bluuebunny/crossref_metadata_2025 huggingface dataset:
Adverse Events in HIV-Infected Persons Receiving Antiretroviral Drug Regimens in a Large Urban Slum in Nairobi, Kenya, 2003-2005
Authors: Kim Andrea A. , Wanjiku Lucy , Macharia Doris K. , Wangai Mary , Isavwa Anthony , Abdi Hussein , Marston Barbara J. , Ilako Festus , Kjaer Mette , Chebet Kenneth , De Cock Kevin M. , Weidle Paul J.
Published: July 2007

Objective: This article describes toxicities to antiretroviral therapy (ART) among HIV-infected patients receiving care at a clinic in a large urban slum in Nairobi, Kenya. Methods: Patients were treated with nonnucleoside reverse transcriptase inhibitor-based ART and followed at scheduled intervals. Frequencies and cumulative probabilities of toxicities were calculated. Results: Among 283 patients starting ART, any and severe clinical toxicity were recorded as 65% and 6%, respectively. Cumulative probabilities for remaining free of any and severe clinical toxicities at 6, 12, and 18 months, were 0.47, 0.26, and 0.17, respectively and 0.98, 0.95, and 0.89, respectively. The probability of remaining free from elevated and grade 3 or 4 serum aminotransferase (AST) at 6, 12, and 18 months were 0.62, 0.42, and 0.21, respectively, and 0.99 at 6, 12, and 18 months. Conclusions: ART toxicities were frequent, but severe toxicities were less common. In resource-limited settings, ART toxicity should not represent a barrier to care.
African American Men's Perceptions of Factors Influencing Health-Information Seeking
Authors: Sanders Thompson Vetta L. , Talley Michael , Caito Nikki , Kreuter Matthew
Published: July 2007

The lack of health information is one of several factors implicated in the poor health status of African American men. Although a growing body of research delineates the obstacles to African Americans' engagement in preventive health behaviors, relatively little is known about the barriers that adversely affect men's involvement in health-information seeking. This article presents qualitative data on African American men's information seeking through an analysis of focus group data. Three research questions are addressed: (a) What health-information concerns and needs do African American men have? (b) How do African American men describe their efforts to obtain health information? and (c) What factors facilitate or inhibit health-information seeking by African American men? The implications of the data and suggestions for future research are provided.
CCR1/CCL5 (RANTES) receptor-ligand interactions modulate allogeneic T-cell responses and graft-versus-host disease following stem-cell transplantation
Authors: Choi Sung W. , Hildebrandt Gerhard C. , Olkiewicz Krystyna M. , Hanauer David A. , Chaudhary Meghana N. , Silva Ines A. , Rogers Clare E. , Deurloo Daphne T. , Fisher Jacki M. , Liu Chen , Adams David , Chensue Stephen W. , Cooke Kenneth R.
Published: July 2007

Acute graft-versus-host disease (GVHD) and leukemic relapse are serious complications of allogeneic stem-cell transplantation (SCT). Recruitment of activated T cells to host target tissues or sites of leukemic infiltration (graft-versus-leukemia [GVL]) is likely mediated by chemokine receptor–ligand interactions. We examined the contribution of donor cell CCR1 expression to the development of GVHD and GVL using a well-established murine SCT model (B6 → B6D2F1) and CCR1-deficient mice (CCR1−/−). Allo-SCT with CCR1−/− donor cells significantly reduced systemic and target organ GVHD severity, and CCR1 expression on both T cells and accessory cells contributed to GVHD mortality. Significant GVL activity was preserved following CCR1−/− SCT, but the survival advantage diminished with increasing tumor burden. We then explored the effects of CCR1 expression on allo-specific T-cell responses. Although cytolytic effector function was maintained on a per-cell basis, T-cell proliferation and IFNγ secretion were significantly reduced both in vivo and in vitro. T-cell function was partially dependent on interactions between CCR1 and CCL5. Collectively, these data demonstrate that CCR1 expression on donor cells contributes to the development of both GVHD and GVL, and suggest that CCR1/CCL5 receptor-ligand interactions modulate allo-specific T-cell responses occurring in this context.
Impact on and use of an inner-city London Infectious Diseases Department by international migrants: a questionnaire survey
Authors: Cooke Graham , Hargreaves Sally , Natkunarajah Jana , Sandhu Gurjinder , Dhasmana Devesh , Eliahoo Joseph , Holmes Alison , Friedland Jon S
Published: July 2007

Background

The UK has witnessed a considerable increase in immigration in the past decade. Migrant may face barriers to accessing appropriate health care on arrival and the current focus on screening certain migrants for tuberculosis on arrival is considered inadequate. We assessed the implications for an inner-city London Infectious Diseases Department in a high migrant area.

Methods

We administered an anonymous 20-point questionnaire survey to all admitted patients during a 6 week period. Questions related to sociodemographic characteristics and clinical presentation. Analysis was by migration status (UK born vs overseas born).

