bluuebunny/crossref_metadata_2025 huggingface dataset:
A haemophilia treatment centre‐administered disease management programme in patients with bleeding disorders
Authors: TENCER T. , ROBERSON C. , DUNCAN N. , JOHNSON K. , SHAPIRO A.
Published: May 2007

Summary.  The objective of this study is to describe a disease management programme (DMP) for the bleeding disorder population insured by Indiana’s high‐risk insurance plan, and to assess the associated costs and outcomes. All bleeding disorder patients, covered by the state plan as their primary health insurance, were enrolled into a DMP administered by the Indiana Hemophilia & Thrombosis Center (IHTC). A pre/postintervention study design was used, with 1‐year pre‐enrollment serving as the baseline period and 1‐year postenrollment as the study period. Claims data were used to assess hospitalizations, emergency room (ER) visits, total medical and clotting factor costs and factor units dispensed. Medical records were used to assess disease severity and other comorbidities. Thirty‐one continuously enrolled patients had complete data over 2 years. Approximately 84% of the population was male, 81% with haemophilia. The average costs of care in the baseline year and the first year of the programme were $161 441 and $118 293, respectively. The decrease in the total costs was primarily attributed to a decrease in outpatient factor costs, which resulted from decreased factor utilization and lower per unit factor costs. The mean number of inpatient hospital days and ER visits for the DMP population decreased from 1.3 and 1.4 to 0.4 and 0.6, baseline and first year, respectively. Owing to the small sample size and high variability of the population, the differences were not statistically significant. The DMP appears to have reduced the total costs and resource utilization, although the study was underpowered.
Home percutaneous endoscopic gastrostomy feeding: perceptions of patients, carers, nurses and dietitians
Authors: Brotherton Ailsa M. , Abbott Janice , Hurley Margaret A. , Aggett Peter J.
Published: May 2007

Title.  Home percutaneous endoscopic gastrostomy feeding: perceptions of patients, carers, nurses and dietitians

Aim.  This paper is a report of a study to compare the perceptions of adult patients, family carers, nurses and dietitians regarding home percutaneous endoscopic gastrostomy feeding.

Background.  Healthcare professionals have a major role in patient selection for gastrostomy placement and the provision of aftercare but it is not clear if patients, their carers and healthcare professionals have similar perceptions of the initiation and delivery of feeding and of the care in general.

Method.  A cross‐sectional mixed‐method study using purposive sampling, semi‐structured interviews and questionnaires was performed. Interviews were undertaken during 2005 with adult patients and carers of adults receiving home feeding. A questionnaire containing comparable questions was distributed to the lead district nurse and dietitian providing the individual patient's care. Binomial regression was used to analyse any differences in perceptions across the groups of respondents.

Results.  Nurses and dietitians had similar perceptions of gastrostomy feeding in adults. Family carers’ perceptions matched those of professionals more closely than did those of patients. The greatest difference in perceptions was between patients and their family carers. Respondents’ views about success of feeding and the appropriateness of the feeding regimen were similar, but greater differences existed regarding quality of life, withdrawal of feeding and choice in decision‐making about tube placement.

Conclusion.  There is a need for increased patient and carer involvement in decision‐making and for sufficient, appropriate information to facilitate informed decision‐making. Practitioners who involve carers in decision‐making, where patients lack capacity, need to be aware that carers may not represent the views of patients.
Heterochromatic and genetic features are consistent with recombination suppression of the self‐incompatibility locus in Antirrhinum
Authors: Yang Qiuying , Zhang Dongfen , Li Qun , Cheng Zhukuan , Xue Yongbiao
Published: May 2007

Self‐incompatibility (SI) is a genetic mechanism to prevent self‐fertilization that is found in many species of flowering plants. Molecular studies have demonstrated that the S‐RNase and SLF/SFB genes encoded by the single polymorphic S locus, which control the pollen and pistil functions of SI in three distantly related families, the Solanaceae, Scrophulariaceae and Rosaceae, are organized in a haplotype‐specific manner. Previous work suggested that the haplotype structure of the two genes is probably maintained by recombination suppression at the S locus. To examine features associated with this suppression, we first mapped the S locus of Antirrhinum hispanicum, a member of the Scrophulariaceae, to a highly heterochromatic region close to the distal end of the short arm of chromosome 8. Both leptotene chromosome and DNA fiber fluorescence in situ hybridization analyses showed an obvious haplotype specificity of the Antirrhinum S locus that is consistent with its haplotype structure. A chromosome inversion was also detected around this region between A. majus and A. hispanicum. These results revealed that DNA sequence polymorphism and a heterochromatic location are associated with the S locus. Possible roles of these features in maintenance of the haplotype specificity involved in both self and non‐self recognition are discussed.
Directional Freezing of Equine Semen in Large Volumes
Authors: Saragusty J , Gacitua H , Pettit MT , Arav A
Published: May 2007

