bluuebunny/crossref_metadata_2025 huggingface dataset:
An update on the treatment of detrusor‐sphincter dyssynergia with botulinum toxin type A
Authors: Schurch Brigitte , Schmid Daniel M. , Knapp Peter A.
Published: July 2007

The aim of this study was to evaluate the relaxant effect of two preparations (BOTOX® versus Dysport®) of botulinum toxin type A (BTX‐A) on the external urethral sphincter in patients with neurogenic voiding disorders. Ten male spinal cord injury patients with detrusor‐ external urethral sphincter dyssynergia (DSD) were clinically assessed before, and 4–6 weeks after, transurethral or transperineal BTX‐A injections (BOTOX® 100 U or Dysport® 250 U) into the external urethral sphincter. Patients with persistent difficulties in voiding or high post‐void residual volumes were re‐injected with the same product up to three times. All patients were urodynamically examined within 120 days of injection. In total, 30 BTX‐A injection cycles (one to three injections) were administered. Significant (P < 0.05) reductions in the DSD duration post‐injection, the time interval between the start of bladder contractions and voiding, and DSD seventy post‐treatment were observed. All patients who presented with a residual volume pre‐treatment showed a marked decrease post‐treatment. These effects lasted 6 months. Improvements in urodynamic parameters were significantly better following BOTOX® than DysporP treatment (P < 0.05), although the Dysport® dose used is now considered less potent than that of BOTOX®. Thus, injections of BTX‐A into the external urethral sphincter are a valuable treatment option for DSD in spinal cord injury patients. Treatment success appears to depend on the seventy of DSD before treatment.
Botulinum toxin type A treatment of hip and thigh spasticity: a technique for injection of psoas major muscle
Authors: Ward Anthony B.
Published: July 2007

Spasticity of the hip and thigh can result from spinal cord injury, multiple sclerosis, cerebral palsy and numerous other neurological conditions. Chronic hip spasticity causes the patient extreme difficulty in walking and maintaining a comfortable posture. First‐line treatment usually consists of oral anti‐spastic agents, although these are often associated with a high side‐effect burden. intramuscular injections of botulinum toxin type A (BTX‐A), particularly into the psoas major muscle, have proved to be of functional benefit to the patient. A highly reliable and reproducible method for injecting the psoas major muscle through a para‐spinal route has been developed to reduce the power of the muscle and hip flexion deformity. Injection occurs through the middle of the erector spinae muscle at L2, L3 and L4, delivering a total of 150 U BTX‐A to the psoas major muscle. Follow‐up with a substantial rehabilitation programme reliably ensures a decrease in Modified Ashworth Scores and improvements in the outcome assessment scores measured.
The use of botulinum toxin type A in spastic diplegia due to cerebral palsy
Authors: Ward Anthony B.
Published: July 2007

Spastic diplegia is a severely disabling condition and many current treatment options offer the patient no real therapeutic benefit. Intramuscular injection of botulinum toxin type A (BTX‐A) has demonstrated the ability to decrease spasticity, improve mobility and delay the need for surgery in patients with spastic diplegia. The study described here was a pilot to a larger study and it aimed to identify the most suitable and sensitive outcome measures to detect the benefits of BTX‐A injection. Five adolescents with hip spasticity due to cerebral palsy were injected with BTX‐A into the psoas major muscle (for thigh adduction problems) or the soleus muscle (to correct ‘toe clawing’). Assessments of gait and mobility were carried out every month for the 4‐month study period. Following injection with BTX‐A, improvement in patient mobility was most evident in subjects with thigh adduction problems. A reduction in 10‐m walking time and an increase in stride length was also more pronounced in patients injected in the psoas. Three of the five patients treated demonstrated an improved Modified Ashworth Scale score at the end of the 4‐month observation period. The results conclude that spastic diplegics with problems related to the hip, may benefit from BTX‐A. Patients who experience ‘toe clawing’ present different problems and the measures used did not pick up on the benefits gained by the patients.
Screening of GABAA‐receptor gene mutations in primary dystonia
Authors: Shang H. , Lang D. , Burgunder J.‐M. , Kaelin‐Lang A.
Published: July 2007

