bluuebunny/crossref_metadata_2025 huggingface dataset:
Analgesic and antiemetic effect of ketorolac vs. betamethasone or dexamethasone after ambulatory surgery
Authors: Thagaard K. S. , Jensen H. H. , Raeder J.
Published: January 2007

Background:  Glucocorticoids are known to provide slower onset and more prolonged duration of analgesic effect than ketorolac. In the present study, we wanted to evaluate the effect over time from a single dose of either intravenous (i.v.) dexamethasone or an intramuscular (i.m.) depot formulation of betamethasone compared with i.v. ketorolac.

Materials and methods:  One hundred and seventy‐nine patients admitted for mixed ambulatory surgery were included in the study. After induction of general i.v. anaesthesia, the patients were randomized to receive double‐blindly either dexamethasone 4 mg i.v. (Group D) or betamethasone depot formulation 12 mg i.m. (Group B) or ketorolac 30 mg i.v. (Group K). Fentanyl was used for rescue analgesic medication in the post‐operative care unit (PACU) and codeine with paracetamol after discharge, for a study period of 3 days.

Results:  There was significantly less post‐operative pain in the ketorolac group during the stay in the unit (88% with minor or less pain in Group K vs. 74% and 67% in Groups D and B, respectively, P < 0.05), significantly less need for rescue medication (P < 0.05) and significantly less nausea or vomiting (12% in Group K vs. 30% in the other groups pooled, P < 0.05). The ketorolac patients were significantly faster for ready discharge, median 165 min vs. 192 min and 203 min in Groups D and B, respectively (P < 0.01). There were no differences between the groups in perceived pain, nausea, vomiting or rescue analgesic consumption in the 4‐ to 72‐h period.

Conclusion:  Dexamethasone 4 mg or bethamethasone 12 mg did not provide prolonged post‐operative analgesic effect compared with ketorolac 30 mg, which was superior for analgesia and antiemesis in the PACU.
Myocardial metabolic monitoring with the microdialysis technique during and after open heart surgery
Authors: Pöling J. , Rees W. , Klaus S. , Bahlmann L. , Hübner N. , Mantovani V. , Warnecke H.
Published: January 2007

Background:  Post‐operative ischemia after coronary artery bypass grafting (CABG) is well described but effective intervention requires immediate diagnosis. One possible way of increasing efficacy of peri‐operative myocardial monitoring is using the microdialysis technique.

Methods:  In 30 patients undergoing routine CABG, a microdialysis catheter was inserted in the left heart in an area of abnormal ventricular contraction. A second catheter was placed in normal tissue of the right ventricle. Microdialysis measurements were performed at time intervals before, during and 24 h after cardiopulmonary bypass (CPB) and retrospectively compared with standard clinical monitoring and clinical course.

Results:  During CPB, both ventricles showed signs of poor tissue oxygenation. Glycerol was significantly higher in the left myocardium (146 ± 67 vs. 72 ± 36 μmol/l) and the glucose/lactate ratio (GLR), as a marker of nutritional disorder of the right ventricle (41 ± 15% vs. 67 ± 17%, P < 0.05), had significantly better values at this time point. Myocardial lactate concentrations were significantly higher in the dyskinetic segments (2.82 ± 0.81 vs. 1.5 ± 0.81 μM). During this period, no abnormal clinical standard monitoring results were observed. Post‐operative significantly increased lactate/pyruvate ratios of three patients were clinically associated with peri‐operative myocardial infarction (108 ± 67 vs. 38 ± 9, P < 0.05). The lactate/pyruvate ratio started rising before any other standard monitoring tools showed abnormal values.

Conclusions:  Peri‐operative microdialytic measurements of parameters related to ischemia can be safely performed in a clinical setting, resulting in faster and more reliable detection of ongoing or new ischemia.
CHANGES IN THEIN VITROPHARMACODYNAMIC PROPERTIES OF METOPROLOL IN ATRIA ISOLATED FROM SPONTANEOUSLY HYPERTENSIVE RATS
Authors: Di Verniero Carla , Höcht Christian , Opezzo Javier A W , Taira Carlos A
Published: January 2007

The present study addressed possible changes in the dissociation constant of metoprolol and its inverse agonist activity in spontaneously hypertensive rats (SHR). In addition, a possible correlation between cardiac hypertrophy and the inverse agonist activity of metoprolol was explored.

In order to determine the dissociation constant (expressed as the pKb) of metoprolol, a cumulative concentration–response curve to noradrenaline was constructed in the absence or presence of metoprolol (0.1, 1 or 10 µmol/L). In a second experiment, a cumulative concentration–response curve to metoprolol was constructed to determine its inverse agonist activity.

The ventricular weight of SHR was significantly greater compared with Wistar‐Kyoto (WKY) rats. A rightward shift of the concentration–response curve to noradrenaline was observed in SHR compared with WKY rats. The pKbof metoprolol was smaller in SHR compared with WKY rats (6.35 ± 0.14vs6.99 ± 0.12, respectively;P < 0.05). No difference was observed in the maximal response (Emax) of the concentration–time effect of metoprolol in WKY rats and SHR (−29.1 ± 7.1vs−28.2 ± 8.5%, respectively;n = 6 for both). However, the concentration of metoprolol eliciting a half‐maximal effect (expressed as the pEC50) was significantly smaller in SHR compared with WKY rats (4.82 ± 0.07vs5.29 ± 0.13, respectively;n = 6;P < 0.05). Although a significant correlation (r = –0.876) between the ventricular weight/bodyweight (VW/BW) ratio and the pEC50of the chronotropic effect of metoprolol was found, no relationship (r = –0.257) was found between the VW/BW ratio and Emax.