Contents

Despite its potential impact on the horse industry, sperm cryopreservation is not an established technology throughout the industry, for a number of reasons that include a reduction in pregnancy rate and increased cost per pregnancy. We have evaluated a novel directional freezing technique, based on a multi‐thermal gradient (MTG), by comparing it with the conventional, controlled‐rate cryopreservation method (CRCM). Ninety‐seven ejaculates with ≥50% motility, collected from 31 stallions were each divided into two parts and subsequently frozen by either MTG or CRCM. Frozen samples were then stored in liquid nitrogen until thawing. The two treatments were evaluated by three methods: progressive linear motility (PLM), viability stain and hypoosmotic swelling (HOS) test. High correlation was found between the three evaluation methods for all post‐thaw samples. Eighty‐eight per cent of the ejaculates frozen by MTG had post‐thaw PLM ≥35%, whereas only 59% of the ejaculates frozen by CRCM had such motility. Post‐thaw evaluations of samples frozen by MTG and CRCM were: PLM – 50.2 ± 1.5% and 37.4 ± 1.5%, respectively; viability – 53.6 ± 1.5% and 39.5 ± 1.4%, respectively; membrane integrity, as evaluated by HOS – 36.2 ± 1.3% and 26.5 ± 1.1%, respectively. The differences according to all the evaluation methods were highly significant (p < 0.001), and the results indicate that freezing stallion semen by MTG is superior to CRCM.
Post‐streptococcal glomerulonephritis in Sydney: A 16‐year retrospective review
Authors: Blyth Christopher C , Robertson Peter W , Rosenberg Andrew R
Published: May 2007

Aim:  Post‐streptococcal glomerulonephritis (PSGN) is a frequent cause of acute nephritis in children. Numerous studies have described PSGN in high‐risk populations yet few data describing PSGN in a low‐incidence population exist. This study aimed to describe the epidemiology, clinical manifestations, diagnosis, complications and outcomes of PSGN in an urban Australian population.

Methods:  A 16‐year retrospective review of case notes and laboratory data was conducted at a tertiary Sydney paediatric hospital.

Results:  Thirty‐seven children were treated for PSGN with a mean age of 8.1 years (range 2.6–14.1 years). Twenty‐eight subjects (75.7%) had a history of a recent upper respiratory tract or skin infection. Hypertension and/or oedema was present in 29 subjects (78.4%). Streptococcal pharyngitis was identified as the likely source in 17 subjects (45.9%). Skin infections occurred less frequently. Antibodies against streptolysin O, streptokinase or deoxyribonuclease B were elevated when a single titre was measured in 35 subjects (94.6%). Thirty subjects (81.1%) developed renal impairment (median peak creatinine, 95 µmol/L, range 39–880 µmol/L). No correlation was demonstrated between peak creatinine, age, ethnicity, streptococcal titres and serum complement levels. The mean length of admission was 8.2 days. Seven subjects (18.9%) had a complicated course with three subjects requiring dialysis. Only one subject has ongoing renal dysfunction.

Conclusion:  Significant differences are seen in a low‐incidence urban Australian population with PSGN when compared with endemic or epidemic disease in high‐risk populations. The higher rates of complications that were seen compared with previously studied populations need further clarification.
Cows milk protein enteropathy and granulomatous duodenitis in a newborn
Authors: Ozbek Ozlem Y , Canan Oguz , Ozcay Figen , Bilezikci Banu
Published: May 2007

Abstract:  Cow’s milk protein enteropathy is a symptom complex that composed of severe diarrhoea and malnutrition. This disorder is caused by non‐immunoglobulin E‐mediated food allergy. Its clinical features and natural course have been explained in many reports, of different types of cow’s milk and soy reactions. In the present article, we describe a newborn patient who presented with chronic diarrhoea and failure to thrive diagnosed as cow’s milk protein enteropathy. The duodenal biopsy revealed granulamatous duodenitis which has not been described before. Her clinical and pathological findings responded well to cow’s milk elimination. We suggest that food allergies should be considered in differential diagnosis of patients with chronic diarrhoea and failure to thrive.
Ingested magnets and gastrointestinal complications
Authors: Alzahem Abdulrahman M , Soundappan Soundappan SV , Jefferies Heather , Cass Daniel T
Published: May 2007

Abstract:  Multiple magnet ingestion is an unexpected health hazard in children that can lead to significant gastrointestinal morbidity. The magnets are attracted to each other across the bowel wall and this may lead to pressure necrosis, resulting in perforation, fistula formation, and/or intestinal obstruction. We report herein a case of small bowel obstruction following ingestion of two magnets. The public and clinicians should be aware of the health hazard of such devices.
Administration of pamidronate helps prevent immediate postparathyroidectomy hungry bone syndrome
Authors: DAVENPORT ANDREW , STEARNS MICHAEL P
Published: May 2007

Background  Despite the use of vitamin D analogues and oral calcium supplements, hypocalcaemia following surgical parathyroidectomy is a common problem, because of the so‐called hungry bone syndrome.

Methods  The aim of this audit was to determine whether the change in clinical practice by the administration of pamidronate before parathyroidectomy, in addition to standard perioperative management, could prevent severe postoperative hypocalcaemia.

Results  The postoperative course of 37 end‐stage renal failure patients on regular dialysis referred for total parathyroidectomy were reviewed. Twenty‐seven patients had been given pamidronate 24–48 h before surgery. Pamidronate reduced corrected serum calcium from 2.54 ± 0.18 mmol/L (mean ± SD) to 2.36 ± 0.18 before surgery (P < 0.05). Following surgery, serum calcium in the 10 patients given standard therapy alone fell to a nadir of 2.08 mmol/L (1.75–2.19) (median (interquartile range) by the first postoperative day, and all 10 patients required additional support with multiple boluses of intravenous calcium. In the pamidronate group, the lowest median postoperative calcium was 2.3 mmol/L (2.2–2.46), P < 0.05, and only two patients required additional support with intravenous calcium, χ2 = 27, P < 0.001). However, in the longer term the annual percentage increase in bone mineral density following parathyroidectomy was non‐statistically lower in the pamidronate group compared with the controls (lumbar spine (L1–L4), 0.041 ± 0.04 vs 0.058 ± 0.41, P = 0.23 and femoral neck, 0.03 ± 0.03 vs 0.107 ± 0.1, P = 0.15, respectively).

