bluuebunny/crossref_metadata_2025 huggingface dataset:
Does the Initial Distribution Volume of Glucose Reflect the Central Extracellular Fluid Volume Status in Critically ill Patients?
Authors: Ishihara H. , Takamura K. , Koh H. , Iwakawa T. , Tsubo T. , Matsuki A.
Published: May 2009

Objective: Our experimental studies have indicated that the initial distribution volume of glucose (IDVG) has potential to evaluate the central extracellular fluid (ECF) volume status in the body. The purpose of the present study was to compare the IDVG and cardiac output (CO) in critically ill patients with or without expansion of the central ECF volume and to test whether a larger IDVG is observed during the presence of increased central ECF volume than during the absence of it. Design and Setting: The study was prospective and was conducted in the intensive care unit, University of Hirosaki Hospital, after approval of the institutional ethical committee. Patients: Fourteen patients with accumulation of the central ECF volume (the accumulation group) and 29 patients without it (the non-accumulation group) were studied. Interventions: Glucose 5 g was infused over 30 s when the patients’ hemodynamic states were relatively stable. Blood samples were taken immediately before infusion and during 7 min post-infusion. Thermodilution CO was also measured before each glucose challenge. A total of 81 comparisons were performed. Measurements and Results: The IDVG was calculated using a one-compartment model. A linear correlation was obtained between the IDVG and CO in the non-accumulation group (r = 0.89, n = 54, p < 0.001). The IDVG-CO ratio was higher in the accumulation group than in the non-accumulation group (p < 0.01). The increased plasma glucose concentrations at 3 min postinfusion were inversely proportional to the IDVG (r = -0.90, n = 81, p < 0.001). Conclusions: Results demonstrated that a larger IDVG was obtained during accumulation of the central ECF volume and support the hypothesis that the IDVG reflects the central ECF status in critically ill patients characterized in our study, even though CO influences the IDVG.
Prävalenz des humanen T-Zell-Leukämievirus I/II (HTLV-I/II) bei Dauerblutspendern aus urbanen und ländlichen Gebieten
Authors: Hitzler W. , Kiefhaber K. , Runkel S. , Jochum C.
Published: May 2009

Hintergrund: Ziel der Untersuchung ist die Ermittlung der Prävalenz von HTLV-I/II bei Dauerblutspendern in Deutschland zur Beurteilung eines möglichen Übertragungsrisikos durch Bluttransfusionen. Material und Methodik: 43185 Serum-proben von 11303 Dauerblutspendern des Jahres 1993 wurden auf HTLV-I/II-Antikörper untersucht (Abbott, HTLV-I-EIA). Als zusätzlicher Test für alle wiederholt positiven Proben diente ein ELISA (Pasteur, Platelia® HTLV-I New), als Bestätigungstests wurden ein Immunoblot [Diag. Biotechnology (Pte) Ltd., HTLV Blot 2.3] und die PCR (Hoffmann-La Roche, Amplicor® HTLV-I/II) verwendet. Ergebnisse: Die im HTLV-I-EIA reaktiven Spender wurden in vier Gruppen unter-teilt: positiv, grenzwertig, potentiell serokonvertiert und alternierend. Mit Hilfe von Bestätigungstests konnte jedoch nur bei einer Spenderin eindeutig eine persistierende HTLV-II-Infektion nachgewiesen werden. Eine HTLV-I-Infektion war bei keinem Spender nachzuweisen. Schlußfolgerungen: Vor dem Hintergrund der äußerst geringen Prävalenz von HTLV I/II von 0,01% erscheint die routinemäßige Testung von Blutspenden zur Zeit nicht notwendig. Regelmäßige epidemiologische Studien zur Verbreitung des HTL-Virus in Anbetracht der zunehmenden Fernreisen in endemische Gebiete sollten durchgeführt werden.
Qualitätssicherung in der autologen Hämotherapie – Risiko bei Eigenblutentnahmen
Authors: Michaelis G. , Schlegel E. , Voigt P. , Bernek S. , Biscoping J.
Published: May 2009

Ziel: Routinemäβige Erfassung und Dokumentation ent-nahmebedingter Vorkommnisse (EBV) als qualitätssichernde Maβnahme während Eigenblutentnahmen (EBS). Hilft eine Datenbank-Auswertung anhand protokollierter EBV zur Risi-koabschätzung bei Eigenblutspendern? Design: Datenbank-Abfrage von insgesamt 2479 Entnahmeprotokollen (Daten-bank EBOS) bezüglich der EBV nach Schweregraden (SG 1 = klinisch ohne Bedeutung; SG 2 = behandlungsbedürftig; SG > 2 stationäre Aufnahme erforderlich). Rahmen: Bereich für Autologe Hämotherapie einer Anaesthesie-Abteilung eines akademischen Lehrkrankenhauses. Teilnehmer: 898 Patienten im Zeitraum April 1993 bis März 1995, welche an einem pr-äoperativen Eigenblutprogramm teilnahmen. Ergebnisse: Insgesamt wurden 617 EBV bei 480 Entnahmen (entspricht 19,4% aller EBS) dokumentiert. Nur bei 85 Spenden (entspricht 3,4%) erwiesen sich 121 Vorkommnisse als behandlungsbedürftig (= SG 2), wobei Hypotension und Bradykardie mit 57,9% bzw. 24,8% am häufigsten registriert wurden. Diese Ereignisse traten bei Erstspenden häufiger als bei Wieder-holungsentnahmen auf. Der Anteil der Patientinnen lag mit 70,4% deutlich über dem der männlichen Spender. Weder die Verteilung der ASA-Risikogruppen noch die Altersverteilung der Spender mit EBV und SG 2 unterschied sich von denen des Gesamtkollektivs. EBV mit SG > 2 traten bei den EBS nicht auf. Schluβfolgerungen: Behandlungsbedürftige EBV traten selten auf. Als Hauptvorkommnisse erwiesen sich Hypotension und Bradykardie, welche durch einen relativen Volumenmangel sowie vasovagale Reaktionen erklärt werden können. Prädestiniert hierfür waren vor allem weibliche Erst-spender. Durch eine qualifizierte Überwachung der Patienten während der EBS lassen sich der sogenannte Gefahrenschwer-punkt Blutentnahme entschärfen und vergleichbar niedrige Nebenwirkungsraten wie bei der homologen Spende erzielen.
Blutverlust bei älteren Probanden und die Folgen für Rheologie und kardiale Leistungsfähigkeit
Authors: Ocklitz E. , Janetzko K. , Börner D. , Gehring H. , Schmücker G. , Klüter H. , Klotz K.-E. , Kuppe H.
Published: May 2009

