bluuebunny/crossref_metadata_2025 huggingface dataset:
CASE REPORT: TROUBLE‐SHOOTING FOR DIFFICULT CASES OF COMMON BILE DUCT STONES WITH ENDOSCOPIC TREATMENT
Authors: Tanaka Kiyohito , Yasuda Kenjiro , Uno Koji , Kawabata Hideaki , Kawamura Takuji , Morikawa Soichiro
Published: May 2010

A case of basket catheter impaction was experienced during treatment for a common bile duct (CBD) stone. In cases of large CBD stones, mechanical basket lithotripsy or extracorporeal shock wave lithotripsy (ESWL) is usually carried out. However, once basket catheter impaction occurs, ESWL should be performed in the remaining basket catheter, which is passed through the patient's nose, and further ESWL basket lithotripsy must be carried out at a later time. On one occasion, a mechanical lithotripter was inserted along‐side the conventional basket catheter through the incised papilla. This procedure is a safe and useful method for the clearance of CBD stones that cannot be removed with standard endoscopic procedures due to an impacted basket catheter.
LOCAL RECURRENCE AND SURVEILLANCE AFTER ENDOSCOPIC RESECTION OF LARGE COLORECTAL TUMORS
Authors: Hotta Kinichi , Saito Yutaka , Matsuda Takahisa , Shinohara Tomoaki , Oyama Tsuneo
Published: May 2010

Local recurrence rates after endoscopic piecemeal mucosal resection (EPMR) typically range from 10 to 23%. In our previous study, the local recurrence rate after a piecemeal resection was significantly higher than that after an en bloc resection, irrespective of tumor size or macroscopic features. To reduce local recurrence after an EPMR, it is important to carefully note the circumferences of the edge and base of the ulcer. Recently, endoscopic submucosal dissection (ESD) was developed and recognized for its effectiveness in large, complete, en bloc resections and precise pathological assessments. ESD also showed lower local recurrence rates, ranging from 0 to 3% in previous, retrospective studies. However, ESD showed a higher perforation rate and longer procedure times; thus, it is necessary to improve ESD. An appropriate surveillance interval after EPMR was still controversial, and recommendations of some guidelines ranged from 2 to 9 months. In order to determine the appropriate interval, a randomized controlled study is necessary.
SURGICAL INDICATIONS AND PROCEDURES FOR BLEEDING PEPTIC ULCER
Authors: Abe Nobutsugu , Takeuchi Hirohisa , Yanagida Osamu , Sugiyama Masanori , Atomi Yutaka
Published: May 2010

Recent important insights into the surgical treatment of bleeding peptic ulcer are reviewed in this article. Although the widespread use of endoscopic treatment and interventional radiology has reduced the number of surgical cases, surgery still plays a pivotal role in managing bleeding peptic ulcer. Failure to stop the bleeding by endoscopy and/or interventional radiology is the most important indication for emergency surgery. An early elective/planned surgery after the initial endoscopic control to prevent life‐threatening rebleeding seems justified in patients who have risk factors for rebleeding, although its true efficacy still remains controversial. The surgical procedures in emergency situations should be limited to safe hemostasis. The addition of acid‐reduction surgery may be unnecessary as a result of the increasing utilization of proton pump inhibitors. Angiographic embolization may be a less invasive alternative to surgery, and may further enhance endoscopic hemostasis.
PREVALENCE AND CLINICOPATHOLOGICAL FEATURES OF NONPOLYPOID COLORECTAL NEOPLASMS: SHOULD WE PAY MORE ATTENTION TO IDENTIFYING FLAT AND DEPRESSED LESIONS?
Authors: Matsuda Takahisa , Saito Yutaka , Hotta Kinichi , Sano Yasushi , Fujii Takahiro
Published: May 2010

Flat and depressed (nonpolypoid) colorectal lesions have been described for over two decades by Japanese investigators. These neoplastic lesions are typically smaller than polypoid ones and can be more difficult to identify during screening colonoscopy. In particular, depressed type colorectal lesions are usually small in size, with a number of studies showing them to be at greater risk for developing high‐grade dysplasia or submucosal invasive cancer. It has also been suggested that they may follow a different carcinogenic pathway to flat elevated or protruding adenomas. This paper summarizes recent data of nonpolypoid colorectal neoplasms from Western and Asian countries.
IMPACT OF NARROW‐BAND IMAGING IN SCREENING COLONOSCOPY
Authors: Uraoka Toshio , Higashi Reiji , Saito Yutaka , Matsuda Takahisa , Yamamoto Kazuhide
Published: May 2010

Narrow band‐imaging (NBI) enhances mucosal visualization of the vascular network and surface structure and helps to increase the visibility of neoplasia by improving contrast. Studies on the detectability of colorectal neoplastic lesions using NBI have primarily been reported in Western countries, but the published opinions and conclusions remain controversial at the present time. Our earlier prospective pilot study demonstrated that NBI colonoscopy significantly improved detection of flat lesions, which are more likely to be missed, particularly on the right side of the colon. It is especially important that even examiners performing routine screening colonoscopies become sufficiently familiar with flat and depressed lesions and then take full advantage of the endoscopic systems and specific image enhancement functions currently available for improved detection of flat and diminutive lesions. Adequate bowel preparation is another important consideration.
FEASIBILITY OF INTERVENTIONAL ENDOSCOPIC ULTRASOUND USING FORWARD‐VIEWING AND CURVED LINEAR‐ARRAY ECHOENDOSCOPE: A LITERATURE REVIEW
Authors: Irisawa Atsushi , Imaizumi Hiroshi , Hikichi Takuto , Takagi Tadayuki , Ohira Hiromasa
Published: May 2010