In summary, the present study provides the first evidence of a change in thein vitropharmacodynamic properties of metoprolol in SHR. The sympathetic overactivity present in SHR not only reduces the positive chronotropic effect of noradrenaline, but also diminishes the constant dissociation of metoprolol from atrial β1‐adrenoceptors and its inverse agonist activity. A significant correlation between the VW/BW ratio and the inverse agonist potency of metoprolol was found, suggesting a possible link between cardiac hypertrophy and the reduction of the inverse agonist activity of metoprolol.
ANGIOTENSIN II INCREASES TISSUE‐SPECIFIC INHIBITOR OF METALLOPROTEINASE‐2 EXPRESSION IN RAT AORTIC SMOOTH MUSCLE CELLS IN VIVO: EVIDENCE OF A PRESSURE‐INDEPENDENT EFFECT
Authors: Castoldi G , Di Gioia CRT , Travaglini C , Busca G , Redaelli S , Bombardi C , Stella A
Published: January 2007

Angiotensin (Ang) II plays a major role in vascular remodelling. Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) are involved in the tissue remodelling processes. The aim of the present study was to investigate whether AngII modulates TIMP‐2 expression in rat aortic smooth muscle cells in vivo.

Angiotensin II (200 ng/kg per min, s.c.) or AngII + losartan (10 mg/kg per day, s.c.) or normal saline was administered continuously by osmotic minipumps to Sprague‐Dawley rats for 1 week. In addition, the effect of endogenous AngII on TIMP‐2 expression was evaluated in renovascular hypertensive rats (two kidney, one clip (2K1C) and one kidney, one clip (1K1C) models). Control rats (sham 2K1C and sham 1K1C rats) underwent sham‐clipping of the left renal artery. At the end of the treatment, plasma renin activity was measured by radioimmunoassay, aortic TIMP‐2 mRNA expression was evaluated by real‐time polymerase chain reaction and/or northern blotting and protein expression was evaluated by immunohistochemistry. Systolic blood pressure (SBP) was measured twice a week by the tail‐cuff method.

Exogenous AngII administration produced the expected increase in SBP (P = 0.02) compared with the control saline‐treated group. The increase in SBP was abolished in AngII + losartan‐treated rats. Administration of AngII caused a significant increase in TIMP‐2 expression (P = 0.01) in rat aortic smooth muscle cells that was abolished in AngII + losartan‐treated rats. In renovascular hypertensive rats, SBP was higher (P < 0.0001) in 2K1C and 1K1C rats compared with the corresponding sham‐operated rats. Plasma renin activity was higher (P < 0.01) in 2K1C rats compared with the other groups. The expression of TIMP‐2 was significantly (P < 0.05) increased only in 2K1C rats.

Our in vivo data demonstrate that exogenous and endogenous AngII increases TIMP‐2 expression in rat aortic smooth muscle cells. This effect is not dependent on the AngII‐induced increase in blood pressure and is mediated by angiotensin AT1 receptors.
POTENTIAL FOR ENDOTHELIN‐1‐MEDIATED IMPAIRMENT OF CONTRACTILE ACTIVITY IN HYPERTENSION
Authors: Kolka Cathryn M , Rattigan Stephen , Richards Stephen M , Clark Michael G
Published: January 2007

The present study examined the potential for reduced exercise capacity observed in hypertensive patients as a result of elevated levels of endothelin (ET)‐1. We have previously reported that ET‐1 exerts low‐dose stimulatory or high‐dose inhibitory effects on the metabolism of the rat isolated perfused hindlimb from its vasoconstrictor activity.

Herein, we determined whether there are similar effects on tension development by the rat isolated constant‐flow hindlimb during ET‐1‐mediated vasoconstriction.

The dose‐dependent vasoconstrictor effects of ET‐1 on metabolism in contracting muscle were the same as those observed previously in resting muscle. Highest concentrations of ET‐1 gave rise to a transient stimulation followed by a marked inhibition of tension development, consistent with a decrease in aerobic capacity of the muscle. The vasoconstriction due to the higher doses of ET‐1 was not dilated by electrical stimulation.

In conclusion, the biphasic nature of the actions of ET‐1 suggests that although lower concentrations of ET‐1 do not affect exercise capacity, higher concentrations that may occur in hypertension are inhibitory to metabolism and aerobic capacity of muscle. The inhibitory effects of ET‐1 appear to result from enhanced functional shunting.
BENEFICIAL EFFECT OF XANTHOANGELOL, A CHALCONE COMPOUND FROM ANGELICA KEISKEI, ON LIPID METABOLISM IN STROKE‐PRONE SPONTANEOUSLY HYPERTENSIVE RATS
Authors: Ogawa Hiroshi , Okada Yukiko , Kamisako Toshinori , Baba Kimiye
Published: January 2007

Recently, we reported that 4‐hydroxyderricin, one of the major chalcones in Angelica keiskei extract (ethyl acetate extract from the yellow liquid of stems), exerted hypotensive and lipid regulatory actions in stroke‐prone spontaneously hypertensive rats (SHRSP). In the present study, we isolated xanthoangelol, another major chalcone in A. keiskei extract, and examined the effect of dietary xanthoangelol on blood pressure and lipid metabolism in SHRSP.

Six‐week‐old male SHRSP were fed diets containing 0.02% or 0.1% xanthoangelol (0.02 and 0.10 Xan, respectively) for 7 weeks, with free access to the diet and water. There were no significant changes in daily food intake, bodyweight or systolic blood pressure throughout the experimental period. Serum total cholesterol levels tended to decrease in the two experimental groups (albeit not significantly), which was due to a dose‐dependent decrease in the cholesterol content of the low‐density lipoprotein (LDL) fraction. These results suggest that dietary xanthoangelol decreases serum LDL levels.