Ziel: Die Auswirkung einer einmaligen hypovolämischen Blutspende auf die Rheologie und die ergometrisch bestimm-bare Leistungsfähigkeit bei klinisch gesunden älteren Blut-spendern wurde untersucht. Design: Prospektive kontrollierte Verlaufsstudie. Rahmen: Blutspendezentrale einer Univer-sität. Teilnehmer: 54 klinisch gesunde Routine-Blutspender, davon 37 als Blutspender und 17 als Kontrollgruppe. Interventionen: Die Laufbandergometrie-Tests wurden am Tag vor und am Tag nach der Blutspende durchgeführt, die venösen Blutentnahmen erfolgten direkt vor und nach der Blutspende. Gemessen wurden zusätzlich hämatologische (Hämatokrit, Hämoglobin, MCV und Erythrozyten) und rheologische (Fibrinogen, Serumeiweiβ und Plasmaviskosität) Parameter. Ergebnisse: Alle Teilnehmer (Spender- und Kontrollgruppe) zeigten signifikante Verbesserungen der kardialen Leistungsfähigkeit. Das Ausmaβ der Verbesserung war zwischen den beiden Gruppen nicht signifikant unterschiedlich. In der Spen-dergruppe wurde erwartungsgemäβ ein Absinken der hämato-logischen und rheologischen Parameter beobachtet. Schluβfol-gerungen: Ein kompensierter moderater Blutverlust hat kei-nen meβbaren negativen Einfluβ auf die kardiale Situation bei älteren Probanden. Die Eigen- oder Fremdblutspende kann somit in gewissem Rahmen auch für ältere Patienten empfoh-len werden.
HIV-Antigentestung beim Blutspendedienst des BRK: Persistierend positiver p24-Antigentest bei einem seropositiven gesunden Blutspender
Authors: Michel P. , Weise W.
Published: May 2009

Hintergrund: Zur Minimierung des «Diagnostischen Fensters» und des resultierenden HIV-Restrisikos wird im Blutspende-wesen der Einsatz von Methoden zur Antigenbestimmung diskutiert. Material und Methodik: Der Blutspendedienst des BRK führt seit Oktober 1992 routinemäβig anläβlich jeder Blutspende den HIV-p24-Antigentest durch. Ergebnisse: Die Untersuchung von 1,6 Millionen Blutspenden auf das Vorliegen von p24-Antigen konnte keine zusätzliche HIV-Infektion auf-decken. Bei einem von 10 Spendern, die im Untersuchungszeit-raum einen positiv bestätigten HIV-Antikörpertest aufwiesen, konnte über zirka 10 Wochen ein persistierend positiver p24-Antigentest beobachtet werden. Schluβfolgerung: Die durch den Einsatz des p24-Antigentestes erreichbare Verkürzung des diagnostischen Fensters, die etwa der postulierten Verkürzung durch Einsatz der HIV-PCR entspricht, ist in einer Population mit niedriger HIV-Prävalenz den statistischen Erwartungen gemäβ nur durch Testung einer gröβeren Anzahl von Proban-den belegbar.
Leukocyte Depletion
Authors: Novotny V.M.J.
Published: May 2009

Leukocyte depletion of blood components has been shown to be effective in the prevention of HLA alloimmunization and cytomegalovirus (CMV) infection and reactivation in patient groups at risk. If all blood products are leukocyte-reduced to below 5 × 106 leukocytes, a primary immune response to HLA antigens can be avoided; secondary immune responses are not avoided. While other viruses have been shown to be contained predominantly in leukocytes, only in the case of CMV leukocyte reduction is effective in preventing viral transmission. Leukocyte reduction also reduces transfusion-related viral reactivation. Although leukocytes may not be the only cause, their removal reduces the incidence of nonhemolytic febrile transfusion reactions. Leukocyte depletion is not effective in preventing graft-versus-host disease. A number of techniques can be used to achieve low levels of leukocytes in blood products, and each must be carefully validated and controlled to assure the products are adequately and consistently leukocyte-reduced.
Immunglobuline und Nierenkrankheiten – Nutzen und Risiken
Authors: John S. , Schmieder R.E.
Published: May 2009