Oblique‐viewing curved linear‐array echoendoscopes are widely used for interventional endoscopic ultrasound (EUS), not only for diagnostic but also for therapeutic procedures. Recently, development of a forward‐viewing curved linear‐array echoendoscope (FV‐ES) has been made. Several reports describe the usefulness of this new equipment for therapeutic interventional EUS, especially for pseudocyst drainage. A salient advantage of the FV‐ES is that it enables the axial application of force during needle insertion and stenting. Furthermore, by attaching a cap device to the tip, the endoscope's capability can be expanded. Although the FV‐ES has a narrower scanning range (90 deg) than that afforded by the oblique‐viewing curved linear‐array echoendoscope (180 deg), this characteristic reportedly does not hinder the performance of interventional EUS. The FV‐ES might contribute to the advancement of interventional EUS.
PRELIMINARY EXPERIENCE OF A PROTOTYPE FORWARD‐VIEWING CURVED LINEAR ARRAY ECHOENDOSCOPE IN A TRAINING PHANTOM MODEL
Authors: Imaizumi Hiroshi , Irisawa Atushi
Published: May 2010

Oblique‐viewing curved linear array (OV‐CLA) echoendoscopes have been widely used to perform endoscopic ultrasonography‐guided fine needle aspiration and interventional endoscopic ultrasonography. Recently a prototype forward‐viewing curved liner array (FV‐CLA) echoendoscope was developed. In the present trial, 11 endoscopists participated in a hands‐on trial and a questionnaire survey to evaluate the operation performance and visualization performance of a prototype FV‐CLA scope in a phantom model designed for training of endoscopic ultrasonography. The results of our trial suggested that the FV‐CLA scope is slightly inferior or equivalent to the conventional OV‐CLA scope in operation performance, and that the FV‐CLA scope is equivalent to the OV‐CLA scope with regard to the visualization performance in a phantom model.
Interpretation of the prostate‐specific antigen history in assessing life‐threatening prostate cancer
Authors: Kettermann Anna E. , Ferrucci Luigi , Trock Bruce J. , Metter E. Jeffrey , Loeb Stacy , Carter H. Ballentine
Published: May 2010

Study Type – Diagnosis (validating cohort) Level of Evidence 1b

OBJECTIVE

To present an effective approach to the early detection of lethal prostate cancer using longitudinal data on prostate‐specific antigen (PSA) and its rate of change, i.e. PSA velocity (PSAV). This longitudinal approach might also be extendible to other biomarkers.

SUBJECTS AND METHODS

PSAV was calculated using five techniques for 634 subjects with at least three PSA measurements in a longitudinal ageing study, censoring PSA levels of >10 ng/mL. The efficacy for predicting death from prostate cancer was assessed with concordance indices and by using net reclassification improvement (NRI), which indicated the net increase in sensitivity and specificity when adding a biomarker to a base Cox proportional hazards model. The PSAV techniques were compared for the 5–10 years before the clinical diagnosis of prostate cancer. The most effective technique was then applied at the transition point when each man’s PSA history curve transformed from linear to exponentially increasing, and its predictive value was compared to that of concurrent PSA level.

RESULTS

A PSA transition point was found in 522 (82%) of the 634 men, including all 11 who died from prostate cancer. At the transition point, the mean PSA level was 1.4 ng/mL, and PSAV but not PSA level was significantly higher among men who died from prostate cancer than among men who did not (P= 0.021 vs P= 0.112; Wilcoxon two‐sample test). At the transition point, adding PSAV to a base model consisting of age and date of diagnosis improved the concordance index by 0.05, and significantly improved the overall sensitivity and specificity (NRI, P= 0.028), while adding PSA level to the same base model resulted in little improvement (concordance index increase <0.01 and NRI P= 0.275).

CONCLUSION

When the shape of a man’s PSA history curve changes from linear to exponential, PSAV might help in the early identification of life‐threatening prostate cancer at a time when PSA values are still low in most men.
Mother Abuse: A Matter of Youth Justice, Child Welfare or Domestic Violence?
Authors: Hunter Caroline , Nixon Judy , Parr Sadie
Published: May 2010

International evidence suggests that in advanced welfare states the abuse of parents, most particularly mothers, by their (most frequently male) adolescent children is increasingly prevalent. In the United Kingdom, however, child‐to‐mother abuse remains one of the most under‐acknowledged and under‐researched forms of family violence. Although it is an issue shrouded in silence, stigma, and shame, the authors' work in the youth justice sphere, focusing on interventions to deal with anti‐social behaviour, suggests that adolescent violence toward mothers is a topical and prevalent issue. We identify different ways of conceptualizing it in the policy realms of youth justice, child welfare, and domestic violence. The behaviour of both child/young person and mother is constructed in ways which inform the assignment of blame and responsibility. The paper highlights the silence that surrounds the issue in both the policy and wider academic spheres, hiding the failure of service providers to respond to this very destructive form of intimate interpersonal violence.
How Does Cognitive Conflict in Design Teams Support the Development of Creative Ideas?
Authors: Badke‐Schaub Petra , Goldschmidt Gabriela , Meijer Martijn
Published: May 2010