Several lines of evidence suggest that GABA‐ergic neurotransmission plays a role in the pathogenesis of primary dystonia in humans. In this study, we tested the hypothesis that mutations in the GABRA1, GABRB3, and GABRG2 genes encoding the α1, β3, and γ subunits of the GABAA receptor are involved in familial primary dystonia. All exons and exon–intron boundaries of the above genes were amplified by PCR from genomic DNA in 28 patients who had primary dystonia and a positive family history but had no mutation in any other genes known to be involved in primary dystonia. The PCR products were analyzed by single strand conformation polymorphism followed by sequencing of variant conformers compared with normal controls (n = 54). We found no mutations in these genes. We did, however, find a new polymorphism, 559 + 80G>A in intron 5 of GABRA1, and we also confirmed several that were previously reported, including 315C>T in exon 3 and 588C>T in exon 5 of GABRG2, but there were no significant differences between controls and patients in the allele and genotype frequencies of these polymorphisms. In conclusion, mutations of GABRA1, GABRB3, and GABRG2 appear not to play a major role in the development of familial primary dystonia.
Inhibition of mitochondrial function in astrocytes: implications for neuroprotection
Authors: Voloboueva Ludmila A. , Suh Sang Won , Swanson Raymond A. , Giffard Rona G.
Published: July 2007

Much evidence suggests that astrocytes protect neurons against ischemic injury. Although astrocytes are more resistant to some insults than neurons, few studies offer insight into the real time changes of astrocytic protective functions with stress. Mitochondria are one of the primary targets of ischemic injury in astrocytes. We investigated the time course of changes in astrocytic ATP levels, plasma membrane potential, and glutamate uptake, a key protective function, induced by mitochondrial inhibition. Our results show that significant functional change precedes reduction in astrocytic viability with mitochondrial inhibition. Using the mitochondrial inhibitor fluorocitrate (FC, 0.25 mmol/L) that is preferentially taken by astrocytes we found that inhibition of astrocyte mitochondria increased vulnerability of co‐cultured neurons to glutamate toxicity. In our studies, the rates of FC‐induced astrocytic mitochondrial depolarization were accelerated in mixed astrocyte/neuron cultures. We hypothesized that the more rapid mitochondrial depolarization was promoted by an additional energetic demand imposed be the co‐cultured neurons. To test this hypothesis, we exposed pure astrocytic cultures to 0.01–1 mmol/L aspartate as a metabolic load. Aspartate application accelerated the rates of FC‐induced mitochondrial depolarization, and, at 1 mmol/L, induced astrocytic death, suggesting that strong energetic demands during ischemia can compromise astrocytic function and viability.
PECAM‐1 engagement counteracts ICAM‐1‐induced signaling in brain vascular endothelial cells2
Authors: Couty Jean‐Pierre , Rampon Christine , Leveque Mathilde , Laran‐Chich Marie‐Pierre , Bourdoulous Sandrine , Greenwood John , Couraud Pierre‐Olivier
Published: July 2007

Interactions between leukocytes and vascular endothelial cells are mediated by a complex set of membrane adhesion molecules which transduce bi‐directional signals in both cell types. Endothelium of the cerebral blood vessels, which constitute the blood–brain barrier, strictly controls adhesion and trafficking of leukocytes into the brain. Investigating signaling pathways triggered by the engagement of adhesion molecules expressed on brain endothelial cells, we previously documented the role of ICAM‐1 in activation of the tyrosine phosphorylation of several actin‐binding proteins and subsequent rearrangements of the actin cytoskeleton. In the present study, we show that, whereas PECAM‐1 is known to control positively the trans‐endothelial migration of leukocytes via homophilic interactions between leukocytes and endothelial cells, PECAM‐1 engagement on brain endothelial surface unexpectedly counteracts the ICAM‐1‐induced tyrosine phosphorylation of cortactin and rearrangements of the actin cytoskeleton. We present evidence that the PECAM‐1‐associated tyrosine phosphatase SHP‐2 is required for ICAM‐1 signaling, suggesting that its activity might crucially contribute to the regulation of ICAM‐1 signaling by PECAM‐1. Our findings reveal a novel activity for PECAM‐1 which, by counteracting ICAM‐1‐induced activation, could directly contribute to limit activation and maintain integrity of brain vascular endothelium.
Circulating economic geographies: citation patterns and citation behaviour in economic geography, 1982–2006
Authors: Foster Jamie , Muellerleile Chris , Olds Kris , Peck Jamie
Published: July 2007