In the liver, significant dose‐dependent decreases in relative liver liver weight and total triglyceride content were seen in the 0.02 and 0.10 Xan groups. In addition, a significant decrease in total cholesterol content was found in the 0.10 Xan group, which may be due to an elevation of faecal cholesterol excretion in addition to the decrease in liver weight.

Investigation of the hepatic mRNA expression of proteins involved in lipid metabolism indicated that there was a significant increase in peroxisome proliferator‐activated receptor (PPAR) α mRNA expression associated with the tendency for increases in acyl‐coenzyme A (CoA) synthetase and acyl‐CoA oxidase mRNA expression in the 0.10 Xan group, which may be responsible, at least in part, for the decrease in hepatic triglyceride content in the xanthoangelol‐treated rats. In additon, a significant increase in LDL receptor mRNA expression in the 0.10 Xan group may be responsible, at least in part, for the decrease in serum LDL levels in the xanthoangelol‐treated rats.

In conclusion, dietary xanthoangelol results in a reduction of serum LDL levels and decreases in total cholesterol and triglyceride contents in the liver of SHRSP. These beneficial effects are more effective following consumption of diet containing 0.10% xanthoangelol.
Pick’s disease with Pick bodies: An unusual autopsy case showing degeneration of the pontine nucleus, dentate nucleus, Clarke’s column, and lower motor neuron
Authors: Oda Tatsuro , Tsuchiya Kuniaki , Arai Tetsuaki , Togo Takashi , Uchikado Hirotake , De Silva Rohan , Lees Andrew , Akiyama Haruhiko , Haga Chie , Ikeda Kenji , Kato Motoichiro , Kato Yuji , Hara Tsunekatsu , Onaya Mitsumoto , Hori Koji , Teramoto Hiroshi , Tominaga Itaru
Published: January 2007

We report a 51‐year‐old female with Pick’s disease with Pick bodies (PDPB) showing a brainweight of 530 g. This case was considered to be a very rare case of PDPB, in which the lesion developed in the temporal and frontal lobes and later spread to the parietal lobe, occipital lobe, brainstem, cerebellum and spinal cord. This case showed very atypical clinicopathological findings. Clinically, bulging eyes and myoclonus were observed. Neuropathologically, Pick bodies were widely distributed beyond the usual distribution areas to the parietal cortices, occipital cortices, dentate nuclei, motor neuron nuclei in the brain stem, and spinal cord. The atypical clinical symptoms and the widespread neuropathological abnormalities observed in this case seem to represent an extremely extended form of PDPB.
Protein‐bound crotonaldehyde accumulates in the spinal cord of superoxide dismutase‐1 mutation‐associated familial amyotrophic lateral sclerosis and its transgenic mouse model
Authors: Shibata Noriyuki , Kawaguchi Motoko , Uchida Koji , Kakita Akiyoshi , Takahashi Hitoshi , Nakano Ryoichi , Fujimura Harutoshi , Sakoda Saburo , Ihara Yuetsu , Nobukuni Keigo , Takehisa Yasushi , Kuroda Shigetoshi , Kokubo Yasumasa , Kuzuhara Shigeki , Honma Taku , Mochizuki Yoko , Mizutani Tomohiko , Yamada Satoshi , Toi Sono , Sasaki Shoichi , Iwata Makoto , Hirano Asao , Yamamoto Tomoko , Kato Yoichiro , Sawada Tatsuo , Kobayashi Makio
Published: January 2007

Growing evidence documents oxidative stress involvement in ALS. We previously demonstrated accumulation of a protein‐bound form of the highly toxic lipid peroxidation product crotonaldehyde (CRA) in the spinal cord of sporadic ALS patients. In the present study, to the determine the role for CRA in the disease processes of superoxide dismutase‐1 (SOD1) mutation‐associated familial ALS (FALS), we performed immunohistochemical and semiquantitative cell count analyses of protein‐bound CRA (P‐CRA) in the spinal cord of SOD1‐mutated FALS and its transgenic mouse model. Immunohistochemical analysis revealed increased P‐CRA immunoreactivity in the spinal cord of the FALS patients and the transgenic mice compared to their respective controls. In the FALS patients, P‐CRA immunoreactivity was localized in almost all of the chromatolytic motor neurons, neurofilamentous conglomerates, spheroids, cordlike swollen axons, reactive astrocytes and microglia, and the surrounding neuropil in the affected areas represented by the anterior horns. In the transgenic mice, P‐CRA immunoreactivity was localized in only a few ventral horn glia in the presymptomatic stage, in almost all of the vacuolated motor neurons and cordlike swollen axons and some of the ventral horn reactive astrocytes and microglia in the onset stage, and in many of the ventral horn reactive astrocytes and microglia in the advanced stage. Cell count analysis on mouse spinal cord sections disclosed a statistically significant increase in the density of P‐CRA‐immunoreactive glia in the ventral horns of the young to old G93A mice compared to the age‐matched control mice. The present results indicate that enhanced CRA formation occurs in motor neurons and reactive glia in the spinal cord of SOD1‐mutated FALS and its transgenic mouse model as well as sporadic ALS, suggesting implications for CRA in the pathomechanism common to these forms of ALS.
Diagnostic clues and more from photographs
Authors: Hirano Asao , Wate Reika
Published: January 2007

