bluuebunny/crossref_metadata_2025 huggingface dataset:
Palaeosecular variation of the Earth's magnetic field during the last 10000 years based on the annually laminated sediment of Lake Nautäjarvi, central Finland
Authors: Ojala Antti E.K. , Saarinen Timo
Published: October 2002

A palaeomagnetic study of the Lake Nautajärvi sediment sequence in central Finland demonstrates that varved lake sediments can provideregionally applicable secular variations curves for Holocene stratigraphic correlation and age control. Based on x-ray radiography and digital image analysis techniques we constructed an inherent and continuous varve chronology for the Lake Nautajärvi varve sequence, which covers nearly 10000 years with an estimated counting error of less than ±1% and a mean sedimentation rate of 0.66 mm yr-1. We reconstructed a record of the palaeomagnetic secular variation (PSV) of the Earth's magnetic field in this nearly 7 m long section of clastic-organic varves. Mineral magnetic measurements indicated that pseudosingle-domain magnetite is the major carrier of the remanence. PSV shows many of the familiar features of declination and inclination that have previously been recorded in northern Europe. In addition, the Lake Nautajärvi record contains a continuous record of relative palaeointensity.
Quantitative multiproxy assessment of long-term patterns of Holocene environmental change from a small lake near Abisko, northern Sweden
Authors: Bigler Christian , Larocque Isabelle , Peglar Sylvia M. , Birks H. J.B. , Hall Roland I.
Published: October 2002

Quantitative reconstructions are made of Holocene changes in climatic and environmental conditions from analyses of pollen, chironomids and diatoms in identical stratigraphic levels of a sediment core from Vuoskkujávri (68°20'43 N, 19°06'00 E, 348 m a.s.l.) near Abisko in northern Sweden (Lapland). Transfer functions, based on regional calibration sets, are applied to reconstruct Holocene patterns in mean July air temperature (using all three indicators), mean January air temperature (pollen), annual precipitation (pollen) and lakewater pH (diatoms). During periods with ‘good’ fit to the modern calibration sets all mean July air-temperature inferences based on the three proxy indicators reveal a general trend of decreasing temperature: pollen-inferred mean July air temperature shows a decrease of c. 1.1°C since 7500 cal. yrs BP; the chironomids show a decrease of c. 1.2°C since the early Holocene; whereas the diatoms show a decrease of c. 1.5°C since 6000 cal. yrs BP. Pollen-inferred mean January air temperature indicates that winters may have been warmer by c. 3.0°C during the early Holocene, followed by a gradual cooling until 8500 cal. yrs BP ( c. 1.0°C warmer than today) and a subsequent warming until 7000 cal. yrs BP ( c. 2.0°C warmer than today). Since 7000 cal. yrs BP, a gradual cooling towards the present-day values is inferred. According to the pollen, annual precipitation may have been considerably higher during the early Holocene than today ( c. +150 mm) and increased until 7000 cal. yrs BP ( c. +320 mm). Since 7000 cal. yrs BP, annual precipitation decreased continuously towards present-day values. Diatom-inferred pH trends show that natural acidification of c. 0.5 pH units followed deglaciation; present-day values were reached c. 5000 cal. yrs BP. The early Holocene is identified as a problematic time period for the application of modern calibration sets, as diatoms show ‘poor’ fit to the calibration set from 10 600 to 6000 cal. yrs BP, pollen from 10 600 to 7500 cal. yrs BP, and chironomids from 10 250 to 10 000 cal. yrs BP. Compared with estimates from the COHMAP GCM model, mean July air-temperature inferences based on biological proxies at Vuoskkujávri suggest a more moderate decrease in temperature over the past 9000 years.
Effects of carbendazim on rat thyroid, parathyroid, pituitary and adrenal glands and their hormones
Authors: Barlas N , Selmanoglu G , Kockaya A , Songür S
Published: October 2002

The purpose of this study is to determine the effects of low and high dose of carbendazim on the level of certain hormones and endocrine glands (thyroid, parathyroid, adrenal and pituitary glands) of male rats. Carbendazim is a systemic fungicide with activity against a number of plant pathogens. In this study, daily doses of 0, 150, 300 and 600 mg/kg per day carbendazim were applied to male rats by gavage for 15 weeks. At the end of the experiment, T3, T4, TSH, ACTH and GH levels in rat serum were analysed. Thyroid, parathyroid, adrenal and pituitary glands of rats were taken. A significant increase was observed in serum T3 levels of the rats, which were exposed to 300 mg/kg per day carbendazim doses, compared to the serum T3 levels of the control group. There were no differences between the control and carbendazim-treated group of rats regarding serum TSH, T4, ACTH and growth hormone levels. This showed us that carbendazim caused histopathological damages in thyroid, parathyroid and adrenal glands of rats. No changes were observed in pituitary glands of treated rats. These results suggest that a high quantity of subchronic carbendazim exposure affects thyroid, parathyroid and adrenal glands.
Nephrotoxicity in rats induced by chlorpryfos-ethyl and ameliorating effects of antioxidantsy
Authors: Oncu M , Gultekin F , Karaöz E , Altuntas I , Delibas N
Published: October 2002