The paper presents a citation analysis of articles published in economic geography (broadly defined) in the period since the 1980s, with a supplementary analysis of significant books in the field. The overwhelmingly Anglocentric character of ‘international’ economic geography is reaffirmed, as both journal publishing and the citation ‘market’ are dominated by authors from the UK, US and Canada. There is some evidence, however, that the field is beginning to internationalize, just as there are also indications that the reach of economic geography, qua‘exporter’, is extending into other parts of the social sciences.
Regulatory risk and farmers’ caution with pesticides in Costa Rica
Authors: Galt Ryan E
Published: July 2007

In a globalizing economy, agri‐food regulation in the industrialized world increasingly affects food‐producing industries and farmers in developing countries. Discussions of these transformations remain mostly disconnected from the literature on pesticide use in developing countries, which emphasizes widespread pesticide misuse and abuse. Previous attempts to consider the relationship between agri‐food regulation and farmers’ pesticide use are found lacking because they do not situate it deeply enough within the social relations of exchange in contract farming. Using a political ecological approach attentive to this relationship, I found many farmers exercising considerable caution in their pesticide use vis‐à‐vis residues on mini‐squash and chayote, the main export crops in Northern Cartago and the Ujarrás Valley, Costa Rica. Exporters’ mediation of regulatory risk – conceptualized as the possibility that an actor's behaviour will be subject to state regulation and that out of compliance behaviour will result in negative consequences that impact the actor – largely explains why this type of caution occurs. A gap between regulation and practice persists, however, because of the local history of residue violations and a related misinterpretation of pesticides’ colour bands. The conclusion critiques the first world/third world binary that is mapped onto pesticide use research as preventing advancements in understanding farmers’ pesticide use, shows the applicability of political ecology's chain of explanation to the local consequences of agri‐food regulation from afar and proposes further engagement between agri‐food studies and political ecology to better theorize local–global interactions between land users and the new spatiality of economic governance in agri‐food networks.
Environmental movements in space‐time: the Czech and Slovak republics from Stalinism to post‐socialism
Authors: Sarre Philip , Jehlička Petr
Published: July 2007

To demonstrate the role of space and time in social movements, the paper analyses the evolution and context of the environmental movement in the Czech and Slovak republics from 1948 to 1998. It shows that the movement's identity was formed under socialism and that political opportunity and resource availability changed markedly over time, as did its organisational and spatial structure. The movement played a significant part in the collapse of the socialist regime, but in the 1990s was marginalised in the interests of building a market economy and an independent Slovakia. Nevertheless a diverse and flexible range of groups existed by the late 1990s. The successive space‐times allow analysis of the multiple and changing variables that influence the geography of social movements.
Dual Tachycardias Associating Double‐Exit Left Aortic Sinus Cusp Tachycardia with Paroxysmal Atrial Fibrillation: Evidence of a Link Between Both Arrhythmias by Means of the Autonomic Nervous System
Authors: BORTONE AGUSTÍN , COMBES NICOLAS , BOVEDA SERGE , ALBENQUE JEAN‐PAUL
Published: July 2007

Introduction: Dual tachycardias associating paroxysmal atrial fibrillation (AF) with double‐exit left aortic sinus cusp tachycardia (LASCT) are described for the first time in a patient referred for AF ablation.