During over 50 years of the first author’s career in neuropathology at Montefiore Medical Center in New York, we have come across certain interesting neuropathological findings. In this communication, some photographs showing macroscopic, microscopic and electron microscopic significant findings are selected to illustrate usefulness not only for the diagnosis but also for understanding of the nervous system. The six topics presented in this paper are: (i) unattached presynaptic terminals in cerebellar neuroblastoma; (ii) neurofibrillary tangle formation in the nucleus basalis of Meynert ipsilateral to a massive cerebral infarct; (iii) orderly arrangement of tumor cells in leptomeningeal carcinomatosis; (iv) interface between craniopharyngioma and brain tissue; (v) neurofibrillary tangles and Lewy bodies in a single neuron; and (vi) Cu/Zn superoxide dismutase positive Lewy body‐like hyaline inclusions in anterior horn cells in familial motor neuron diseases. Analyses of these findings are presented for an educational purpose.
Molecular phylogeny and ultrastructure of Selenidium serpulae (Apicomplexa, Archigregarinia) from the calcareous tubeworm Serpula vermicularis (Annelida, Polychaeta, Sabellida)
Authors: Leander Brian S.
Published: January 2007

Archigregarines are dynamic single‐celled parasites that inhabit the intestinal systems of marine invertebrates, especially suspension feeding and deposit feeding polychaetes. Certain archigregarines in the genus Selenidium have retained several plesiomorphic characters, and improved knowledge of these species is expected to shed considerable light onto the earliest stages in apicomplexan evolution. Although archigregarines are related to some of the most notorious parasites known (e.g., Cryptosporidium and Plasmodium), current knowledge of the group is meagre. In an attempt to improve our understanding of archigregarine diversity and evolution, I have characterised the general ultrastructure and molecular phylogenetic position of Selenidium serpulae (Lankester) Caullery and Mesnil. The parasites were isolated from the intestines of the calcareous tubeworm Serpula vermicularis (Polychaeta) collected in the eastern Pacific Ocean. The trophozoites (extracellular feeding stages) were spindle‐shaped and capable of slow and continuous bending, and coiling, especially when dislodged from the host epithelium. The trophozoite surface was composed of 19–23 longitudinal folds, prominent transverse folds and a robust, trilayered pellicle subtended by a single row of microtubules, each surrounded by an electron transparent sheath. Putative mitochondria were observed, but they were inconspicuous and apparently highly reduced, a condition that is indicative of anaerobic metabolism. The small subunit (SSU) rDNA sequence from S. serpulae was very closely related to two (short) sequences derived from an environmental PCR survey of an oxygen‐depleted hydrothermal vent system in the Gulf of California, namely C1‐E017 (AY046619) and C2‐E016 (AY046806). This result suggested that archigregarines with a morphology and lifecycle much like that in S. serpulae are thriving in this oxygen poor ecosystem. In addition, phylogenetic analyses of a larger SSU rDNA dataset (excluding the shorter environmental sequences) indicated that the nearest sister lineage to S. serpulae was S. vivax, a bizarre tape‐like gregarine found in the intestines of sipunculids. This relationship was bolstered by comparative ultrastructural data and helped to illustrate that the diversification and biogeographical distribution of archigregarine parasites is probably more extensive than usually assumed.
Fish community comparisons along environmental gradients in lakes of France and north‐east USA
Authors: Irz Pascal , Michonneau François , Oberdorff Thierry , Whittier Thomas R. , Lamouroux Nicolas , Mouillot David , Argillier Christine
Published: January 2007

Aim  To assess whether eight traits of fish communities (species richness, three reproductive traits and four trophic traits) respond similarly to environmental gradients, and consequently display convergence between the lakes of France and north‐east USA (NEUSA).

Location  75 French and 168 north‐east USA lakes.

Methods  The data encompass fish surveys, the assignment of species into reproductive and trophic guilds, and environmental variables characterizing the lakes and their catchments. The analytical procedure was adapted from the recommendations of Schluter (1986) [Ecology, 67, 1073–1085].

Results  The comparison of the regional pools of lacustrine fishes indicated that NEUSA was about twice as speciose as France, mostly due to higher species turnover across lakes, although NEUSA lakes were consistently about 20% more speciose than French lakes for a given surface area. Warmer environments were consistently inhabited by a higher proportion of phytophilous and guarder species than were colder lakes. Hence there was convergence in community reproductive traits. Conversely, there was no evidence of convergence in the trophic structure of lacustrine fish communities between regions.

Main conclusions  The influence of temperature on the availability and quality of spawning substrates appears to be a major constraint on present‐day lacustrine fish communities. In parallel, phylogenetic constraints, past events such as the diversification of the North American fish fauna, and selective extinctions during Pleistocene glaciations and subsequent recolonizations contribute to explaining the dissimilarities between the communities of the two regions and differences in their relationship to the environment.
OPTIMAL INSTRUMENTS IN TIME SERIES: A SURVEY
Authors: Anatolyev Stanislav
Published: January 2007

Abstract This article surveys estimation in stationary time‐series models using the approach of optimal instrumentation. We review tools that allow construction and implementation of optimal instrumental variables estimators in various circumstances – in single‐ and multiperiod models, in the absence and presence of conditional heteroskedasticity, by considering linear and non‐linear instruments. We also discuss issues adjacent to the theme of optimal instruments. The article is directed primarily towards practitioners, but econometric theorists and teachers of graduate econometrics may also find it useful.
Cross Country Differences in Trust in Television and the Governance of Public Broadcasters
Authors: Connolly Sara , Hargreaves Heap Shaun P.
Published: January 2007

This paper offers an explanation of European cross country differences in the trust enjoyed by television. Our argument turns on the way that, while there is significant public ownership of television in all countries (so that trust in broadcasting as a whole is bound to depend importantly on trust in public broadcasters), the extent of independence of these public broadcasters from government varies across countries and this affects their trustworthiness. Trust in television matters not only because of the special influence that television plays in the political system but also because there is evidence that trust in institutions directly contributes to individuals' subjective well‐being.
Polarized Futures
Authors: Goorha Prateek
Published: January 2007

