1.39 to 1.18 ± 0.94). There was no significant difference between treated sites at both of the evaluation points in time. At 6 months after treatment, 7 of 10 patients completed the clinical trial, and some degree of clinical improvement remained in four of seven patients; recurrence occurred in the other patients.

Conclusions  Although recurrence occurred in some patients, NBUVB treatment appears to be a safe and useful modality for the treatment of PMH.
Geriatric teledermatology: store‐and‐forward vs. face‐to‐face examination
Authors: Rubegni P. , Nami N. , Cevenini G. , Poggiali S. , Hofmann‐Wellenhof R. , Massone C. , Bilenchi R. , Bartalini M. , Cappelli R. , Fimiani M.
Published: February 2011

Background  Telemedicine could be useful in countries like Italy to meet the needs of elderly patients and in particular in those in precarious general conditions, for whom travelling even short distances can pose considerable practical and economical difficulties.

Objective  The aim of this study was to determine the efficacy of store‐and‐forward teledermatology vs face‐to‐face consultations in elderly patients.

Methods  A total of 130 geriatric patients with skin diseases requiring dermatological examination were enrolled. The patients examined, consisting of 60 men (46.15%) and 70 women (53.85%), were aged between 66 and 97 years (mean age 80.58 years). Three dermatologists of the department, with equal experience took turns in face‐to‐face examination and teledermatology (store‐and‐forward). To compare face‐to‐face dermatological examinations with the asynchronous store‐and‐forward approach of teledermatology, we considered diagnostic agreement (ICD‐9 code), therapeutic agreement and concordance of diagnostic confidence.

Results  One hundred and fourteen of 130 patients were diagnosed with the same ICD‐9 code, making a total observed agreement of 87.7% with a Cohen’s κ estimated of 0.863. Agreement between therapies was 69.6% (Cohen’s κ = 0.640). As it concerns diagnostic confidence, dermatologists appeared generally slightly less certain of their diagnosis by telemedicine.

Conclusions  Store‐and‐forward teledermatology can improve diagnostic and therapeutic care for skin disease in elderly who lack easy and/or direct access to dermatologists.
Predation risk and competitive interactions affect foraging of an endangered refuge‐dependent herbivore
Authors: Tuft K. D. , Crowther M. S. , Connell K. , Müller S. , McArthur C.
Published: February 2011

Predators can have non‐lethal effects on prey by causing animals to restrict their foraging in order to avoid predation risk. These effects can be of conservation concern when an introduced predator constrains the foraging behaviour of a threatened species, and therefore its access to resources. We examined the spatial response of foraging in endangered brush‐tailed rock‐wallabies to predation risk and food while taking into account the potentially competitive role of sympatric herbivores. We compared the occurrence (presence/absence) of rock‐wallaby faecal pellets to the availability of edible vegetation, presence of sympatric macropods and predation risk factors such as distance from refuge and presence of shelter points. Rock‐wallabies managed predation risk by foraging closer to their refuge and more often at shelter points. They foraged more where edible vegetation was higher, but only in the absence of predators and sympatric macropods, indicating that rock‐wallaby foraging is restricted by their interactions with other species. The constraints on foraging behaviour demonstrated in this study can be used to guide management strategies aimed at conserving rock‐wallaby populations.
The aquaporin gene family of the ectomycorrhizal fungus Laccaria bicolor: lessons for symbiotic functions
Authors: Dietz Sandra , von Bülow Julia , Beitz Eric , Nehls Uwe
Published: February 2011

See also the Commentary by Maurel and Plassard
Effect of experimental Staphylococcus aureus mastitis on compositional quality of goat milk
Authors: MUNGATANA NANCY K , NGURE RAPHAEL M , SHITANDI ANAKALO , ONYIEGO BERNARD , MUTUMBA MAURICE
Published: February 2011

Infection of 10 dairy goats of mixed breed with Staphylococcus aureus resulted in changes in concentration of certain analytes in milk, which became more pronounced as the infection progressed. Somatic cell counts reached a peak increase of 147% of pre‐infection levels, free fatty acids 49%, sodium 14%, Chloride 16% and Copper 47%. Decreases in milk concentration included lactose at a maximum 8%, iron at 47%, potassium at 10% and Calcium at 12% of pre‐infection levels. Protein, nitrogen and magnesium levels appeared unaffected by infection. Following curative treatment, changes in the analytes resolved towards normal levels by the fourth week post‐treatment.
School factors that facilitate or hinder the ability of teaching assistants to effectively support pupils with autism spectrum disorders (ASDs) in mainstream secondary schools
Authors: Symes Wendy , Humphrey Neil
Published: February 2011