Results

111 of 133 patients completed the survey (response rate 83.4%). 58 (52.2%) were born in the UK; 53 (47.7%) of the cohort were overseas born. Overseas-born were over-represented in comparison to Census data for this survey site (47.7% vs 33.6%; proportional difference 0.142 [95% CI 0.049–0.235]; p = 0.002): overseas born reported 33 different countries of birth, most (73.6%) of whom arrived in the UK pre-1975 and self-reported their nationality as British. A smaller number (26.4%) were new migrants to the UK (≤10 years), mostly refugees/asylum seekers. Overseas-born patients presented with a broad range and more severe spectrum of infections, differing from the UK-born population, resulting in two deaths in this group only. Presentation with a primary infection was associated with refugee/asylum status (n = 8; OR 6.35 [95% CI 1.28–31.50]; p = 0.023), being a new migrant (12; 10.62 [2.24–50.23]; p = 0.003), and being overseas born (31; 3.69 [1.67–8.18]; p = 0.001). Not having registered with a primary-care physician was associated with being overseas born, being a refugee/asylum seeker, being a new migrant, not having English as a first language, and being in the UK for ≤5 years. No significant differences were found between groups in terms of duration of illness prior to presentation or duration of hospitalisation (mean 11.74 days [SD 12.69]).

Conclusion

Migrants presented with a range of more severe infections, which suggests they face barriers to accessing appropriate health care and screening both on arrival and once settled through primary care services. A more organised and holistic approach to migrant health care is required.
Chemerin Is a Novel Adipokine Associated with Obesity and Metabolic Syndrome
Authors: Bozaoglu Kiymet , Bolton Kristy , McMillan Janine , Zimmet Paul , Jowett Jeremy , Collier Greg , Walder Ken , Segal David
Published: July 2007

Soluble protein hormones are key regulators of a number of metabolic processes, including food intake and insulin sensitivity. We have used a signal sequence trap to identify genes that encode secreted or membrane-bound proteins in Psammomys obesus, an animal model of obesity and type 2 diabetes (T2D). Using this signal sequence trap, we identified the chemokine chemerin as being a novel adipokine. Gene expression of chemerin and its receptor, chemokine-like receptor 1 (CMKLR1), was significantly higher in adipose tissue of obese and type 2 diabetic P. obesus compared with lean, normoglycemic P. obesus. Fractionation of P. obesus adipose tissue confirmed that chemerin was predominantly expressed in adipocytes, whereas CMKLR1 was expressed in both adipocytes and stromal-vascular cells of adipose tissue. In 3T3-L1 adipocytes, chemerin was markedly induced during differentiation, whereas CMKLR1 was down-regulated during differentiation. Serum chemerin levels were measured by ELISA in human plasma samples from 114 subjects with T2D and 142 normal glucose tolerant controls. Plasma chemerin levels were not significantly different between subjects with T2D and normal controls. However, in normal glucose tolerant subjects, plasma chemerin levels were significantly associated with body mass index, circulating triglycerides, and blood pressure. Here we report, for the first time, that chemerin is an adipokine, and circulating levels of chemerin are associated with several key aspects of metabolic syndrome.
Does Glucocorticoid Receptor Blockade Exacerbate Tissue Damage after Mineralocorticoid/Salt Administration?
Authors: Rickard Amanda J. , Funder John W. , Morgan James , Fuller Peter J. , Young Morag J.
Published: July 2007

Mineralocorticoid receptor (MR) antagonism reverses established inflammation, oxidative stress, and cardiac fibrosis in the mineralocorticoid/salt-treated rat, whereas withdrawal of the mineralocorticoid deoxycorticosterone (DOC) alone does not. Glucocorticoid receptors (GRs) play a central role in regulating inflammatory responses but are also involved in cardiovascular homeostasis. Physiological glucocorticoids bind MR with high affinity, equivalent to that for aldosterone, but are normally prevented from activating MR by pre-receptor metabolism by 11β-hydroxysteroid dehydrogenase 2. We have previously shown a continuing fibrotic and hypertrophic effect after DOC withdrawal, putatively mediated by activation of glucocorticoid/MR complexes; the present study investigates whether this effect is moderated by antiinflammatory effects mediated via GR. Uninephrectomized rats, drinking 0.9% saline solution, were treated as follows: control; DOC (20 mg/wk) for 4 wk; DOC for 4 wk and no steroid wk 5–8; DOC for 4 wk plus the MR antagonist eplerenone (50 mg/kg·d) wk 5–8; DOC for 4 wk plus the GR antagonist RU486 (2 mg/d) wk 5–8; and DOC for 4 wk plus RU486 and eplerenone for wk 5–8. After steroid withdrawal, mineralocorticoid/salt-induced cardiac hypertrophy is sustained, but not hypertension. Inflammation and fibrosis persist after DOC withdrawal, and GR blockade with RU486 has no effect on these responses. Rats receiving RU486 for wk 5–8 after DOC withdrawal showed marginal blood pressure elevation, whereas eplerenone alone or coadministered with RU486 reversed all DOC/salt-induced circulatory and cardiac pathology. Thus, sustained responses after mineralocorticoid withdrawal appear to be independent of GR signaling, in that blockade of endogenous antiinflammatory effects via GR does not lead to an increase in the severity of responses in the mineralocorticoid/salt-treated rat after steroid withdrawal.
Protease-Resistant Insulin-Like Growth Factor (IGF)-Binding Protein-4 Inhibits IGF-I Actions and Neointimal Expansion in a Porcine Model of Neointimal Hyperplasia
Authors: Nichols T. C. , Busby W. H. , Merricks E. , Sipos J. , Rowland M. , Sitko K. , Clemmons D. R.
Published: July 2007