Case: Both tachycardias were successfully ablated under Carto‐Merge® guidance. Noteworthy, vagal denervation during AF ablation was responsible for an immediate decrease in LASCT occurrence and inducibility.

Conclusion: This case highlights the critical role that the autonomic nervous system plays within the cardiac arrhythmia framework.
Reduction of P‐Wave Duration and Successful Pulmonary Vein Isolation in Patients with Atrial Fibrillation
Authors: OGAWA MASAHIRO , KUMAGAI KOICHIRO , VAKULENKO MARTA , YASUDA TOMOO , SIEGERMAN CARIN , GARFINKEL ALAN , CHEN PENG‐SHENG , SAKU KEIJIRO
Published: July 2007

Introduction: We hypothesize that successful pulmonary vein (PV) isolation can shorten the P‐wave duration in patients with atrial fibrillation (AF).

Methods and Results: We recorded magnified surface electrocardiogram (ECG) and P‐wave signal‐averaged ECG using 12 electrode leads before and after 31 PV isolation procedures in 27 patients with AF. The patients were followed for 16 ± 4 months. Repeat ablation studies documented failed PV isolation in seven patients with AF recurrences. At baseline, the maximal P‐wave duration in patients without AF recurrence (161 ± 7 msec) was slightly shorter than that in patients with AF recurrence (168 ± 10 msec, P < 0.05). After ablation, patients without recurrence showed a significant reduction of P‐wave duration from 161 ± 7 msec to 151 ± 8 msec (P < 0.0001). In contrast, no change of P‐wave duration was noted in patients with recurrences. These findings were confirmed with signal averaged ECG of the P‐waves. Three‐dimensional (3‐D) computer simulation using an atrial cell model showed that elimination of the muscle sleeves inside the PV resulted in a shortening of the P‐wave duration and change of the terminal portion of the P‐wave morphology.

Conclusions: A significant shortening of P‐wave duration by P‐wave signal‐averaged ECG can be used as an indicator for successful PV isolation. These findings suggest that activation of the PV muscle sleeves may be an important component of the terminal portion of the P‐wave on surface ECG.
Obstructive Sleep Apnea and its Relationship to Cardiac Arrhythmias
Authors: ARIAS MIGUEL A. , SÁNCHEZ ANA M.
Published: July 2007

Obstructive sleep apnea (OSA) affects approximately 4% of middle‐aged men and 2% of middle‐aged women. Cardiac arrhythmias are common problems in patients with OSA, even though the true prevalence and clinical relevance of cardiac arrhythmias remains to be determined. The presence and complexity of both tachyarrhythmias and bradyarrhythmias may influence morbidity, mortality, and the quality of life for OSA patients. Although the exact mechanisms underlying the link between OSA and cardiac arrhythmias are not well established, they could be partially the same proposed mechanisms relating OSA to different cardiovascular diseases. OSA is characterized by repetitive pharyngeal collapse during sleep that leads to markedly reduced or absent airflow, followed by oxyhemoglobin desaturation, persistent inspiratory efforts against an occluded airway, and termination by arousal from sleep. These mechanisms elicit a variety of autonomic, hemodynamic, humoral, and neuroendocrine responses that by themselves evoke acute and chronic changes in cardiovascular function. These effects may lead to the development of cardiac arrhythmias and any other form of cardiovascular disease linked to OSA. The aims of this review are to describe the essential cardiovascular pathophysiological aspects of OSA, to outline the relationship between OSA and both tachyarrhythmias and bradyarrhythmias and their possible influence in the natural history of OSA patients, and to assess the effects of OSA treatment on the presence of cardiac arrhythmias.
Biventricular Versus Right Ventricular Pacing in Patients with AV Block (BLOCK HF): Clinical Study Design and Rationale
Authors: CURTIS ANNE B. , ADAMSON PHILIP B. , CHUNG EUGENE , JOHN SUTTON MARTIN ST. , TANG FENG , WORLEY SETH
Published: July 2007

Background: Right ventricular (RV) pacing restores ventricular systole in patients with atrioventricular (AV) block, yet recent studies have suggested that in patients with AV block and left ventricular (LV) dysfunction, RV pacing may exacerbate the progression to heart failure (HF). BLOCK HF is a prospective, multi‐center, randomized, double‐blind, controlled trial designed to determine whether patients with AV block, LV dysfunction (EF ≤ 50%), and mild to moderate HF (NYHA I‐III) who require pacing benefit from biventricular (BiV) pacing, compared with RV pacing alone.