Growing numbers of pupils with autism spectrum disorders (ASDs) are attending mainstream schools, and increasing numbers of teaching assistants (TAs) are being deployed into classrooms to support them. Evidence suggests, however, that pupils who have a TA may underperform academically, receive less attention from their teachers and be isolated from their peer group. Issues relating to the deployment and training of these staff, and their relationships with class teachers have been raised as contributing to the negative impact of TAs. However, school factors – such as inclusive school culture and teacher training – have been overlooked. In light of this, the objectives of the current study were to (1) develop understanding of the aspects of school culture that TAs feel contribute to the development of inclusion, and (2) identify aspects of school culture, policies and practices that facilitate or hinder their ability to effectively support pupils with ASD. Fifteen TAs supporting pupils with ASD in four mainstream secondary schools were interviewed. Thematic analysis identified positive attitudes towards pupils with special educational needs, school leadership support for inclusion, collaboration and respect as components of an inclusive school culture. The factors perceived as facilitating or hindering the ability of TAs to effectively include pupils with ASD included access to expertise, communication within school and teaching staff awareness of ASD. These findings are discussed in relation to the growing literature on inclusive education for pupils with ASD.
Cardiac arrhythmia induced by interferon beta‐1a
Authors: Kastalli Sarrah , El Aïdli Sihem , Mourali Sami , Zaïem Ahmed , Daghfous Riadh , Lakhal Mohamed
Published: February 2011

Cardiac adverse effects have never been reported with interferon (INF) beta. We report a case of left bundle branch block in a 35‐year‐old woman treated with INF beta‐1a for multiple sclerosis. Five years after INF therapy, she presented loss of consciousness, retrosternal pains, short breath and lowered tolerance of effort. ECG and Holter 24‐h ECG monitoring revealed permanent complete left bundle branch block. Nine months after stopping INF, no abnormalities were found at ECG and echocardiogram examination.
Effect of alprazolam on anxiety and cardiomyopathy induced by doxorubicin in mice
Authors: Anwar Md Jamir , Pillai Krishna K. , Khanam Razia , Akhtar Mohammad , Vohora Divya
Published: February 2011

Anxiety following heart failure (HF) and/or myocardial infarction (MI) can impede recovery and constitute a major risk factor for further cardiac events. The present study was aimed to evaluate anxiety following doxorubicin (DOX)‐induced cardiomyopathy, a rodent model for HF, in mice. Furthermore, the study investigated the effect of alprazolam on anxiety and cardiomyopathy in this model. The study was carried out in Swiss albino mice. DOX was used at a dose of 10 mg/kg i.v. Alprazolam was administered at doses of 0.5, 1 and 2 mg/kg po for 7 days’ pre‐ and 7 days’ post‐DOX. Anxiety was measured on day 8 and on day 14 using elevated plus maze and Vogel’s conflict test. On 14th day, serum lactate dehydrogenase (LDH) was estimated. The mice were then killed and hearts were dissected out for estimation of thiobarbituric acid reactive substance and Transmission Electron Microscopy (TEM) studies. Our results showed that DOX administration induced cardiomyopathy in mice. This was evidenced by an increased serum LDH and tissue malondialdehyde (MDA) and was confirmed by TEM studies. Alprazolam treatment for 14 days dose dependently reversed DOX‐induced increase in LDH and MDA as well as the morphological alterations induced by DOX in TEM studies. Furthermore, alprazolam also reversed the anxiety‐like effects induced by DOX in both the tests for anxiety. Thus, alprazolam appears to be a good candidate for alleviating anxiety in patients following MI or HF.
A GENERAL METHOD FOR CREATING LORENZ CURVES
Authors: WANG ZUXIANG , NG YEW‐KWANG , SMYTH RUSSELL
Published: February 2011

A general method to construct parametric Lorenz models of the weighted‐product form is offered in this paper. Initially, a general result to describe the conditions for the weighted‐product model to be a Lorenz curve, created by using several component parametric Lorenz models, is given. We show that the key property for an ideal component model is that the ratio between its second derivative and its first derivative is increasing. Then, a set of Lorenz models, consisting of a basic group of models, along with their convex combinations, is proposed, and it is shown that any model in the set possesses this key property. We introduce the concept of balanced fit, which provides a means of assigning weights, according to the preferences of the practitioner, to two alternative objectives for developing Lorenz curves in practice. These objectives are generating an acceptable Lorenz curve and improving the accuracy of the density estimation. We apply the balanced fit approach to income survey data from China to illustrate the performance of our models. We first show that our models outperform other popular traditional Lorenz models in the literature. Second, we compare the results generated by the balanced fit approach applied to one of the Lorenz models that we develop with those generated by the kernel method to show that the approach proposed in the paper generates plausible density estimates.
Pharmacological characterization of GSK1004723, a novel, long‐acting antagonist at histamine H1and H3receptors
Authors: Slack RJ , Russell LJ , Hall DA , Luttmann MA , Ford AJ , Saunders KA , Hodgson ST , Connor HE , Browning C , Clark KL
Published: February 2011

BACKGROUND AND PURPOSEPreclinical pharmacological characterization of GSK1004723, a novel, dual histamine H1and H3receptor antagonist.

