bluuebunny/crossref_metadata_2025 huggingface dataset:
Chlorine stable isotope ratios as tracer for pore‐water advection rates in a submarine gas‐hydrate field: implication for hydrate concentration
Authors: HESSE R. , EGEBERG P. K. , FRAPE S. K.
Published: January 2006

At Ocean Drilling Program Site 997 in Blake Ridge gas‐hydrate field in West Atlantic, pore‐water studies revealed a pronounced downward depletion of the heavy chlorine isotope to nearly −4‰δ37Cl at approximately 750 m below sea floor (mbsf) associated with a 10% downward chlorinity decrease. This is one of the stronger 37Cl depletions hitherto reported for marine pore waters. Chlorinity reductions in hydrate‐bearing sediments commonly result from fresh‐water release by hydrate melting. However, in situ measurements at Site 997 suggest that >50% of the chlorinity reduction occurred prior to hydrate dissociation. Modeling the chlorinity profile shows that advection of a strongly 37Cl‐depleted, low‐chlorinity water (506 mm) from below the drilled sequence can explain the reduction prior to sampling. Fitting the model to the δ37Cl curve yielded an advection rate of 0.18 mm year−1. Diffusive mixing with near‐0‰‐δ37Cl paleo‐seawater with maximum chlorinity at shallow subsurface depths (561 mm at approximately 20 mbsf) produced the smooth, steady trend. Separating that part of the freshening caused by advection and diffusion from that due to hydrate dissociation allowed estimation of average hydrate concentrations of 3.8% of the pore space (up to 24.5% in hydrate‐rich layers; near‐100% in rare massive hydrate layers). The deep‐seated source of the 37Cl‐depleted, low‐chlorinity water remains unknown and might be located below the sedimentary section in the oceanic basement.
Studies of Caenorhabditis elegans DAF‐2/insulin signaling reveal targets for pharmacological manipulation of lifespan
Authors: Gami Minaxi S. , Wolkow Catherine A.
Published: January 2006

Much excitement has arisen from the observation that decrements in insulin‐like signaling can dramatically extend lifespan in the nematode, Caenorhabditis elegans, and fruitfly, Drosophila melanogaster. In addition, there are tantalizing hints that the IGF‐I pathway in mice may have similar effects. In addition to dramatic effects on lifespan, invertebrate insulin‐like signaling also promotes changes in stress resistance, metabolism and development. Which, if any, of the various phenotypes of insulin pathway mutants are relevant to longevity? What are the genes that function in collaboration with insulin to prolong lifespan? These questions are at the heart of current research in C. elegans longevity. Two main theories exist as to the mechanism behind insulin's effects on invertebrate longevity. One theory is that insulin programs metabolic parameters that prolong or reduce lifespan. The other theory is that insulin determines the cell's ability to endure oxidative stress from respiration, thereby determining the rate of aging. However, these mechanisms are not mutually exclusive and several studies seem to support a role for both. Here, we review recently published reports investigating the mechanisms behind insulin's dramatic effect on longevity. We also spotlight several C. elegans genes that are now known to interact with insulin signaling to determine lifespan. These insights into pathways affecting invertebrate lifespan may provide a basis for developing strategies for pharmacological manipulation of human lifespan.
Thirty‐day typing and screening for patients undergoing elective surgery: experience at a large cancer center
Authors: Narvios Aida B. , Rozner Mark , Lichtiger Benjamin
Published: January 2006

BACKGROUND:  Preoperative testing in patients scheduled to undergo surgery often includes determining the ABO group and Rh type and screening for atypical alloantibodies in blood samples. AABB recommends obtaining blood samples within 3 days of transfusion. This was extended to 30 days to minimize the number of phlebotomies, avoid delays in providing blood during surgery, and decrease the laboratory workload. This study was conducted to show that extending the expiration date of the preoperative blood sample for blood typing and screening to 30 days will serve our purpose and provide better patient care.

STUDY DESIGN AND METHODS:  Data were collected for all patients undergoing elective surgery with perioperative blood samples submitted to our blood bank over 31 months. Each patient completed a questionnaire to determine whether his or her samples qualified for a 30‐day preoperative clot. The questionnaires were validated upon preoperative screening. A transfusion medicine physician made the final determination regarding whether the samples qualified for 30‐day typing and screening. These blood samples were used for cross‐matching to find compatible blood during surgery.

RESULTS:  A total of 12,310 preoperative blood samples were received with a request for typing and screening, 4,370 (35.5%) of which qualified for a 30‐day expiration date. No significant problems were encountered with these blood samples.

CONCLUSION:  Extension of the preoperative clot expiration date from 3 to 30 days has improved service to our patients and their physicians and indirectly reduced the laboratory workload.
The effect of patient‐controlled analgesia on coadministered red blood cells
Authors: Yousef Hanan M. , Padmore Ruth F. , Neurath Doris D. , Rock Gail A.
Published: January 2006

BACKGROUND:  Patient‐controlled analgesia (PCA) provides effective pain control. The possibility of administrating opioids in the same line as red blood cells (RBCs) for patients with poor venous access has been entertained. The literature on this approach is not extensive, but generally cautionary.

STUDY DESIGN AND METHODS:  Standard concentrations of morphine, hydromorphone (Dilaudid), and meperidine (Demerol) were used to determine the effect on RBCs. Three in vitro approaches were used: 1) continuous low‐dose opioid infusion with a single bolus, 2) continuous infusion with multiple boluses, and 3) assessment of RBCs with different concentrations of opioids in test tubes. Samples were assayed for hemoglobin (Hb), mean corpuscular volume (MCV), plasma Hb, potassium, and lactate dehydrogenase, and a peripheral blood smear was made.