Immunglobuline (Ig) wurden erstmals 1952 eingesetzt, um Hypogammaglobulinämien zu behandeln. Inzwischen werden sie bei einer Vielzahl verschiedener Erkrankungen therapeutisch angewendet. Nebenwirkungen einer Ig-Therapie sind meistens allergischer Natur, schwere Nebenwirkungen werden nur selten beobachtet. Eine seltene und wenig beachtete Nebenwirkung ist das Auftreten eines akuten Nierenversagens. Prädisponierende Risikofaktoren hierfür können nicht eindeutig defïniert werden, allerdings ist das Risiko bei bereits zugrundeliegender chronischer Nierenerkrankung erhöht. Das klinische Bild reicht von asymptomatischen Kreatininerhö-hungen bis zum anurischen akuten Nierenversagen, das mor-phologisch durch eine ausgeprägte Vakuolisierung der Tubulus-epithelien charakterisiert ist. Nach Absetzen einer Ig-Therapie erholt sich die Nierenfunktion in der Regel schnell. Die Mecha-nismen dieses Nierenversagens sind nicht eindeutig geklärt. Umgekehrt mehren sich Berichte über den therapeutischen Nutzen von Ig bei verschiedenen Formen einer chronischen Glome-rulonephritis, besonders bei der IgA-Nephritis. Ig wurden auch erfolgreich bei der Behandlung schwerer Verlaufsformen eines systemischen Lupus erythematodes und bei der «antineutrophile cytoplasmatic antibody»-positiven Nephritis eingesetzt, die auf eine konventionelle Therapie nicht ansprachen. Allerdings han-delt es sich hierbei um kleine Fallserien oder Einzelfallberichte. Weitere Untersuchungen sind notwendig, um diese Ergebnisse zu bestätigen. Bei Patienten mit akutem Nierenversagen sind Infektionen eine häufige Komplikation, die zur Entwicklung weiterer Endorganversagen und zu der noch immer hohen Morta-lität bei dieser Erkrankung beitragen. Ergebnisse einer prospekti-ven, Placebo-kontrollierten Studie, bei der Ig am Anfang eines akuten Nierenversagens gegeben wurden, lassen vermuten, daβ Ig schwere infektiöse Komplikationen vermeiden helfen und somit die Letalität günstig beeinflussen.
Cardiac Workup of Ischemic Stroke
Authors: Morris Jane G. , Duffis E. Jesus , Fisher Marc
Published: May 2009

Background and Purpose—

Discovering potential cardiac sources of stroke is an important part of the urgent evaluation of the ischemic stroke patient as it often impacts treatment decisions that are essential for determining secondary stroke prevention strategies, yet the optimal approach to the cardiac workup of an ischemic stroke patient is not known.

Methods—

A review of the literature concerning the utility of cardiac rhythm monitoring (ECG, telemetry, Holter monitors, and event recorders) and structural imaging (transthoracic and transesophageal echocardiography) was performed.

Results—

Data supporting a definitive, optimal, and cost-effective approach are lacking, though some data suggest that appropriate patient selection can improve the diagnostic and therapeutic yield of rhythm monitoring and echocardiography in the evaluation of stroke etiology.

Conclusions—

Based on available data, an algorithmic approach for the evaluation of patients with acute ischemic cerebrovascular events that takes into account therapeutic and diagnostic yield as well as cost-efficiency is proposed.
Vertebrobasilar Stenosis Predicts High Early Recurrent Stroke Risk in Posterior Circulation Stroke and TIA
Authors: Gulli Giosué , Khan Sofia , Markus Hugh S.
Published: May 2009

Background and Purpose—

20% of ischemic stroke is in the posterior circulation, but there is little prospective data on early recurrent stroke risk and whether vertebrobasilar stenosis predicts a high recurrence risk. This natural history data are important as it is technically possible to stent such lesions. Contrast enhanced MRA (CE-MRA) and CT angiography (CTA) now allow noninvasive identification of vertebrobasilar stenosis.

Methods—

216 consecutive patients presenting with posterior circulation TIA or stroke were recruited and prospectively followed for 90 days. 8 patients with vertebral dissection were excluded. CE-MRA or CTA at presentation and 90-day follow-up was available in 182. Any posterior circulation TIA/stroke in the month before the presenting episode was recorded.

Results—

Taking the first event (including TIA/stroke in the previous month) as the index case recurrent stroke risk in patients with stenosis was 30.5% versus 8.9% in those without; RR 3.4 (95% CI 1.7 to 7.0),
P
<0.001). Taking the presenting episode as the index case the risk was 13.8% versus 4.1%; RR 3.4 (95% CI 1.1 to 10.5)
P
=0.0274. The probability of recurrence was highest soon after the initial event.

Conclusions—

The presence of vertebro-basilar stenosis identifies a group of patients with posterior circulation stroke who have a high early recurrent stroke risk. Early intervention might reduce recurrent stroke risk. Vertebral stenosis can now be treated by stenting, but determining whether this reduces the early stoke risk requires randomized controlled trials.
Dietary Protein, but Not Carbohydrate, Is a Primary Determinant of the Onset of Stroke in Stroke-Prone Spontaneously Hypertensive Rats
Authors: Chiba Tsuyoshi , Itoh Tatsuki , Tabuchi Masaki , Satou Takao , Ezaki Osamu
Published: May 2009

Background and Purpose—

Previously, an inverse association has been found between the dietary proportion of protein or fat and incidence of intracerebral hemorrhage. A positive association has been found with respect to carbohydrate intake. To examine what changes in macronutrient intake are causative, animal studies were conducted.

Methods—

Stroke-prone spontaneously hypertensive rats (SHRSP) were fed diets with varying ratios of macronutrients ad libitum, and the onset of stroke was examined.