In essence, convergence in the ergodic distribution of political regimes has come to be known as the End of History thesis. This essay argues that, in fact, the end of history is not imminent. The future distribution of political regimes, like that of economic income, shows signs of polarization instead. Jointly, these are significant findings for our field and deserve more attention than they currently garner.
Oil outlook to 2025
Authors:   OPEC Secretariat
Published: January 2007

Oil is expected to maintain its leading position in meeting the world's growing energy needs for at least the next two decades. In the reference scenario, oil demand is set to rise by 30 million barrels per day over the next twenty years. However, although developing countries account for most of the rise, energy poverty will remain an important issue. From the supply perspective, the resource base is sufficient to satisfy expected oil demand growth. Non‐OPEC supply is eventually expected to reach a plateau, and, therefore, over the longer‐term, OPEC will be relied upon to supply most of the incremental barrel. These projections underline the need for substantial investment along the entire hydrocarbon supply chain, although the global scale of upstream investment that this outlook implies is not expected to be greater in magnitude than that witnessed in the past. Nevertheless, oil prices must be sufficient to mobilise the resources to supply the market with the necessary oil.

In line with OPEC's longstanding commitment to support oil market stability, OPEC crude capacity expansion plans are already in place to reach almost 38 mb/d by the end of 2010. This demonstrates the seriousness OPEC attaches to the need for security of energy supply. However, energy security has to be seen from both supply and demand perspectives. Uncertainty over future demand translates into large uncertainties over the amount of oil that OPEC Member Countries will eventually need to supply. Even over the medium‐term to 2010, there is an estimated range of uncertainty of $50 billion for required investment, increasing to $140 bn by 2015.

The investment challenge extends along the entire supply chain. The downstream sector is a very important part of that chain. Over the coming decade, rising volumes, the continued move towards demand for lighter products, and the movement towards significantly cleaner products, means that the downstream sector will require significant investment. However, investments are coming at a considerably slower pace than warranted by the expected demand growth. Ways need to be explored that could accelerate expansion plans, and create the right investment climate.

A further critical issue concerns whether increasing use of fossil fuels is consistent with the protection of the environment. Technological options that allow continued use of fossil fuels in a carbon‐constrained world must be considered. One promising example is carbon capture and storage. Steps need to be taken to move this technology forward with large‐scale demonstration projects.
A randomized, single‐blind comparison of topical clindamycin + benzoyl peroxide (Duac®) and erythromycin + zinc acetate (Zineryt®) in the treatment of mild to moderate facial acne vulgaris
Authors: Langner A , Sheehan‐Dare R , Layton A
Published: January 2007

Background  Antibiotics are often combined with other agents to provide topical acne treatments that are effective against both inflammatory and non‐inflammatory lesions and minimize the development of antibiotic resistance.

Objectives  To compare the clinical effectiveness of two combination treatments for facial acne: a ready mixed, once daily gel containing clindamycin phosphate (1%) plus benzoyl peroxide (5%) (CDP + BPO) and a twice daily solution of erythromycin (4%) plus zinc acetate (1.2%) (ERY + Zn).

Methods/patients  In this assessor‐blind, randomized study, 73 patients were treated with CDP + BPO once daily and 75 patients with ERY + Zn twice daily. The treatment period was 12 weeks and lesion counts and global improvement were assessed at weeks 1, 2, 4, 8 and 12.

Results  CDP + BPO showed an earlier onset of action with a faster significant reduction in total lesion counts than ERY + Zn. The proportion of patients with at least a 30% improvement in non‐inflammatory lesions at week 1 was 31.5% for CDP + BPO and 17.3% for ERY + Zn; the corresponding percentages for inflammatory lesions were 39.7% and 29.3%. A difference was also observed at week 2 (53.4% vs. 36.0% for non‐inflammatory lesions and 72.6% vs. 53.3% for inflammatory lesions). The trend in favour of CDP + BPO, although less marked, continued to the end of the study, with reductions in the total lesion count at endpoint of 69.8% for CDP + BPO group and 64.5% for ERY + Zn group. Both treatments were well tolerated.

Conclusions  CDP + BPO and ERY + Zn are effective treatments for acne but CDP + BPO has an earlier onset of action that should improve patient compliance.
Mineral precipitation associated with vertical fault zones: the interaction of solute advection, diffusion and chemical kinetics
Authors: ZHAO CHONGBIN , HOBBS B. E. , ORD A. , HORNBY P. , PENG SHENGLIN , LIU LIANGMING
Published: January 2007