IGF-I has been shown to play a role in the progression of atherosclerosis in experimental animal models. IGF-binding protein-4 (IGFBP-4) binds to IGF-I and prevents its association with receptors. Overexpression of a protease-resistant form of IGFBP-4 has been shown to inhibit the ability of IGF-I to stimulate normal smooth muscle cell growth in mice. Based on these observations, we prepared a protease-resistant form of IGFBP-4 and infused it into hypercholesterolemic pigs. Infusion of the protease-resistant mutant inhibited lesion development by 53.3 ± 6.1% (n = 6; P < 0.01). Control vessels that received an equimolar concentration of IGF-I and the protease-resistant IGFBP-4 showed no reduction in lesion size compared with control lesions that were infused with vehicle. Infusion of a nonmutated form of IGFBP-4 did not significantly inhibit lesion development. Proliferating cell nuclear antigen analysis showed that the mutant IGFBP-4 appeared to inhibit cell proliferation. The area occupied by extracellular matrix was also reduced proportionally compared with total lesion area. Immunoblotting revealed that the mutant IGFBP-4 remained intact, whereas the wild-type IGFBP-4 that was infused was proteolytically cleaved. Further analysis of the lesions revealed that a marker protein, IGFBP-5, whose synthesis is stimulated by IGF-I, was decreased in the lesions that received the protease-resistant, IGFBP-4 mutant, whereas there was no change in lesions that received wild-type IGFBP-4 or the mutant protein plus IGF-I. These findings clearly illustrate that infusion of protease-resistant IGFBP-4 into the perilesion environment results in inhibition of cell proliferation and attenuation of the development of neointima. The findings support the hypothesis that inhibiting IGFBP-4 proteolysis in the lesion microenvironment could be an effective means for regulating neointimal expansion.
The functional architecture of the shark's dorsal-octavolateral nucleus:an in vitro study
Authors: Rotem Naama , Sestieri Emanuel , Cohen Dana , Paulin Mike , Meiri Hanoch , Yarom Yosef
Published: July 2007

Learning to predict the component in the sensory information resulting from the organism's own activity enables it to respond appropriately to unexpected stimuli. For example, the elasmobranch dorsal octavolateral nucleus (DON) can apparently extract the unexpected component (i.e. generated by nearby organisms) from the incoming electrosensory signals. Here we introduce a novel and unique experimental approach that combines the advantages of in vitro preparations with the integrity of in vivo conditions. In such an experimental system one can study, under control conditions, the cellular and network mechanisms that underlie cancellation of expected sensory inputs.

Using extracellular and intracellular recordings we compared the dynamics and spatiotemporal organization of the electrosensory afferent nerve and parallel fiber inputs to the DON. The afferent nerve has a low threshold and high conduction velocity; a stimulus that recruits a small number of fibers is sufficient to activate the principal neurons. The excitatory postsynaptic potential in the principal cells evoked by afferent nerve fibers has fast kinetics that efficiently reach the threshold for action potential. In contrast, the parallel fibers have low conduction velocity, high threshold and extensive convergence on the principal neurons of the DON. The excitatory postsynaptic response has slow kinetics that provides a wide time window for integration of inputs.

The highly efficient connection between the afferent nerve and the principal neurons in the DON indicates that filtration occurring in the DON cannot be mediated simply by summation of the parallel fibers' signals with the afferent sensory signals. Hence we propose that the filtering may be mediated via secondary neurons that adjust the principal neurons'sensitivity to afferent inputs.
Flight stabilization control of a hovering model insect
Authors: Sun Mao , Wang Ji Kang
Published: July 2007

The longitudinal stabilization control of a hovering model insect was studied using the method of computational fluid dynamics to compute the stability and control derivatives, and the techniques of eigenvalue and eigenvector analysis and modal decomposition, for solving the equations of motion (morphological and certain kinematical data of hoverflies were used for the model insect).

The model insect has the same three natural modes of motion as those reported recently for a hovering bumblebee: one unstable oscillatory mode, one stable fast subsidence mode and one stable slow subsidence mode. Controllability analysis shows that although unstable, the flight is controllable. For stable hovering, the unstable oscillatory mode needs to be stabilized and the slow subsidence mode needs stability augmentation. The former can be accomplished by feeding back pitch attitude, pitch rate and horizontal velocity to produce \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({\delta}{\bar{{\phi}}}\) \end{document} orδα 2; the latter by feeding back vertical velocity to produce δΦ or δα1 (δΦ, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({\delta}{\bar{{\phi}}}\) \end{document}, δα1and δα2 denote control inputs: δΦ and \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \({\delta}{\bar{{\phi}}}\) \end{document} represent changes in stroke amplitude and mean stroke angle, respectively; δα1represents an equal change whilst δα2 a differential change in the geometrical angles of attack of the downstroke and upstroke).
Skeletal strain patterns and growth in the emu hindlimb during ontogeny
Authors: Main Russell P. , Biewener Andrew A.
Published: July 2007