Results—

When 10% of calories were from fat, rats fed a high-protein/low-carbohydrate diet (55% calories from protein) had a delayed onset of stroke, whereas rats fed a low-protein/high-carbohydrate diet (5% calories from protein) had an accelerated onset of stroke. When 30% of calories were from carbohydrate, a marked delay in the onset of stroke was observed when the diet was high in protein. When 85% of calories were from carbohydrate, rats fed 7.5% of calories as protein displayed an accelerated onset of stroke. When 20% of calories were from protein, increased fat content did not affect the onset of stroke. However, with a fat-free diet, when 20% of calories were from protein, the onset of stroke was delayed, whereas when 10% of calories were from protein, the onset of stroke was accelerated.

Conclusions—

The amount of protein, but not of carbohydrate and fat, is a primary determinant of the onset of stroke. However, when calories from protein are relatively low in the diet (10%), fat is necessary to delay the onset of stroke in SHRSP.
An Investigation of Alternative Schools in One State: Implications for Students With Disabilities
Authors: Wasburn-Moses Leah
Published: May 2009

Despite the continued growth of inclusive practices, an increasing number of students with disabilities are being served in alternative school settings. However, the number of students served in these settings, and the services they are receiving, remains virtually unexplored. This study reports the results of a survey of alternative schools in one Midwestern state. Particular attention was paid to the participation of students with disabilities in these settings and the services they are receiving. Results indicated that, despite access to valuable supports and services, some students with disabilities placed in alternative settings may be experiencing significant service gaps. Of serious concern is the placement of students who have committed criminal offenses. Implications include a pressing need for data collection and increased advocacy.
Marital History, Race, and Social Security Spouse and Widow Benefit Eligibility in the United States
Authors: Tamborini Christopher R. , Iams Howard M. , Whitman Kevin
Published: May 2009

Large-scale changes in American family structures over the past decades have important implications for the retirement experiences of women. In this study, the authors use a restricted-use file of the Marital History Module of the U.S. Census Bureau's Survey of Income and Program Participation to investigate changes in the marital histories of women aged 40 to 69 years between 1990 and 2004, with a focus on outcomes relevant for Social Security spouse and widow benefit eligibility. Multinomial and binary logistic regression analyses show significant changes in women's marital patterns since 1990, with more substantial shifts occurring among recent cohorts. Due to downward trends in marriage, the authors find a modest decline in Social Security spouse and widow benefit eligibility in 2004, particularly among Black women born toward the end of the baby boom generation.
Ecological framework of information interactions and information infrastructures
Authors: Huvila Isto
Published: May 2009

There has been notably little convergence between information organization and information use studies. A framework for explicating the contextual interplay of information interactions and infrastructures of information, and more specifically the interface of information work and knowledge organization systems, is proposed. The theoretical foundations of the framework are based on systems theory and ecological approach. It is suggested that the interplay of information use and information infrastructures may be conceptualized as a systemic interaction, which is driven by the simultaneous influence of human activity related warrants and infrastructural affordances and constraints. The model provides an instrument that explicates the interplay of human information use and information infrastructures.
Ethical or Unethical Persuasion?
Authors: Barton Ellen , Eggly Susan
Published: May 2009

Based on a sample of 22 oncology encounters, this article presents a discourse analysis of positive, neutral, or negative valence in the presentation of three elements of informed consent—purpose, benefits, and risks—in offers to participate in clinical trials. It is found that physicians regularly present these key elements of consent with a positive valence, perhaps blurring the distinction between clinical care and clinical research in trial offers. The authors argue that the rhetoric of trial offers constructs and reflects the complex relationships of two competing ethical frameworks—contemporary bioethics and professional medical ethics—both aimed at governing the discourse of trial offers. The authors consider the status of ethical or unethical persuasion within each framework, proposing what is called the best-option principle as the ethical principle governing trial offers within professional medical ethics.
Effect of occupational exposure to elemental mercury in the amalgam on thymulin hormone production among dental staff
Authors: Farahat SA , Rashed LA , Zawilla NH , Farouk SM
Published: May 2009

Occupational exposure of dental staff to elemental mercury vapor released from dental amalgam is an issue of concern because of the possible immunological and neurological adverse outcomes. Recently, studies have reported that inorganic mercury induces immunosuppression by decreasing the production of thymus gland hormone (thymulin). This study aimed at investigating mercury body burden in dental staff and the relation of this burden to the potential impact of mercury on thymus gland hormone level (thymulin). Besides, the work aimed at verifying mercury effect on nitric oxide synthetase as a possible mechanism of its immunotoxicity. The study population consisted of a group of dental staff ( n = 39) [21 dentists and 18 nurses] and a matched control group ( n = 42). Each individual was subjected to detailed occupational and medical history taking and to estimation of urinary mercury (U-Hg) and blood mercury (B-Hg) as indicators of mercury body burden and exposure, respectively. Measurement of total thymulin hormone blood level, and plasma level of nitrite and nitrate (indicators of nitric oxide) was also done. The study showed a significantly increased U-Hg and B-Hg levels in the dental staff compared to their controls. This elevation of mercury body burden was associated with significant reduction in thymulin hormone blood level and nitric oxide parameters. These results were more evident in the group of nurses compared to the dentists. In conclusion, our results show that dentists and dental nurses have significant exposure to mercury vapor and point to the negative impact of mercury on thymus gland functions and confirm the implication that the nitric oxide pathway is a possible mechanism for this impact. Moreover, the study raises attention to the importance of hygiene measures in reduction of exposure to mercury vapor released from dental amalgam.
Biological safety of liposome-fullerene consisting of hydrogenated lecithin, glycine soja sterols, and fullerene-C60 upon photocytotoxicity and bacterial reverse mutagenicity
Authors: Kato S , Aoshima H , Saitoh Y , Miwa N
Published: May 2009