Objective: The primary objective of this trial is to determine whether the time to first event (all‐cause mortality, heart failure‐related urgent care, or a ≥ 15% increase in left ventricular end systolic volume index [LVESVI]) for patients with BiV pacing is superior to that of patients with RV pacing.

Methods: Patients with AV block and LV dysfunction who require permanent pacing and undergo successful implantation of a commercial Medtronic CRT device, with or without an ICD, will be randomized to BiV or RV pacing. Patients are followed at least every 6 months until study closure. Up to 1,636 patients may be enrolled in 150 centers worldwide.

Conclusion: BLOCK HF is a large, randomized, clinical study in pacing‐indicated patients with AV block, mild to moderate HF symptoms, and LV dysfunction to determine whether BiV pacing is superior to RV pacing in slowing the progression of HF.
Spontaneous Pulmonary Vein Firing in Man: Relationship to Tachycardia‐Pause Early Afterdepolarizations and Triggered Arrhythmia in Canine Pulmonary Veins In Vitro
Authors: PATTERSON EUGENE , JACKMAN WARREN M. , BECKMAN KAREN J. , LAZZARA RALPH , LOCKWOOD DEBORAH , SCHERLAG BENJAMIN J. , WU RICHARD , PO SUNNY
Published: July 2007

Introduction: Rapid firing originating within pulmonary veins (PVs) initiates atrial fibrillation (AF). The following studies were performed to evaluate spontaneous PV firing in patients with AF to distinguish focal versus reentrant mechanisms.

Methods: Intracardiac recordings were obtained in 18 patients demonstrating paroxysmal AF. Microelectrode (ME) recordings were obtained from superfused canine PV sleeves (N = 48).

Results: Spontaneous PV firing (566 ± 16 bpm; 127 ± 6 ms cycle length) giving rise to AF (52 episodes) was observed. Tachycardia‐pause initiation was present in 132 of 200 episodes of rapid PV firing and 34 of 52 AF episodes. The pause cycle length preceding PV firing was 1,039 ± 86 ms following tachycardia (420 ± 40 ms cycle length). The remaining episodes were initiated following a 702 ± 32 ms pause during sinus rhythm (588 ± 63 ms). Spontaneous firing recorded with a multipolar mapping catheter did not detect electrical activity bridging the diastolic interval between the initial ectopic and preceding post‐pause sinus beat. Tachycardia‐pause initiated PV firing (138 ± 7 ms coupling interval) in patients correlated with tachycardia‐pause enhanced isometric force, early afterdepolarization (EAD) amplitude, and triggered firing within canine PVs. Rapid firing (1,172 ± 134 bpm; 51 ± 8 ms cycle length) following an abbreviated coupling interval (69 ± 12 ms) was initiated in 13 of 18 canine PVs following tachycardia‐pause pacing during norepinephrine + acetylcholine superfusion. Stimulation selectively activating local autonomic nerve terminals facilitated tachycardia‐pause triggered firing in canine PVs (5 of 15 vs 0 of 15; P < 0.05).