This article is concerned with chemical reactions that occur between two interacting parallel fluid flows using mixing in vertical faults as an example. Mineral precipitation associated with fluid flow in permeable fault zones results in mineralization and chemical reaction (alteration) patterns, which in turn are strongly dependent on interactions between solute advection (controlled by fluid flow rates), solute diffusion/dispersion and chemical kinetics. These interactions can be understood by simultaneously considering two dimensionless numbers, the Damköhler number and the Z‐number. The Damköhler number expresses the interaction between solute advection (flow rate) and chemical kinetics, while the Z‐number expresses the interaction between solute diffusion/dispersion and chemical kinetics. Based on the Damköhler and Z‐numbers, two chemical equilibrium length‐scales are defined, dominated by either solute advection or by solute diffusion/dispersion. For a permeable vertical fault zone and for a given solute diffusion/dispersion coefficient, there exist three possible types of chemical reaction patterns, depending on both the flow rate and the chemical reaction rate. These three types are: (i) those dominated by solute diffusion and dispersion resulting in precipitation at the lower tip of a vertical fault and as a thin sliver within the fault, (ii) those dominated by solute advection resulting in precipitation at or above the upper tip of the fault, and (iii) those in which advection and diffusion/dispersion play similar roles resulting in wide mineralization within the fault. Theoretical analysis indicates that there exists both an optimal flow rate and an optimal chemical reaction rate, such that chemical equilibrium following focusing and mixing of two fluids may be attained within the fault zone (i.e. type 3). However, for rapid and parallel flows, such as those resulting from a lithostatic pressure gradient, it is difficult for a chemical reaction to reach equilibrium within the fault zone, if the two fluids are not well mixed before entering the fault zone. Numerical examples are given to illustrate the three possible types of chemical reaction patterns.
Long‐term effects of various crop rotations for managing salt‐affected soils through a field scale decision support system – a case study
Authors: Kaur R. , Malik R. , Paul M.
Published: January 2007

Appropriate crop rotations coupled to water use plans are the basic means of managing salt‐affected soils. Recommendation of suitable crop rotations for salt‐affected land requires prediction of their long‐term impact on soil salinity/sodicity build‐up and consequent crop yield reduction. This is conventionally achieved through long‐term field experiments. However, such evaluations are site specific, expensive and time consuming. Appropriate decision support systems (DSS) can be a cost‐effective means in such cases. This study demonstrates the application of one such DSS for recommending the best crop rotation for a salt‐affected field in Gurgaon district of Haryana (India). Before application, the DSS was extensively validated on 11 farmer's fields and one experimental field in Gurgaon and Karnal districts of Haryana. The DSS gave realistic estimates of root zone soil salinity/sodicity and relative crop yield reductions under the local management practices. These estimates were associated with absolute mean relative errors ranging between 0.02 and 0.24. Ten‐year impact assessments of existing (i.e. paddy–wheat, P‐W) and 10 alternative crop rotation plans with the validated DSS showed that pearl millet‐based sequences were, environmentally and agronomically, the most suitable options for the test field. However, a cost–benefit analysis of DSS‐simulated average annual crop yields, under various crop rotations, showed that the economic return of pearl millet‐based sequences was about 13% less than fallow–wheat (F‐W) rotations and 4% less than P‐W rotations. Hence F‐W was recommended as the most beneficial environmental choice and economically the most robust alternative crop sequence for the salt‐affected field.
Manipulating the N release from N‐rich crop residues by using organic wastes on soils with different textures
Authors: Chaves B. , De Neve S. , Piulats L. M. , Boeckx P. , Van Cleemput O. , Hofman G.
Published: January 2007

The potential to manipulate the N release from vegetable crop residues (cauliflower, leek) by using organic wastes was tested under field conditions on three soil textures during 2 years (silt loam, sandy loam and loamy sand). During the first year, incorporation of green waste compost and sawdust did not significantly increase microbial biomass N and did not lead to a significant N immobilization of crop residue‐N. During the second year, straw did increase microbial biomass N and showed a good N immobilization potential in all textures. The largest increase in microbial biomass N and the greatest N immobilization occurred in the loamy sand soil. The texture effect was probably because of better incorporation of the crop residues and immobilizer wastes in the loamy sand soil compared with the other textures. During spring, there was no consistent remineralization of immobilized N after the addition of malting sludge or vinasses in either year. This could be a result of the limited amount of N immobilized and available for remineralization in the first year or an unsuitable composition of the remineralizer wastes.
Leaching and crop uptake of N, P and K from organic and conventional cropping systems on a clay soil
Authors: Aronsson H. , Torstensson G. , Bergström L.
Published: January 2007

In this study, three types of cropping systems with different nutrient management strategies were studied on a clay soil with the aim of comparing leaching of N, P and K and obtaining knowledge on nutrient budgets. A conventional cropping system with cereals and application of mineral fertilizers (CON) was compared with two organic cropping systems, one without animal manure in which green manure crops were used for N supply (OGM) and one where animal manure (cattle slurry) was applied (OAM). Leaching and crop uptake of N, P and K, and soil mineral N were measured in pipe‐drained plots over a 6‐year period.

The mean annual leaching loads of N were moderate and did not differ significantly (P > 0.05) between treatments; 13 kg N ha−1in CON, 11 kg N ha−1in OGM and 7.4 kg N ha−1in OAM. Average annual P leaching showed greater variation than N leaching and was significantly greater in OGM (0.81 kg ha−1 year−1) than in CON (0.36 kg ha−1) and OAM (0.41 kg ha−1). For all cropping systems, removal in harvested crops was the most important export of nutrients from the field and constituted between 80 and 94% of total N outputs (harvested and leached N). Yields of cereals in the organic systems were considerably less (15–50%) than in the CON system, leading to a less efficient use of N than in the conventional system.
The Relationship between Work Hours and Utilization of General Practitioners in Four Canadian Provinces
Authors: Fell Deshayne B. , Kephart George , Curtis Lori J. , Bower Kelly , Muhajarine Nazeem , Reid Robert , Roos Leslie
Published: January 2007

Objective. To assess whether long work hours act as a barrier to accessing general practitioner (GP) services.

Data Sources. Secondary data from the 1996/1997 National Population Health Survey (NPHS) and administrative health services utilization data from four Canadian provinces.

Study Design. This study was cross‐sectional, however, employment variables and GP utilization were reflective of the 12‐month period preceding the NPHS interview date. Negative binomial regression was used to model the relationship between the number of GP visits in a 1‐year period and employment‐related variables while adjusting for other determinants of GP utilization including education, income, and health status.