RESULTS:  Addition of each drug as a single or multiple bolus(‐es) with continuous infusion showed the same effects as normal saline. In vitro exposure of Demerol at a 1:2 ratio (drug:blood) increased the MCV (110 fL), at 1:1 the MCV was 120 fL, and there was 4.5 percent hemolysis. At 2:1, hemolysis increased to 9.2 percent. Both morphine and Dilaudid had similar effects as normal saline.

CONCLUSION:  Morphine, Dilaudid, and Demerol, given as a bolus in the intravenous line, have the same effects as those seen with saline. When mixed directly with the blood for more than 1 hour, however, Demerol caused increasing RBC swelling and at high, nontherapeutic concentrations, caused hemolysis. Our study suggests that analgesia delivered via PCA may be safely coadministered with RBCs. Further clinical study is warranted.
Perioperative red cell, plasma, and blood volume change in patients undergoing cardiac surgery
Authors: Slight Robert D. , Bappu Norzeihan J. , Nzewi Onyekwelu C. , McClelland D. Brian L. , Mankad Pankaj S.
Published: January 2006

BACKGROUND:  Current blood prescription in cardiac surgery is based largely on hemoglobin (Hb) concentration. Hb may not provide a reliable guide to the patient's red cell (RBC) volume (RCV) during cardiac surgery as a consequence of the high fluid loads infused. This study provides estimates of the perioperative changes in RCV, plasma volume (PV), and blood volume (BV) with a view to developing a more accurate way of assessing a patient's need for transfusion.

STUDY DESIGN AND METHODS:  Thirty adult elective cardiac surgery patients were recruited to the study. The preoperative RCV was calculated by use of a standard nomogram. Losses and gains in RCV at several time points were added or subtracted from the baseline value. Estimates of PV and BV were derived from patient hematocrit level and RCV for each time point.

RESULTS:  The greatest perioperative loss of RCV occurred during cardiopulmonary bypass (CPB); however, half of this loss was returned to the patient at the end of CPB. A net gain of RCV occurred during the period of intensive care management. PV and BV showed two distinct peaks, immediately after CPB and at 16 hours after intensive therapy unit return.

CONCLUSIONS:  PV and BV expansion are significant factors that may lead to a Hb value that is misleadingly low in that it overestimates the decrease in RCV. This effect could lead to unnecessary transfusion if the RBC transfusion threshold is based only on Hb concentration.
ABO‐mismatched marrow processing for transplantation: results of 114 procedures and analysis of immediate adverse events and hematopoietic recovery
Authors: Larghero Jerome , Rea Delphine , Esperou Helene , Biscay Nicole , Maurer Marie‐Noelle , Lacassagne Marie‐Noelle , Ternaux Brigitte , Traineau Richard , Yakouben Karima , Dosquet Christine , Socié Gerard , Gluckman Eliane , Benbunan Marc , Marolleau Jean‐Pierre
Published: January 2006

BACKGROUND:  Red cell (RBC) depletion is needed to bypass ABO mismatch in allogeneic bone marrow transplantation (BMT). Technical and clinical data obtained after bone marrow (BM) processing with a continuous‐flow cell separator (Cobe Spectra, Gambro BCT) are reported.

STUDY DESIGN AND METHODS:  RBC depletion and recovery of nucleated cells, CD3+ cells, CD34+ cells, and colony‐forming unit–granulocyte‐macrophage were calculated. Bacteriologic contaminations, side effects of graft infusion, and hematopoietic recovery were analyzed.

RESULTS:  A total of 114 BM samples were processed. The mean volume collected was 1099 mL (range, 390‐2450 mL). Initial and residual mean RBCs volumes were 309.9 and 4.0 mL corresponding to a depletion of 98.6 ± 0.78 percent. Before processing, the mean numbers of nucleated cells, granulocytes, CD3+ cells, CD34+ cells, and CFU‐GM were 20.28 × 109, 12.79 × 109, 1.96 × 109, 356.7 × 106, and 195.6 × 105, respectively. The mean corresponding recoveries after processing were 33.66, 48.98, 82.02, 82.2, and 93.9 percent. Limited side effects were observed in 14 patients without correlation with residual RBCs volume. All but two patients engrafted.

CONCLUSION:  BM processing with the Cobe Spectra cell separator provides high rates of RBC depletion without significant side effects after BMT.
Risk‐Based Integrity and Inspection Modeling (RBIIM) of Process Components/System
Authors: Khan Faisal I. , Haddara Mahmoud M. , Bhattacharya Subrata K.
Published: January 2006