Conclusion  Preoperative pamidronate in combination with high doses of oral alfacalcidol and calcium supplements can prevent symptomatic postoperative hypocalcaemia, reduce the requirement for intensive monitoring of calcium, reduce patient morbidity, and reduce hospital stay from 9.2 ± 1.9 to 5.7 ± 2.9 days, P < 0.05. However, in the longer term pamidronate may potentially delay bone remodelling.
AUSTRALIAN CREDIT UNIONS AND THE DEMUTUALIZATION AGENDA
Authors: DAVIS Kevin
Published: May 2007

ABSTRACT**:  There is a strong prospect of widespread demutualization occurring in the Australian credit union industry in coming years. This paper explains the reasons for this phenomenon, identifies some potentially undesirable social consequences, and examines the relative merits of alternative types of demutualization process. It identifies a number of principles which warrant reflection in the design of legislation addressing demutualization processes.
Attitudes and perceptions regarding skin cancer and sun protection behaviour in an Irish population
Authors: Jones B , Oh C , Corkery E , Hanley R , Egan CA
Published: May 2007

Background  Although people seem to be well educated on the harmful effects of the sun, they continue to intentionally expose themselves without adequate protection.

Aims  To ascertain baseline knowledge regarding skin cancer and review the sun protection behaviours in an Irish population and the effect of doctor‐based education on these behaviours.

Methods  Two hundred participants were recruited for a questionnaire‐based study on their perceptions regarding skin cancer and their sun protection behaviour. They were divided into two groups, with one group receiving doctor‐based education following the initial survey, and a follow‐up questionnaire was carried out within 3 months.

Results  Ninety per cent of participants knew that sun exposure was the major risk factor for skin cancer, and 95% knew that sun beds were not a safe way to tan. Despite this, <20% used regular sunscreen, and 30% had used or were currently using sun beds in order to tan.

Conclusion  Our study indicated that although the participants’ knowledge of skin cancer and risk of sun exposure is high, their sun‐protective attitudes were not influenced by education in the clinical setting.
Interview with Raymond Gifford, Jr., MD
Authors: Moser Marvin
Published: May 2007

It is appropriate that Raymond Gifford, Jr., MD, is considered an icon of hypertension. Dr. Gifford has been actively involved in research and treatment efforts in the field of hypertension for more than 45 years. He has been a strong voice in correcting the myths and misconceptions that prevailed in the 1940s and early 1950s about this disease. Dr. Gifford and other physicians at the Mayo Clinic were among the first to recognize that lowering blood pressure could reverse some of the complications of severe hypertension. They demonstrated that reducing blood pressure would help clear retinal hemorrhages, relieve symptoms of congestive heart failure, and at least temporarily reverse the syndrome of malignant hypertension. Later in his career, at the Cleveland Clinic where he was chairman of the Department of Hypertension and Nephrology for many years, Dr. Gifford worked with Irv Page, Harriet Dustan, Emanuel Bravo, Ed Frohlich, Bob Tarazi, and others on the causes of secondary hypertension. Dr. Gifford was involved in evaluating almost all of the antihypertensive drugs from the 1950s, including the peripheral and ganglion blocking agents, and did some of the early studies on diuretics. I have been fortunate to observe and interact with Dr. Gifford through many of these projects, at meetings and seminars, at the National Heart, Lung, and Blood Institute, and at quiet dinners. He possesses the unique ability to clarify an issue in one or two sentences that oftentimes will have been debated for hours. When Dr. Gifford speaks, people listen. I am always pleased when Dr. Gifford agrees with me; I know I must be right. In the following interview, Dr. Gifford minimizes his contributions, which extend far beyond his involvement in the National High Blood Pressure Education Program and his work at the Cleveland Clinic. Dr. Gifford is retired from practice and the Clinic, but remains a strong voice in the world of hypertension as a frequent speaker at national and international meetings where he always presents an unbiased, scientifically accurate point of view.
Effect of the Dietary Approaches to Stop Hypertension Diet and Reduced Sodium Intake on Blood Pressure Control
Authors: Svetkey Laura P , Simons‐Morton Denise G , Proschan Michael A , Sacks Frank M , Conlin Paul R , Harsha David , Moore Thomas J ,   DASH‐Sodium Collaborative Research Group
Published: May 2007

The authors hypothesized that the Dietary Approaches to Stop Hypertension (DASH) diet and reduced sodium intake would control stage 1 hypertension and reduce high‐normal blood pressure (BP) to optimal levels. Adults with systolic BP 120–159 mm Hg and diastolic BP 80–95 mm Hg were randomly assigned to receive the DASH diet or a typical American (control) diet, consuming three different sodium intakes (higher=142 mmol/d, intermediate=07 mmol/d, and lower=65 mmol/d) for 30 days each. BP control was defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg. Among subjects with hypertension at baseline, at higher sodium intake the DASH diet increased BP control two‐fold over control (63% vs. 32%; 95% confidence interval, 1.4–2.9). Reducing sodium intake in the control diet group increased BP control 2.3‐fold (74% vs. 32%; 95% confidence interval, 1.7–3.2). The maximum BP control rate (84%) was achieved with the DASH/lower sodium diet. BP became normal or optimal in 71% of persons consuming the control/lower sodium diet and 77% of persons consuming the DASH/lower sodium diet. Both the DASH diet and reduced sodium intake improved BP control.
Slowing Cardiovascular Disease Progression in African‐American Patients: Diabetes Management
Authors: Gavin James R.
Published: May 2007