EXPERIMENTAL APPROACHGSK1004723 was characterizedin vitroandin vivousing methods that included radioligand binding, intracellular calcium mobilization, cAMP production, GTPγS binding, superfused human bronchus and guinea pig whole body plethysmography.

KEY RESULTSIn cell membranes over‐expressing human recombinant H1and H3receptors, GSK1004723 displayed high affinity, competitive binding (H1pKi = 10.2; H3pKi = 10.6). In addition, GSK1004723 demonstrated slow dissociation from both receptors with at1/2of 1.2 and 1.5 h for H1and H3respectively. GSK1004723 specifically antagonized H1receptor mediated increases in intracellular calcium and H3receptor mediated increases in GTPγS binding. The antagonism exerted was retained after cell washing, consistent with slow dissociation from H1and H3receptors. Duration of action was further evaluated using superfused human bronchus preparations. GSK1004723 (100 nmol·L−1) reversed an established contractile response to histamine. When GSK1004723 was removed from the perfusate, only 20% recovery of the histamine response was observed over 10 h. Moreover, 21 h post‐exposure to GSK1004723 there remained almost complete antagonism of responses to histamine.In vivopharmacology was studied in conscious guinea pigs in which nasal congestion induced by intranasal histamine was measured indirectly (plethysmography). GSK1004723 (0.1 and 1 mg·mL−1intranasal) antagonized the histamine‐induced response with a duration of up to 72 h.

CONCLUSIONS AND IMPLICATIONSGSK1004723 is a potent and selective histamine H1and H3receptor antagonist with a long duration of action and represents a potential novel therapy for allergic rhinitis.
Protein kinase C phosphorylates the cAMP response element binding protein in the hypothalamic paraventricular nucleus during morphine withdrawal
Authors: Martín F , Mora L , Laorden ML , Milanés MV
Published: February 2011

BACKGROUND AND PURPOSE

Exposure to drugs of abuse or stress results in adaptation in the brain involving changes in gene expression and transcription factors. Morphine withdrawal modulates gene expression through various second‐messenger signal transduction systems. Here, we investigated changes in activation of the transcription factor, cAMP‐response element binding protein (CREB), in the hypothalamic paraventricular nucleus (PVN) and the kinases that may mediate the morphine withdrawal‐triggered activation of CREB and the response of the hypothalamic‐pituitary‐adrenocortical (HPA) axis after naloxone‐induced morphine withdrawal.

EXPERIMENTAL APPROACH

The effects of morphine dependence and withdrawal, phosphorylated CREB (pCREB), corticotrophin‐releasing factor (CRF) expression in the PVN and HPA axis activity were measured using immunoblotting, immunohistochemistry and radioimmunoassay in controls and in morphine‐dependent rats, withdrawn with naloxone and pretreated with vehicle, calphostin C, chelerythrine (inhibitors of protein kinase C (PKC) or SL‐327 [inhibitor of extracellular signal regulated kinase (ERK) kinase]. In addition, changes in PKCα and PKCγ immunoreactivity were measured after 60 min of withdrawal.

KEY RESULTS

In morphine‐withdrawn rats, pCREB immunoreactivity was increased within CRF immunoreactive neurons in the PVN and plasma corticosterone levels were raised. SL‐327, at doses that reduced the augmented pERK levels in the PVN, did not attenuate the rise in pCREB immunoreactivity or plasma corticosterone secretion. In contrast, PKC inhibition reduced the withdrawal‐triggered rise in pCREB, pERK1/2 and corticosterone secretion.

CONCLUSIONS AND IMPLICATIONS

PKC mediated, in part, both CREB activation and the HPA response to morphine withdrawal. The ERK kinase/ERK pathway might not be necessary for either activation of CREB or HPA axis hyperactivity.
The world of the Renaissance herbal
Authors: Elliott Brent
Published: February 2011

A herbal is a treatise on medicinal plants; the intended audience was traditionally one of doctors and apothecaries, and the purpose was to enable them to know which plants to use for medical purposes, and how to identify them in the field. In the 1530s appeared the first herbals for which artists were employed to draw plants from real specimens, rather than simply copying older illustrations – which, as a result of generations of manuscript copying, were not useful for practical identification purposes. Herbals became a genre with a strong market, and all the publishing traditions of plagiarism and competition can be traced during the course of the 16th and 17th centuries. They also became the focus for one aspect of the rediscovery of the classical past: the endeavour to rediscover the works of Pliny and Dioscorides, and the attempt to determine accurately which plants those authors had described – for there was no significant concept of geographical distribution in the early 16th century, until previously unknown plants began to be introduced from the Americas. As the interest in both classical botany and new plants spread, the market for herbals widened, and they began to include information on garden varieties, thus providing a record of European horticultural activity.
River gods: personifying nature in sixteenth‐century Italy
Authors: Lazzaro Claudia
Published: February 2011