Process plants deal with hazardous (highly flammable and toxic) chemicals at extreme conditions of temperature and pressure. Proper inspection and maintenance of these facilities is paramount for the maintenance of safe and continuous operation. This article proposes a risk‐based methodology for integrity and inspection modeling (RBIIM) to ensure safe and fault‐free operation of the facility. This methodology uses a gamma distribution to model the material degradation and a Bayesian updating method to improve the distribution based on actual inspection results. The method deals with the two cases of perfect and imperfect inspections. The measurement error resulting from imperfect inspections is modeled as a zero‐mean, normally distributed random process. The risk is calculated using the probability of failure and the consequence is assessed in terms of cost as a function of time. The risk function is used to determine an optimal inspection and replacement interval. The calculated inspection and replacement interval is subsequently used in the design of an integrity inspection plan. Two case studies are presented: the maintenance of an autoclave and the maintenance of a pipeline segment. For the autoclave, the interval between two successive inspections is found to be 19 years. For the pipeline, the next inspection is due after 5 years from now. Measurements taken at inspections are used in estimating a new degradation rate that can then be used to update the failure distribution function.
Risk Analysis for Biological Hazards: What We Need to Know about Invasive Species
Authors: Stohlgren Thomas J. , Schnase John L.
Published: January 2006

Risk analysis for biological invasions is similar to other types of natural and human hazards. For example, risk analysis for chemical spills requires the evaluation of basic information on where a spill occurs; exposure level and toxicity of the chemical agent; knowledge of the physical processes involved in its rate and direction of spread; and potential impacts to the environment, economy, and human health relative to containment costs. Unlike typical chemical spills, biological invasions can have long lag times from introduction and establishment to successful invasion, they reproduce, and they can spread rapidly by physical and biological processes. We use a risk analysis framework to suggest a general strategy for risk analysis for invasive species and invaded habitats. It requires: (1) problem formation (scoping the problem, defining assessment endpoints); (2) analysis (information on species traits, matching species traits to suitable habitats, estimating exposure, surveys of current distribution and abundance); (3) risk characterization (understanding of data completeness, estimates of the “potential” distribution and abundance; estimates of the potential rate of spread; and probable risks, impacts, and costs); and (4) risk management (containment potential, costs, and opportunity costs; legal mandates and social considerations and information science and technology needs).
A Search for Thresholds and Other Nonlinearities in the Relationship Between Hexavalent Chromium and Lung Cancer
Authors: Park Robert M. , Stayner Leslie T.
Published: January 2006

The exposure‐response relationship for airborne hexavalent chromium exposure and lung cancer mortality is well described by a linear relative rate model. However, categorical analyses have been interpreted to suggest the presence of a threshold. This study investigates nonlinear features of the exposure response in a cohort of 2,357 chemical workers with 122 lung cancer deaths. In Poisson regression, a simple model representing a two‐step carcinogenesis process was evaluated. In a one‐stage context, fractional polynomials were investigated. Cumulative exposure dose metrics were examined corresponding to cumulative exposure thresholds, exposure intensity (concentration) thresholds, dose‐rate effects, and declining burden of accumulated effect on future risk. A simple two‐stage model of carcinogenesis provided no improvement in fit. The best‐fitting one‐stage models used simple cumulative exposure with no threshold for exposure intensity and had sufficient power to rule out thresholds as large as 30 μg/m3 CrO3 (16 μg/m3 as Cr+6) (one‐sided 95% confidence limit, likelihood ratio test). Slightly better‐fitting models were observed with cumulative exposure thresholds of 0.03 and 0.5 mg‐yr/m3 (as CrO3) with and without an exposure‐race interaction term, respectively. With the best model, cumulative exposure thresholds as large as 0.4 mg‐yr/m3 CrO3 were excluded (two‐sided upper 95% confidence limit, likelihood ratio test). A small departure from dose‐rate linearity was observed, corresponding to (intensity)0.8 but was not statistically significant. Models in which risk‐inducing damage burdens declined over time, based on half‐lives ranging from 0.1 to 40 years, fit less well than assuming a constant burden. A half‐life of 8 years or less was excluded (one‐sided 95% confidence limit). Examination of nonlinear features of the hexavalent chromium‐lung cancer exposure response in a population used in a recent risk assessment supports using the traditional (lagged) cumulative exposure paradigm: no intensity (concentration) threshold, linearity in intensity, and constant increment in risk following exposure.
Unusual Pulmonary Venous Flow Profile in a Patient with Mitral Valve Perforation Secondary to Bacterial Endocarditis
Authors: Modi Shalini , Koul Deepak , Afonso Luis
Published: January 2006

Pulmonary venous flow patterns have been well described in the literature to assess severity of mitral regurgitation (MR) and the degree of diastolic dysfunction. We report a case of posterior mitral leaflet perforation due to bacterial endocarditis causing an alteration of pulmonary venous flow, not previously described in the literature. This pulmonary venous flow pattern is unique in that it reflects dynamic changes in left atrial pressure in the background of severe MR.
Real‐Time Three‐Dimensional Echocardiography in Diagnosis of Right Ventricular Pseudoaneurysm after Pacemaker Implantation
Authors: Shen Xuedong , Holmberg Mark J. , Sype John , Hunter Claire , Mooss Aryan N. , Mohiuddin Syed M.
Published: January 2006

Right ventricular rupture is a critical cardiac complication associated with cardiac tamponade and death. Occasionally, the site of rupture may be contained by the parietal pericardium and thrombus, thus forming a pseudoaneurysm. Cases of traumatic pseudoaneurysm of the right ventricle have been reported. However, right ventricular pseudoaneurysm following pacemaker implantation has not been previously reported. This case demonstrates two right ventricular pseudoaneurysms following perforation of the right ventricular wall using real‐time three‐dimensional echocardiography (3DE) after pacemaker implantation although only one definite pseudoaneurysm was diagnosed by routine two‐dimensional echocardiography (2DE). We also found that color Doppler 3DE enhanced visualization of the connections between the right ventricle and the pseudoaneurysm. Color Doppler 3DE allowed us to peel away the myocardial tissue and rotate the image to study the jets from different angles. In summary, real‐time 3DE and color Doppler 3DE provided excellent visualization of the right ventricular pseudoaneurysm, flow between the ventricle and the pseudoaneurysm, and additional information to that obtained by 2DE.
Collagen Fiber Morphology Determines Echogenicity of Myocardial Scar: Implications for Image Interpretation
Authors: Tabel Ghasan M. , Whittaker Peter , Vlachonassios Konstantinos , Sonawala Mehul , Chandraratna P. Anthony
Published: January 2006