Most studies examining changes in mechanical performance in animals across size have typically focused on inter-specific comparisons across large size ranges. Scale effects, however, can also have important consequences in vertebrates as they increase in size and mass during ontogeny. The goal of this study was to examine how growth and development in the emu (Dromaius novaehollandiae) hindlimb skeleton reflects the demands placed upon it by ontogenetic changes in locomotor mechanics and body mass. Bone strain patterns in the femur and tibiotarsus (TBT) were related to ontogenetic changes in limb kinematics, ground reaction forces, and ontogenetic scaling patterns of the cross-sectional bone geometry, curvature and mineral ash content over a 4.4-fold increase in leg length and 65-fold increase in mass. Although the distribution of principal and axial strains remained similar in both bones over the ontogenetic size range examined, principal strains on the cranial femur and caudal femur and TBT increased significantly during growth. The ontogenetic increase in principal strains in these bones was likely caused by isometry or only slight positive allometry in bone cross-sectional geometry during growth, while relative limb loading remained similar. The growth-related increase in bone strain magnitude was likely mitigated by increased bone mineralization and decreased curvature. Throughout most of ontogeny, shear strains dominated loading in both bones. This was reflected in the nearly circular cross-sectional geometry of the femur and TBT, suggesting selection for resistance to high torsional loads, as opposed to the more eccentric cross-sectional geometries often associated with the bending common to tetrapods with parasagittal limb orientations, for which in vivobone strains have typically been measured to date.
Mechanics of a `simple' ear: tympanal vibrations in noctuid moths
Authors: Windmill J. F. C. , Fullard J. H. , Robert D.
Published: July 2007

Anatomically, the ears of moths are considered to be among the simplest ears found in animals. Microscanning laser vibrometry was used to examine the surface vibrations of the entire tympanal region of the ears of the noctuid moths Agrotis exclamationis, Noctua pronuba, Xestia c-nigrum and Xestia triangulum. During stimulation with ultrasound at intensities known to activate receptor neurones, the tympanum vibrates with maximum deflection amplitudes at the location where the receptor cells attach. In the reportedly heterogeneous tympana of noctuid moths, this attachment site is an opaque zone that is surrounded by a transparent, thinner cuticular region. In response to sound pressure, this region moves relatively little compared with the opaque zone. Thus, the deflections of the moth tympanic membrane are not those of a simple circular drum. The acoustic sensitivity of the ear of N. pronuba, as measured on the attachment site, is 100±14 nm Pa–1 (N=10), corresponding to tympanal motion of a mere 200 pm at sound pressure levels near the neural threshold.
In ovotemperature manipulation influences embryonic motility and growth of limb tissues in the chick (Gallus gallus)
Authors: Hammond Christina L. , Simbi Biggy H. , Stickland Neil C.
Published: July 2007

The chick embryo, developing in the egg, is an ideal system in which to investigate the effects of incubation environment on the development of the embryo. We show that raising the temperature of the eggs by just one degree,from 37.5°C to 38.5°C, during embryonic days (ED) 4–7 causes profound changes in development. We demonstrate that embryonic movement is significantly increased in the chicks raised at 38.5°C both during the period in which they are at the higher temperature but also 4 days after their return to the control temperature. Concomitant with this increase in embryonic activity, the embryos raised at higher temperature grow to significantly heavier weights and exhibit significantly longer leg bones (tibia and tarsus)than the controls from ED12 onwards, although mineralization occurs normally. Additionally, the number of leg myonuclei is increased from ED12 in the embryos raised at the higher temperature. This is likely to promote greater leg muscle growth later in development, which may provide postural stability to the chicks posthatch. These changes are similar to those seen when drugs are injected to increase embryonic activity. We therefore believe that the increased embryonic activity provides a mechanism that can explain the increased growth of leg muscle and bone seen when the eggs are incubated for 3 days at higher temperature.
An Overview of the History and Economic Geology of the Natural Cement Industry at Rosendale, Ulster County, New York
Authors: Werner Dietrich , Burmeister Kurtis C.
Published: July 2007

The Rosendale region of southeastern New York State is widely recognized as the source of the highest quality natural cement in North America. The North American natural cement industry was founded in 1819 by Canvass White in central New York, but soon shifted to Rosendale where it flourished for over 150 years. By the end of the 19th century, the superior quality of Rosendale cement was known worldwide and was actively used in the construction of some of America’s most enduring landmarks. Rosendale natural cement’s reputation stems from the unique composition of the clay-rich layers of dolostone in the Upper Silurian Rondout Formation from which it is manufactured. Miners utilized room-and-pillar techniques to extract this dolostone from strongly deformed strata in the Rosendale region, creating unique bedrock exposures in mines that are something of an engineering marvel. The exposures resulting from these mining activities have long attracted the attention of geologists for research and education. Production of natural cement transformed extracted dolostone into barrels of cement through a labor-intensive process involving calcination in kilns, cracking, and grinding. Barrels of cement produced were quickly shipped at competitive prices via the Delaware and Hudson Canal, which directly connected the Rosendale natural cement region to major shipping avenues.
Irradiation Hardening and Microstructure Evolution of Ion-irradiated ODS Ferritic Steels
Authors: Yutani Kentaro , Kasada Ryuta , Kishimoto Hirotatsu , Kimura Akihiko
Published: July 2007

Irradiation hardening and microstructural change of oxide dispersion strengthened (ODS) ferritic steels were investigated by using the ion-irradiation technique. The material used for the present study was K3 (16C-2W-0.3Ti-4.6Al-0.4Y2O3) ODS ferritic steel for the application to Generation IV concept advanced reactors and fusion reactors. 6.4 MeV Fe3+ ions were used to irradiate to the K3 ODS steel by using a 1.7 MeV tandem accelerator. The irradiation temperatures were 300°C and 500°C. The nominal displacement damage rate and total displacement damage were 1×10−3 dpa/s and up to 10 dpa at about 600-nm depth from the irradiated surface, respectively. Nano-indentation hardness was evaluated with a Berkovich indenter. After the ion-irradiation at 300°C up to 1 dpa, the normalized nano-indentation hardness (hardness after irradiation/hardness before irradiation) of the K3 ODS steel reached about 1.28 and the value showed no change up to 10 dpa. On the other hand, the ion-irradiation at 500°C up to 10 dpa showed no significant irradiation hardening. TEM observation revealed that dense and fine dislocation loops were formed in the ion-irradiated steels at 300°C, which were probably enough to explain the irradiation hardening.
Postpartum care of the perineum
Authors: Fitzpatrick Myra , O'Herlihy Colm
Published: July 2007

Key content

Vaginal birth is traumatic to the pelvic floor and perineum.