Is cognitive conflict detrimental to the development of innovative ideas in design teams, or is it a precondition for innovative performance? Assuming that there is a relationship between cognitive conflict and innovation, what kind of strategies do teams use in situations of cognitive conflict and what are the consequences for creativity? This paper reports on a study analysing how design teams cope with cognitive conflict during idea generation in an experiment. The design process was captured in protocols that were generated from video recordings. We report the results of the analysis of verbal protocols according to the five styles of (cognitive) conflict behaviour: competing, collaborating, compromising, avoiding and accommodating. Out of six teams, the results of the two highest and two lowest scoring teams are compared as regards innovation and functionality, which we see as the two components of creative outcomes. We show that design teams, even in a laboratory environment, encounter a considerable amount of cognitive conflict. A statistical comparison between the groups with the highest and the lowest innovative/functional design concept scores reveals significant differences in their conflict behaviour styles. The high innovation and high functionality groups used a more competing and a more compromising style, whereas groups rated low on the same parameters used a more collaborating style. The high rating groups on both creativity components used a more associating and rejecting behaviour style; the high innovation groups also generated more new ideas than the low innovation groups. The low rating groups on both innovation and functionality tended to repeat ideas more frequently. The main finding is that, in contrast with reports in previous research, the groups with higher innovation and functionality scores collaborated less than their peers in the low rating groups on these parameters. We interpret these results as signifying that creative performance in teams is not achieved mainly by agreement but needs cognitive confrontation.
How the Network Position of R&D Team Managers and Members Affects their Evaluations of Creative Performance
Authors: Kratzer Jan , Hölzle Katharina , Gemünden Hans G.
Published: May 2010

Monitoring the creative performance of R&D teams as the nucleus of creating new knowledge is inherently difficult. In most cases, only the team managers and team members can be tapped as reliable sources of information. However, there are indications that neither team managers nor team members provide a sufficient introspection to evaluate the R&D team's creative performance. This contradiction was investigated in 51 R&D teams by examining the team managers' and members' network position and their resulting performance evaluations. The central findings of the study are that team managers and members evaluate the creative performance of their R&D teams more negatively when the amount and variety of information they are supplied are insufficient and that there are no relevant differences between team managers' and team members' evaluations or network positions.
Dreaming of a Smallholding
Authors: Blekesaune Arild , Haugen Marit S. , Villa Mariann
Published: May 2010

The article examines a phenomenon associated with the rural idyll – the dream of becoming the owner of a smallholding in the countryside. Much research and policy concern in Norway have focused upon rural–urban migration trends and the consequences of the urbanisation process on the sustainability of rural communities. Less attention has been given to the counter trend, that is, urban dwellers searching for a better quality of life in the countryside. The article is based on data from a Norwegian national survey and analyses a question measuring respondents' interest in buying a smallholding. The analysis involves an estimation of a regression model to determine which demographic, socioeconomic and attitudinal variables influence people's interest in buying a smallholding. Further, we were interested in their plans for the smallholding (farming, residence, second home) and the kind of influences these potential new smallholding owners might have on rural communities. Three categories of potential smallholders are identified: aspiring farmers, country‐life lovers and recreation seekers. The results indicate that those who live in urban areas are more interested in buying a smallholding than those already living in rural areas.
Mobility Demands and Participation in Remote Rural Areas
Authors: Osti Giorgio
Published: May 2010

Although some rural areas of Italy are close to the country's most developed regions, in recent decades they have entered demographic decline: today, these areas are characterised by very high percentages of old people and very small numbers of family members. In some mountain villages the relational web is so weak as to represent a severe form of exclusion. Increasing virtual and physical mobility is seen as an answer to depopulation and marginality. The article seeks to verify the plausibility of the idea that mobility organisation can improve the traditional policies of territorial development by placing more emphasis on the involvement of the local population in transport services. To this end, it constructs a typology of rural areas on the basis of Kaufmann's categories of connectivity and reversibility. These ideal types are then used to analyse the trends and chances of mobility in remote Italian rural areas.
Managed migration? Nurse recruitment and the consequences of state policy
Authors: Bach Stephen
Published: May 2010

This article analyses the main trends in nurse migration to the UK and highlights the importance of state policy as a major influence shaping employer utilisation of migrant nurses. The introduction of the points‐based immigration system is considered, and the consequences for migrant nurses, employers and trade unions are examined.
Formulation and stability of a novel artificial sebum under conditions of storage and use
Authors: Stefaniak Aleksandr B. , Harvey Christopher J. , Wertz Philip W.
Published: May 2010

Synopsis

Materials in contact with liquids on the human skin surface may dissolve and permeate into skin. Release and permeation of chemicals in contact with skin is often estimated in vitro using artificial skin liquids, although sebum lipids are generally not included in these models. The purposes of this research were to develop a representative artificial sebum that contains the appropriate types of lipids at levels that match human values and quantitatively characterize the model to understand its utility for in vitro testing. Artificial sebum that consisted of 10 lipids at proportions that closely resembled human sebum was characterized using thin layer chromatography under a variety of storage and use conditions (dry and liquid, 4°C and 32°C, with and without vitamin E) for 28 days. Levels of sebum constituents maintained in solution and dry at 4°C were stable through the duration of the test period. Levels of all sebum lipids maintained dry at 32°C were stable in the presence of vitamin E; however, squalene oxidized rapidly in the absence of vitamin E. Liquids on the human skin surface consist of sebum and sweat with minor amounts of cellular debris and intercellular lipid from the stratum corneum. The relative importance of each component for release of chemicals from materials in contact with skin will depend upon the type of material (metal, organic, etc.). A model artificial sebum was formulated and characterized to aid researchers in understanding potential release of chemicals from materials in contact with skin and subsequent partitioning and absorption.
Block Buying and Choice of Issue Method in UK Seasoned Equity Offers
Authors: Armitage Seth
Published: May 2010