Fibrous tissue appears as echo dense areas on conventional ultrasound images; however, the determinants of such echo brightness have not been assessed. We demonstrated previously, using 600‐MHz ultrasound images, that collagen fiber morphology determines echo brightness. In the current study, we tested the hypothesis that collagen fiber morphology also determines echogenicity of myocardial scar at the lower transducer frequencies used in conventional ultrasound. We examined both the infarcted and noninfarcted regions of rat hearts 1 and 3 weeks after permanent coronary artery occlusion. Ultrasound images obtained from excised hearts were digitized to quantify echocardiographic brightness. The hearts were then sectioned, stained with picrosirius red, and examined with polarized light microscopy. We found that myocardial scar tissue appeared either hyperechoic or normoechoic depending on collagen fiber morphology. Specifically, the hyperechoic areas corresponded to the 3‐week‐old infarcted regions containing thick collagen fibers that appeared predominantly orange when viewed with polarized light. In contrast, normoechoic areas corresponded to the 1‐week‐old infarcted regions containing thin collagen fibers that appeared predominantly green and also to noninfarcted myocardium. We conclude that the echogenicity of tissue early after infarction is similar to that found in normal, noninfarcted myocardium, thus compromising the ability of echocardiography to distinguish between these two states based on echotexture.
Tissue Doppler Evaluation of Intraventricular Asynchrony in Isolated Left Bundle Branch Block
Authors: Melek Mehmet , Esen Ozlem , Esen Ali Metin , Barutcu Irfan , Onrat Ersel , Kaya Dayimi
Published: January 2006

Background: The aim of this study was to evaluate normal subjects with isolated left bundle branch block (LBBB) using tissue Doppler imaging (TDI) for the presence of intraventricular asynchrony. Methods and Results: For this purpose, 23 subjects with isolated LBBB were compared with age‐matched asymptomatic healthy subjects without LBBB with respect to global ejection fraction (EF) and isovolumic contraction time (ICTm) in separate left ventricular segments. TDI evaluation revealed prolongation of the ICTm in all of the segments in the LBBB group. Moreover, the ICTm differed significantly in each segment in the LBBB group. The ICTm in the lateral segments were shown to be longer compared to the anteroseptal segments. Conclusion: Our results indicate the presence of intraventricular asynchrony in isolated LBBB. This fact may play a role in the decreased global EF and increased cardiac mortality in patients with isolated LBBB.
Transesophageal Echocardiography Impacts Management and Evaluation of Patients with Stroke, Transient Ischemic Attack, or Peripheral Embolism
Authors: Dawn Buddhadeb , Hasnie Abdul M.A. , Calzada Norberto , Longaker Rita A. , Stoddard Marcus F.
Published: January 2006

The relative impact of transesophageal echocardiography (TEE) on the management of patients with specific embolic events, namely nonhemorrhagic cerebrovascular accident (CVA), transient ischemic attack (TIA), or peripheral embolism is controversial. The impact of TEE in 234 adult subjects with CVA (n = 141), TIA (n = 59), or peripheral embolism (n = 34) was determined. TEE was diagnostic of a potential embolic source in 61%, 51%, and 62% of patients with CVA, TIA, and peripheral embolism, respectively (P = NS). TEE results changed medication or surgical treatment in 32%, 22%, and 32% of patients with CVA, TIA, and peripheral embolism, respectively (P = NS). Anticoagulation was started on the basis of TEE findings in 11%, 12%, and 18% of patients with CVA, TIA, and peripheral embolism, respectively (P = NS). In 77% of all patients, TEE findings confirmed as appropriate the empiric decision made prior to TEE, to anticoagulate (60%; 12/20) or not to anticoagulate (79%; 168/214). These data demonstrate that TEE findings have a significant and similar impact on the clinical management of patients with various types of potential embolism. Future studies addressing the effectiveness of treatment, guided by TEE findings, in the prevention of recurrent embolic events are needed.
Real‐Time 3‐Dimensional Echocardiography Evaluation of Intracardiac Masses
Authors: Asch Federico M. , Bieganski Szymon P. , Panza Julio A. , Weissman Neil J.
Published: January 2006