The prevalence of type 2 diabetes has grown to epidemic proportions in the United States and is disproportionately higher in certain ethnic groups. African Americans, Hispanic Americans, Native Americans, and Asian Americans have an approximately two‐fold higher rate of type 2 diabetes than whites. The increased prevalence of type 2 diabetes mirrors the growing rates of overweight and obese persons in the United States. While the highest rate of diabetes occurs at age 60 years and older, the fastest growing segment of the population with type 2 diabetes is younger than age 39 years. Because most diabetes‐related deaths are due to cardiovascular disease, an aggressive management strategy for type 2 diabetes must address both coronary heart disease risk factor reduction and glycemic control. Both the microvascular and macrovascular complications of type 2 diabetes can be prevented or slowed with aggressive therapy. Glycemic dysfunction can be moderated by aggressive combination therapy that focuses on the pathophysiology of diabetes in an individual patient and combines two or three oral agents, such as an insulin sensitizer with an insulin secretagogue or two insulin sensitizers with different loci of action. The goal of glycemic control is reduction of glycated hemoglobin to <7%. An appropriate management strategy should not be limited to lowering blood glucose levels alone but must also address obesity, hypertension, dyslipidemia, atherosclerosis, and the increased tendency for clotting in persons with type 2 diabetes. Treatment to reduce blood pressure to <130/80 mm Hg is recommended; to accomplish this, multiple antihypertensive agents are usually necessary. The goals for correction of dyslipidemia are to reduce low‐density‐lipoprotein cholesterol levels to <100 mg/dL, increase high‐density‐lipoprotein cholesterol levels to >40 mg/dL for men and >50 mg/dL for women, and decrease triglyceride levels to <150 mg/dL. Optimal therapy for persons with diabetes should include diet and exercise with medical nutrition therapy, lowering glycated hemoglobin with intensive glycemic control, and correcting high blood pressure and dyslipidemia with early, intensive, multidrug pharmacologic therapy.
Clinical Features and Management of Selected Hypertensive Emergencies
Authors: Elliott William J.
Published: May 2007

A hypertensive emergency, defined as an elevated blood pressure with evidence of acute target organ damage, can manifest in many forms, including neurological, cardiac, renal, and obstetric. After diagnosis, effective parenteral antihypertensive therapy (typically, nitroprusside starting at 0.5 μg/kg/min, but some physicians prefer fenoldopam or nicardipine) should be given in the hospital. In general, blood pressure should be reduced about 10% during the first hour and another 15% gradually over 2–3 more hours. The exception is aortic dissection, for which treatment includes a β blocker, and the target is systolic blood pressure <120 mm Hg after 20 minutes. Oral antihypertensive therapy can usually be instituted after 6–12 hours of parenteral therapy. Consideration should be given to secondary causes of hypertension after transfer from the intensive care unit. Because of advances in antihypertensive therapy and management, “malignant hypertension” should be malignant no longer.
Hypertension and Heart Failure
Authors: Moser Marvin , Schocken Douglas D. , Basile Jan N. , Cushman William C.
Published: May 2007

Following a symposium on hypertension in Tampa, FL, in February 2004, a roundtable discussion was held to review new data regarding the management of hypertension and heart failure. The discussion was moderated by Dr. Marvin Moser of the Yale University School of Medicine, New Haven, CT. Panel members included Dr. Douglas Schocken of the University of South Florida, Tampa, FL; Dr. Jan Basile of the Ralph H. Johnson Veterans Affairs Medical Center and the Medical University of South Carolina, Charleston, SC; and Dr. William Cushman of the University of Tennessee College of Medicine, Memphis, TN.
Hypertension Treatment Guidelines
Authors: Moser Marvin , Papademetriou Vasilios , Pickering Thomas G , Sica Domenic A
Published: May 2007

In May 2004, a symposium updating the management of hypertension was held in Washington, DC. This was telecast to more than 200 medical facilities throughout the United States. Participants included Marvin Moser, MD, of the Yale University School of Medicine, New Haven, CT; Vasilios Papademetriou, MD, of the Department of Veterans Affairs and Georgetown University Medical Centers, Washington, DC; Thomas G. Pickering, MD, DPhil, of Columbia University College of Physicians and Surgeons, New York, NY; and Domenic A. Sica, MD, of Virginia Commonwealth University, Richmond, VA.
Dietary Salt, Blood Pressure, and Microalbuminuria
Authors: Weir Matthew R.
Published: May 2007

The relationship between dietary salt, blood pressure, and risk for cardiovascular disease has been debated for decades. Microalbuminuria is a biomarker for both cardiovascular and kidney disease. The presence of microalbuminuria correlates directly with the risk for myocardial infarction and stroke and indicates individuals at risk for the development of progressive kidney disease. Since patients with the metabolic syndrome, diabetes, or chronic kidney disease often are blood pressure salt sensitive, and it is well known that increasing dietary salt may offset both the antihypertensive and antiproteinuric effects of renin‐angiotensin system blocking drugs, physicians must consider increased salt intake as a potential modifiable risk factor for progression of chronic kidney disease and possibly even cardiovascular disease.
Stroke in Patients With Diabetes and Hypertension
Authors: McFarlane Samy I. , Sica Domenic A. , Sowers James R.
Published: May 2007