This essay traces the Renaissance appropriation of the ancient river god type from the discovery of several ancient statues and their display in the Vatican Statue Court to the first example of their use in a garden. Through an association with water, the natural element that the figure personified, the river god came to express the Renaissance understanding of nature as fertile and effortlessly bountiful, a male counterpart to female images of abundance. This is demonstrated in both installations of ancient statues and modern recreations in print (The Judgement of Paris, a collaboration of Raphael and Marcantonio Raimondi), paint (Giulio Romano in the Palazzo del Te), and sculpture (Niccolò Tribolo's statues). The Medici Pope Leo X was the first to employ river gods to denote political entities in public festivities, and in the borders of the tapestries that Raphael designed for him, personifications of cities, rivers, and mountains identify geographical regions and anticipate their later use in gardens. Tribolo's lost river gods at the Villa Medici at Castello, reflected in title pages to works by Cosimo Bartoli, translated the river god type into a Florentine aesthetic, influenced by Michelangelo's body torsions, to signify through their form both the specific place and the flourishing of nature there.
Outdoor pursuits: Spanish gardens, the huerto and Lope de Vega's Novelas a Marcia Leonarda
Authors: Samson Alexander
Published: February 2011

The imprecision of the early modern lexis for Spanish gardens reflects their liminality and the distinctness of outdoor pursuits shaped by the climate and geography of the Iberian penninsula. Literary evocations of gardens from Lazarillo to Lope de Vega's Novelas a Marcia Leonarda underline this extra‐mural nature, the public pleasures and hidden dangers that awaited beyond the city in shady, watery retreats. In his own garden, Lope cultivated flowers, including the fashionable tulip, an activity that served in his poetry as metaphor and synecdoche for the moral ambivalence of his shaping activities as a writer of fiction, in stories that were an explicit part of his own seductions.
Experiencing the past: the archaeology of some Renaissance gardens
Authors: Dix Brian
Published: February 2011

Analytical fieldwork and other archaeological investigation of the topography and physical remains of Renaissance gardens increase our understanding of how such places were originally experienced, together with demonstrating technological progress and developments in garden design. The recovery of the actual details of construction, maintenance and alteration gives an immediacy to the evidence depicted in historical maps and other views or described in contemporary written accounts; it may also be used to corroborate the accuracy of such information. Case studies using a multi‐source approach illustrate the nature of surviving archaeological evidence and the scope for its interpretation, showing how an individual setting could be contrived to enhance its qualities, not simply in connection with intellectual meaning, taste, and beauty but equally for social display and to project an image of status and authority. The visibility, form, and function of different garden elements were used both to promote the owner's aspirations and to manipulate the viewer's experience, and investigation and analysis using archaeological methods should be an integral part of future interdisciplinary or collaborative studies.
‘My innocent diversion of gardening’: Mary Somerset's plants
Authors: Munroe Jennifer
Published: February 2011

Mary Somerset, first Duchess of Beaufort, was respected in her day as a collector and cultivator of plants, both exotic and common, on her estate in Badminton. And yet, when she writes to Sir Robert Southwell  in 1694, she is surprisingly humble about her achievements, calling hers an ‘innocent diversion of gardening’. Manuscript and published papers make it clear, however, that Somerset's work with plants was impressive and influential, hardly an ‘innocent diversion’. This essay demonstrates how Somerset's work with plants blurs the line between ‘gardening’ and the twin fields of horticulture and botany. By revaluing the kind of work Somerset did and the knowledge it embodied, we can reposition her (and potentially, other women like her) as a player in the early fields of botany and horticulture, as a woman who saw herself as contributing to bodies of knowledge in significant and lasting ways.
The early influence of albumin administration on protein metabolism and wound healing in burned rats
Authors: Kobayashi Nobuhisa , Nagai Hideo , Yasuda Yoshikazu , Kanazawa Kyotaro
Published: February 2011

Hypoalbuminemia is often claimed to impair wound healing, and therefore albumin has traditionally been administered to derive beneficial effects on general physiologic conditions including the nutritional state. However, the influence of albumin administration on systemic protein metabolism and wound healing is still unclear. Therefore, the objective of this study was to investigate the influence of albumin administration on protein metabolism and wound healing in burned rats. After receiving basic total parenteral nutrition (TPN) for 4 days, Sprague‐Dawley rats underwent a 6‐cm skin incision in the back and a burn involving 20 percent of the whole body surface. The rats were divided into three groups. Group I continued to receive basic TPN. Group II was given basic TPN, but 20 percent of the total nitrogen was replaced by albumin. Group III was administered basic TPN plus albumin equivalent to 20 percent of ‐the total nitrogen of basic TPN. Group IV had the skin incision but no burn, receiving only basic TPN. All the groups were euthanized 4 days after the burn or skin incision. The wound healing potential in terms of tensile strength was enhanced by replacement and addition of albumin (groups II and III, respectively) after a 20 percent burn. Hydroxyproline levels in the wound tended to increase in group II, and significantly increased in group III. Whereas albumin replacement (group II) did not remarkably change the protein metabolism, albumin addition (group III) significantly increased both protein synthesis (S) and breakdown (B) with the S/B ratio and nitrogen balance remaining the same as with albumin‐free nutrition (group I). The urinary 3‐methyl‐histidine/ceatinine ratio significantly increased after burn in group III. We conclude that intravenous albumin administration enhanced incisional wound healing in burned rats. Increased protein synthesis with concurrent myolysis and protein breakdown by albumin addition (group III) was observed during wound healing.
5‐HT1D Receptor Immunoreactivity in the Sphenopalatine Ganglion: Implications for the Efficacy of Triptans in the Treatment of Autonomic Signs Associated With Cluster Headache
Authors: Ivanusic Jason J. , Kwok Matthew M.K. , Ahn Andrew H. , Jennings Ernest A.
Published: February 2011