Various water-soluble derivatives of fullerene-C60 (C60) have been developed as detoxifiers for reactive oxygen species (ROS), whereas C60 incorporated in liposome (Lpsm) has not been reported yet. We prepared the liposome-fullerene (0.2% aqueous phase, Lpsm-Flln) which was composed of hydrogenated lecithin, glycine soja (soybean) sterols, and C60 in the weight ratio of 89.7:10:0.3, then examined the photocytotoxicity and bacterial reverse mutagenicity, as comparing with the Lpsm containing no C60. Photocytoxicity of Lpsm-Flln or Lpsm was examined using Balb/3T3 fibroblastic cells at graded doses of 0.49–1000 μg/mL under the condition of UVA- or sham-irradiation. The cells were irradiated with UVA (5 J/cm2, 320–400 nm, λmax = 360 nm) at room temperature for 50 min. The resultant cell viability (% of control) did not decrease dose-dependently to 50% or less regardless of the UVA-irradiation. These results show that Lpsm-Flln or Lpsm does not possess photocytotoxicity to Balb/3T3 fibroblasts, and Lpsm-Flln may not exert a UVA-catalytic ROS-increasing action. A possibility for the reverse mutation by Lpsm-Flln or Lpsm was examined on four histidine-demanding strains of Salmonella typhimurium and a tryptophan-demanding strain of Escherichia coli. As for the dosages of Lpsm-Flln or Lpsm (313–5000 μg/plate), the dose-dependency of the number of reverse mutation colonies of each strain did not show a twice or more difference versus the negative control regardless of the metabolic activation, and, in contrast, marked differences for five positive controls (sodium azide, N-ethyl-N′-nitro-N-nitrosoguanidine, 2-nitrofluorene, 9-aminoacridine, and 2-aminoanthracene). The growth inhibition of bacterial strains and the deposition of Lpsm-Flln or Lpsm were not found. As a result, the bacterial reverse mutagenicity of Lpsm-Flln or Lpsm was judged to be negative under the conditions of this test. Thus, Lpsm-Flln and Lpsm may not give any significant biological toxic effects, such as photocytotoxicity and bacterial reverse mutagenicity.
Reduced Incidence of Aspiration With Spoon‐Thick Consistency in Stroke Patients
Authors: Diniz Patricia B. , Vanin Gabriela , Xavier Rogerio , Parente Maria Alice
Published: May 2009

Background: Dysphagia and aspiration occur frequently in stroke patients. The aim of the present study was to evaluate 2 consistencies (liquid and spoon‐thick/pudding‐like) regarding the risk of aspiration and to determine the usefulness of a bedside speech therapy assessment to predict risk of aspiration. Methods: This randomized, crossover clinical trial was carried out April to August 2001 at a university hospital. Sixty‐one inpatients diagnosed with acute phase or prior stroke received liquid and spoon‐thick (pudding‐like) feeds during nasoendoscopy and bedside clinical assessment. Results: Aspiration occured in only 3 patients with the spoon‐thick consistency vs 21 with the liquid consistency (relative risk = 0.13; 95% confidence interval = 0.04–0.39; P < .001). The bedside assessment had a sensitivity of 81% and a specificity of 70.8% to detect risk of aspiration. Conclusions: The use of a spoon‐thick consistency reduced the risk of aspiration compared with the liquid consistency. Clinical assessment was useful to predict aspiration, although the probability of dysphagia in the presence of a negative clinical assessment (29%) is a reason for concern.
Senescent Swallowing: Impact, Strategies, and Interventions
Authors: Ney Denise M. , Weiss Jennifer M. , Kind Amy J. H. , Robbins JoAnne
Published: May 2009

The risk for disordered oropharyngeal swallowing (dysphagia) increases with age. Loss of swallowing function can have devastating health implications, including dehydration, malnutrition, pneumonia, and reduced quality of life. Age‐related changes increase risk for dysphagia. First, natural, healthy aging takes its toll on head and neck anatomy and physiologic and neural mechanisms underpinning swallowing function. This progression of change contributes to alterations in the swallowing in healthy older adults and is termed presbyphagia, naturally diminishing functional reserve. Second, disease prevalence increases with age, and dysphagia is a comorbidity of many age‐related diseases and/or their treatments. Sensory changes, medication, sarcopenia, and age‐related diseases are discussed herein. Recent findings that health complications are associated with dysphagia are presented. Nutrient requirements, fluid intake, and nutrition assessment for older adults are reviewed relative to dysphagia. Dysphagia screening and the pros and cons of tube feeding as a solution are discussed. Optimal intervention strategies for elders with dysphagia ranging from compensatory interventions to more rigorous exercise approaches are presented. Compelling evidence of improved functional swallowing and eating outcomes resulting from active rehabilitation focusing on increasing strength of head and neck musculature is provided. In summary, although oropharyngeal dysphagia may be life threatening, so are some of the traditional alternatives, particularly for frail, elderly patients. Although the state of the evidence calls for more research, this review indicates that the behavioral, dietary, and environmental modifications emerging in this past decade are compassionate, promising, and, in many cases, preferred alternatives to the always present option of tube feeding.
The Physiologic Response and Associated Clinical Benefits From Provision of Early Enteral Nutrition
Authors: McClave Stephen A. , Heyland Daren K.
Published: May 2009