Conclusions: The studies demonstrate (1) tachycardia‐pause initiation of rapid, short‐coupled PV firing in AF patients and (2) tachycardia‐pause facilitation of isometric force, EAD formation, and autonomic‐dependent triggered firing within canine PVs, suggestive of a common arrhythmia mechanism.
Flecainide Suppresses Bidirectional Ventricular Tachycardia and Reverses Tachycardia‐Induced Cardiomyopathy in Andersen‐Tawil Syndrome
Authors: PELLIZZÓN OSCAR A. , KALAIZICH LUIS , PTÁČEK LOUIS J. , TRISTANI‐FIROUZI MARTIN , GONZALEZ MARIO D.
Published: July 2007

Bidirectional ventricular tachycardia (BVT), although a rare arrhythmia in the general population, is frequently observed in patients with Andersen‐Tawil syndrome and long QT interval. However, the pharmacologic treatment of this arrhythmia remains unknown. In the present study, we documented the favorable antiarrhythmic action of flecainide in a young woman with sustained BVT and Andersen‐Tawil syndrome. She presented with incessant BVT that could only be terminated with flecainide. During sinus rhythm, a prolonged QT interval was observed. Genetic studies revealed a mutation in the K+ channel gene KCNJ2. Over a 4‐year follow‐up period, recurrence of her arrhythmia occurred twice. The first episode was due to noncompliance and resolved with resumption of flecainide therapy. The second recurrence was associated with a tachycardia‐induced cardiomyopathy and resolved when the dose of flecainide was increased from 200 to 300 mg daily. This report suggests that flecainide can be effective in controlling BVT associated with Andersen‐Tawil syndrome and indicates that the left ventricular dysfunction is secondary to the arrhythmia and not due to an associated phenotypic manifestation of the disorder.
A New Approach for Complete Isolation of the Posterior Left Atrium Including Pulmonary Veins for Atrial Fibrillation
Authors: KUMAGAI KOICHIRO , MURAOKA SOICHI , MITSUTAKE CHIHARU , TAKASHIMA HIDEO , NAKASHIMA HIDEKO
Published: July 2007

Introduction: Esophageal injury is a potential complication after catheter ablation of the posterior left atrium (LA). Therefore, we describe a new approach for complete isolation of the posterior LA including all pulmonary veins (PVs) without vertical lesions along the esophageal aspect of the posterior LA, namely Box isolation.

Methods and Results: Ninety‐one patients with paroxysmal atrial fibrillation (AF) underwent Box isolation. Continuous lesions at the anterior portions of the ipsilateral PVs were initially created and then linear ablation of LA roof and bottom was performed to isolate the posterior LA. Continuous vertical lesions at the posterior portions of PVs along the esophageal aspect of the posterior LA were not created. Ablation was performed with an 8‐mm‐tip catheter. The endpoint was the absence of electrical activity and the inability to pace the posterior LA and all PVs in sinus rhythm. Complete isolation of the posterior LA was achieved in 82 patients (90%). Ablation resulted in the termination of AF in 65%, and subsequent noninducibility of AF in 71% of the patients. A repeat ablation was performed in six of nine patients with recurrence of arrhythmia. At 13 ± 3 months of follow‐up, 86 patients (95%) were arrhythmia‐free without antiarrhythmic drugs.

Conclusion: This study shows that it is possible to achieve complete isolation of the posterior LA including all PVs without posterior vertical lesions. Box isolation is associated with a high clinical success rate.
Using Traditional Measurements of the Left Atrial Diameter to Predict the Left Atrial Volume Index
Authors: Kedia Gautam , Habibzadeh Mohammed Reza , Kudithipudi Vijayasree , Molls Frank , Sorrell Vincent L.
Published: July 2007