Nephrotoxicity induced by chlorpyrifos-ethyl (CE) and ameliorating effects of melatonin and vitamin E plus vitamin C were evaluated in rats exposed to CE. Experimental groups were as follows: control (C), CE treated (CE), vitamin E plus vitamin C treated (Vit), melatonin treated (Mel), vitamin E plus vitamin C plus CE treated (Vit+CE), and melatonin plus CE treated (Mel+CE). The rats in the CE, Vit+CE and Mel+CE groups were administered orally with CE in two equal doses of 41 mg/kg body weight (0.25 LD50). Melatonin and vitamins E and C were administrated intramuscularly at the doses of 10, 150 and 200 mg/kg, respectively. The levels of thiobarbituric acid reactive substance (TBARS) and antioxidant potential (AOP), and the activities of glutathione peroxidase (GSHPx), catalase (CAT) and superoxide dismutase (SOD) were studied in the homogenates of kidney tissue. There were no significant differences in the activities of SOD and CAT between the experimental groups. The level of TBARS increased significantly (P<0.05) while AOP decreased significantly (P<0.05) in the CE group compared with the C group. GSH-Px activity was significantly (P<0.05) lower in the CE group and higher in the melatonin group than the control group. Histopathological changes were found in the kidney tissue of rats treated with CE. These were infiltration in mononuclear cells at perivascular and peritubular areas, hydropic degenerations in tubule epithelium and glomerular sclerosis. The severity of the lesions was reduced by administration of vitamins and melatonin. These results suggest that CE increases lipid peroxidation and decreases AOP by increasing oxidative stress, and that high doses of melatonin and a combination of vitamin E plus vitamin C considerably reduce the toxic effect of CE on kidney tissue of rats.
Fluctuations in levels of antiphospholipid antibodies and increased coagulation activation markers in normal andheparin-treated antiphospholipid syndrome pregnancies
Authors: Donohoe S , Quenby S , Mackie I , Panal G , Farquharson R , Malia R , Kingdom J , Machin S
Published: October 2002

Antiphospholipidantibodies (aPL) are associated with anincreased risk of thrombosis and recurrent miscarriage. Weassessed levels of coagulation activation markers and aPL during normal pregnancy and in women with the antiphospholipid syndrome (aPS). Fluctuations in aPL levels were observed in all patients with aPS. No particular pattern of antibody positivity, or fluctuation in aPL level,was associated with poor pregnancy outcome. A significant increase was observed in levels of factor XIIa(FXIIa; P 0.001), factor VIIa (FVIIa, P 0.001), thrombin antithrombin complexes (TAT; P 0.001), prothrombin fragment F1.2 (F1.2; P 0.001) and D-dimer (DD; P 0.05) during normalpregnancy. Factor VIIa, TAT, F1.2 and DD increased significantly before 20 weeks gestation, while a statistically significant increase in FXIIa levels was first detected between weeks 20 and 30 of gestation. In pregnant women with aPS, increases in FXIIa were similar to those in normal pregnancy, but increasedFVIIa levels were not observed until after 30 weeks gestation.Similar to normal pregnancy, increased levels of TATandF1.2 were detected in aPS pregnancies before 20 weeks gestation, but increased DD were not observed until afterweek 20. Surprisingly, women with aPS receiving low molecular weight heparin prophylaxis had significantly higher (P 0.02) levels of TAT (median 8.6; interquartile range (IQR) 6.5–20.8) between weeks 20 and 30 of gestation compared to the normal pregnant population (median 5.9; IQR 4.7–7.9), thus indicating increased thrombin generationin women with aPS in mid-pregnancy.
Protein-losing enteropathy in systemic lupus erythematosus: report of a severe, persistent case and review of pathophysiology
Authors: Yazici Y , Erkan D , Levine D M , Parker T S , Lockshin M D
Published: October 2002

Protein-losing enteropathy (PLE) is a rare manifestation of systemic lupus erythematosus (SLE). We report a severe and resistant case of PLE, discuss pathophysiology and possible role of cytokines in the disease process. We also present a review of the current literature.
Menstrual disturbances in patients with systemic lupus erythematosus without alkylating therapy: clinical, hormonal and therapeutic associations
Authors: Pasoto S G , Mendonça B B , Bonfá E
Published: October 2002

We have evaluated 36 consecutive systemic lupus erythematosus (SLE) female patients, age 18–39 years, without current or previous alkylating therapy, in order to determine the prevalence of the menstrual disturbances and their clinical, hormonal and therapeutic associations.Seventeen patients presented normal cycles, whereas menstrual alterations were observed in 19. Ovarian function was generally preserved in these groups. Sub-clinical thyroid disease (normal free T4 and elevated TSH) and slightly increased prolactin levels were detected in 8% of patients, with comparable frequencies in both groups. Similarly, the current use of azathioprine was not associated with menstrual disturbances. Percentages of prednisone current use (P = 0.3), mean dose (P = 0.062), and percentages of patients on high doses (30 mg/day; P = 0.09) were comparable in patients with or without menstrual alterations. In contrast, the mean SLEDAI levels (P = 0.02) and the frequency of patients with SLEDAI ≥ 8 (P = 0.008) were higher in patients with irregular cycles. Interestingly, 5=7 (71%) of the patients with menstrual disturbances and a new significant flare (SLEDAI ≥8) were evaluated before the introduction of high dose steroid, supporting the idea that disease activity is a major factor in menstrual disorders in SLE patients without alkylating therapy.
The nature and outcome of infection in systemic lupus erythematosus
Authors: Gladman D D , Hussain F , Iban D , Urowitz M B
Published: October 2002