Stroke is major public health problem leading to increased morbidity and mortality. Modifiable risk factors for stroke include hypertension, diabetes, atrial fibrillation, dyslipidemia, smoking, and alcohol abuse. Among these risk factors, diabetes and hypertension are rapidly growing epidemics leading to a substantial increase in cardiovascular disease and stroke. In this review, the authors discuss the risk factors for stroke with emphasis on the diabetic and hypertensive population, highlighting the interventions that have been shown to decrease stroke risk in this patient population.
David Ayman, MD: An Early Investigator of Clinical Hypertension
Authors: Materson Barry J. , Leclercq Baudouin
Published: May 2007

Dr. David Ayman (1901–1986) was an astute clinician and observer who challenged medical dogma by performing placebo‐controlled studies and by meticulous measurement of blood pressure under standardized conditions. He demonstrated that almost all drugs reported to have an antihypertensive effect in the early 20th century had achieved nothing more than placebo response. He noted the marked variability of blood pressure and devised methods to reduce that variability. These observations led to his publications concerning what is now known as “white coat” or office hypertension. He determined blood pressure personally in 1524 members of 277 families over three generations and made observations on the hereditary nature of hypertension that countered the single‐gene thinking of the day. His work is proof that clinical inquisitiveness, hard work, and the courage to challenge conventional wisdom can result in significant contributions to medicine and science.
EUROPA: Has Anything New Been Learned With Angiotensin‐Converting Enzyme Inhibitors?
Authors: Sica Domenic A
Published: May 2007

The European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease (EUROPA) involved 12,218 patients with stable coronary artery disease. Patients in this trial were randomized to the angiotensin‐converting enzyme inhibitor perindopril (8 mg/d) or placebo in addition to optimized conventional therapy and followed for an average of 4 years. Perindopril reduced the primary end points of cardiovascular disease, myocardial infarction, and cardiac arrest by 20% (p=0.0003). Moreover, the angiotensin‐converting enzyme inhibitor reduced the rate of fatal and nonfatal myocardial infarction by 24% (p=0.001). The results from EUROPA complement those observed in the Heart Outcomes and Prevention Evaluation (HOPE) study and provide further support for the concept of angiotensin‐converting enzyme inhibitors conferring cardiovascular protection as a class effect.
Your Drug, My Drug, or Our Drugs: How Aggressive Should We Be With Antihypertensive Therapy?
Authors: Izzo Joseph L.
Published: May 2007

In the prevention of hypertensive complications, especially stroke and kidney disease, “lower is better” because for each decrease of 20 mm Hg systolic or 10 mm Hg diastolic pressure in the population, cardiovascular risk is halved. Ideally, the goal for each patient should be to reach the lowest blood pressure that is well tolerated, a value that may be well below the arbitrary threshold value of 140/90 mm Hg. For the majority of “uncomplicated hypertensives,” the question of single‐drug therapy is essentially moot, because more than one agent is almost always required to optimally control blood pressure. In individuals who already have heart or kidney disease, there are compelling indications for the use of drugs that block the renin‐angiotensin system, but the large outcome studies that spawned these recommendations are themselves combination trials. Thus, in virtually all patients, more than one drug is indicated. The best combinations take advantage of long durations of action and complementary mechanisms of action of the component and are not only able to effectively lower blood pressure, but also to favorably affect the natural history of hypertensive complications. Regimens—including fixed‐dose combination products—that combine a thiazide diuretic or calcium antagonist with an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker are most efficient. In summary, why would an astute clinician (or informed patient) be satisfied with the relatively limited effects of any single class of antihypertensive agents when better overall protection is possible?
Comparative Antihypertensive Efficacy of Angiotensin Receptor Blocker‐Based Treatment in African‐American and White Patients
Authors: Bakris George L. , Smith David H.G. , Giles Thomas D. , White William B. , Davidai Giora , Weber Michael A.
Published: May 2007

Blood pressure (BP) reuctions with agents that block the renin‐angiotensin system are regarded as less effective as monotherapy in African Americans than other ethnic groups. This practice‐based study compares the efficacy of an angiotensin receptor blocker‐based regimen in African‐American and Caucasian patients. Included in the 10‐week study were 173 African‐American and 1296 Caucasian patients. Efficacy was based on differences in 24‐hour ambulatory BP. After baseline ambulatory BP monitoring and office BPs were obtained, all patients were started or switched to the angiotensin receptor blocker telmisartan, 40–80 mg daily, plus hydro‐chlorothiazide 12.5 mg daily (if needed for office BP control: <140/90 mm Hg). More African Americans required the addition of a low‐dose thiazide diuretic than Caucasians (47.3% vs. 34.9%; p=0.021). Once patients with white coat hypertension were excluded (i.e., those with baseline ambulatory BP monitoring <130/80 mm Hg), ambulatory BP monitoring changes were similar between groups. A greater proportion of African Americans than Caucasians without white coat hypertension also needed combination therapy (52.1% vs. 39.5%; p=0.04). While achievement of BP goal was similar between groups by office criterion (<140/90 mm Hg), differences were noted by ambulatory BP monitoring (<130/80 mm Hg) (48.0% in African American vs. 63.2% in Caucasians; p=0.01) despite the same BP reductions, reflecting higher baseline values in African Americans. We conclude that an angiotensin receptor blocker as part of a BP‐lower‐ing strategy is effective in previously untreated African‐American patients, although a higher proportion will require the use of a diuretic compared with Caucasians.
Single‐ or Double‐Blind Treatment With Balsamodendron tnukul and Nifedipine in Hypertensive Patients
Authors: Panneerselvam Jayabal , Sambandam Ganapathy , Nalini Namasivayam
Published: May 2007