Abstract:  Much of the new equity declined by existing shareholders in UK SEOs is bought in a few large blocks, both by other existing holders and by new investors. The paper argues that a placing process via negotiation with investors facilitates the purchase of large blocks better than the alternative method of selling rights on the market, and that this helps to explain the decline of rights issues in the UK. Other explanations for use of the placing method appear to be of limited relevance, except perhaps certificaton of issuer value.
Are language and social communication intact in children with congenital visual impairment at school age?
Authors: Tadić Valerie , Pring Linda , Dale Naomi
Published: May 2010

Background:  Development of children with congenital visual impairment (VI) has been associated with vulnerable socio‐communicative outcomes often bearing striking similarities to those of sighted children with autism.1 To date, very little is known about language and social communication in children with VI of normal intelligence.

Methods:  We examined the presentation of language and social communication of 15 children with VI and normal‐range verbal intelligence, age 6–12 years, using a standardised language assessment and parental reports of everyday social and communicative behaviours. Their profiles were compared to those of typically developing sighted children of similar age and verbal ability.

Results:  Compared to their sighted peers, and relative to their own good and potentially superior structural language skills, children with VI showed significantly poorer use of language for social purposes. Pragmatic language weaknesses were a part of a broader socio‐communicative profile of difficulties, present in a substantial proportion of these children and consistent with the pattern found in sighted children with autism.

Conclusions:  There are ongoing socio‐communicative and pragmatic language difficulties in children with congenital VI at school age, despite their good intellectual abilities and advanced linguistic skills. Further research is required to unpack the underlying causes and factors maintaining this vulnerability in such children.
Remote sensing of plant functional types
Authors: Ustin Susan L. , Gamon John A.
Published: May 2010

Conceptually, plant functional types represent a classification scheme between species and broad vegetation types. Historically, these were based on physiological, structural and/or phenological properties, whereas recently, they have reflected plant responses to resources or environmental conditions. Often, an underlying assumption, based on an economic analogy, is that the functional role of vegetation can be identified by linked sets of morphological and physiological traits constrained by resources, based on the hypothesis of functional convergence. Using these concepts, ecologists have defined a variety of functional traits that are often context dependent, and the diversity of proposed traits demonstrates the lack of agreement on universal categories. Historically, remotely sensed data have been interpreted in ways that parallel these observations, often focused on the categorization of vegetation into discrete types, often dependent on the sampling scale. At the same time, current thinking in both ecology and remote sensing has moved towards viewing vegetation as a continuum rather than as discrete classes. The capabilities of new remote sensing instruments have led us to propose a new concept of optically distinguishable functional types (‘optical types’) as a unique way to address the scale dependence of this problem. This would ensure more direct relationships between ecological information and remote sensing observations.

Contents

Summary
795

I.
Introduction
796

II.
History of functional‐type classifications of vegetation
796

III.
History of remote sensing of vegetation
799

IV.
New sensors and perspectives
802

V.
Measuring detailed canopy structure
806

VI.
The emerging hypothesis of ‘optical types’
810

VII.
Conclusions
811

Acknowledgements
811

References
811
RGS9‐2 mediates specific inhibition of agonist‐induced internalization of D2‐dopamine receptors
Authors: Celver Jeremy , Sharma Meenakshi , Kovoor Abraham
Published: May 2010

J. Neurochem.(2010)114, 739–749.

Regulator of G protein signaling 9‐2 (RGS9‐2), a member of the RGS family of GTPase accelerating proteins, is expressed specifically in the striatum, a brain region involved in controlling movement, motivation, mood and addiction. RGS9‐2 can be found co‐localized with D2‐class dopamine receptors in medium spiny striatal neurons and altered functioning of both RGS9‐2 and D2‐like dopamine receptors have been implicated in schizophrenia, movement disorders and reward responses. Previously we showed that RGS9‐2 can specifically co‐localize with D2‐dopamine receptors (D2R). Here we provide further evidence of the specificity of RGS9‐2 for regulating D2R cellular functions: the expression of RGS9‐2 inhibits dopamine‐mediated cellular internalization of D2R, while the expression of another RGS protein, RGS4, had no effect. In addition, the agonist‐mediated internalization of the G protein coupled delta opioid receptor was unaffected by RGS9‐2 expression. We utilized mutant constructs of RGS9‐2 to show that the RGS9‐2 DEP (for Disheveled, EGL‐10, Pleckstrin homology) domain and the GTPase accelerating activity of RGS9‐2 were necessary for mediating specific inhibition of D2R internalization.
AAV‐mediated expression of wild‐type and ALS‐linked mutant VAPB selectively triggers death of motoneurons through a Ca2+‐dependent ER‐associated pathway
Authors: Langou Karine , Moumen Anice , Pellegrino Christophe , Aebischer Julianne , Medina Igor , Aebischer Patrick , Raoul Cédric
Published: May 2010