Infection remains a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). To describe the nature and outcomes of infection and determine their associated risk factors in patients with SLE, we performed a nested case–control study at the University of Toronto Lupus Clinic, with prospective follow-up according to a standard protocol since 1970. Cases were SLE patients seen between January 1987 and January 1992 who had documented infections and controls were patients without infection from the same cohort matched for age, gender and time of visit. The type, site and outcome of infection were recorded for each case. A conditional logistic regression analysis was performed to compare factors associated with infection in cases and their controls. Ninety-three patients had 148 infection episodes; the majority were bacterial, but viral, fungal and protozoan organisms were also identified (multiple organisms in seven). Forty-eight patients required hospital admission and three patients died. Steroids at time of infection, as well as use ever, duration and dose, immunosuppressivesat time of infection and use ever, active renal disease, CNS damage, SLEDAI at the time of infection, adjusted mean SLEDAI and variability measure were significantly associated with infection by univariate analysis. By multivariate analysis one factor remained statistically significant: use of steroids ever (P=0.029). Infection carries a large burden for SLE patients. Until new medications which will control disease activity without predisposing to infection are developed, careful titration of steroids and cytotoxic drugs to control disease activity will remain crucial.
Clinical and immunogenetic characterization of Mexican patients with ‘Rhupus’
Authors: Simón J A , Granados J , Cabiedes J , Morales J Rúz , Varela J Alcocer
Published: October 2002

The coexistence of systemic lupus erythematosus and rheumatoid arthritis (rhupus), is a rare clinical condition. To date, 50 cases of rhupus have been described worldwide; however, the lack of clinical criteria for this rheumatic condition has created confusion in the characterization of this disorder. Nevertheless, in this paper we describe a comprehensive clinical and serological characterization of a cohort of 22 Mexican patients with rhupus, supported by generic HLA-DR phenotyping.

We found that rhupus patients have a special clinical behavior. In this setting, the signs and symptoms of rheumatoid arthritis prevail, little organic damage associated with systemic lupus erythematosus (SLE) exists and none of the cases present thrombosis or morbidity during pregnancy in spite of presenting a high frequency of anticardiolipin antibodies. We also found an increased frequency of HLA-DR1 and HLA-DR2 alleles compared to healthy ethnically matched controls, systemic lupus erythematosus and rheumatoid arthritis patients.
Expansion of marginal zone B cells is not sufficient for the development of renal disease in NZB×NZW F1 mice
Authors: Schuster H , Martin T , Marcellin L , Garaud J-C , Pasquali J-L , Korganow A S
Published: October 2002

The mechanisms which govern the production of autoantibodies and of tissue damage during systemic lupus (SLE) are still unclear. In the NZB£NZW F1 (BW) model of SLE glomerulonephritis, the activation and commitment of B cells are thought to play a major role in disease progression. Previous analysis has suggested that these mice have a substantial increase of marginal zone (MZ) B cells before the occurrence of the disease. Owing to the probable role of this B cell subset in autoantibody production, it was important to define the possible link between this abnormality and the occurrence of kidney damage.

Using cytofluorometry analysis, we followed the splenic MZ B cell phenotype in different series of mice with shared autoimmune genetic background and histologically defined renal status.

By comparing BW females and BW males, NZB and NZW mice, we confirm that BW mice have an increase in MZ B cells but this MZ B cells expansion is not directly linked to tissue lesions. Genetically modified BW female mice with a restricted repertoire of B and T cell antigen receptors, and which do not develop nephritis, exhibit the same increase of MZ B cells, suggesting that this increase does not depend on a specific set of antigens. Moreover, our analysis brings to light a predisease state in BW males, with autoantibody production and mesangial deposits.
Circulating angiogenesis inhibitor endostatin and positive endothelial growth regulators in patients with systemic lupus erythematosus
Authors: Robak E , Wozániacka A , Sysa-Jedrzejowska A , Stepien H , Robak T
Published: October 2002

Serum concentrations of three angiogenic cytokines: vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), interleukin-18 (IL-18) and antiangiogenic factor endostatin in the serum of 52 patients with systemic lupus erythematosus (SLE) and 20 healthy subjects were investigated. The possible association between serum levels of these proteins and SLE activity as well as correlation between the concentrations of angiogenic cytokines and the level of endostatin was also analyzed. VEGF and IL-18 were detectable in all SLE patients and healthy control group. bFGF was measurable in 71.2% of patients with SLE and 65% of healthy persons. Endostatin was detectable in 94.2% of SLE patients and 95% of normal subjects. The serum levels of endostatin and bFGF were not significantly different in SLE and healthy control (P > 0.05). The median concentration of VEGF was higher in active SLE (238.4pg/ml) than in inactive disease (118.1pg/ml, P < 0.05) or in control group (133.5pg/ml, P < 0.04). The median serum level of IL-18 was higher in the SLE patients (595.2pg/ml) than in the control group (252.7pg/ml) (P < 0.001). The correlations between the levels of angiogenic cytokines and endostatin with clinical features, laboratory abnormalities and also with the type of treatment were analysed. We found a positive correlation between VEGF serum concentration and SLE activity according to SLAM score (r=0.275, P < 0.05). The significant positive correlation was also found between IL-18 and endostatin (r=0.289, P < 0.04). In contrast, the correlation between bFGF and endostatin was significantly negative (r=7 0.299, P < 0.04). In conclusion, serum levels of the angiogenic and antiangiogenic factors may play an important role in SLE pathogenesis.
Celecoxib for systemic lupus erythematosus: case series and literature review of the use of NSAIDs in SLE
Authors: Lander S A , Wallace D J , Weisman M H
Published: October 2002