Faecal incontinence, perineal pain, urinary incontinence and dyspareunia can all be long‐term effects of such damage.

Recognition and management of perineal trauma postpartum is vital.

Women rarely volunteer information regarding faecal incontinence and dyspareunia.

A dedicated pelvic floor clinic may be the most appropriate setting in which to care for women who are affected.

Learning objectives

To learn about the guidelines in place for the repair of perineal trauma following delivery.

To recognise that anal sphincter damage may require follow‐up and appropriate investigation.

To learn that direct questioning of women about dyspareunia and faecal incontinence is necessary to elicit information.

Ethical issues

Is it the responsibility of women to present with their problems or should nursing and medical staff look for them?

Financial constraints inappropriately limit the provision of small, highly focused clinics.

Please cite this article as: Fitzpatrick M, O'Herlihy C, Postpartum care of the perineum. The Obstetrician & Gynaecologist 2007;9:164–170.
Planned vaginal breech delivery: should this be the mode of choice?
Authors: van Iddekinge Basil
Published: July 2007

Key content

The risks of serious early perinatal morbidity and mortality are three times higher for planned vaginal breech delivery than for elective caesarean section.

Because morbidity and mortality are relatively low, a large number of caesarean sections needs to be performed to avoid a single adverse event.

External cephalic version appears to be a safe procedure that can halve the number of breech presentations but the procedure is not risk‐free.

Four guidelines or directives are outlined but need to be adapted to the setting in which they are applied.

Planned vaginal breech delivery is an acceptable choice to offer, provided strict protocols are followed.

Learning objectives

To gain an awareness of the risk factors and benefits of external cephalic version.

To gain an awareness of the short and long‐term risk factors and benefits to the mother and child of planned vaginal breech delivery compared with elective caesarean section.

To be able to manage breech presentation at term in different clinical and in differently resourced settings.

Ethical issues

Can planned vaginal breech delivery be justified?

How can expertise in vaginal breech delivery be learned or taught if a policy of elective caesarean section is implemented?

How can we obtain genuine informed consent when there are so many areas of uncertainty for degree of risk and benefit?

Please cite this article as: van Iddekinge B. Planned vaginal breech delivery: should this be the mode of choice? The Obstetrician & Gynaecologist 2007;9:171–176.
Health technology assessment in obstetrics and gynaecology. Part 2: application in practice
Authors: Abedin Parveen , Daniels Jane , Khan Khalid S
Published: July 2007

Key content

The process of health technology assessment (HTA) is demonstrated using two examples: a systematic review and a clinical trial.

The HTA of anti‐D prophylaxis for Rh‐negative pregnant women was undertaken to inform a decision on whether to introduce this intervention universally.

Using statistical methods to pool the results, it was calculated that the number needed to treat with antenatal anti‐D prophylaxis to avoid one case of sensitisation was 278.

The EVALUATE trial was designed to investigate differences in complication rates between laparoscopic and abdominal hysterectomy and between laparoscopic and vaginal hysterectomy.

The laparoscopic procedure has a higher mean cost per quality‐adjusted life year (QALY), but it scores significantly higher on all the quality of life questionnaires. Ultimately, it will be the willingness of the National Health Service to pay the extra cost per additional QALY that will decide whether it is adopted into routine practice.

Learning objectives

To understand, through examples, the practical application of the process of HTA in everyday clinical practice.

To appreciate the incorporation of clinical and economic evaluations into assessment of effectiveness.

To understand the quality criteria for assessing primary studies in a systematic review.

Ethical issues

It is no longer sufficient to consider only the clinical effectiveness of a technology. HTA should include an economic evaluation to determine value for money.

Systematic reviews provide evidence of effectiveness, although implementation of a technology will depend on its relative importance to policy decision makers.

Researchers need to be transparent in any shortcomings in the design or conduct of their trials and reviews.

Please cite this article as: Abedin P, Daniels J, Khan KS. Health technology assessment in obstetrics and gynaecology. Part 2: application in practice. The Obstetrician & Gynaecologist 2007;9:181–187.
Hemogenic Endothelial Progenitor Cells Isolated from Human Umbilical Cord Blood
Authors: Wu Xiao , Lensch M. William , Wylie-Sears Jill , Daley George Q. , Bischoff Joyce
Published: July 2007

Hemogenic endothelium has been identified in embryonic dorsal aorta and in tissues generated from mouse embryonic stem cells, but to date there is no evidence for such bipotential cells in postnatal tissues or blood. Here we identify a cell population from human umbilical cord blood that gives rise to both endothelial cells and hematopoietic progenitors in vitro. Cord blood CD34+/CD133+ cells plated at high density in an endothelial basal medium formed an endothelial monolayer and a nonadherent cell population after 14–21 days. AML-1, a factor required for definitive hematopoiesis, was detected at low levels in adherent cells and at high levels in nonadherent cells. Nonadherent cells coexpressed the endothelial marker vascular endothelial (VE)-cadherin and the hematopoietic marker CD45, whereas adherent cells were composed primarily of VE-cadherin+/CD45− cells and a smaller fraction of VE-cadherin+/CD45+ cells. Both nonadherent and adherent cells produced hematopoietic colonies in methylcellulose, with the adherent cells yielding more colony-forming units (CFU)-GEMM compared with the nonadherent cells. To determine whether the adherent endothelial cells were producing hematopoietic progenitors, single cells from the adherent population were expanded in 96-well dishes for 14 days. The clonal populations expressed VE-cadherin, and a subset expressed AML-1, ε-globin, and γ-globin. Three of 17 clonal cell populations gave rise to early CFU-GEMM hematopoietic progenitors and burst-forming unit-erythroid progenitors. These results provide evidence for hemogenic endothelial cells in human umbilical cord blood.