Provision of enteral nutrition (EN) to critically ill patients early upon admission to the intensive care unit exerts a beneficial physiologic effect that downregulates systemic immune responses, reduces oxidative stress, and improves patient outcome. Adding specific pharmaconutrient agents to EN in certain patient populations has a synergistic effect, magnifying the degree of this favorable physiologic response. In contrast, failure to provide enteral nutrients creates a physiologic profile that exacerbates oxidative stress and increases the systemic inflammatory response syndrome. Unfortunately, parenteral nutrition (PN) in the form and manner currently provided in North America does not appear to mimic the same physiologic response seen with EN. In the future, use of alternative fuel sources, steps to promote better tolerance of EN, and innovative strategies for delivery of both EN and PN may serve to further enhance the physiologic effect of nutrition therapy and to achieve even greater improvement in patient outcome.
School-Wide Positive Behavior Support in High School
Authors: Flannery K. Brigid , Sugai George , Anderson Cynthia M.
Published: May 2009

School-wide positive behavior support (SWPBS) is designed to promote positive teaching and learning climates supporting positive social behavior and academic achievement. As a proactive school-wide approach, all students and all staff across all settings are considered. This approach has been implemented in more than 5,000 schools across the United States to date, primarily in elementary and middle schools. High schools are complex organizations with multiple administrators, large numbers of staff and students, and varied expectations related to academic achievement and successful diploma completion. Although key features of SWPBS are similar across schools, specific implementation strategies often are different in high schools. In this article, the authors first delineate the critical features of SWPBS and then present results from a survey of sample high schools implementing SWPBS. They use survey results as a foundation from which to provide guidelines to school teams attempting to implement SWPBS in high schools.
Prominent brainstem and cerebellar involvement in multiple sclerosis with psoriasis
Authors: Ganesvaran G , Greer JM , Pender MP
Published: May 2009

Introduction

We identified a subgroup of 20 patients with multiple sclerosis (MS) and psoriasis within a total group of 692 patients with MS.

Results

There was a high (80%) incidence of brainstem and/or cerebellar involvement and a high mean (±SD) Multiple Sclerosis Severity Score (6.06 ± 2.88) in this subgroup. Of the patients who were human leukocyte antigen typed, 53% carried the MS-associated allele, DRB1*1501, and 27% carried the psoriasis-associated DRB1*07 allele.

Conclusion

The high incidence of brainstem and cerebellar involvement might be explained by the greater severity of MS and the high frequency (60%) of carriage of DRB1*04, DRB1*07, and/or DRB1*13 alleles, which are associated with brainstem and cerebellar involvement in MS.
Review: Current treatment of vestibular, ocular motor disorders and nystagmus
Authors: Strupp Michael , Brandt Thomas
Published: May 2009

Vertigo and dizziness are among the most common complaints with a lifetime prevalence of about 30%. The various forms of vestibular disorders can be treated with pharmacological therapy, physical therapy, psychotherapeutic measures or, rarely, surgery. In this review, the current pharmacological treatment options for peripheral and central vestibular, cerebellar and ocular motor disorders will be described. They are as follows for peripheral vestibular disorders. In vestibular neuritis recovery of the peripheral vestibular function can be improved by treatment with oral corticosteroids. In Menie`re's disease a recent study showed long-term high-dose treatment with betahistine has a significant effect on the frequency of the attacks. The use of aminopyridines introduced a new therapeutic principle in the treatment of downbeat and upbeat nystagmus and episodic ataxia type 2 (EA 2). These potassium channel blockers presumably increase the activity and excitability of cerebellar Purkinje cells, thereby augmenting the inhibitory influence of these cells on vestibular and cerebellar nuclei. A few studies showed that baclofen improves periodic alternating nystagmus, and gabapentin and memantine, pendular nystagmus. However, many other eye movement disorders such as ocular flutter opsoclonus, central positioning, or see-saw nystagmus are still difficult to treat. Although progress has been made in the treatment of vestibular neuritis, downbeat and upbeat nystagmus, as well as EA 2, state-of-the-art trials must still be performed on many vestibular and ocular motor disorders, namely Menie`re's disease, bilateral vestibular failure, vestibular paroxysmia, vestibular migraine, and many forms of central eye movement disorders.
Review: Diagnosis and management of essential tremor and dystonic tremor
Authors: Gironell Alexandre , Kulisevsky Jaime
Published: May 2009

Essential tremor (ET) is the most common adult movement disorder. Traditionally considered as a benign disease, it can cause an important physical and psychosocial disability. Drug treatment for ET remains poor and often unsatisfactory. Current therapeutic strategies for ET are reviewed according to the level of discomfort caused by tremor. For mild tremor, nonpharmacological strategies consist of alcohol and acute pharmacological therapy; for moderate tremor, pharmacological therapies (propranolol, gabapentin, primidone, topiramate, alprazolam and other drugs); and for severe tremor, the role of functional surgery is emphasised (thalamic deep brain stimulation, thalamotomy). The more specific treatment of head tremor with the use of botulinum toxin is also discussed. Several points are discussed to guide the immediate research into this disease in the near future. Dystonic tremor is a common symptom in dystonia. Diagnostic criteria for dystonic tremor and differential diagnosis with psychogenic tremor and ET are described. Treatment of dystonic tremor matches the treatment of dystonia. In cases of symptomatic dystonic tremor similar to ET, therapeutic strategies would be the same as for ET.
Review: Pathogenesis and treatment of immune-mediated neuropathies
Authors: Lehmann Helmar C. , Meyer zu Horste Gerd , Kieseier Bernd C. , Hartung Hans-Peter
Published: May 2009