The primary objectives of this study were to evaluate the safety and efficacy of the cyclooxygenase-2 inhibitor celecoxib in systemic lupus erythematosus (SLE) patients both with and without a self-reported sulfa drug allergy and to review the literature on the use of nonsteroidal agents in SLE subjects. A retrospective review of medical records was performed for 50 SLE patients seen by a community-based rheumatologist and treated with open label celecoxib in doses of 200–400 mg/day for a period of 1–9 months. A MEDLINE search of all articles pertaining to the use of NSAIDs in patients with SLE since 1966 was undertaken.

We noted that, in this cohort of celecoxib-treated SLE patients from an office rheumatology practice, the majority demonstrated some improvement, and little toxicity was observed. SLE patients with self-reported sulfa allergies were not more likely to have adverse reactions to celecoxib than non-sulfa allergic patients. The literature review performed herein reveals that, although NSAID toxicity should be a continuing concern in an SLE population, structural dissimilarities between celecoxib and the sulfonamide antimicrobials may make true crossallergenicity less likely to be a clinical problem. These results suggest that patients with SLE can be safely and effectively treated with celecoxib; however, further studies are needed to assess the effectiveness and safety of all NSAIDs in SLE.
Oculomotor palsy in six patients with systemic lupus erythematosus. A possible role of antiphospholipid syndrome
Authors: Genevay S , Hayem G , Hamza S , Palazzo E , Meyer O , Kahn M-F
Published: October 2002

The objective of this study was to describe clinical, laboratory,and radiologicalfeatures in systemic lupus erythematosus (SLE) patients with oculomotor palsy (OMP). Among a cohort of 750 SLE patients receiving follow-up at our unit between 1985 and 2000, all patients with OMP were studied. Clinical and laboratory data were recorded, as well as cerebral magnetic resonance imaging (MRI) findings where available. Immunological tests included tests for presence and specificity of antinuclear and antiphospholipidantibodies. Six patients had OMP, which occurred within the first 3 years in two patients and after more than 20 years in two patients. Four patients had focal neuropsychiatricSLE (NPSLE) manifestations and two had diffuse neurological involvement. The four patients with focal NPSLE were either anticardiolipin or lupus anticoagulant-positive. Cerebral fluid was abnormal in two of four patients who had this test. In four of the six patients, cerebral MRI showed evidence of vasculopathy. The therapeutic regimens varied, although all six patients initially received high-dose corticosteroids. OMP resolved or improved significantly in all six patients. OMP in SLE occurs in a broad spectrum of clinical situations but is an infrequent manifestation of NPSLE. This case series, together with literature review data, suggests various pathophysiologicalmechanisms in patients with focal or diffuse neurological symptoms. In patients with focal NPSLE, a possible cause of OMP is microthrombosis associated with presence of antiphospholipid antibodies.
Management of pregnancy in women with pulmonary hypertension secondary to SLE and anti-phospholipid syndrome
Authors: Mcmillan E , Martin W L , Waugh J , Rushton I , Lewis M , Clutton-Brock T , Townend J N , Kilby M D , Gordon C
Published: October 2002

Pulmonary hypertension is found in about 10% of patients with systemic lupus erythematosis (SLE). Pulmonary hypertension may be present at the time of diagnosis or may develop after the diagnosis of SLE or anti-phospholipid syndrome (APS). It often presents in the reproductive years and has a significant impact on pregnancy outcome, being a significant cause of indirect maternal deaths. In our observationalcase series of three patients there were two deaths (66%). In cases 1 and 2 the pulmonary hypertension developed during pregnancy and deteriorated rapidly with markedly abnormal mean pulmonary artery pressures of 80 and 70 mmHg respectively prior to death. Both patients died within 48 hours of delivery. In case 3 the pulmonary hypertensionwas milder and was diagnosed very early in pregnancy. The patient received multidisciplinary care from the first trimester and the management of the pregnancy, delivery and the early puerperium was planned. Careful epidural anaesthesia was used and the patient had invasive monitoring on the intensive therapy unit (ITU) for 72 hours. Women with pulmonary hypertensionneed to be aware of the high risk of maternal mortality associated with pregnancy but we believe that an improvement in outcome can be achieved by careful assessment and the use of a multidisciplinary approach from early in pregnancy.
Added value of three-way methods for the analysis of mortality trends illustrated with worldwide female cancer mortality (1968-1985)
Authors: Kroonenberg P M , Murakami T , Coebergh J WW
Published: October 2002