Disclosure of potential conflicts of interest is found at the end of this article.
Inhibition of Histone Deacetylase Activates Side Population Cells in Kidney and Partially Reverses Chronic Renal Injury
Authors: Imai Naohiko , Hishikawa Keiichi , Marumo Takeshi , Hirahashi Junichi , Inowa Toshihiko , Matsuzaki Yumi , Okano Hideyuki , Kitamura Tadaichi , Salant David , Fujita Toshiro
Published: July 2007

Bone morphogenic protein (BMP)-7 is expressed in the adult kidney and reverses chronic renal injury when given exogenously. Here, we report that a histone deacetylase inhibitor, trichostatin A (TSA), attenuates chronic renal injury, in part, by augmenting the expression of BMP-7 in kidney side population (SP) cells. We induced accelerated nephrotoxic serum nephritis (NTN) in C57BL/6 mice and treated them with TSA for 3 weeks. Compared with vehicle-treated NTN mice, treatment with TSA prevented the progression of proteinuria, glomerulosclerosis, interstitial fibrosis, and loss of kidney SP cells. Basal gene expression of renoprotective factors such as BMP-7, vascular endothelial growth factor, and hepatocyte growth factor was significantly higher in kidney SP cells as compared with non-SP cells. Treatment with TSA significantly upregulated the expression of BMP-7 in SP cells but not in non-SP cells. Moreover, initiation of treatment with TSA after 3 weeks of NTN (for 3 weeks, until 6 weeks) partially but significantly reversed renal dysfunction. Our results indicate an important role of SP cells in the kidney as one of the possible generator cells of BMP-7 and TSA as a stimulator of the cells in reversing chronic renal disease.

Disclosure of potential conflicts of interest is found at the end of this article.
Global Epiproteomic Signatures Distinguish Embryonic Stem Cells from Differentiated Cells
Authors: Dai Bo , Rasmussen Theodore P.
Published: July 2007

Complex organisms contain a variety of distinct cell types but only a single genome. Therefore, cellular identity must be specified by the developmentally regulated expression of a subset of genes from an otherwise static genome. In mammals, genomic DNA is modified by cytosine methylation, resulting in a pattern that is distinctive for each cell type (the epigenome). Because nucleosomal histones are subject to a wide variety of post-translational modifications (PTMs), we reasoned that an analogous “epiproteome” might exist that could also be correlated with cellular identity. Here, we show that the quantitative evaluation of nucleosome PTMs yields epiproteomic signatures that are useful for the investigation of stem cell differentiation, chromatin function, cellular identity, and epigenetic responses to pharmacologic agents. We have developed a novel enzyme-linked immunosorbent assay-based method for the quantitative evaluation of the steady-state levels of PTMs and histone variants in preparations of native intact nucleosomes. We show that epiproteomic responses to the histone deacetylase inhibitor trichostatin A trigger changes in histone methylation as well as acetylation, and that the epiproteomic responses differ between mouse embryonic stem cells and mouse embryonic fibroblasts (MEFs). ESCs subjected to retinoic acid-induced differentiation contain reconfigured nucleosomes that include increased content of the histone variant macroH2A and other changes. Furthermore, ESCs can be distinguished from embryonal carcinoma cells and MEFs based purely on their epiproteomic signatures. These results indicate that epiproteomic nucleosomal signatures are useful for the investigation of stem cell identity and differentiation, nuclear reprogramming, epigenetic regulation, chromatin dynamics, and assays for compounds with epigenetic activities.

Disclosure of potential conflicts of interest is found at the end of this article.
The effect of viscosity on surface tension measurements by the drop weight method
Authors: Kaully T. , Siegmann A. , Shacham D. , Marmur A.
Published: July 2007

Viscosity is one of the parameters affecting the measured surface tension, as fluid mechanics affects the measurement process using conventional methods. Several methods including the selected planes (SPM) and WDSM which combines the weight drop method (WDM) and SPM, are applied to surface tension measurement of high viscous liquids. Yet, none of them treats the viscosity effect separately. The current publication presents a simple, easy to apply empirical approach of satisfactory accuracy, for evaluation of surface tension of liquids having wide range of viscosities up to 10 Pa s. The proposed method is based on Tate's law and the “drop weight” method using calibration curves of known liquids having similar surface tensions but different viscosities. Drop weight of liquids having viscosity ≥0.05 Pa s, was found to be significantly affected by the liquid viscosity. The shape factor, f, of high viscosity liquids was found to correlate linearly with the logarithm of viscosity, pointing the importance of viscosity correction. The experimental correlation presented in the current work can be used as a tool for the evaluation of surface tension for high viscosity liquids such as prepolymers. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci, 2007
Combining Models ADM1 and ASM2d in a Sequencing Batch Reactor Simulation
Authors: Kauder J. , Boes N. , Pasel C. , Herbell J.‐D.
Published: July 2007