Editor's note: This preliminary report on the results of treatment with a plant extract alone and in combination with a calcium channel blocker suggests that we should be alert to the potential benefit of some naturally occurring substances. These should be carefully evaluated for the treatment of hypertension and dyslipidemia. Foxglove and rauwolfia are just two examples of how careful observations led to useful therapeutic aspects.

This study assessed and compared the effects of Balsamodendron mukul (an extract of the gum of a small tree) and nifedipine (a calcium‐channel‐blocking reference drug) on blood pressure, lipids, lipoproteins, and phospholipids in randomly selected patients with essential hypertension. Fifty‐seven newly diagnosed hypertensive patients were randomly divided into three groups. They received either single‐blind B. mukul (1.5 g/d) or single‐blind nifedipine (10 mg/d) double‐blind therapy with nifedipine (10 mg/d) and B. mukul (1.5 g/d) for 6 weeks. These groups were compared with control subjects. On treatment with B. mukul, levels of systolic blood pressure, diastolic blood pressure, plasma total cholesterol, low‐density lipoprotein cholesterol, very low‐density lipoprotein cholesterol, triglycerides, free fatty acids, and phospho‐lipid levels were significantly reduced, and high‐density lipoprotein cholesterol levels were significantly elevated, as compared with untreated hypertensive patients. Combined therapy with B. mukul and nifedipine was more beneficial than the treatment with B. mukul alone. Our study suggests that B. mukul may be an effective antihypertensive and hypolipidemic agent.
Genuine Episodic Memory Deficits and Executive Dysfunctions in Alcoholic Subjects Early in Abstinence
Authors: Pitel Anne Lise , Beaunieux Hélène , Witkowski Thomas , Vabret François , Guillery‐Girard Bérengère , Quinette Peggy , Desgranges Béatrice , Eustache Francis
Published: May 2007

Background: Chronic alcoholism is known to impair episodic memory function, but the specific nature of this impairment is still unclear. Moreover, it has never been established whether episodic memory deficit in alcoholism is an intrinsic memory deficit or whether it has an executive origin. Thus, the objectives are to specify which episodic memory processes are impaired early in abstinence from alcohol and to determine whether they should be regarded as genuine memory deficits or rather as the indirect consequences of executive impairments.

Methods: Forty recently detoxified alcoholic inpatients at alcohol entry treatment and 55 group‐matched controls underwent a neuropsychological assessment of episodic memory and executive functions. The episodic memory evaluation consisted of 3 tasks complementing each other designed to measure the different episodic memory components (learning, storage, encoding and retrieval, contextual memory, and autonoetic consciousness) and 5 executive tasks testing capacities of organization, inhibition, flexibility, updating, and integration.

Results: Compared with control subjects, alcoholic patients presented impaired learning abilities, encoding processes, retrieval processes, contextual memory and autonoetic consciousness. However, there was no difference between the 2 groups regarding the storage capacities assessed by the rate of forgetting. Concerning executive functions, alcoholic subjects displayed deficits in each executive task used. Nevertheless, stepwise regression analyses showed that only performances on fluency tasks were significantly predictive of some of the episodic memory disorders (learning abilities for 40%, encoding processes for 20%, temporal memory for 21%, and state of consciousness associated with memories for 26%) in the alcoholic group.

Discussion: At alcohol treatment entry, alcoholic patients present genuine episodic memory deficits that cannot be regarded solely as the consequences of executive dysfunctions. These results are in accordance with neuroimaging findings showing hippocampal atrophy. Moreover, given the involvement of episodic memory and executive functions in alcohol treatment, these data could have clinical implications.
Acute Ethanol Administration Rapidly Increases Phosphorylation of Conventional Protein Kinase C in Specific Mammalian Brain Regions in Vivo
Authors: Wilkie Mary Beth , Besheer Joyce , Kelley Stephen P. , Kumar Sandeep , O'Buckley Todd K. , Morrow A. Leslie , Hodge Clyde W.
Published: May 2007

Background: Protein kinase C (PKC) is a family of isoenzymes that regulate a variety of functions in the central nervous system including neurotransmitter release, ion channel activity, and cell differentiation. Growing evidence suggests that specific isoforms of PKC influence a variety of behavioral, biochemical, and physiological effects of ethanol in mammals. The purpose of this study was to determine whether acute ethanol exposure alters phosphorylation of conventional PKC isoforms at a threonine 674 (p‐cPKC) site in the hydrophobic domain of the kinase, which is required for its catalytic activity.

Methods: Male rats were administered a dose range of ethanol (0, 0.5, 1, or 2 g/kg, intragastric) and brain tissue was removed 10 minutes later for evaluation of changes in p‐cPKC expression using immunohistochemistry and Western blot methods.