Trends in mortality rates are usually presented per tumour site or per country without an overall analysis of the complete data encompassing all three aspects (tumour sites, countries, trends). This paper presents a methodology for such an overall analysis using three-way methods applied to a data set on female mortality rates for 17 tumour sites of 43 countries for the years 1968-1985. Multivariate techniques like biplots and three-mode principal component analysis within an overall three-way analysis-of-variance framework were used. We confirmed the known patterns of comparatively high mortality for women due to cancer of the bladder, intestines, pancreas, rectum, breast, ovary, skin and leukaemia and the relatively low mortality rates for liver cancer in Western and Northern Europe, the USA, Australia and New Zealand. Also, the reverse pattern was observed for Middle and Southern Europe, Hong Kong, Singapore, and in Japan, and in some but not all Latin American countries. The relatively mortality due to cancer was high in the lungs, mouth, larynx and oesophagus in the British Isles, but was much less in other European countries. Mortality due to cancer of the thyroid, uterus, gall bladder and stomach was high in Middle European countries, as was the case in Japan, Chile and Costa Rica. Rates were low for Southern European countries, North America, Australia and New Zealand. Specific deviating patterns in the data were the more rapidly decreasing mortality rates for stomach cancer in Chile and Japan and the more rapidly increasing mortality rates for lung cancer in the USA, Scotland and Denmark. In conclusion, using three-way methods, it was feasible to analyse the cancer mortality data in their entirety. This enabled the simultaneous comparison of trends in relative mortality rates between all countries due to all tumour sites, as well as the identification of specific deviating trends for specific tumour sites in specific countries.
Mixture models for quantitative HIV RNA data
Authors: Moulton Lawrence H , Curriero Frank C , Barroso Paulo F
Published: October 2002

Clinical investigators are increasing their use of quantitative determinations of HIV viral load in their study populations. The distributions of these measures may be highly skewed, left-censored, and with an extra spike below the detection limit of the assay. We recommend use of a mixture model in this situation, with two sets of explanatory covariates. We extend this model to incorporate multiple measures across time, and to employ shared parameters as a way of increasing model efficiency and parsimony. Data from a cohort of HIV-infected men are used to illustrate these features, and simulations are performed to assess the utility of shared parameters.
Privacy of Patients in the Forensic Department of a Psychiatric Clinic: a phenomenological Study
Authors: Koller K , Hantikainen V
Published: October 2002

This study, based on the phenomenological approach, was aimed at exploring the meaning of privacy for forensic psychiatric patients. The narratives of two such patients, diagnosed with schizophrenia and hospitalized on a forensic unit because of a killing offence, were analysed by means of qualitative content analysis. The study was conducted in a Swiss psychiatric clinic with forensic units. The results demonstrated that ‘privacy’ is not a question of luxury but a very basic human right. The ethical implications for nurses acting as key workers in such situations are highlighted. Recommendations for practice are detailed.
Confirming Older Adult Patients’ Views of Who They Are and Would Like To Be
Authors: Randers Ingrid , Olson Tina H , Mattiasson Anne-Cathrine
Published: October 2002

This article reveals a 91-year-old cognitively intact man’s lived experiences of being cared for in a geriatric context in which the majority of the patients were cognitively impaired. A narrative patient story was analysed phenomenologically. The findings indicate that this patient’s basic needs for ethical care were not met. The staff did not see him as a unique individual with his own preferences, resources and abilities to master his life. In order to survive this lack of ethical care, he played the role of an ‘old cognitively impaired man’, which provided him with at least the understanding and attention the cognitively impaired patients received from the staff. The findings also indicate that ethical care is independent of whether or not older cognitively intact and impaired patients stay or live in the same unit, but it is more dependent on a caregiver’s ability to respect and confirm each and every patient for who he or she is and would like to be.
Spearheading clinical intervention documentation into the future: an Alberta Cancer Board study
Authors: Moosa Ashraf , Nyrose Judith
Published: October 2002

Objective. The Alberta Cancer Board (ACB) Pharmacy recognizing the significance and merits of intervention documentation examined the reporting methods at the ACB’s two major tertiary cancer treatment centres, the Cross Cancer Institute (CCI) and the Tom Baker Cancer Centre (TBCC). The goal of the project was to identify interventions and actions performed by pharmacists and the resulting outcomes. This information would then be forwarded to the pharmacy computer team to implement electronic documentation of clinical interventions utilizing the pharmacy software program (RxTFC).

Data Sources. The student collected information through focus groups, literature reviews, shadowing and interviewing pharmacists, manual/paper documentation review and checking the ‘notes’ section of the computer software program (RxTFC).

Study Selection. Published literature on intervention documentation was researched and those relevant to clinical documentation in ambulatory care settings were selected.

Data Extraction. There was an extensive data collection process, a student researcher was able to define, identify and develop the types of interventions and actions that ACB pharmacists perform daily and the outcomes of the provision of these clinical services. Mosby’s definitions for intervention, action and outcome were adopted in order to aid when sorting and classifying data collected.

Data Synthesis. The types of documentation and a list of interventions and actions are summarized in tables. The results indicate that manual forms that are currently in ACB pharmacies are not being used to their full capacity and/or are not being used as they were originally intended. Possible reasons are a lack of self-reporting, differing reporting styles among pharmacists, a lack of time and/or inconvenient manual documentation systems currently in place. Also, pharmacists differ in their perceptions on what constitutes an intervention. Advantages and disadvantages of both manual and electronic reporting practices are outlined.