Objective.— To determine if 5‐HT1D receptors are located in the sphenopalatine ganglion.

Background.— While the 5‐HT1D receptor has been described in sensory and sympathetic ganglia in the head, it was not known whether they were also located in parasympathetic ganglia.

Methods.— We used retrograde labeling combined with immunohistochemistry to examine 5‐HT1D receptor immunoreactivity in rat sphenopalatine ganglion neurons that project to the lacrimal gland, nasal mucosa, cerebral vasculature, and trigeminal ganglion.

Results.— We found 5‐HT1D receptor immunoreactivity in nerve terminals around postganglionic cell bodies within the sphenopalatine ganglion. All 5‐HT1D‐immunoreactive terminals were also immunoreactive for calcitonin gene‐related peptide but not vesicular acetylcholine transporter, suggesting that they were sensory and not preganglionic parasympathetic fibers. Our retrograde labeling studies showed that approximately 30% of sphenopalatine ganglion neurons innervating the lacrimal gland, 23% innervating the nasal mucosa, and 39% innervating the trigeminal ganglion were in apparent contact with 5‐HT1D receptor containing nerve terminals.

Conclusion.— These data suggest that 5‐HT1D receptors within primary afferent neurons that innervate the sphenopalatine ganglion are in a position to modulate the excitability of postganglionic parasympathetic neurons that innervate the lacrimal gland and nasal mucosa, as well as the trigeminal ganglion. This has implications for triptan (5‐HT1D receptor agonist) actions on parasympathetic symptoms in cluster headache.
The Extracranial Vascular Theory of Migraine—A Great Story Confirmed by the Facts
Authors: Shevel Elliot
Published: February 2011

Over the years, there has been a considerable amount of controversy as to whether the vascular component of migraine pain arises from the intracranial or the extracranial vessels or both. Some have even questioned whether vasodilatation even plays a significant role in migraine pain and have described it as an unimportant epiphenomenon. In this review, evidence is presented that confirms (1) vasodilatation is indeed a source of pain in migraine; (2) this dilatation does not involve the intracranial vasculature; (3) the extracranial terminal branches of the external carotid artery are a significant source of pain in migraine.
The Role of Neuroimaging in Children and Adolescents With Recurrent Headaches – Multicenter Study
Authors: Rho Young‐Il , Chung Hee‐Jung , Suh Eun‐Sook , Lee Kon‐Hee , Eun Baik‐Lin , Nam Sang‐Ook , Kim Won‐Seop , Eun So‐Hee , Kim Young‐Ok
Published: February 2011

Objectives.— To evaluate the role of neuroimaging and to estimate the prevalence of significant and treatable intracranial lesions in children and adolescents with recurrent headaches.

Background.— Neuroimaging studies are commonly performed in children and adolescent patients with headache because of increasing demands by parents and physicians, although objective data and studies to support this widespread practice are minimal.

Methods.— We retrospectively reviewed the medical records of all 1562 (male 724, female 838) new patients presenting with recurrent headaches to 9 Pediatric Neurology Clinics of tertiary Hospitals. Data regarding age of onset, duration of symptoms before presentation, frequency, duration of each episode, intensity, location and quality of headache, associated neurologic symptoms and a comprehensive neurological examination were obtained for each patient. The International Classification of Headache Disorders, second edition, was used to classify headache types.

Results.— Neuroimaging procedures were performed in 77.1% of the patients. Overall, 9.3% (112/1204) of the patients had abnormal findings from neuroimaging. The highest yield was in patients with an abnormal neurological examination wherein abnormal findings on neuroimaging were seen in 50.0% (9/18) of patients (P < .001). The yield was low when imaging was carried out in view of changes in the type of headache (12.9% [26/201]), neurologic dysfunction (10.8% [9/83]), recent onset of severe headaches (7.0% [12/171]), and demands of parent and physicians (10.1% [21/208]). Eleven patients underwent surgery based on neuroimaging results. There was no significant relation between abnormality on neuroimaging and age, sex, headache type, age of onset of headache, duration of symptoms before presentation, duration, frequency, location and intensity of headache (P > .05).