Results: Immunohistochemical data show that the highest dose of ethanol (2 g/kg) rapidly increases p‐cPKC immunoreactivity specifically in the nucleus accumbens (core and shell), lateral septum, and hippocampus (CA3 and dentate gyrus). Western blot analysis further showed that ethanol (2 g/kg) increased p‐cPKC expression in the P2 membrane fraction of tissue from the nucleus accumbens and hippocampus. Although p‐cPKC was expressed in numerous other brain regions, including the caudate nucleus, amygdala, and cortex, no changes were observed in response to acute ethanol. Total PKCγ immunoreactivity was surveyed throughout the brain and showed no change following acute ethanol injection.

Conclusions: These results suggest that ethanol rapidly promotes phosphorylation of cPKC in limbic brain regions, which may underlie effects of acute ethanol on the nervous system and behavior.
Radiofrequency Catheter Ablation of Sustained Monomorphic Ventricular Tachycardia in Hypertrophic Cardiomyopathy
Authors: RODRIGUEZ LUZ‐MARIA , SMEETS JOEP L.R.M. , TIMMERMANS CARL , BLOMMAERT DOMINIQUE , Van DANTZIG JAN M. , De MUINCK EBO , WELLENS HEIN J.J.
Published: May 2007

Monomorphic VT in HCM. Introduction: Incessant monomorphic ventricular tachycardia (VT) with a right bundle branch block morphology and a northwest axis is a rare arrhythmic complication in a patient with hypertrophic cardiomyopathy and apical left ventricular aneurysm.

Methods and Results: The origin of this VT was localized using the following criteria: the presence of entrainment without fusion, equal internals from the stimulus to the beginning of the QRS complex and from the electrogram to the QRS complex during VT, and the first postpacing interval identical to the tachycardia cycle length. Radiofrequency energy applied to the septoapical part of the apical left ventricular aneurysm terminated the tachycardia within 2 seconds.

Conclusion: Using criteria to guide radiofrequency (RF) ablation of VT in patients with coronary artery disease, an incessant monomorphic VT in a patient with hypertrophic cardiomyopathy was successfully ablated.
Expedited, Chemically Enhanced Sperm Cell Recovery from Cotton Swabs for Rape Kit Analysis*
Authors: Norris Jessica V. , Manning Kate , Linke Sarah J. , Ferrance Jerome P. , Landers James P.
Published: May 2007

Abstract:  This report focuses on the development of a method for chemically induced enhancement of cell elution and recovery from cotton swabs. The method exploits the exclusive use of detergents for intact cell removal, and can be utilized in conjunction with, or to circumvent, conventional differential extraction (DE). Samples treated with Sarkosyl (54.4 ± 1.8%) and sodium dodecyl sulfate (SDS) (78.5 ± 0.7%) yielded higher sperm cell recoveries than a conventional DE buffer (39.4 ± 2.1%). The results indicated that the choice of detergent affected sperm cell yield, with anionic detergents having the greatest effect. Storage time of samples affected the concentration of detergent required for optimal sperm cell recovery, longer times requiring increased detergent concentrations. In addition, the extent of sperm cell lysis by proteinase K digestion was evaluated. The results indicate that the exclusive use of SDS enhances the release of sperm and epithelial cells from a cotton swab as compared with DE buffer, providing for a more effective DNA analysis.
Virtual Bronchoscopy
Authors: McLennan G. , Namati E. , Ganatra J. , Suter M. , O'Brien E. E. , Lecamwasam K. , Van Beek E. J. R. , Hoffman E. A.
Published: May 2007

Virtual bronchoscopy is evolving rapidly, and is becoming accepted into standard clinical practice. Virtual bronchoscopy is a term, which encompasses not only multi‐row detector X‐ray computerized tomography‐derived images, but also other computer graphics and computer vision‐derived value‐added digital imagery. Other imaging data sources used to create three‐dimensional image renderings of the bronchial tree include magnetic resonance imaging, positron emission tomography, the digital colour image taken at real bronchoscopy as part of macro‐optical imaging, and various emerging micro‐optical imaging modalities, such as catheter‐based confocal microscopy and optical coherence tomography. Software solutions now exist for providing simple renderings of the bronchial tree through which a fly‐through of the airway lumen along the centreline of the airway can be added (the fly‐through mimics the view that a real flexible bronchoscope affords the operator). The images so produced are visually accurate and with currently available software also analytically correct. More advanced virtual bronchoscopic applications, including image‐based pathfinding to mediastinal and peripheral lung structures, are also in development, and are finding their way into clinical studies. Exciting and synergistic data sets composed of image data from multiple image sources are also being constructed. One emerging issue is to enhance the understanding and reporting on these data sets, which are often complex, and which are full of useful as well as redundant information. The new discipline of eidomics will inform the non‐specialist end user, and act to predict important outcomes. These increasingly powerful tools will continue to advance the use of imaging in technology‐supported personalized medicine, to compliment the information from genomics.
Immediate Placement of Implants and Appliance in an Irradiated Patient: A Case Study
Authors: Brandt Robert Lewis , Balanoff William
Published: May 2007

Purpose  The purpose of this study was to evaluate the immediate placement of implants and appliance using hyperbaric oxygenation on a 45‐year‐old male with a history of sqaumous cell carcinoma of the floor of the mouth.

Materials  Five Nobel Biocare implants between the mental foamina were used along with a course of pre‐ and postsurgical hyperbaric oxygenation.

Results  After 39 months, the patient is symptom free and shows no signs of rejection.