Data Extraction Methods. NPHS and administrative data were linked to create an analysis file.

Principal Findings. Subjects with long, standard work hours (>45 hours/week, with most hours during the day) had significantly lower GP utilization rates compared with full‐time workers. White‐collar workers with long work hours visited a GP significantly less often than white‐collar workers with regular hours.

Conclusions. Long work hours may act as a nonfinancial barrier to accessing GP services independent of health status.
Is Thirty‐Day Hospital Mortality Really Lower for Black Veterans Compared with White Veterans?
Authors: Volpp Kevin G. , Stone Roslyn , Lave Judith R. , Jha Ashish K. , Pauly Mark , Klusaritz Heather , Chen Huanyu , Cen Liyi , Brucker Nancy , Polsky Daniel
Published: January 2007

Objective. To examine the source of observed lower risk‐adjusted mortality for blacks than whites within the Veterans Affairs (VA) system by accounting for hospital site where treated, potential under‐reporting of black deaths, discretion on hospital admission, quality improvement efforts, and interactions by age group.

Data Sources. Data are from the VA Patient Treatment File on 406,550 hospitalizations of veterans admitted with a principal diagnosis of acute myocardial infarction, stroke, hip fracture, gastrointestinal bleeding, congestive heart failure, or pneumonia between 1996 and 2002. Information on deaths was obtained from the VA Beneficiary Identification Record Locator System and the National Death Index.

Study Design. This was a retrospective observational study of hospitalizations throughout the VA system nationally. The primary outcome studied was all‐location mortality within 30 days of hospital admission. The key study variable was whether a patient was black or white.

Principal Findings. For each of the six study conditions, unadjusted 30‐day mortality rates were significantly lower for blacks than for whites (p<.01). These results did not vary after adjusting for hospital site where treated, more complete ascertainment of deaths, and in comparing results for conditions for which hospital admission is discretionary versus nondiscretionary. There were also no significant changes in the degree of difference by race in mortality by race following quality improvement efforts within VA. Risk‐adjusted mortality was consistently lower for blacks than for whites only within the population of veterans over age 65.

Conclusions. Black veterans have significantly lower 30‐day mortality than white veterans for six common, high severity conditions, but this is generally limited to veterans over age 65. This differential by age suggests that it is unlikely that lower 30‐day mortality rates among blacks within VA are driven by treatment differences by race.
Titration of HCTZ to 50 mg Daily in Individuals With Stage 2 Systolic Hypertension Pretreated With an Angiotensin Receptor Blocker
Authors: Izzo Joseph L. , Neutel Joel M. , Tonous Silfani PhD  , Dubiel Robert , Walker Findlay ,   Study Investigators
Published: January 2007

The authors studied the combination of hydrochlorothiazide (HCTZ) 50 mg/d plus olmesartan medoxomil (OM) 40 mg/d in stage 2 systolic hypertension during an extension phase of an open‐label 12‐week dose titration study. Subjects whose blood pressure remained above 120/80 mm Hg (n=105) on OM 40/HCTZ 25 mg/d subsequently received OM 40/HCTZ 50 mg/d for 4 weeks. Increasing HCTZ from 25 mg/d to 50 mg/d decreased systolic blood pressure by 3.6 mm Hg, increased BP control rates (<140/90 mm Hg) from 70.4% to 77.5%, and increased BP normalization rates (<120/80 mm Hg) from 15.4% to 27.8%. The combination was well tolerated. Compared with OM 40 mg/d monotherapy, neither dose of HCTZ affected serum potassium, but both increased serum glucose by about 5%. There was a dose‐dependent increase in uric acid but no acute gout attacks. OM 40/HCTZ 50 mg/d is an effective strategy for managing stage 2 systolic hypertension.
Improvement in “uremic” cardiomyopathy by persistent ultrafiltration
Authors: TÖZ Hüseyin , ÖZKAHYA Mehmet , ÖZERKAN Filiz , AŞÇI Gülay , OK Ercan
Published: January 2007

Some patients with end‐stage renal disease suffer severe cardiac dilatation with functional disturbances, notably low ejection fraction (EF) and valvular regurgitation. They often have normal or low blood pressure, and tolerate ultrafiltration (UF) poorly. The aim of our study was to investigate to what extent this condition can still be improved by persistent slow UF. Twelve patients with cardiothoracic index >0.54 and EF <0.45 but otherwise uncomplicated were treated by slow, prolonged UF during hemodialysis (3 times a week) sessions, if necessary supplemented by isolated UF sessions on a separate day. Repeated chest X‐rays and Doppler echocardiography were applied. During treatment periods varying from 20 to 120 days, all of the patients lost weight (12±10 kg) and became edema free. Cardiothoracic index decreased in all patients from a mean of 0.59±0.04 to 0.47±0.03. Blood pressure decreased when it had been elevated and increased when it was below normal. Ejection fraction increased in all of them from a mean of 0.31±0.9 to 0.50±0.9. Mitral and tricuspid regurgitation were found in every patient and disappeared or improved in all of them. Striking improvement of cardiac dilatation and dysfunction can be achieved by carefully monitored persistent UF in the majority of patients with seemingly intractable dilated cardiomyopathy.
Clinical epidemiology of parathyroidectomy in hemodialysis patients: The USRDS waves 1, 3, and 4 study
Authors: SLININ Yelena , FOLEY Robert N. , COLLINS Allan J.
Published: January 2007