Conclusions.— Neuroimaging procedures in children and adolescents with headaches, although not always required, are very commonly performed. We suggest that more strict guidelines for rational use of neuroimaging are needed for pediatric headache patients.
Nutraceuticals and Headache: The Biological Basis
Authors: Taylor Frederick R.
Published: February 2011

Nutrition must affect the structure and functioning of the brain. Since the brain has very high metabolic activity, what we consume throughout the day is likely to dramatically influence both its structure and moment to moment function. It follows that nutritional approaches to all neurological disorders are being researched and entering medical practice, while nutraceutical use is a mainstay of public habits. This review discusses the biological basis for non‐conventional or non‐mainstream approaches to the treatment of migraine. This requires at least limited discussion of current migraine pathophysiologic theory. How nutrients and other chemicals and approaches are mechanistically involved within migraine pathways is the focus of this article. The nutraceuticals reviewed in detail are: magnesium, riboflavin, coenzyme Q10, petasites, and feverfew with additional comments on marijuana and oxygen/hyperbaric oxygen. This article reviews the science when known related to the potential genetic susceptibility and sensitivity to these treatments. As we know, the basic science in this field is very preliminary, so whether to combine approaches and presumably mechanisms or use them alone or with or without conventional therapies is far from clear. Nonetheless, as more patients and providers participate in patient‐centered approaches to care, knowledge of the science underpinning nutritional, nutraceutical, and complementary approaches to treatment for migraine will certainly benefit this interaction.
Effects of Dose and Period of Neonatal Alcohol Exposure on the Context Preexposure Facilitation Effect
Authors: Murawski Nathen J. , Stanton Mark E.
Published: February 2011

Background:  Alcohol exposure in the rat on postnatal days (PD) 4 to 9 is known to partially damage the hippocampus and to impair hippocampus‐dependent behavioral tasks. We previously reported that PD4 to 9 alcohol exposure eliminated the context preexposure facilitation effect (CPFE) in juvenile rats, a hippocampus‐dependent variant of contextual fear conditioning. In the CPFE, context exposure and immediate shock occur on successive occasions and this produces conditioned freezing relative to a control group that is not preexposed to the training context. Here, we extend our earlier findings by examining the effects of neonatal alcohol administered at multiple doses or over different neonatal exposure periods.

Method:  Rat pups (male and female) were exposed to a single binge dose of alcohol at one of 3 doses (2.75, 4.00, or 5.25 g/kg/d) over PD4 to 9 (Experiment 1) or to 5.25 g over PD4 to 6 or PD7 to 9 (Experiment 2). Sham‐intubated (SI) and undisturbed (UD) rats served as controls. On PD31, rats were preexposed to either the training context (Pre) or an alternate context (No‐Pre). On PD32, rats received an immediate unsignaled footshock (1.5 mA, 2 seconds) in the training context. Finally, on PD33, all rats were returned to the training context and tested for contextual freezing over a 5‐minute period.

Results:  Undisturbed‐ and SI‐Pre rats showed the CPFE, i.e., context preexposure facilitated contextual conditioning, relative to their No‐Pre counterparts. The immediate shock deficit was present in all No‐Pre groups, regardless of previous alcohol exposure. In Experiment 1, blood alcohol level was negatively correlated with contextual freezing. Group 2.75 g‐Pre did not differ from controls. Group 4.00 g‐Pre froze significantly less than Groups UD‐ and SI‐Pre but more than Group 5.25‐Pre, which showed the immediate shock deficit. In Experiment 2, alcohol exposure limited to PD7 to 9, but not PD4 to 6, disrupted the CPFE.

Conclusions:  This is the first demonstration of dose‐related impairment on a hippocampus‐dependent task produced by neonatal alcohol exposure in the rat. Exposure period effects support previous studies of alcohol and spatial learning. The CPFE is a more sensitive behavioral task that can be used to elucidate developmental alcohol‐induced deficits over a range of alcohol doses that are more relevant to human exposure levels.
Long‐Term Mortality of Patients Admitted to the Hospital With Alcohol Withdrawal Syndrome
Authors: Campos Joaquin , Roca Lorena , Gude Francisco , Gonzalez‐Quintela Arturo
Published: February 2011

Background:  Although it is well known that alcoholism increases long‐term mortality, there is a paucity of data regarding long‐term prognosis in alcoholic patients who have an episode of alcohol withdrawal syndrome (AWS).

Methods:  We studied a cohort of 1,265 individuals with severe AWS who were admitted to a single university hospital between 1996 and 2006. Median age was 49 years (range 18 to 89 years). A total of 1,085 (85.8%) were men. Median follow‐up was 34 months (range 0 to 121 months). Survival of patients with AWS was compared with that of a reference cohort of 1,362 individuals from the same area. In addition, age‐ and sex‐standardized mortality ratios were calculated using the general population from the region (Galicia, Spain) as the reference.