J. Neurochem. (2010) 114, 795–809.

A dominant mutation in the gene coding for the vesicle‐associated membrane protein‐associated protein B (VAPB) was associated with amyotrophic lateral sclerosis, a fatal paralytic disorder characterized by the selective loss of motoneurons in the brain and spinal cord. Adeno‐associated viral vectors that we show to transduce up to 90% of motoneurons in vitro were used to model VAPB‐associated neurodegenerative process. We observed that Adeno‐associated viral‐mediated over‐expression of both wild‐type and mutated form of human VAPB selectively induces death of primary motoneurons, albeit with different kinetics. We provide evidence that ER stress and impaired homeostatic regulation of calcium (Ca2+) are implicated in the death process. Finally, we found that completion of the motoneuron death program triggered by the over‐expression of wild‐type and mutant VAPB implicates calpains, caspase 12 and 3. Our viral‐based in vitro model, which recapitulates the selective vulnerability of motoneurons to the presence of mutant VAPB and also to VAPB gene dosage effect, identifies aberrant Ca2+ signals and ER‐derived death pathways as important events in the motoneuron degenerative process.
ERP and RT Delays in Long‐Term Abstinent Alcoholics in Processing of Emotional Facial Expressions During Gender and Emotion Categorization Tasks
Authors: Fein George , Key Kameron , Szymanski Michael D.
Published: May 2010

Background:  There is considerable evidence that alcoholics differ from nonalcoholics in the processing of stimuli that have emotional content. The current study examines those differences that are present in multi‐year abstinent individuals.

Methods:  We compared reaction time (RT), accuracy, and Event Related Potentials (ERP) measures in long‐term abstinent alcoholics (LTAA, n = 52) with that in age‐ and gender‐comparable nonalcoholic controls (NAC, n = 47). Subjects were presented with male and female faces exhibiting happy, neutral, or sad facial expressions and were instructed to identify the picture gender in 1 task and the emotion being expressed in a subsequent task.

Results:  LTAA had slower RTs than NAC when instructed to identify emotion, while RT was comparable when identifying gender. There were no differences between groups on task accuracy. P160 latency was increased in LTAA for both tasks compared to NAC, though P160 amplitude did not differ between groups. The P160 effect was about 5 × as large as the RT effect and was statistically independent of the RT effect, while the RT effect was no longer present after removing variance because of the P160 effect.

Conclusions:  Our data demonstrate slower early processing of emotional facial stimuli in alcoholics that is unresolved by long‐term abstinence and is most sensitively indexed by delayed P160 latency in LTAA.
Noninvasive Diagnosis of Large Esophageal Varices by Fibroscan: Strong Influence of the Cirrhosis Etiology
Authors: Nguyen‐Khac Eric , Saint‐Leger Pierre , Tramier Blaise , Coevoet Hugues , Capron Dominique , Dupas Jean‐Louis
Published: May 2010

Background:  Large esophageal varices (LOV) were diagnosed by endoscopy in patients with cirrhosis. Noninvasive method would be valuable.

Aims:  To evaluate the diagnostic performance of Fibroscan for LOV prediction and to investigate the prognostic value of liver stiffness (LS) in cirrhosis.

Patients and Methods:  One hundred and eighty‐three patients with cirrhosis (103 alcohol, 58 viral, and 22 others) underwent an endoscopy and a Fibroscan. Of those patients, 41 (22.4%) had LOV.

Results:  Median LS was 33.66 kPa (range: 12–75), higher in patients with LOV than those without (51.24 ± 1.61 vs. 29.81 ± 1.82 kPa, p < 0.0001), and in alcoholic than nonalcoholic (40.39 ± 1.75 vs. 25.73 ± 1.82, p < 0.0001). In whole population, a LS ≥48 kPa predicted LOV with sensitivity, specificity, positive, negative predictive values (PPV, NPV) of 73.2, 73.2, 44.1, and 90.4%, respectively, and an area under ROC curve (AUROC) of 0.75 (CI 95%: 0.69–0.82). For alcoholic cirrhosis, LS was ≥47.2 kPa with sensitivity, specificity, PPV, NPV of 84.6, 63.6, 44, and 92.5%, respectively, AUROC 0.77 (0.68–0.85). For viral cirrhosis, a LS ≥19.8 kPa generated diagnostic values of 88.9, 55.1, 26.7, and 96.4% and 0.73 (0.60–0.84). Sixteen (8.75%) patients died at 1 year. In multivariate analysis, LS was not predictive of mortality.

Conclusions:  Etiology of cirrhosis has strong impact on LS cutoff for diagnosis of LOV. Studies should be performed with homogenous cirrhosis etiology.
Age of Drinking Onset as a Moderator of the Efficacy of Parent‐Based, Brief Motivational, and Combined Intervention Approaches to Reduce Drinking and Consequences Among College Students
Authors: Mallett Kimberly A. , Ray Anne E. , Turrisi Rob , Belden Calum , Bachrach Rachel L. , Larimer Mary E.
Published: May 2010

Background:  The current study tested age of onset as a moderator of intervention efficacy on drinking and consequence outcomes among a high‐risk population of college students (i.e., former high school athletes).

Methods:  Students were randomized to one of four conditions: assessment only control, combined parent‐based intervention (PBI) and brief motivational intervention (BMI), PBI alone, and BMI alone. Participants (n = 1,275) completed web‐administered measures at baseline (summer before starting college) and 10‐month follow‐up.