Despite advances in the medical management of secondary hyperparathyroidism, parathyroidectomy remains necessary in some end‐stage renal disease patients. Observational studies may help with the design of intervention trials. We linked the retrospective Waves 1, 3, and 4 Dialysis Morbidity and Mortality Study datasets to Medicare claims data to identify incident parathyroidectomy in 10,588 Medicare patients receiving hemodialysis in the United States on December 31, 1993. The mean age was 60.0 years, and the mean follow‐up 3.6 years. De novo parathyroidectomy incidence was 14.2/1000 patient‐years. Considered as quintiles (Q), higher levels of standard bone metabolism variables were associated (p<0.0001) with parathyroidectomy stepwise, such that adjusted hazards ratios (AHR) for Q5 (vs. Q1) were, for calcium (>10.3 mg/dL), 5.09 (3.64–7.10); for phosphorus (>7.5 mg/dL), 2.92 (2.06–4.15); for calcium‐phosphorus product (>71 mg2/dL2), 3.32 (2.27–4.85); and for parathyroid hormone (PTH; >480 pg/mL), 13.81 (7.47–25.55). Other antecedent associations included younger age, lower hemoglobin, and longer dialysis vintage, while transplantation, as a time‐dependent covariate, was associated with lower hazards ratios. Using interval Poisson analysis, parathyroidectomy was associated with higher mortality risk ratios in the first year, and progressively lower risk ratios subsequently. Demographic variables may modify the risk of parathyroidectomy. Younger patients on long‐term hemodialysis may be at a special risk. Parathyroidectomy risk increases stepwise with alterations in bone metabolism variables, suggesting that a single‐threshold management approach may not be ideal.
Catheter lock heparin concentration: Effects on tissue plasminogen activator use in tunneled cuffed catheters
Authors: HOLLEY Jean L. , BAILEY Sandra
Published: January 2007

The optimal cost‐effective heparin concentration for locking tunneled cuffed hemodialysis catheters (TCC) is unclear. We performed a retrospective review of tissue plasminogen activator (tpa) use in TCC in 2 hemodialysis units that used different heparin concentrations for TCC lock to evaluate the effectiveness of lower dose heparin as a lock for TCC. Catheter blood flow rate per treatment, units of heparin given during treatments, patient hemoglobin values and use of warfarin, and tpa use were compared for all patients using TCC for at least 3 months in 2 in‐center hemodialysis units between 11/04 and 5/05. Both units used the same type of catheters and biocompatible, non‐re‐use dialyzers. Unit A used heparin 1000 U/mL for catheter locks, and Unit B used heparin 10,000 U/mL for catheter locks. Twelve of 19 Unit A patients, tpa and 14 of 45 Unit B patients received intracatheter during the study period (p=0.0009). There were no differences in the number of patients on warfarin, treatment blood flow rate, or mean hemoglobin levels between the 2 groups. The mean heparin units given during hemodialysis treatments was higher in Unit A patients (3.92±2.2 vs. 3.83±2.5 1000 U, p=0.05). Assuming a 4.1 mL total catheter lumen volume, the cost of heparin 1000 U/mL lock was $0.20 per treatment and heparin 10,000 U/mL cost $2.67/treatment; tpa cost $89.02/use. Using the 10,000 U/mL heparin as a catheter lock was associated with less frequent use of tpa. However, the significantly lower cost of the 1000 U/mL heparin could result in significant savings despite higher tpa use. This retrospective, uncontrolled study of a small number of patients suggests that comparing low and high heparin concentrations as a TCC lock would be worthwhile. Prospective studies would be helpful to define the most appropriate and cost‐effective lock for TCC.
Gene polymorphisms of tissue plasminogen activator and plasminogen activator inhibitor‐1 in Turkish patients with generalized aggressive periodontitis
Authors: Emingil Gülnur , Berdeli Afig , Gürkan Ali , Han Saygan Buket , Köse Timur , Atilla Gül
Published: January 2007

Aim: Tissue plasminogen activator (t‐PA) and plasminogen activator inhibitor‐1 (PAI‐1) have important roles in proteolytic events in periodontitis. The aim of this study was to investigate TPA and PAI‐1 gene polymorphisms in relation to susceptibility to generalized aggressive periodontitis (G‐AgP).

Methods: Genomic DNA was obtained from peripheral blood of 90 G‐AgP patients and 154 periodontally healthy subjects. 4G/5G polymorphism in the promoter region of the PAI‐1 gene and Alu‐repeat insertion/deletion (I/D) polymorphism in intron 8 of the TPA gene were genotyped by polymerase chain reaction and endonuclease digestion.

Results: The genotype distributions of TPA and PAI‐1 genes were similar between G‐AgP and healthy subjects (p>0.05). The distribution of TPA genotypes in G‐AgP patients was 33.4% D/D, 44.4% I/D, and 22.2% I/I and was 26.3% D/D, 40.4% I/D, and 33.3% I/I in healthy subjects. The D allele was 55.6% in G‐AgP and 46.6% in healthy subjects. There was a significant difference among study groups in D allele frequencies (p=0.044). The PAI‐1 genotype distribution in G‐AgP was 29.1% 4G/4G, 43.0% 4G/5G, and 27.9% 5G/5G, while it was 35.7% 4G/4G, 43.8% 4G/5G, and 20.5% 5G/5G in healthy subjects.

Conclusion: These data suggest that the D polymorphic allele of TPA gene polymorphism could be associated with susceptibility to G‐AgP in Turkish subjects.
Voriconazole‐induced pseudoporphyria
Authors: Tolland J P , McKeown P P , Corbett J R
Published: January 2007

Pseudoporphyria is a bullous photosensitivity, the commonest aetiology being secondary to various ingested medications. Voriconazole is a relatively new second‐generation triazole antifungal agent. There have only been two reports of pseudoporphyria secondary to voriconazole. We report the third case of this phenomenon occurring in a lady being treated for disseminated candidal infection.