The Anaerobic Digestion Model No. 1 (ADM) and the Activated Sludge Model No. 2d (ASM) have been combined in a sequencing batch reactor simulation using a FORTRAN ODE solver. Special attention has been paid to the interface definition between the two models which use different biological state variables. The simulation results demonstrate the alternating treatment characteristics resulting from the sequence of anaerobic and aerobic steps. A parameter study reveals the process optimization potential of the model. Some numerical issues of the ADM are discussed in detail. The Jacobian matrix is provided, and the error handling of negative gas‐rates and negative concentrations is described from a numerical point of view.
Study of the Preparation of Flavone Imprinted Silica Microspheres and Their Molecular Recognition Function
Authors: Zhang Y.‐Q. , Qin Z. , Tu Z.‐Y.
Published: July 2007

The aim of this study is to prepare flavone imprinted silica with good sphericity. Previous studies have demonstrated that imprinted silica can be synthesized using a simple sol‐gel method and a grinding‐sieving process. Despite the simplicity of the synthetic method, the appearance of the final product obtained is often very irregular and nonuniform. This product has many utilization issues and problems, e.g., residues and low operability. In this study, one type of novel spherical flavone imprinted silica was synthesized. A sol‐gel method and molecular imprinting technique were employed. By using luteolin as a template molecule, aminopropyltriethoxysilane (APTS) as the functional monomer, tetraethoxysilane (TEOS) as the cross‐linking agent, molecularly imprinted silica microspheres were prepared via a two‐stage reaction. The preparation conditions were monitored by the appearance of the products. SEM images show that under optimum conditions, the diameters of these microspheres are ca. 20–30 μm. The amino group adsorption peaks can be seen from the IR spectra. Results from elemental analysis indicate that 3.206 μmol of amino groups were successfully introduced into 1 g of product. This microspheric adsorbent has a high adsorption capacity to the template molecule, high adsorption selectivity and reproducibility. The adsorption capacity amounted to 32.987 mg/g and the separation factor was up to 84.3, while the adsorption capacity hardly decreased after 15 cycles.
Velocity Profiles of Suspension Flows through an Abrupt Contraction Measured by Magnetic Resonance Imaging
Authors: Yasuda K. , Ohara N. , Muguruma M.
Published: July 2007

Velocity profiles in steady flows of fluid/particle mixtures through a duct with an abrupt contraction were measured by magnetic resonance imaging. Aqueous solutions of carboxymethyl cellulose containing particles, including spheres, disk‐like particles, and short fibers, at high volume fractions were used. As a result, a plug‐like velocity profile was observed in a straight duct flow for every suspension, but the velocity profile depends on the particle shape at contraction. Disk‐like particles caused an unsteady flow, and short fibers caused a concave shape in the velocity profile near the centerline upstream of the contraction. Spheres did not affect the flow field. The concave profile became obvious with increased volume fraction of fiber. This result is caused by the larger elongational viscosity of the fiber suspension near the centerline of the channel, as compared with that of the sphere suspension.
Photocatalytic Degradation of Benzene in Air Streams in an Optical Fiber Photoreactor
Authors: Ma C. M. , Wang W. , Ku Y. , Jeng F. T.
Published: July 2007

Photocatalytic decomposition of gaseous benzene at room temperature was studied with a differential‐type optical fiber reactor using TiO2 as the photocatalyst. The effects of humidity, UV light intensity and benzene concentration on the performance of the reactor for benzene decomposition were investigated. It was observed that both the apparent quantum yields of benzene decomposition and CO2 production were superior to the traditional photoreactor, especially under limited UV light supply. In addition, deactivation of the TiO2 catalyst heavily relied on the humidity contained in the airflow. Purging with ozone‐containing air rapidly decomposed the organic residues adhering to the TiO2 surface and regenerated the deactivated catalyst within 30 minutes.
Synthesis and Structures of Alkali(alkoxy) Antimonates and Bismuthates
Authors: Veith Michael , Yu Eung‐Chul , Huch Volker
Published: July 2007