Results:  Overall, the combined intervention demonstrated the strongest and most consistent reductions across all outcomes, particularly with the youngest initiators. Participants who initiated drinking at the youngest ages had significantly lower peak drinking, typical weekly drinking, and reported consequences at follow‐up when they received the combined intervention when compared to the control group. The BMI and PBI groups, when examined independently, demonstrated significant effects across outcomes but were inconsistent across the different age groups.

Conclusion:  Results suggest the combination of a PBI and a peer‐delivered BMI is an appropriate and efficacious way to reduce drinking and related consequences among individuals who initiated drinking earlier in adolescence and are at an increased risk of experiencing alcohol problems.
Acute Ethanol Effects on Brain Activation in Low‐ and High‐Level Responders to Alcohol
Authors: Trim Ryan S. , Simmons Alan N. , Tolentino Neil J. , Hall Shana A. , Matthews Scott C. , Robinson Shannon K. , Smith Tom L. , Padula Claudia B. , Paulus Martin P. , Tapert Susan F. , Schuckit Marc A.
Published: May 2010

Background:  A low level of response (LR) to alcohol is an important endophenotype associated with an increased risk of alcoholism. However, little is known about how neural functioning may differ between individuals with low and high LRs to alcohol. This study examined whether LR group effects on neural activity varied as a function of acute alcohol consumption.

Methods:  A total of 30 matched high‐ and low‐LR pairs (N = 60 healthy young adults) were recruited from the University of California, San Diego, and administered a structured diagnostic interview and laboratory alcohol challenge followed by two functional magnetic resonance imaging (fMRI) sessions under placebo and alcohol conditions, in randomized order. Task performance and blood oxygen level‐dependent response contrast to high relative to low working memory load in an event‐related visual working memory (VWM) task were examined across 120 fMRI sessions.

Results:  Both LR groups performed similarly on the VWM task across conditions. A significant LR group by condition interaction effect was observed in inferior frontal and cingulate regions, such that alcohol attenuated the LR group differences found under placebo (p < 0.05). The LR group by condition effect remained even after controlling for cerebral blood flow, age, and typical drinking quantity.

Conclusions:  Alcohol had differential effects on brain activation for low‐ and high‐LR individuals within frontal and cingulate regions. These findings represent an additional step in the search for physiological correlates of a low LR and identify brain regions that may be associated with the low LR response.
Transcallosal White Matter Degradation Detected With Quantitative Fiber Tracking in Alcoholic Men and Women: Selective Relations to Dissociable Functions
Authors: Pfefferbaum Adolf , Rosenbloom Margaret J. , Fama Rosemary , Sassoon Stephanie A. , Sullivan Edith V.
Published: May 2010

Introduction: Excessive alcohol consumption can adversely affect white matter fibers and disrupt transmission of neuronal signals. Here, we examined six anatomically defined transcallosal white matter fiber bundles and asked whether any bundle was specifically vulnerable to alcohol, what aspect of white matter integrity was most affected, whether women were more vulnerable than men, and whether evidence of compromise in specific bundles was associated with deficits in balance, sustained attention, associative learning, and psychomotor function, commonly affected in alcoholics.

Methods: Diffusion tensor imaging quantitative fiber tracking assessed integrity of six transcallosal white matter bundles in 87 alcoholics (59 men, 28 women) and 88 healthy controls (42 men, 46 women). Measures included orientational diffusion coherence (fractional anisotropy, FA) and magnitude of diffusion, quantified separately for axial (longitudinal; λL) and radial (transverse; λT) diffusivity. The Digit Symbol Test and a test of ataxia were also administered.

Results: Alcoholism negatively affected callosal FA and λT of all but the sensory‐motor bundle. Women showed no evidence for greater vulnerability to alcohol than men. Multiple regression analyses confirmed a double dissociation: higher diffusivity in sensory‐motor and parietal bundles was associated with poorer balance but not psychomotor speed, whereas higher diffusivity in prefrontal and temporal bundles was associated with slower psychomotor speed but not balance.

Conclusions: This study revealed stronger alcohol effects for FA and radial diffusivity than axial diffusivity, suggesting myelin degradation, but no evidence for greater vulnerability to alcohol in women than men. The presence of brain‐behavior relationships provides support for the role of alcoholism‐related commissural white matter degradation as a substrate of cognitive and motor impairment. Identification of a double dissociation provides further support for the role of selective white matter integrity in specific domains of performance.
MAOA Interacts With the ALDH2 Gene in Anxiety–Depression Alcohol Dependence
Authors: Lee Sheng‐Yu , Hahn Cheng‐Yi , Lee Jia‐Fu , Huang San‐Yuan , Chen Shiou‐Lan , Kuo Po‐Hsiu , Lee I Hui , Yeh Tzung Lieh , Yang Yen Kuang , Chen Shih‐Heng , Ko Huei‐Chen , Lu Ru‐Band
Published: May 2010

Background:  Alcohol dependence is usually comorbid with anxiety disorder, depressive disorder, or both; this comorbidity may increase drinking behavior. We previously hypothesized that anxiety–depressive alcohol dependence (ANX/DEP ALC) was a genetically specific subtype of alcohol dependence. ANX/DEP ALC may be related to dopamine and serotonin, which are catalyzed by monoamine oxidase A (MAOA) and acetaldehyde dehydrogenase 2 (ALDH2). The aim of this study was to determine whether the interaction between the MAOA and the ALDH2 genes is associated with ANX/DEP ALC.