Conclusions. Clinical intervention documentation is an important tool for pharmacists to ensure that patients are provided with the best pharmaceutical care available in oncology settings. J Oncol Pharm Practice (2001) 7, 35-46
Mitoxantrone-induced cardiotoxicity
Authors: Darko William , Smith Adrienne L , King Evelyn L , Grethlein Sara J
Published: October 2002

Anthracycline-induced cardiotoxicity has been well documented in the literature. Doxorubicin has been most commonly implicated; however, electrocardiogram changes have also been reported with the use of mitoxantrone. We report a case of a 55-year-old female with recurrent acute myelogenous leukemia who underwent reinduction therapy with mitoxantrone and etoposide daily for five doses. Nearing completion of her fifth mitoxantrone dose, she complained of chest tightness and developed bradycardia. Her symptoms resolved with discontinuation of the agent; however, upon rechallenge, she again developed sinus bradycardia with premature ventricular contractions and a corrected QT interval of 0.499 seconds. Clinicians should be aware of the risk factors for mitoxantrone-induced cardiotoxicity and monitor their patients appropriately while on therapy.
Anti-viral properties of interferon beta treatment in patients with multiple sclerosis
Authors: Hong J , Tejada-Simon M V , Rivera V M , Zang Y CQ , Zhang J Z
Published: October 2002

Viral infections are potentially associated with the etiology and pathogenesis of multiple sclerosis (MS). It has been speculated that the treatment efficacy of interferon beta (IFN beta) in MS may relate to its anti-viral properties. The study was undertaken to evaluate the in vivo anti-viral effects of IFN beta-1a in patients with MS. Human herpesvirus-6 (HHV-6) was studied as an example for being a latent neurotropic virus. IFN beta used at concentrations of approximately 0.5 mg/ml was shown to significantly reduce in vitro HHV-6 replication in a susceptible T-cell line. Sera derived from 23 MS patients treated with IFN beta-1a were examined for serum cell-free DNA of HHV-6 as an indicator for viral replication and the reactivity of IgM antibodies to a recombinant HHV-6 virion protein containing a known immunoreactive region. The results were compared with those of control sera obtained from untreated MS (n=29) and healthy individuals (n=21). The findings indicated that IFN beta treatment significantly reduced HHV-6 replication as evident by decreased cell-free DNA in treated MS specimens. The results correlated with decreased IgM reactivity to the HHV-6 antigen in treated MS patients compared to untreated controls, suggesting reduced exposure to HHV-6. The findings were confirmed in paired sera obtained from seven MS patients before and after the treatment. The study provides new evidence indicating that IFN beta has potent in vivo anti-viral effects that may contribute to the treatment efficacy in MS.
Intrathecal synthesis of matrix metalloproteinase-9 in patients with multiple sclerosis: implication for pathogenesis
Authors: Liuzzi G M , Trojano M , Fanelli M , Avolio C , Fasano A , Livrea P , Riccio P
Published: October 2002

Matrix metalloproteinase-9 (MMP-9) was detected by zymography and enzyme-linked immunosorbent assay (ELISA) in matched serum and cerebrospinal fluid (CSF) samples from patients with neurological diseases. Patients with relapsing-remitting multiple sclerosis (RR-MS) had serum and CSF MMP-9 levels comparable to those from patients with inflammatory neurological diseases (INDs), but higher than patients with non-inflammatory neurological diseases (NINDs) and healthy donors (HDs). MMP-9 increased in active RR-MS in comparison with inactive RR-MS implying that MMP-9 in MS is related with clinical disease activity. A correlation between the CSF/serum albumin (QAlb) and CSF/serum MMP-9 (QMMP-9) was observed in IND and NIND but not in RR-MS patients, indicating that CSF MMP-9 levels in NIND and IND patients could be influenced by serum MMP-9 and blood-brain barrier (BBB) permeability properties. MS patients had higher values of QMMP-9:QAlb (MMP-9 index) than IND and NIND patients suggesting that in MS the increase in CSF MMP-9 could be due to intrathecal synthesis of MMP-9. A significant inverse correlation was found between MMP-9 and its endogenous inhibitor TIMP-1 in RR-MS indicating that in MS patients both the increase in MMP-9 and the decrease in TIMP-1 serum levels could contribute to BBB disruption and T-lymphocyte entry into the CNS.
Multiple sclerosis in the tropics: genetic association to STR’s loci spanning the HLA and TNF
Authors: Palacio L G , Rivera D , Builes J J , Jiménez M E , Salgar M , Anaya J M , Jiménez I , Camargo M , Arcos-Burgos M , Sánchez J L
Published: October 2002

Clear evidence has been presented correlating gene polymorphisms at 6p21.3-21.4 (containing HLA and TNF) and the predisposition to acquire multiple sclerosis (MS). In a previous study, we found that polymorphisms at HLA DQA1 were associated with being or not being predisposed to MS in individuals inhabiting the tropics, where the prevalence of MS is significantly lower than in subtropical areas. Here, we tested the hypothesis that polymorphisms at D6S276, D6S265, D6S273 and D6S291 microsatellite loci are in strong linkage disequilibrium with a major genetic factor predisposing to MS. These microsatellites span the 6p21.3 region with intervals of 5 cM establishing particular landmarks for the HLA and TNF loci. Thirty-five MS patients and 35 controls, age, sex, social, ethnically and geographically matched healthy individuals, were studied. After testing the fit of gene frequencies to the normal distribution and performing the correlation for multiple comparisons, we found significant differences among the case and the control frequencies for the allele 202 belonging to the marker D6S276 (Pc =0.00455) and for the allele 114 belonging to the marker D6S265 (Pc=0.0084). For these two alleles at different loci, we found higher frequencies in the cases than in the controls. A nonsignificant p value was found in testing the existence of linkage disequilibrium among the studied loci in the cases and in the controls. In conclusion, the current study adds evidence to the established association among polymorphisms of genes located at 6p21.3-21.4 and MS. Furthermore, because of the distribution of the tested microsatellite loci, the more probable critical region could be correlated with the TNF neighborhood.
The use of multiple sclerosis databases at neurological university hospitals in Germany
Authors: Pette M , Zettl U K
Published: October 2002