Conclusion  Using an accepted hyperbaric oxygenation protocol when placing and restoring immediate implants in this patient resulted in a successful treatment outcome.
Assessing Herbivory Rates of Leaf‐Cutting Ant (Atta colombica) Colonies Through Short‐Term Refuse Deposition Counts
Authors: Herz Hubert , Beyschlag Wolfram , Hölldobler Berthold
Published: May 2007

Leaf‐cutting ants (generaAttaandAcromyrmex) are considered dominant herbivores of Neotropical forests. However, so far quantitative, long‐term, and large‐scale assessments of their impact on these ecosystems are rare, because the available assessment methods were laborious and/or destructive. We describe a rapid, nondestructive, and inexpensive method to estimate the long‐term harvest ofAtta colombicacolonies. Workers ofA. colombicadump the colony refuse (exhausted fungal substrate) outside the nest. A single trail connects the refuse pile and the nest. In contrast to the foraging activity, the refuse deposition rate (the number of deposited refuse particles per minute) is diurnally constant and varies little on subsequent days. The number of refuse particles deposited per day was tightly correlated with the number of harvested fragments in nests of differing sizes (R2= 0.77,P< 0.0001). Therefore, the daily harvest of a particular colony can be calculated from short‐term counts (5 min) of the refuse deposition rate at any time of the day. Combining these data with information on average fragment size (weight and/or area) allows the calculation of the total daily amount of biomass and/or foliage area harvested by the colony. This new method facilitates quantifyingA. colombicaherbivory on scales of populations and ecosystems, or over long‐term scales.
Herbivory Rate of Leaf‐Cutting Ants in a Tropical Moist Forest in Panama at the Population and Ecosystem Scales
Authors: Herz Hubert , Beyschlag Wolfram , Hölldobler Berthold
Published: May 2007

Leaf‐cutting ants are frequently characterized as the major herbivores in the Neotropics, but quantitative data to back up this assumption are scarce. In this study, the consumption and herbivory rates for the entire leaf‐cutting ant (Atta colombica, Formicidae) population in an old secondary forest on Barro Colorado Island (BCI) in Panama were determined over 15 mo (on average 49 colonies). The number of harvested leaf fragments was calculated from monthly refuse deposition rates of the colonies and the regression between refuse deposition and harvesting rates. The inclusion of fragment characteristics (proportion of leaf fragments in the harvest, average fragment weight, and area) allowed us to calculate consumption and herbivory rates at colony, population, and ecosystem levels. TheA. colombicapopulation harvested 13.2 tons of biomass/yr and 13.1 ha of leaf area/yr, and deposited 9.4 tons of refuse material/yr. Rates varied considerably among colonies. At the ecosystem level,i.e., per forest area, herbivory rates were 132 kg biomass/ha/yr and 1310 m2foliage/ha/yr. For the area on BCI whereA. colombicaoccurs (100 ha), this is equivalent to 2.1 percent of the foliage area in the forest or 1.7 percent of the annual leaf‐area production. This value is considerably lower than previously published estimates of leaf‐cutting ant herbivory rates in tropical forests.
USE OF DIGITALIZED IMAGES TO VISUALLY ASSESS COLOR OF COOKED SAUSAGES
Authors: PIETTE J.‐P. G. , FORTIN J. R. , HOK L. , DURAND N. C.
Published: May 2007

A study was undertaken to explore the use of computer imaging to assess the color of cured meat products. Wiener sausages were manufactured to produce a color gradient. Increasing amounts of red carmine were added to the raw sausage emulsion (0, 50, 65, 100, 125, and 150 ppm) so that the extreme shades (0 and 150 ppm carmine) were clearly different, while the smallest color difference (e.g. 50 and 65 ppm carmine) was barely perceptible. Slices of the sausages containing 0, SO, 100, 125, atzd 15O ppm of carmine were presented to a group of 10 trained panelists in a standard lightbooth (065 lighting, 978 ± 21 lux; ASTM 1996) and the panelists were asked to evaluate the relarive color difference between each sausage and a reference sausage (65 ppm carmine), using the standard R‐index multiple comparison test. The panelists were also asked to make the same evaluation while looking at digitalized images of the sausage slices on a high quality color computer screen. In general, small differences in shade (Δa* 1.0–1.8) were more ofen perceived by panelists when these were looking at slice images on the computer screen than when observing the actual slices in the lightbooth.
THE SHEAR FORCE OF VERY‐RAPIDLY CHILLED LAMB 2: THE EFFECT OF MUSCLE EXCISION
Authors: McGEEHIN B. , REDMOND G.A. , SHERIDAN J.J. , BUTLER F.
Published: May 2007

The effect of chilling rate and muscle excision on the shear force of ovine muscle (M. longissimus thoracis et lumborum) was examined. Conventional chilling involved chilling at 4C for 24 h and very‐rapid chilling involved chilling at −20C for 3.5 h followed by conventional chilling for 20.5 h. After 24 h all muscles were aged for a further four days. Approximately 30 min after slaughter, one M. longissimus thoracis et lumborum was excised from each carcass and placed in the same chill as the remainder of the carcass. This gave a total of four different treatments. Shear force was assessed at I and 5 days postmortem by Warner‐Bratzler shear force measurement. Excision led to reduced shear force in the very‐rapid chilling regime but increased shear force in the conventionally chilled muscles. Aging improved shear force for all chilling treatments. No significant difference was found in the rate of pH fall, between the chilling treatments.