The size of an intracardiac mass (vegetation, tumor, or thrombus) is an important predictor for embolic events and for response to treatment. Maximum diameter measurements from two‐dimensional (2D) echocardiography are routinely used to determine mass size. However, most masses are irregularly shaped, making it difficult to accurately image or select the largest diameter. The selection of a diameter that is not truly the largest may lead to underestimation of the true size of the mass and a misrepresentation of the patients' prognosis. Three‐dimensional (3D) echocardiography images the entire volume of a mass allowing for accurate measurements in multiple planes. We tested the hypothesis that measurements of the maximum diameter of a mass by 3D echocardiography are larger than those obtained by 2D echocardiography. Methods: Patients with findings of an intracardiac mass by 2D transthoracic (TTE) or transesophageal (TEE) echocardiogram were imaged using real‐time three‐dimensional echocardiography (RT3DE) within 24 hours. The complete mass was acquired on RT3DE. Maximum mass diameter was measured on 2D and RT3DE. Comparison of measurements between RT3DE and 2D was performed using correlation coefficients and Bland‐Altman analyses. Results: In 19 masses evaluated in 17 patients, there was a strong correlation between 2D TTE and RT3DE maximum diameter measurements (R2=0.88, P < 0.01) but correlation was fair for 2D TEE (R2=0.48, P=0.02). In addition, 2D maximum diameter also correlated with 3D volumes (R2=0.72, P < 0.01 for TTE and R2=0.56, P < 0.01 for TEE). However, there was a consistent underestimation of maximum diameter measured by 2D (TTE and TEE) regardless of the size, location, and etiology of the mass. 2D TTE underestimates cardiac mass size by 24.6% (P < 0.001) compared to RT3DE and 2D TEE underestimated size by 19.8% (P=0.01). Conclusion: These findings suggest that RT3DE may be the technique of choice for the noninvasive evaluation of intracardiac mass size.
Usefulness of a New Proposed Tissue Doppler Imaging Global Function Index in Hypertrophic Cardiomyopathy
Authors: Araujo Aloir Q. , Arteaga Edmundo , Ianni Barbara M. , Salemi Vera Maria C. , Ramires Felix J.A. , Matsumoto Afonso Y. , Fernandes Fabio , Mady Charles
Published: January 2006

Background: A global function index (GFI) derived from tissue Doppler imaging (TDI) has been proposed to improve the diagnosis of hypertrophic cardiomyopathy (HCM). We aimed to evaluate the usefulness of this index in a large selected HCM population. Methods: GFI =[E/Ea]/Sa, was calculated at mitral annulus lateral and septal borders in 164 HCM patients and in 40 healthy volunteers. Group comparisons and correlations between GFI and other variables were performed. Results: Of the 164 patients, 69 (42%) had a peak gradient >30 mmHg in the left ventricle outflow tract (LVOT). GFI (lateral or septal) was not normally distributed. There were differences among controls, obstructive HCM, and nonobstructive HCM (P < 0.0001), but significant overlap of GFI values were observed between groups. GFI was correlated to septal thickness (r = 0.44; P < 0.0001), left atrial diameter (r = 0.52; P < 0.0001), and LVOT gradient (r = 0.58; P < 0.0001). Conclusion: In a selected HCM population, GFI was limited by its asymmetrical distribution and significant overlap of values between groups. Further studies are necessary to verify the reliability of GFI in the clinical practice and its position among other tissue Doppler indices.
Bridging‐Stress Evaluation in a Ni/Al2O3 System via the Digital Image‐Correlation Technique
Authors: Mekky Waleed , Nicholson Patrick S.
Published: January 2006

The bridging‐stress opening‐displacement relation of a nickel layer in an alumina sandwich has been determined experimentally using the digital image correlation (DIC) technique. The strain development in the ligament during extension was recorded, revealing three distinct zones. DIC proved to be a simple and accurate method to characterize deformation of the single Ni ligament during deformation.
Visual outcomes with the yellow intraocular lens
Authors: Leibovitch Igal , Lai Tze , Porter Neroli , Pietris George , Newland Henry , Selva Dinesh
Published: January 2006

Purpose:  To compare postoperative best distance visual acuity (VA), contrast sensitivity and colour perception with the blue light‐filtering AcrySof® Natural (SN60AT) and AcrySof® single‐piece (SA60AT) intraocular lenses (IOLs).

Methods:  This was a prospective, randomized, comparative, interventional study comparing postoperative performance between the SN60 and SA60 IOLs. There were nine patients (nine eyes) in the SN60 group and 10 patients (10 eyes) in the SA60 group. All patients were operated using phacoemulsification. Postoperative VA (Snellen chart), contrast sensitivity (Pelli−Robson contrast sensitivity chart) and colour perception (Farnsworth−Munsell D‐15 panel test) were measured at 1, 3 and 6 months postoperatively.

Results:  Postoperative best corrected VA after 6 months was 20/20 or better in 89% of SN60 eyes and 100% of SA60 eyes. Postoperative contrast sensitivity scores improved significantly in both groups under both photopic and mesopic conditions. There were no statistically significant differences in contrast sensitivity scores between the SN60 and SA60 groups at any of the postoperative evaluation time‐points. Postoperative colour perception improved significantly in both the SN60 and SA60 groups, and there were no statistically significant differences in colour perception performance between the two groups.

Conclusion:  The blue light‐filtering AcrySof® Natural (SN60) IOL has postoperative visual performance comparable with that of the AcrySof® single‐piece (SA60) IOL.
Severe mental illness across cultures
Authors: Bhugra D.
Published: January 2006

Objective:  International studies have shown that the outcome of illnesses like schizophrenia vary across cultures. The good outcome in developing countries depends upon a number of factors.

Method:  Using both primary and secondary sources, existing literature was reviewed. Using terms severe mental illness, culture and schizophrenia, Medline, Psychinfo and Embase were searched. Further searches were conducted using secondary searches.

Results:  The impact of culture and its components on the individual and their families influences compliance, engagement with services and expectations of treatment. Cultures also impact upon identity and explanatory models of individuals.