Methods:  We recruited 383 Han Chinese men in Taiwan: 143 ANX/DEP ALC and 240 healthy controls. The diagnosis of ANX/DEP ALC (alcohol dependence with a past or current history of anxiety, depressive disorder, or both) was made using DSM‐IV criteria. Genotypes of ALDH2 and MAOA‐uVNTR (variable number of tandem repeat located upstream) were determined using PCR‐RFLP.

Results:  The ALDH2, but not the MAOA‐uVNTR, polymorphism was associated with ANX/DEP ALC. After stratifying the MAOA‐uVNTR polymorphism, we found a stronger association between the ALDH2*1/*2 and *2/*2 genotypes and the controls in the MAOA‐uVNTR 4‐repeat subgroup. Logistic regression significantly associated the interaction between ALDH2 and MAOA variants with ANX/DEP ALC.

Conclusion:  We conclude that the MAOA and ALDH2 genes interact in ANX/DEP ALC. Although the MAOA gene alone is not associated with ANX/DEP ALC, we hypothesize that different variants of MAOA‐uVNTR polymorphisms modify the protective effects of the ALDH2*2 allele on ANX/DEP ALC in Han Chinese in Taiwan.
Impact of Chronic Alcohol Ingestion on Cardiac Muscle Protein Expression
Authors: Fogle Rachel L. , Lynch Christopher J. , Palopoli Mary , Deiter Gina , Stanley Bruce A. , Vary Thomas C.
Published: May 2010

Background:  Chronic alcohol abuse contributes not only to an increased risk of health‐related complications, but also to a premature mortality in adults. Myocardial dysfunction, including the development of a syndrome referred to as alcoholic cardiomyopathy, appears to be a major contributing factor. One mechanism to account for the pathogenesis of alcoholic cardiomyopathy involves alterations in protein expression secondary to an inhibition of protein synthesis. However, the full extent to which myocardial proteins are affected by chronic alcohol consumption remains unresolved.

Methods:  The purpose of this study was to examine the effect of chronic alcohol consumption on the expression of cardiac proteins. Male rats were maintained for 16 weeks on a 40% ethanol‐containing diet in which alcohol was provided both in drinking water and agar blocks. Control animals were pair‐fed to consume the same caloric intake. Heart homogenates from control‐ and ethanol‐fed rats were labeled with the cleavable isotope coded affinity tags (ICAT™). Following the reaction with the ICAT™ reagent, we applied one‐dimensional gel electrophoresis with in‐gel trypsin digestion of proteins and subsequent MALDI‐TOF‐TOF mass spectrometric techniques for identification of peptides. Differences in the expression of cardiac proteins from control‐ and ethanol‐fed rats were determined by mass spectrometry approaches.

Results:  Initial proteomic analysis identified and quantified hundreds of cardiac proteins. Major decreases in the expression of specific myocardial proteins were observed. Proteins were grouped depending on their contribution to multiple activities of cardiac function and metabolism, including mitochondrial‐, glycolytic‐, myofibrillar‐, membrane‐associated, and plasma proteins. Another group contained identified proteins that could not be properly categorized under the aforementioned classification system.

Conclusions:  Based on the changes in proteins, we speculate modulation of cardiac muscle protein expression represents a fundamental alteration induced by chronic alcohol consumption, consistent with changes in myocardial wall thickness measured under the same conditions.
Validity Study of Kessler’s Psychological Distress Scales Conducted Among Patients Admitted to French Emergency Department for Alcohol Consumption–Related Disorders
Authors: Arnaud Benjamin , Malet Laurent , Teissedre Frédérique , Izaute Marie , Moustafa Fares , Geneste Julie , Schmidt Jeannot , Llorca Pierre‐Michel , Brousse Georges
Published: May 2010

Background:  Alcohol‐related disorders (ARD) encountered in emergency departments (ED) have a high prevalence and are underestimated. It is necessary to provide professionals with a tool to identify patients in whom there is a risk that alcohol‐related and mental health problems may be associated. Kessler’s K6/10 psychological distress scales are fast, easy‐to‐use, and have been shown to achieve a good performance in the identification of psychological distress associated with ARD.

Aim:  The aim of this study was to evaluate the psychometric properties of the Kessler scales, version 6 and 10, with a sample of patients admitted to EDs for alcohol consumption.

Methods:  On the day after their admission, with a zero “blood” alcohol concentration, 71 patients were randomly assigned to be assessed using 6 or 10 items version. The internal consistency and factor structure of the K6/10 versions were examined. Convergent validity was measured using the Hospital Anxiety and Depression Scale (HADS) and the Hamilton Depression Rating Scale (HDRS).

Results:  The prevalence of psychological distress in our sample was approximately 60%. The selected threshold scores were 10 for K6 (Sensitivity: 0.92; Specificity: 0.62) and 14 for K10 (Sensitivity: 0.95; Specificity: 0.54). The Cronbach coefficients for K6 and K10 were 0.76 and 0.84, respectively. The factor analyses indicated the multidimensional nature of K6/10. The 2 versions, containing 6 and 10 items respectively, correlated better with the HADS (0.83 and 0.70, respectively) than with the HDRS (0.51 and 0.49, respectively). The areas under the ROC Curve indicated a high level of accuracy for both the K6 (0.87) and the K10 (0.77). The difference was not statistically significant.