The development of easy-to-use, clinically oriented multiple sclerosis (MS) database programs has been started, thus paving the way for MS centers to computerize their patient records and to improve quality management. To evaluate the prevalence of such programs at German neurological hospitals, a questionnaire was designed and sent to all clinic directors. With a return of more than 92%, it became evident that MS databases are still being used only by a minority of 22% on a regular basis. We did not recognize the predominance of a single program. A new MS database system that is being presently implemented in Germany is described.
Radiation arteritis following treatment for Wilms’ tumor: an unusual case of weight loss
Authors: Ghosh Amit Kumar , Lundstrom Carl E , Edwards William D
Published: October 2002

Wilms’ tumor is the most common pediatric primary renal cancer and is highly responsive to surgery and chemotherapy. The role of radiotherapy has evolved in the last three decades from the use of stepwise incremental doses in all patients to the current concept of added radiotherapy in advanced cases or in those with unfavorable pathology. To the authors’ knowledge, this is the first case of a young woman with prior history of Wilms’ tumor and significant weight loss due to radiation arteritis involving the abdominal vasculature. A 31-year-old woman presented with a history of weight loss and severe malnutrition. An angiogram revealed that the aorta was occluded below the renal artery. The celiac artery and the superior mesenteric artery were occluded at the origin, and large intercostal collaterals reconstituted the pelvic circulation. She was initially treated with total parenteral nutrition (TPN) and underwent an infrarenal aortic bypass surgery. Histopathology of the aorta revealed intimal fibrocalcific thickening and changes consistent with radiation-induced arteritis. Later, she was readmitted with progressive hepatic insufficiency. Despite intensive medical therapy, she died of multi-organ failure.
Microalbuminuria: marker of vascular dysfunction, risk factor for cardiovascular disease
Authors: Garg Jay P , Bakris George L
Published: October 2002

Based on the data from large single and multi-center clinical trials, including the Heart Outcomes Prevention Evaluation (HOPE) study, it is clear that the presence of microalbuminuria is a signal from the kidney that cardiovascular risk is increased and that vascular responses are altered. This is exemplified by studies that have demonstrated that the compensatory vaso-dilation seen following relief from prolonged ischemia or infusion of vasodilators such as nitroglycerin is blunted in people with microalbuminuria. Thus, the presence of between 30 and 299 mg/day of albumin in the urine is associated with abnormal vascular responsiveness, which may be the result of more advanced atherosclerosis and not necessarily related to the presence of hypertension or renal disease. Agents known to reduce the rise in microalbuminuria or actually reduce the level of microalbuminuria, such as ACE inhibitors, angiotensin receptor blockers, HMG-CoA reductase inhibitors, beta blockers, non-dihydropyridine calcium channel blockers and diuretics, have all been shown to reduce cardiovascular mortality and in some cases preserve renal function. This article will present an overview of the data that support the assertion that a reduction in the rise of microalbuminuria is a significant consideration in the selection of agents to treat a given risk factor (cholesterol or blood pressure) to a recommended target goal. Achieving such a goal with agents that also impact microalbuminuria will provide for a more complete cardiovascular risk reduction.
Abdominal aortic aneurysms: fresh insights from a novel animal model of the disease
Authors: Manning Michael W , Cassis Lisa A , Huang Jing , Szilvassy Stephen J , Daugherty Alan
Published: October 2002

Abdominal aortic aneurysms (AAA) have a high prevalence in aged populations and are responsible for a large number of deaths. Despite the widespread nature of the disease, relatively little is known regarding mechanisms for formation and progression of aortic aneurysms. In part, this lack of knowledge is attributable to a paucity of animal models for this disease. This review summarizes the available animal models of AAA and focuses on a novel model of reproducible AAA generated by infusion of angiotensin II (AngII) into mice rendered hyperlipidemic by the absence of either apolipoprotein E or low-density lipoprotein receptors. AAA generated by AngII infusion have many characteristics of the human disease including marked luminal expansions, perimedial remodeling, inflammation, thrombosis and a link to hyperlipidemia. As in the human disease, male mice are more susceptible to the development of AAA than females. The vascular pathology occurs from the effects of AngII at AT1 receptors present on bone marrow-derived cells. Studies are ongoing to define the mediators responsible for AngII-induced inflammation and degradation of the medial layer of the vascular wall. The AngII-induced model of AAA has the potential to provide novel insights into the underlying mechanisms of this disease and assist with the development of pharmacological therapies.
DNA hypomethylation and methyltransferase expression in atherosclerotic lesions
Authors: Hiltunen Mikko O , Turunen Mikko P , Häkkinen Tomi P , Rutanen Juha , Hedman Marja , Mäkinen Kimmo , Turunen Anna-Mari , Aalto-Setalä Katriina , Ylä-Herttuala Seppo
Published: October 2002

Arterial smooth muscle cell (SMC) migration and proliferation are central features in atherogenesis. Altered gene expression and cell proliferation in atherosclerotic lesions have some similar characteristics with certain solid tumors and thus might have similar mechanisms that lead to SMC proliferation. Among cancer cells common features are genome-wide hypomethylation which correlates with transformation and tumor progression, and coincident over-expression of methyltransferase (MTase). The purpose of the present study was to analyze whether alterations in DNA methylation and MTase expression are present in atherosclerotic lesions.