Background: Left atrial enlargement by echocardiography is associated with adverse cardiovascular outcomes, yet the best method for assessing left atrial size has not been established. We sought to correlate the traditional left atrial diameter (LAD) measured in the parasternal view with the recently characterized left atrial volume index (LAVI). Methods: 100 routine clinical patients who received a transthoracic echocardiogram for customary indications were studied. The LAD and LAVI were measured in each patient. Results: The mean LAVI was 32.8 milliliters per square meter (ml/m2) and the LAD was 46.8 millimeters (mm). LAD > 4.7 centimeters (cm) was predictive of LAVI > 32 ml/m2 (P < 0.001; OR 17.33; 95% CI = 5.96–50.44). Conclusion: LAD > 4.7 cm via the traditional method can be used to indicate left atrial enlargement. However, a LAD ≤ 4.7 cm does not correlate well with the LAVI, and in such patients, extreme caution should be employed when using the LAD to estimate cardiac prognosis.
Comprehensive Imaging Including Three‐Dimensional Echocardiography of an Infected, Ruptured Sinus of Valsalva Aneurysm
Authors: Medina Hector M. , Vazquez Jacobo , Pritchett Allison , Lakkis Nasser , Dokainish Hisham
Published: July 2007

A 30‐year‐old man presented with fevers and fatigue. Blood cultures grew Streptococcus mitis in 4/4 bottles. Transthoracic three‐dimensional echocardiography revealed an anterior coronary sinus of Valsalva (SOV) aneurysm with fistula formation into the right ventricle with vegetation on the fistulous tract, and a bicuspid aortic valve without vegetation. Transesophageal echocardiography confirmed these findings. After parenteral antibiotic treatment, the patient went for successful repair of the fistula, with the imaging findings confirmed at surgery. This case represents a rare complication of a ruptured SOV aneurysm, with excellent delineation of cardiac anatomy using transthoracic three‐dimensional echocardiography
Eat or be eaten: prevalence and impact of egg cannibalism on two‐spot ladybirds, Adalia bipunctata
Authors: Roy H. E. , Rudge H. , Goldrick L. , Hawkins D.
Published: July 2007

Ladybirds commonly engage in cannibalistic behaviour. Egg cannibalism by first instars is considered advantageous to the cannibal, because it not only results in direct metabolic gain but also a reduction in potential competitors. In this study, we quantified the effect of cannibalism on the development rate and survival of Adalia bipunctata (L.) (Coleoptera: Coccinellidae) larvae through development to the adult stage. We also assessed the synchrony of egg‐hatching in relation to laying order and compared the proportion of eggs cannibalized in egg batches laid as clusters or linearly. Larvae that had consumed a conspecific egg after hatching reached the adult stage 1.65 days earlier than those larvae that had not. Larval and pupal mortality was lower for cannibals compared to non‐cannibals; only 46% of non‐cannibalistic individuals reached the adult stage whereas 81% of cannibals pupated successfully. Egg cannibalism is undoubtedly advantageous to A. bipunctata larvae both in terms of faster development and increased survival. There is a positive correlation between laying and hatching order for eggs laid linearly or in a cluster. There was no significant difference in the proportion of eggs hatching in clusters or in a line (80 and 77%, respectively). The remaining eggs were either cannibalized or did not hatch. The ecological implications of these results are discussed with particular reference to trophic egg plasticity.
Treatment of depression with associated anxiety: comparisons of tricyclic antidepressants and selective serotonin reuptake inhibitors
Authors: Montgomery S. A. , Judge R.
Published: July 2007

Montgomery SA, Judge R. Treatment of depression with associated anxiety: comparisons of tricyclic antidepressants and selective serotonin reuptake inhibitors.

Acta Psychiatr Scand 2000: 101: 9–16. © Munksgaard 2000.

Objective: Evidence indicates that alleviating anxiety symptoms early in the treatment of depression improves treatment compliance, limits treatment discontinuations and contributes to a positive treatment outcome. Because of their sedating effects, the tricyclic antidepressants (TCAs) have historically been the first‐choice agent in treating comorbid depression and anxiety. However, a growing body of evidence suggests that the selective serotonin reuptake inhibitors (SSRIs) can also be suitable therapy.

Method: We reviewed literature regarding the use of TCAs and SSRIs in depressed patients with comorbid anxiety.

Results: SSRIs are at least as effective as TCAs in the treatment of both overall depression as well as anxiety symptoms. TCAs can cause significant and sometimes unacceptable side effects which limit their therapeutic potential. SSRIs, on the other hand, have little or no effect on cholinergic, histaminergic or adrenergic receptors, and have a very favourable tolerability profile.