As(OtBu)3 does not form adducts with alkali metal tert‐butoxides MOtBu (M = Li, Na, K, Rb and Cs), whereas the corresponding Sb(OtBu)3 (2) and Bi(OtBu)3 (3) react with MOtBu (M = K, Rb, Cs) to yield M(OtBu)4Sb (M = K (6), Rb (7), Cs (8)) and M(O‐tBu)4Bi (M = 9), respectively. X‐ray structure determinations for 6 and 9 show them to be one‐dimensional coordination polymers composed of E(OtBu)4 (E = Sb, Bi) units linked through potassium atoms. These E(OtBu)4 units display a ψ‐trigonal‐bipyramidal coordination around the metal atom (SbO = 1.971(2) and 2.181(2) Å, BiO = 2.068(8) and 2.275(8) Å). Both the structures exhibit a planar four‐coordinate environment of oxygen around the potassium atoms (KO = 2.650(2)‐2.967(2) Å in 6, 2.53(1)‐3.15(1) Å in 9). Compound 2 reacts with two equivalents of KOtBu to afford K2Sb(OtBu)5 · dioxane (10), which contains Sb2K2O5 cage units and can be described as an O5 trigonal bipyramid with metal atoms inserted in the equatorial edges. Each metal atom is tetracoordinated by oxygen atoms of the cage (SbO = 1.979(3)‐2.144(3) Å. KO = 2.592(3)‐2.778(2) Å). The dioxane molecules increase the coordination number at each potassium atom to five by forming bridges between the molecules through KO bonds. Reaction of 2 and 3 with NaOtBu produce the cluster compounds Na4Sb2O(OtBu)8 (4) and Na4Bi2O‐(OtBu)8 (5) in high yields. K4Sb2O‐(OtBu)8 (11) is obtained in almost quantitative yield by heating KSb(OtBu)4 in benzene for 24 h. Compounds 4, 5 and 11 crystallise in rhombohedral lattices; the crystal structure analyses show a superposition of molecules. With an isotropic oxygen‐centred M6 octahedron. The formation of these oxo‐tert‐butoxides is accompanied by evolution of isobutene. Addition of four equivalents of THF to 11 gives K4Sb2O(OtBu)8 · 4 THF (12). X‐ray diffraction studies reveal a cis arrangement of the Sb atoms in the central OSb2K4 unit. K4Sb2O2(OiPr)12 (13) is obtained as the major product on heating KSb(OtBu)4 and subsequent reaction with isopropyl alcohol. In the crystal structure, two oxygen‐centred Sb2K2 tetrahedra (KO 2.693(4) Å, SbO = 1.982(5) Å) linked through iPrOK bonds (2.726(7)‐2.738(7) Å) are observed. In the reactions of KSb(OtBu)4 (6) with the metal halides CaCl2, TlCl and CuI, a halide ion is transferred to potassium; this results in formation of potassium halide, the corresponding alkoxide and Sb(OtBu)3.
Linear and Cyclic Platinum σ‐Acetylide Complexes of Tetraethynylethene
Authors: Faust Rüdiger , Diederich François , Gramlich Volker , Seiler Paul
Published: July 2007

The syntheses of the first organometallic mono‐ and dinuclear platinum complexes bearing the tetraethynylethene unit as an η1‐ligand are reported. Structural characterization of two of the trans σ‐bis(acetylide) derivatives by X‐ray crystallography reveals coplanarity of the acetylenic π‐ligands and indicates possible electronic delocalization across the metal center. This notion is further supported by comparing the electronic absorption spectra of the platinum‐containing compounds with those of related tetraethynylethene derivatives without metals. The solidstate structure of a dinuclear complex with two iodoplatinum fragments attached to one set of geminal acetylenes of tetraethynylethene was also investigated by X‐ray diffraction. Hay coupling of a mononuclear species leads to the incorporation of the σ‐bis(acetylide) moiety into a diplatinated metallacycle. This macrocyclic compound represents a novel structural motif in the design of a transition metal linked carbon network based on tetraethynylethene.
First Synthesis of the Functionalized Dioxatricyclic Core Structure of Dictyoxetane and Proposed Biogenesis in Dictyota Dichotoma
Authors: Reinecke Jens , Hoffmann H. M. R.
Published: July 2007

6,8‐Dimethyl‐2,7‐dioxatricyclo[4.2.13,8]nonan‐4β‐ol (9aβ) has been prepared from readily accessible starting materials in eight steps (14% overall yield). The parent dioxatricyclic framework 11 was obtained from 1,5‐dimethyl‐8‐oxabicyclo[3.2.1]oct‐3‐en‐6α‐ol (7) in six steps (28% yield with respect to 7). Based on the experimental introduction of the oxetane moiety in vitro, a biosynthetic pathway is proposed for dictyoxetane (1) from a known dolabellane metabolite.
Total Synthesis of the Trehalase Inhibitor Salbostatin
Authors: Yamagishi Tatsuya , Uchida Chikara , Ogawa Seiichiro
Published: July 2007

The total synthesis of trehalase inhibitor salbostatin (1), recently discovered as a novel metabolite of Streptomyces albus species, has been achieved starting from the major product (58 % yield) from the coupling of the amine di‐O‐isopropylidene‐α‐valienamine and the electrophile 1,5 : 2,3‐dianhydro‐D‐mannitol in 2‐propanol. Deprotection with aqueous acetic acid and subsequent purification on a column of acidic resin afforded 1, which showed inhibitory activity (IC50 = 8.3 μML−1) against silkworm trehalase.
Centropentaindan, a Fenestrane Bearing Five Mutually Fused Indan Units: Syntheses, Molecular Structure, and Bridgehead Substitution
Authors: Kuck Dietmar , Schuster Andreas , Gestmann Detlef , Posteher Frank , Pritzkow Hans
Published: July 2007

Syntheses, properties, and some reactions of a novel centropolycyclic hydrocarbon, centropentaindan (1), are described. The molecular structure of 1 consists of a tetrabenzo[5.5.5.5]fenestrane bearing a fifth centrically fused indan unit. Independent syntheses have been developed employing i) twofold cyclodehydrogenation of tribenzotriquinacene (7) with Pd/C at 500°C, which gives 1 in 50% yield, and ii) a two‐step procedure by tetrabromination of di‐fuso‐centrotriindan (8) followed by condensation with two molecules of benzene, which provides 1 in 88% yield. Some bridgehead‐substituted centropentaindans are described, including the highly labile dibromo derivative 19, and the centrohexacyclic, topologically nonplanar endo‐peroxide 26 and endo‐disulfide 28. The notably rigid ring fusion in the molecular framework of 1 is shown both by X‐ray structural analysis and by particular steric interactions of the two mutually compressed bridgehead substituents.