Immune-mediated neuropathies represent a heterogeneous spectrum of peripheral nerve disorders that can be classified according to time course, predominant involvement of motor/sensory fibers, distribution of deficits and paraclinical parameters such as electrophysiology and serum antibodies. In the last few years, significant advances have been achieved in elucidating underlying pathomechanisms, which made it possible to identify potential therapeutic targets. In this review, we discuss the latest development in pathogenesis and treatment of immune-mediated neuropathies.
Familial spontaneous pneumothorax and lung cysts due to aFolliculinexon 10 mutation
Authors: Sundaram S. , Tasker A. D. , Morrell N. W.
Published: May 2009

Approximately 10% of patients who have a spontaneous pneumothorax have a positive family history. In 1977, Birt, Hogg and Dube (BHD) described a genodermatosis characterised by benign tumours of the hair follicle that has been associated with renal neoplasms and spontaneous pneumothorax. The BHD locus is located on chromosome 17p11.2 and is now known to be due to heterozygous germline mutations in theFolliculingene.

We report three generations of an English family who suffered spontaneous pneumothoraces in the absence of other features of the BHD syndrome and were found to have lung cysts. In addition, we report an antenatal diagnosis (34 weeks gestation) of lung cysts in one affected family member. Genetic analysis in the family has revealed a unique deletion mutation (c. 1537 del-C) involving exon 10.

To our knowledge, this mutation has not been previously described and there is no previous report of antenatal detection of the pulmonary abnormality in BHD syndrome.
Molecular mechanisms of cardiovascular disease in OSAHS: the oxidative stress link
Authors: Lavie L. , Lavie P.
Published: May 2009

Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is a highly prevalent breathing disorder in sleep that is an independent risk factor for cardiovascular morbidity and mortality. A large body of evidence, including clinical studies and cell culture and animal models utilising intermittent hypoxia, delineates the central role of oxidative stress in OSAHS as well as in conditions and comorbidities that aggregate with it. Intermittent hypoxia, the hallmark of OSAHS, is implicated in promoting the formation of reactive oxygen species (ROS) and inducing oxidative stress. The ramifications of increased ROS formation are pivotal. ROS can damage biomolecules, alter cellular functions and function as signalling molecules in physiological as well as in pathophysiological conditions. Consequently, they promote inflammation, endothelial dysfunction and cardiovascular morbidity. Oxidative stress is also a crucial component in obesity, sympathetic activation and metabolic disorders such as hypertension, dyslipidaemia and type 2 diabetes/insulin resistance, which aggregate with OSAHS. These conditions and comorbidities could result directly from the oxidative stress that is characteristic of OSAHS or could develop independently. Hence, oxidative stress represents the common underlying link in OSAHS and the conditions and comorbidities that aggregate with it.
Quantifying intervention-related improvements in exercise tolerance
Authors: Whipp B. J. , Ward S. A.
Published: May 2009

Among the benefits expected to result from a therapeutic intervention in patients with impaired systemic functioning is an increase in exercise tolerance. For this a constant high-intensity work rate has been shown to provide a more sensitive index of improvement than the maximum work rate, or oxygen uptake, on a symptom-limited incremental test.

However, the extremely large variability of the improvement in this particular index of tolerance undermines the ability to make general inferences for the underlying functional improvement. We argue that this is a necessary consequence of the particular work rate chosen for the test and the change in the parameters of the subject's hyperbolic power–duration relationship for that form of exercise: its “critical power” and “curvature constant”.

Without knowledge of these features, any absolute or per cent increase in tolerance time to a single constant-load exercise bout must be interpreted with caution regarding the physiological benefit(s) that have accrued from the intervention.
Diffuse interstitial pneumonia and pulmonary hypertension: a novel manifestation of chronic granulomatous disease
Authors: Khaldi H. , Marchand-Adam S. , Kannengiesser C. , Fabre A. , Debray M. P. , Danel C. , Gougerot-Pocidalo M-A. , El Benna J. , Humbert M. , Aubier M. , Crestani B.
Published: May 2009

The present authors report the case of an adult with chronic granulomatous disease who developed an unusual lung fibrosis associated with severe pulmonary hypertension.

Histological analysis of a lung biopsy showed a diffuse infiltration with pigmented macrophages without granulomas, which particularly involved the pulmonary arterial and venular walls. Clinical and histological findings were suggestive of pulmonary veno-occlusive disease.

Such a clinical association has not been previously described in the literature and might be due to the persistent expression of gp91phox at a very low level.

In conclusion, the present case report illustrates a novel manifestation of chronic granulomatous disease.
Rituximab therapy in autoimmune pulmonary alveolar proteinosis
Authors: Borie R. , Debray M-P. , Laine C. , Aubier M. , Crestani B.
Published: May 2009

Idiopathic pulmonary alveolar proteinosis is presumed to be an autoimmune disorder that may lead to pulmonary insufficiency. However, steroids do not appear to be effective and the standard of therapy is whole-lung lavage. We report the first case of successful therapy with rituximab, which addresses the pathogenic mechanism of pulmonary alveolar proteinosis.
Steps forward in LRTI and tuberculosis: update from the ERS Respiratory Infections Assembly
Authors: Blasi F. , Cosentini R. , Migliori G. B. , Boersma W.
Published: May 2009

Lower respiratory tract infections (LRTIs) and tuberculosis are among the leading reasons for seeking medical care.

In the present report, the most recent advances in the fields of clinical research and basic science of LRTIs and tuberculosis are presented through analysis of some of the best abstracts presented at the 18th European Respiratory Society Annual Congress in Berlin.

The role of viruses in chronic obstructive pulmonary disease exacerbations and the importance of new biomarkers in the diagnosis of bacterial infections in LRTI are discussed.