Conclusion:  Severe mental illness is as likely to be affected by culture as other illnesses. Clinicians need to use multi‐model assessment and management techniques.
The chronic psychiatric patient: problems, promises and perspectives, past, present and future
Authors: Talbott J. A.
Published: January 2006

Objective:  To present an overview of the issues involving the severely and chronically mentally ill over the past 50 years and summarize new research that may aid them.

Method:  To present the problems that have faced and will face this population, the promises that have been made about and to them, and assess how well we fulfilled our promises and handled the problems.

Results:  We have made some but not enough progress in solving the problems facing the severely and chronic mentally ill in the past and at present, but the future holds more hope if recent solid, practical, economically feasible mental health services research is translated through policy and practice into better patient care.

Conclusion:  As pessimistic as we often are about the plight of the chronic mentally ill, their future can be better if recent research is implemented.
The incidence and prevalence of schizophrenia varies with latitude
Authors: Saha S. , Chant D.C. , Welham J.L. , McGrath J.J.
Published: January 2006

Objective:  The aim of this study was to examine the association between latitude and the incidence and prevalence of schizophrenia based on two recently published systematic reviews.

Method:  The analyses were based on 353 incidence rates (from 68 studies) and 258 prevalence estimates (from 94 studies). Exact latitude values were used for cities, and geocentroid values for other sites. Based on three equal latitude bands, we compared the frequency measures of schizophrenia for persons, males and females when adjusted for within‐study variation.

Results:  Prevalence estimates from sites in the high‐latitude band were significantly higher when compared with lower bands for persons, males and females. Incidence rates were positively associated with absolute latitude for males, but neither for females nor persons.

Conclusion:  Variables that have latitude gradients warrant closer inspection in schizophrenia epidemiology.
Mental distress in the Danish general population
Authors: Olsen L. R. , Mortensen E. L. , Bech P.
Published: January 2006

Objective:  To present data on mental distress in the Danish general population using recently validated Hopkins symptom checklist (SCL) subscales and compare with data from other countries. To evaluate associations between mental distress and biopsychosocial factors.

Method:  Questionnaires were sent to a gender‐ and age‐stratified random sample comprising 2040 Danes. Mean SCL subscale scores were calculated. Cases were defined in accordance with the traditional criteria, and Danish and US raw score cut‐offs were compared. A multiple regression model was developed to describe associations between biopsychosocial factors and SCL scores.

Results:  The response rate was 58%. The Danish mean scores were significantly higher than reported for a US non‐patient sample, and Danish raw score cut‐offs for caseness were higher. The Danish scores were closer to Nordic mean scores. Age, gender, social status, somatic disorder and traumatic life events in the past year in work life as well as personal life were significantly associated with the level of mental distress. SCL scores were compared with scores on the Major Depression Inventory.

Conclusion:  The SCL mean scores of the Danish general population were relatively high, but similar to data from the Nordic countries. Consequently, interpretation of the Danish SCL requires Danish norms and Danish cut‐off scores for caseness.
Perspectives of staff on student outreach placements
Authors: Smith M. , Lennon M. A. , Brook A. H. , Robinson P. G.
Published: January 2006

Objective: To explore the perspectives of placement staff on outreach training.

Intervention: Block clinical placements in primary care settings for dental undergraduates and hygiene and therapy students.

Method: After completion of the placements, 32 participating staff across nine primary care locations took part in qualitative interviews and focus groups. The staff provided data on placement organisation, the students’ development and their supervision, and any effects on themselves as hosts.

Results: The major themes included the learning environment, supervision and communication. The staff saw benefits to students in working in a smaller primary care clinic with nursing support and immediately available supervision by a dental generalist. Other benefits included increased confidence, broader clinical experience and applying theoretical learning to new communities. Effective communication and adequate resourcing were critical success factors. There was some disruption of clinics’ normal working, but many unanticipated benefits. Staff supported the outreach placements in primary care settings to enhance students’ dental education.

Conclusions: These findings provide a planning and evaluation framework for dental educators involved in outreach.
Effect of tutorial input in addition to augmented feedback on manual dexterity training and its retention
Authors: Wierinck E. , Puttemans V. , Van Steenberghe D.
Published: January 2006

Abstract  Virtual reality (VR) simulators can be used as tools in manual dexterity training. The visual feedback guides the subject towards proper performance but creates, at the same time, some dependency on this feedback. To overcome this drawback, the effect of adjunct tutorial input on motor learning behaviour was examined. Novice dental students were randomly assigned to one of two training groups or to a non‐training control group, given the task of preparing a geometrical class 1 cavity in phantom teeth. The feedback (FB) group trained under augmented visual feedback conditions, provided by the VR system (DentSimTM). The feedback‐plus (FB+) group received, in addition, standardised expert input to enrich the augmented feedback information. The control group, consisting of same year students, did not participate in any training programme. All preparations were evaluated by the VR scoring system. Performance analyses revealed an overall trend towards significant improvement with practice for the training groups. Performance of the FB+ group was most accurate across training. After 1 day and 3 weeks of no practice, both training groups outperformed the control group. After 4 months, however, only the FB+ condition was significantly more accurate than the control group. The same tendency was noted for the transfer tests. Consequently, cavity preparation experience on a VR system under the condition of frequently provided feedback supplemented with expert input was most beneficial to long time learning.
The length of treatment of aggressive non‐Hodgkin's lymphomas established according to the international prognostic index score: long‐term results of the GISL LA03 study
Authors: Federico Massimo , Luminari Stefano , Gobbi Paolo G. , Sacchi Stefano , Di Renzo Nicola , Lombardo Marco , Merli Francesco , Baldini Luca , Stelitano Caterina , Partesotti Giovanni , Polimeno Giuseppe , Montanini Antonella , Mammi Caterina , Brugiatelli Maura
Published: January 2006