Results:  The risk of mortality was higher in the cohort of patients with AWS than in the reference cohort after adjusting for age, sex, and smoking (hazard ratio 12.7; 95% CI 9.1 to 17.6; p < 0.001). The standardized mortality ratio in patients with AWS was 8.6 (95% CI 7.7 to 9.7). Age, smoking, serum creatinine, serum bilirubin, and prothrombin time at baseline were independently associated with mortality among patients with AWS.

Conclusions:  Long‐term mortality is highly increased in patients who have a history of AWS. Liver and kidney dysfunction are independent predictors of long‐term mortality in patients with AWS.
Ambivalence About Communicating in a Second Language: A Qualitative Study of French Immersion Students’ Willingness to Communicate
Authors: MACINTYRE PETER D. , BURNS CAROLYN , JESSOME ALISON
Published: February 2011

The defining feature of immersion language learning is the omnipresent pressure to communicate in the second language (L2), even as incipient skills are being acquired. This study uses the focused essay technique to investigate ambivalence about communicating among adolescent French immersion students (12–14 years of age). Students described situations in which they were most willing to communicate (241 entries received) and situations in which they were least willing to communicate (179 entries received). Responses reveal complex interrelations among linguistic development, L2 self‐development, and the nonlinguistic issues that typically face adolescents. Most frequently, students discussed communication with teachers and friends in a school context, but other entries described situations outside the classroom, with extended family or encounters with media. Perceived competence and error correction were identified as major issues. Students also described feeling excluded or mocked because of their status as immersion students, but at other times they used language to form a secret club to exclude or poke fun at other people. Although we found substantial similarities between situations in which students are most or least willing to communicate, they can be differentiated by subtle changes in context that affect the authenticity of communication and needs for autonomy, competence, and relatedness.
Does Formal Teacher Education Make a Difference? A Comparison of Pedagogical Thought Units of B.A. Versus M.A. Teachers
Authors: AKBARI RAMIN , DADVAND BABAK
Published: February 2011

The present study investigated the differences in pedagogical thought units between teachers with a bachelor's degree (B.A.) in English and their counterparts with a master's degree (M.A.) in TESOL. English‐as‐a‐foreign‐language (n= 8) teachers with similar teaching experiences (between 2 and 3 years of teaching experience) and teaching in similar contexts (teaching in the same institute, the same book, and the same level of learners) took part in this study. A complete teaching session of each of the participants was video‐recorded and teachers’ pedagogical thoughts were probed using stimulated recall technique. The research found that, on the whole, M.A. teachers produced significantly more pedagogical thoughts compared to the B.A. teachers: The average pedagogical thought units for M.A. teachers was 5.18 per minute, whereas B.A. teachers produced 2.58 of such units per minute. In terms of thought categories, the same families were observed for both groups; however, there were slight differences in their ranking and significant differences in their frequency.
The Percentage of Words Known in a Text and Reading Comprehension
Authors: SCHMITT NORBERT , JIANG XIANGYING , GRABE WILLIAM
Published: February 2011

This study focused on the relationship between percentage of vocabulary known in a text and level of comprehension of the same text. Earlier studies have estimated the percentage of vocabulary necessary for second language learners to understand written texts as being between 95% (Laufer, 1989) and 98% (Hu & Nation, 2000). In this study, 661 participants from 8 countries completed a vocabulary measure based on words drawn from 2 texts, read the texts, and then completed a reading comprehension test for each text. The results revealed a relatively linear relationship between the percentage of vocabulary known and the degree of reading comprehension. There was no indication of a vocabulary “threshold,” where comprehension increased dramatically at a particular percentage of vocabulary knowledge. Results suggest that the 98% estimate is a more reasonable coverage target for readers of academic texts.
Do Tax Increment Finance Districts Stimulate Growth in Real Estate Values?
Authors: Merriman David F. , Skidmore Mark L. , Kashian Russ D.
Published: February 2011

We use data on all Wisconsin municipalities during the period 1990–2003 to study the effect of tax increment finance (TIF) on economic development. We use appropriate statistical techniques to measure the impact of TIF and control variables on aggregate property values. We also examine the possibility communities that use TIF are self‐selected. We find little evidence that TIF has led to significant increases in aggregate property values or that TIF increases the total value of residential and manufacturing property within a community. Surprisingly, we find positive impacts for commercial TIF districts.
When an Unidentified Foreign Object Appears in the Inferior Vena Cava: Recognizing the Presence of TIPS Stent on Transthoracic Echocardiographic Imaging
Authors: Nijmeh George , Frazin Leon J. , Zelinger Allan
Published: February 2011