A significant reduction in genomic 5-methylcytosine content was detected in advanced human atherosclerotic lesions and in lesions of ApoE knock-out mice. SMC were shown to develop hypomethylation in vitro during transformation from a contractile to synthetic pheno-type. Balloon denudation of New Zealand White rabbit aorta caused proliferation of intimal SMC with concomitant genomic hypomethylation in the thickened intima. By using in situ hybridization the overall transcriptional activity was found to be increased in clusters of lesion SMC. Marked heterogeneity was seen in MTase mRNA expression in various types of atherosclerotic lesions among intimal and medial SMC.

These findings show that (1) genomic hypomethylation occurs during atherogenesis in human, mouse and rabbit lesions and that it correlates with increased transcriptional activity; (2) MTase is expressed in atherosclerotic lesions; and (3) hypomethylation is present in advanced lesions at the same level as in malignant tumors and may affect cellular proliferation and gene expression in atherosclerotic lesions.
Sputtering deposition of infra-red reflecting films on ellipsoidal bulbs of energy saving lamps
Authors: Omata Y , Hashimoto N , Kawagoe S , Suemitsu T , Yokoyama M
Published: October 2002

The sputtering deposition (SPD) technique applicable for infra-red reflecting (IR) film coating on ellipsoidal bulbs of halogen lamps was investigated. To realize a uniform IR layer coating on such bulbs, a specifically designed spin and swing motion mechanism for coating bulbs and a novel monitoring system for controlling the coating layer thickness were developed. The IR film coating produced by the SPD processes is shown to offer a worthwhile energy saving of approximately 17% of the lamp power consumption.
Vascular trauma
Authors: Strong DP , Edwards AT
Published: October 2002

Last century saw a marked increase in vascular injuries and their treatment has been improved from the experience gained in the major conflicts in the latter half of the last century. This trend of increasing numbers of vascular injuries has been perpetuated by a rise in civilian violence.

This article reviews the mechanisms, diagnosis and treatment of vascular injury and outlines some of the advances in endovascular techniques for treating vascular trauma.
Separate times, shared spaces: Arthur Ashe, Monument Avenue and the politics of Richmond, Virginia’s symbolic landscape
Authors: Leib Jonathan I.
Published: October 2002

In the late nineteenth and early twentieth centuries, monuments honouring white heroes of the Confederate States of America were erected along Monument Avenue in Richmond, Virginia. In 1995, a vociferous debate occurred in Richmond over a proposal to ‘integrate’ the Avenue, still considered to be the South’s grandest Confederate memorial site, with a statue of the late African American Richmond native, tennis star and human rights activist Arthur Ashe. While on the surface, the main issue in the debate was where to locate the Ashe statue, the underlying debate over Richmond’s symbolic landscape centred on issues of race relations, identity and power in Richmond at the end of the twentieth century.
Delta Opiates Increase Ischemic Tolerance in Isolated Rabbit Jejunum
Authors: Tubbs Robert J. , Porcaro William A. , Lee Won Jae , Blehar David J. , Carraway Robert E. , Przyklenk Karin , Dickson Eric W.
Published: October 2002

Mammalian hibernation is mediated by humoral agonists of the delta opioid receptor (DOR). Moreover, transfer of either humoral or synthetic DOR agonists to non‐hibernators reportedly induces a state of improved myocardial ischemic tolerance. Objective: To determine whether the DOR agonist D‐Ala 2, D‐Leu 5, enkephalin (DADLE) similarly elicits protection in noncardiac—i.e., mesenteric—tissue. Methods: In Protocols 1 and 2, the authors developed and characterized an in vitro model of mesenteric ischemia/reperfusion in isolated rabbit jejunum by documenting the effect of increasing ischemic duration (0 to 120 minutes) and the relative importance of glucose and/or oxygen deprivation on the evolution of jejunal injury. In Protocol 3, jejunal segments were randomized to receive either no treatment (controls) or 15 minutes of pretreatment with 1 μM DADLE, followed by 60 minutes of simulated ischemia and 30 minutes of reperfusion. Jejunal injury was quantified by repeated, time‐matched assessment of peak contractile force evoked by 1 μM acetylcholine (all protocols) and delineation of tissue necrosis (Protocol 1). Results: Development of significant jejunal injury required combined oxygen/glucose deprivation. Moreover, there was a direct relationship between ischemic duration and tissue injury, and a significant inverse correlation between reperfusion contractile force (% of baseline) and the extent of smooth muscle necrosis (r2= 0.87; p < 0.01). Most notably, mesenteric ischemia/reperfusion injury was attenuated by DADLE: reperfusion contractile force was 47 ± 5% versus 36 ± 5% in DADLE‐treated versus control segments (p < 0.01). Conclusions: Treatment with the delta opioid agonist DADLE increases ischemic tolerance of isolated rabbit jejunum.