Abstract:  Objectives: To compare two different schedules of two different anthracycline‐containing regimens, where length of treatment is modulated according to the international prognostic index (IPI) in patients with aggressive non‐Hodgkin's Lymphoma (NHL). Methods: In 1993 the Gruppo Italiano per lo Studio dei Linfomi (GISL) started a randomized 2 × 2 factorial phase III clinical trial for patients with newly diagnosed aggressive NHL comparing ProME(Epidoxorubicin)CE‐CytaBOM (PE‐C) to ProMI(Idarubicin)CE‐CytaBOM (PI‐C) and a fixed to a flexible treatment schedule where anthracycline dose was to be modulated according to observed hematological toxicity. Patients with low or low‐intermediate IPI (IPI 0‐2) and those with intermediate‐high or high IPI (IPI 3‐5) should receive six or eight courses, respectively. Involved‐field radiotherapy was allowed for patients with initial bulky disease or with residual masses. Results: Three hundred and fifty‐six patients were registered into the study and randomized. Patients were well balanced among the four study arms in terms of clinical characteristics and prognostic factors. Three hundred and forty‐five patients were available for evaluation of study endpoints. At the end of induction therapy complete remission rate was 61%, 5‐year failure‐free survival (FFS) rate was 40% and 5‐year overall survival (OS) rate was 59%; no differences were observed according to treatment arms. Patients in the flexible arm received higher dose intensity of anthracycline (P < 0.001) with no apparent increase in toxicity. However, the flexible schedule was not superior to the fixed one. Patients with IPI 3–5 showed lower response rates (45% vs. 67%: P < 0.0001) and lower 5‐year FFS (29% vs. 45%: P < 0.0001) compared to those with IPI 0–2. Conclusions: six courses of fixed or flexible PE‐C or PI‐C can determine a promising success rate in patients with advanced aggressive NHL with IPI 0–2, whereas the same regimens are less effective in patients with IPI 3–5, even if two additional courses are delivered. For the latter group of patients innovative approaches are warranted.
Human marrow mesenchymal stem cell culture: serum‐free medium allows better expansion than classical α‐MEM medium
Authors: Meuleman Nathalie , Tondreau Tatiana , Delforge Alain , Dejeneffe Marielle , Massy Martine , Libertalis Mark , Bron Dominique , Lagneaux Laurence
Published: January 2006

Abstract:  The expansion of mesenchymal stem cells (MSCs) strongly depends on the culture conditions and requires medium supplemented with 10–20% fetal calf serum (FCS) to generate relevant numbers of cells. However, the presence of FCS is a major obstacle for their clinical use. Therefore, we have evaluated the capacity of expansion of MSC in a commercial serum‐free medium (UC) supplemented with a serum substitute (ULTROSER®) in comparison with a classical medium α‐MEM containing 15% FBS. Bone marrow‐mononuclear cells collected from 12 volunteer healthy donors were expanded in two different culture media. MSCs isolated in the both media were morphologically similar and expressed identical phenotypic markers. After the primoculture (P0) and one passage, we obtained significantly more MSC and CFU‐F progenitors in UC medium than in αMEM. Their multipotentiality was preserved during culture, as well as their capacity to support haematopoiesis. In conclusion, our observations strongly suggest that UC is an optimal medium for ex vivo expansion of MSC: it allows a better cell expansion, preserves cell multipotentiality, reduces the culture period and contains low concentration of serum substitute. This medium seems suitable for clinical scale expansion of MSC.
Coagulation factor XI gene analysis in three factor XI deficient Austrian patients
Authors: Dossenbach‐Glaninger Astrid , Hopmeier Pierre
Published: January 2006

Abstract:  Objectives: Hereditary factor XI deficiency is a rare bleeding disorder with worldwide distribution. In Austrian patients only one mutation leading to congenital factor XI deficiency has been reported. In the present study, we identified the molecular basis of factor XI deficiency in three Austrian patients. Methods: Patients attended hospital for other reasons than bleeding disorders. Routine laboratory tests revealed prolonged APTTs due to decreased factor XI levels. We performed automated fluorescent sequencing of the promotor region, exons 1–15 and the flanking intronic regions of the factor XI gene. The mutations found were confirmed by restriction enzyme analysis or sequencing of the non‐coding strand. Results: Fluorescent sequencing revealed two novel mutations, the nonsense mutation Gln116X (443C>T) in exon 5 and a deletion of Ile197 and Asp 198 (687_692delTCGACA) in exon 7. Furthermore, we detected a heterozygous A>G exchange at the third nucleotide of IVS6 (IVS 6 +3A>G), which had already been reported in a FXI deficient individual of French Basque origin. Conclusion: While the IVS 6 +3A>G decreases the calculated splice consensus score from 0.98 in the wild type to 0.56 in the altered sequence and therefore interferes with the consensus splice sequence, the complete loss of the two amino acids Ile197 and Asp198 is expected to interfere with the steric structure and hence the functions of the third apple domain. The Gln116X leads to a premature termination codon resulting in a lack of the light as well as parts of the heavy chain of the FXI protein, most likely resulting in rapid degradation of the truncated mRNA.
Very early cytological and DNA‐cytometric diagnosis of in situ carcinoma in an immunosuppressed liver transplant recipient
Authors: Maraki D. , Hengge U. R. , Becker J. , Boecking A.
Published: January 2006

Backround:  We describe a patient with an in situ carcinoma with the clinical presentation of an erythroplakia of the tongue in an area where DNA‐aneuploidy was detected by means of exfoliative cytology (EC) and DNA‐image‐cytometry 32 months before.