We describe the case of 65‐year‐old female with a history of hypertension, diabetes, and cirrhosis. In the subcostal view on a routine transthoracic echocardiogram (TTE), she is found to have an unidentified round prosthetic appearing object in the inferior vena cava (IVC). Upon further investigation, the object was identified as a transjugular intrahepatic portosystemic shunt (TIPS) stent, which was seen in cross section in a hepatic vein draining into the IVC. Most echocardiographers are unfamiliar with the appearance of a TIPS on TTE. Being able to recognize this will help avoid misdiagnosis and unnecessary further imaging. (Echocardiography 2011;28:E70‐E71)
Effect of Two Different FDA‐approved D‐dimer Assays on Resource Utilization in the Emergency Department
Authors: Sanchez Leon D. , McGillicuddy Daniel C. , Volz Kathryn A. , Fan Shu‐Ling , Joyce Nina , Horowitz Gary L.
Published: February 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:317–321 © 2011 by the Society for Academic Emergency Medicine

Background:  The D‐dimer assay has been shown to be an appropriate test to rule out pulmonary embolism (PE) in low‐risk patients in the emergency department (ED). Multiple assays now are approved to measure D‐dimer levels. Studies have shown a newer assay, Tina‐quant, to have similar diagnostic accuracy to the VIDAS assay.

Objectives:  The objective was to determine effects of transitioning from the VIDAS assay to the Tina‐quant D‐dimer assay on the need for computed tomography angiogram (CTA) and ED length of stay (LOS) in patients being evaluated for PE in the ED.

Methods:  A retrospective cohort study was conducted of patients who had D‐dimer levels ordered at an urban, academic, Level I trauma center with over 55,000 annual ED visits. The results of D‐dimer levels in the ED were recorded over a period of 6 months prior to and 6 months after the transition to the new D‐dimer assay. The numbers of positive and negative D‐dimers and need for subsequent CTAs were recorded for comparison. LOS was also recorded to determine time saved. Medians were calculated and compared using Wilcoxon rank sum.

Results:  During the initial period, 875 D‐dimers were ordered, with a positive rate of 41.5%. During the period after the introduction of the Tina‐quant assay, 859 tests were ordered, with 25.5% having positive results. An absolute decrease of 16% in the number of necessary CTAs (p < 0.003) was seen after the transition to the Tina‐quant assay. LOS data showed a mean LOS of 481 minutes in the ED for patients who underwent testing with the Tina‐quant assay compared to 526 minutes with the VIDAS assay, saving an average of 45 minutes per patient (p < 0.003). The positive rate on performed imaging studies for D‐dimer of > 500 rose from 13 of 308 (4.2%) to 17 of 187 (9.1%).

Conclusions:  Switching D‐dimer assays reduced both LOS and number of imaging studies in our patient population.

ACADEMIC EMERGENCY MEDICINE 2011; 18:1–5 © 2011 by the Society for Academic Emergency Medicine
Preliminary Investigation of the Panic Screening Score for Emergency Department Patients With Unexplained Chest Pain
Authors: Foldes‐Busque Guillaume , Fleet Richard , Poitras Julien , Chauny Jean‐Marc , Belleville Geneviève , Denis Isabelle , Diodati Jean G. , Pelland Marie‐Ève , Lessard Marie‐Josée , Marchand André
Published: February 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:322–325 © 2011 by the Society for Academic Emergency Medicine

Objectives:  The objective was to demonstrate the derivation and the preliminary validation of a brief screening score to improve recognition of panic‐like anxiety in emergency department (ED) patients with unexplained chest pain.

Methods:  This cross‐sectional study included 507 ED patients with unexplained chest pain randomly assigned to the derivation condition (n = 201) or the validation condition (n = 306). The Anxiety Disorders Interview Schedule for DSM‐IV (ADIS‐IV) acted as the criterion standard for panic diagnosis. Receiver operating characteristic (ROC) curves were used to determine which of the sociodemographic, medical, and questionnaire response variables best predicted the presence of panic‐like anxiety in the derivation condition. The selected predictors were entered in a logistic regression analysis to determine variables to be included in the screening score. The predictive validity of the resulting score was evaluated in both conditions.

Results:  The four‐item Panic Screening Score (PSS) identified panic‐like anxiety with a sensitivity of 63% (95% confidence interval [CI] = 52% to 73%) and a specificity of 84% (95% CI = 76% to 90%) in the derivation phase. The positive predictive value was 74% (95% CI = 62% to 93%) and the negative predictive value was 76% (95% CI = 68% to 89%). In the validation phase, the sensitivity and specificity were 53% (95% CI = 44% to 62%) and 85% (95% CI = 78% to 89%), respectively. The positive predictive value was 72% (95% CI = 62% to 80%) and the negative predictive value was 71% (95% CI = 65% to 77%).

Conclusions:  The PSS may be useful to identify patients with unexplained chest pain who could benefit from referral to mental health professionals or their primary care providers for evaluation of panic attack and panic disorder. Prospective studies to improve and validate the PSS, followed by impact analysis, are mandatory before clinical implementation.

ACADEMIC EMERGENCY MEDICINE 2011; 18:1–4 © 2011 by the Society for Academic Emergency Medicine