New tools for the diagnosis of latent and active tuberculosis in special subgroups of patients (children, immunocompromised individuals,etc.), and the new epidemiological threat of multidrug-resistant and extensively drug-resistant tuberculosis cases is analysed.
Biomarkers in the management of COPD
Authors: Lacoma A. , Prat C. , Andreo F. , Domínguez J.
Published: May 2009

Chronic obstructive pulmonary disease (COPD) is still a leading cause of morbidity and mortality worldwide, with a huge socioeconomic impact. New strategies for the management of COPD are required, not only for identifying the origin of the exacerbation episodes, but also to assess an individual risk for each patient. A promising approach is to measure systemic biomarkers and correlate their levels with exacerbation characteristics and clinical prognosis of the disease. Several biomarkers have clearly correlated with the aetiology of lower respiratory tract infections and the response to antibiotic treatment, indicating a potential utility in COPD exacerbation. Nevertheless, the results available at the moment, together with the absence of a gold standard for identifying the aetiological origin of an exacerbation, impedes establishing the real utility of these biomarkers for this concrete task. Regarding the clinical evolution and prognosis, several clinical characteristics have been correlated to biomarker levels. The potential influence of many factors (severity of the disease, presence of comorbidities and treatment) leads to the conclusion that, in the future, the best option would be to monitor levels individually, rather than establishing cut-off points for the general COPD population.
Update on the roles of distal airways in asthma
Authors: Burgel P-R. , de Blic J. , Chanez P. , Delacourt C. , Devillier P. , Didier A. , Dubus J-C. , Frachon I. , Garcia G. , Humbert M. , Laurent F. , Louis R. , Magnan A. , Mahut B. , Perez T. , Roche N. , Tillie-Leblond I. , Tunon de Lara M. , Dusser D.
Published: May 2009

The present review is the summary of an expert workshop that took place in Vence (France) in 2007 on the role of distal airways in asthma. The evidence showing inflammation and remodelling in distal airways, and their possible involvement in asthma control and natural history, was reviewed. The usefulness and limitations of various techniques used for assessing distal airways were also evaluated, including pulmonary function tests and imaging. Finally, the available data studying the benefit of treatment better targeting distal airways in asthma was examined. It was concluded that both proximal and distal airways were involved in asthma and that distal airways were the major determinant of airflow obstruction. Inflammation in distal airways appeared more intense in severe and uncontrolled asthma. Distal airways were poorly attained by conventional aerosol of asthma medications owing to their granulometry, being composed of 3–5 μm particles. Both proximal and distal airways might be targeted either by delivering medications systemically or by aerosol of extra-fine particles. Extra-fine aerosols of long-acting β-agonists, inhaled corticosteroids or inhaled corticosteroid/long-acting β-agonist combinations have been shown in short-term studies to be not inferior to non-extra-fine aerosols of comparators. However, available studies have not yet demonstrated that extra-fine inhaled medications offer increased benefit compared with usual aerosols in asthmatic patients.
Molecular characterization of a rice mutator-phenotype derived from an incompatible cross-pollination reveals transgenerational mobilization of multiple transposable elements and extensive epigenetic instability
Authors: Wang Hongyan , Chai Yang , Chu Xiucheng , Zhao Yunyang , Wu Ying , Zhao Jihong , Ngezahayo Frédéric , Xu Chunming , Liu Bao
Published: May 2009

Background

Inter-specific hybridization occurs frequently in plants, which may induce genetic and epigenetic instabilities in the resultant hybrids, allopolyploids and introgressants. It remains unclear however whether pollination by alien pollens of an incompatible species may impose a "biological stress" even in the absence of genome-merger or genetic introgression, whereby genetic and/or epigenetic instability of the maternal recipient genome might be provoked.

Results

We report here the identification of a rice mutator-phenotype from a set of rice plants derived from a crossing experiment involving two remote and apparently incompatible species,Oryza sativaL. andOenothera biennisL. The mutator-phenotype (named Tong211-LP) showed distinct alteration in several traits, with the most striking being substantially enlarged panicles. Expectably, gel-blotting by total genomic DNA of the pollen-donor showed no evidence for introgression. Characterization of Tong211-LP (S0) and its selfed progenies (S1) ruled out contamination (via seed or pollen) or polyploidy as a cause for its dramatic phenotypic changes, but revealed transgenerational mobilization of several previously characterized transposable elements (TEs), including a MITE (mPing), and three LTR retrotransposons (Osr7, Osr23andTos17). AFLP and MSAP fingerprinting revealed extensive, transgenerational alterations in cytosine methylation and to a less extent also genetic variation in Tong211-LP and its immediate progenies.mPingmobility was found to correlate with cytosine methylation alteration detected by MSAP but not with genetic variation detected by AFLP. Assay by q-RT-PCR of the steady-state transcript abundance of a set of genes encoding for the various putative DNA methyltransferases, 5-methylcytosine DNA glycosylases, and small interference RNA (siRNA) pathway-related proteins showed that, relative to the rice parental line, heritable perturbation in expression of 12 out of the 13 genes occurred in the mutator-phenotype and its sefled progenies.

Conclusion

Transgenerational epigenetic instability in the form of altered cytosine methylation and its associated TE activity occurred in a rice mutator-phenotype produced by pollinating the rice stigma with pollens ofO. biennis. Heritably perturbed homeostatic expression-state of genes involved in maintenance of chromatin structure is likely an underlying cause for the alien pollination-induced transgenerational epigenetic/genetic instability, and which occurred apparently without entailing genome merger or genetic introgression.