Methods:  Brush‐ and scalpel biopsies were obtained from a suspicious lesion of the right border of the tongue prior to scalpel biopsy. After Feulgen restaining of the specimens on glass slides, nuclear DNA‐contents were measured using a TV image analysis system.

Results:  A small reddish lesion of the tongue was diagnosed as malignant through EC and DNA‐image‐cytometry, whereas the synchronous histology from the same area showed only mild dysplasia. A subsequent scalpel biopsy 32 months after the first examination showed an in situ carcinoma.

Conclusions:  Non‐invasive brush biopsies are of great importance for the very early identification of mucosal areas with a high risk for malignant transformation through cytological and DNA‐cytometric examination.
Bipedal ambulation induces experimental scoliosis in C57BL/6J mice with reduced plasma and pineal melatonin levels
Authors: Oyama Junko , Murai Ichiro , Kanazawa Kazunori , Machida Masafumi
Published: January 2006

Abstract:  In addition to the induction of scoliosis in chickens by pinealectomy (PINX), we previously demonstrated that removal of the pineal gland also produces scoliosis in bipedal rats, which can be inhibited by melatonin treatment. Using C57BL/6J mice with genetically low circulating melatonin levels, the main objective of the present study was to investigate whether bipedal ambulation in C57BL/6J mice has the same effects on spinal deformity as those seen in pinealectomized bipedal rats. The present study consisted of two phases. The aim of the first experiment was to determine whether the C57BL/6J mouse strain actually exhibits depressed plasma concentrations and/or pineal contents of melatonin during both the light and the dark phase of the light:dark cycle. The aims of the second experiment were to evaluate; (i) whether bipedal ambulation alone in the C57BL/6J mouse induces scoliosis, and (ii) whether PINX with bipedal ambulation in another mouse strain, i.e. C3H/HeJ, which normally exhibits diurnal fluctuations in melatonin synthesis and secretion, has effects similar to those of bipedal ambulation alone in C57BL/6J mice. C3H/HeJ mice, serving as controls, showed significant increases in both plasma concentrations and pineal contents of melatonin during the dark phase when compared with the light phase. In contrast, there were no differences in either circulating levels or pineal contents of melatonin between the light and dark phases in C57BL/6J mice. Moreover, plasma melatonin levels were below the detection limit of the assay in both phases and pineal melatonin was <10% of that in C3H/HeJ mice. Bipedal ambulation for 40 wk in C57BL/6J mice induced scoliosis at a rate of 64.3%, and two of nine scoliotic mice showed two sites of spinal deformity. This type of ambulation in C3H/HeJ mice resulted in scoliosis at a lower rate (25%), and affected animals had only a single scoliotic site. However, PINX combined with bipedal ambulation in C3H/HeJ mice produced scoliosis at a rate (70%) similar to that seen in C57BL/6J mice, and some double deformations were induced. These results confirm our previous observations in rats, and also support our hypothesis that melatonin as well as the bipedal ambulation appear to play a critical pathogenic role in scoliosis in experimental mammals.
Protective effects of melatonin in experimental free radical‐related ocular diseases
Authors: Siu Andrew W. , Maldonado Maria , Sanchez‐Hidalgo Marina , Tan Dun‐Xian , Reiter Russel J.
Published: January 2006

Abstract:  Melatonin (N‐acetyl‐5‐methoxytryptamine) is an indoleamine with a range of antioxidative properties. Melatonin is endogenously produced in the eye and in other organs. Current evidence suggests that melatonin may act as a protective agent in ocular conditions such as photo‐keratitis, cataract, glaucoma, retinopathy of prematurity and ischemia/reperfusion injury. These diseases are sight‐threatening and they currently remain, for the most part, untreatable. The pathogenesis of these conditions is not entirely clear but oxidative stress has been proposed as one of the causative factors. Elevated levels of various reactive oxygen and nitrogen species have been identified in diseased ocular structures. These reactants damage the structure and deplete the eye of natural defense systems, such as the antioxidant, reduced glutathione, and the antioxidant enzyme superoxide dismutase. Oxidative damage in the eye leads to apoptotic degeneration of retinal neurons and fluid accumulation. Retinal degeneration decreases visual sensitivity and even a small change in the fluid content of the cornea and crystalline lens is sufficient to disrupt ocular transparency. In the eye, melatonin is produced in the retina and in the ciliary body. Continuous regeneration of melatonin in the eye offers a frontier antioxidative defense for both the anterior and posterior eye. However, melatonin production is minimal in newborns and its production gradually wanes in aging individuals as indicated by the large drop in circulating blood concentrations of the indoleamine. These individuals are possibly at risk of contracting degenerative eye diseases that are free radical‐based. Supplementation with melatonin, a potent antioxidant, in especially the aged population should be considered as a prophylaxis to preserve visual functions. It may benefit many individuals worldwide, especially in countries where access to medical facilities is limited.