Conclusions:  This study confirms the good psychometric characteristics of Kessler’s psychological distress scale. Even though similar performances were observed for K6/10, the brevity of the K6 makes it more suitable for use in EDs.
Opiniones: End‐of‐Life Care Preferences and Planning of Older Latinos
Authors: Kelley Amy S. , Wenger Neil S. , Sarkisian Catherine A.
Published: May 2010

OBJECTIVES: To measure end‐of‐life (EOL) care preferences and advance care planning (ACP) in older Latinos and to examine the relationship between culture‐based attitudes and extent of ACP.

DESIGN: Cross‐sectional interview.

SETTING: Twenty‐two senior centers in greater Los Angeles.

PARTICIPANTS: One hundred forty‐seven Latinos aged 60 and older.

MEASUREMENTS: EOL care preferences, extent of ACP, attitudes regarding patient autonomy, family‐centered decision‐making, trust in healthcare providers, and health and sociodemographic characteristics.

RESULTS: If seriously ill, 84% of participants would prefer medical care focused on comfort rather than care focused on extending life, yet 47% had never discussed such preferences with their family or doctor, and 77% had no advance directive. Most participants favored family‐centered decision making (64%) and limited patient autonomy (63%). Greater acculturation, education, and desire for autonomy were associated with having an advance directive (P‐values <.03). Controlling for sociodemographic characteristics, greater acculturation (adjusted odds ratio (AOR)=1.6, 95% confidence interval (CI)=1.1–2.4) and preferring greater autonomy (AOR=1.6, 95% CI=1.1–2.3) were independently associated with having an advance directive.

CONCLUSIONS: The majority of older Latinos studied preferred less‐aggressive, comfort‐focused EOL care, yet few had documented or communicated this preference. This discrepancy places older Latinos at risk of receiving high‐intensity care inconsistent with their preferences.
Hospitalizations and Skilled Nursing Facility Admissions Before and After the Implementation of a Home‐Based Primary Care Program
Authors: Wajnberg Ania , Wang Karen H. , Aniff Mohamed , Kunins Hillary V.
Published: May 2010

OBJECTIVES: To evaluate the effect of an urban house calls program (HCP) on healthcare utilization.

DESIGN: Retrospective chart review with pre/post analysis.

SETTING: Urban home‐based primary care program.

PARTICIPANTS: All participants (N=179) in a capitated insurance program enrolled in a HCP between October 2004 and August 2006.

INTERVENTION: Enrollment into HCP.

MEASUREMENTS: Hospitalizations and skilled nursing facility (SNF) admissions before and after enrollment. Patients with at least one hospitalization or SNF admission before and after enrollment were compared using the McNemar test. Median number of hospitalizations and SNF placements before and after HCP enrollment were compared using the Wilcoxon signed‐rank sum test.

RESULTS: Sixty‐one percent of patients had one or more hospitalizations before enrollment, whereas only 38% had one or more hospitalizations after enrollment (P<.001). Thirty‐eight percent of patients had at least one SNF placement before enrollment, compared with 18% after enrollment (P=.001). The median hospitalization rate decreased from 1 to 0; the median SNF placement rate was 0 (interquartile range 0–1) before enrollment and 0 (interquartile range 0–0) after enrollment (P<.001).

CONCLUSION: A HCP may be associated with fewer hospitalizations and SNF placements. Models of care that reduce morbidity and preserve quality of life are critical to help homebound older adults remain in their communities.
Protein Intake and Incident Frailty in the Women's Health Initiative Observational Study
Authors: Beasley Jeannette M. , LaCroix Andrea Z. , Neuhouser Marian L. , Huang Ying , Tinker Lesley , Woods Nancy , Michael Yvonne , Curb J. David , Prentice Ross L.
Published: May 2010

OBJECTIVES: To evaluate the association between protein intake and incident frailty.

DESIGN: Prospective cohort study.

SETTING: Subset of the Women's Health Initiative Observational Study conducted at 40 clinical centers.

PARTICIPANTS: Twenty‐four thousand four hundred seventeen women aged 65 to 79 who were free of frailty at baseline with plausible self‐reported energy intakes (600–5,000 kcal/day) according to the Food Frequency Questionnaire (FFQ).

MEASUREMENTS: Baseline protein intake was estimated from the FFQ. Calibrated estimates of energy and protein intake were corrected for measurement error using regression calibration equations estimated from objective measures of total energy expenditure (doubly labeled water) and dietary protein (24‐hour urinary nitrogen). After 3 years of follow‐up, frailty was defined as having at least three of the following components: low physical function (measured using the Rand‐36 questionnaire), exhaustion, low physical activity, and unintended weight loss. Multinomial logistic regression models estimated associations for uncalibrated and calibrated protein intake.

RESULTS: Of the 24,417 eligible women, 3,298 (13.5%) developed frailty over 3 years. After adjustment for confounders, a 20% increase in uncalibrated protein intake (%kcal) was associated with a 12% (95% confidence interval (CI)=8–16%) lower risk of frailty, and a 20% increase in calibrated protein intake was associated with a 32% (95% CI=23–50%) lower risk of frailty.

CONCLUSION: Higher protein consumption, as a fraction of energy, is associated with a strong, independent, dose‐responsive lower risk of incident frailty in older women. Using uncalibrated measures underestimated the strength of the association. Incorporating more protein into the diet may be an intervention target for frailty prevention.