Conclusion: The traditional selection of antidepressants based on the presence or absence of anxiety has little scientific support. In considering the overall risk:benefit ratio, SSRIs should be the first line treatment for depression with associated anxiety.
Safety and tolerability considerations: tricyclic antidepressants vs. selective serotonin reuptake inhibitors
Authors: Peretti S. , Judge R. , Hindmarch I.
Published: July 2007

Peretti S, Judge R, Hindmarch I. Safety and tolerability considerations: tricyclic antidepressants vs. selective serotonin reuptake inhibitors. Acta Psychiatr Scand 2000: 101: 17–25. © Munksgaard 2000.

Objective: An important consideration in the choice of an antidepressant is its safety and tolerability.

Method: We present a review of literature, clinical trials and meta‐analyses regarding the safety and tolerability of the tricyclic antidepressants (TCAs) and the selective serotonin reuptake inhibitors (SSRIs) in depressed patients.

Results: The SSRIs have a very favourable side‐effect profile compared to the TCAs and are associated with fewer treatment discontinuations. Unlike the TCAs, they do not cause anticholinergic, hypotensive or sedating reactions, and are not associated with impaired cognitive function. Their most common side‐effects (nausea, vomiting, nervousness, insomnia, headache and sexual dysfunction) are usually mild and typically disappear as treatment continues. The SSRTs also exhibit lower toxicity and lower lethality when taken in an overdose situation. Although the safety profiles of the principal SSRTs appear to be comparable, there is some data showing important differences in the severity and frequency of specific adverse events.

Conclusion: The SSRTs have a more favourable safety profile than the TCAs in both acute and long‐term treatment of major depression.
Compliance with antidepressant therapy and antidepressant discontinuation symptoms
Authors: Demyttenaere K. , Haddad P.
Published: July 2007

Demyttenaere K, Haddad P. Compliance with antidepressant therapy and antidepressant discontinuation symptoms.

Acta Psychiatr Scand 2000: 101: 50–56. © Munksgaard 2000.

Objective: Compliance with antidepressant medication is important in order to achieve all the goals of antidepressant therapy. These goals include symptom resolution, restoration of normal functioning and prevention of relapse or recurrent episodes.

Method: We discuss compliance and review adverse symptoms that may occur when antidepressant treatment is abruptly discontinued or interrupted.

Results: The physician's role in managing compliance includes preventing or minimizing the risk for discontinuation symptoms, counselling patients regarding the risk for symptoms if doses are missed and choosing pharmacotherapy that is forgiving of non‐compliance. Physicians also need to recognize the symptoms of discontinuation syndrome in order to differentiate patients who are non‐compliant from patients who require a dosage adjustment or adjunctive therapy. Finally, physicians need to understand how to treat discontinuation symptoms when they do occur.

Conclusion: Since published data indicate that between 30% and 60% of patients do not take their medications as prescribed, non‐adherence to antidepressant medication is likely to be a significant clinical issue in the management of many patients.
Antidepressant use patterns in clinical practices: comparisons among tricyclic antidepressants and selective serotonin reuptake inhibitors
Authors: Donoghue J.
Published: July 2007

Donoghue J. Antidepressant use patterns in clinical practices: comparisons among tricyclic antidepressants and selective serotonin reuptake inhibitors.

Acta Psychiatr Scand 2000: 101: 57–61. © Munksgaard 2000.

Objective: Antidepressant use in clinical practice may differ from that in randomized controlled trials due to the complex interaction between patients, prescribers and the health‐care system.

Method: A review of studies using data from actual clinical practice has found consistent differences in the prescribing patterns of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).

Results: Patients who initiate therapy on SSRIs are more likely to complete a course of adequate dose and duration of antidepressant therapy than patients who initiate therapy on a TCA. Differences in prescribing patterns have also emerged among the most common SSRIs, fluoxetine, sertraline and paroxetine, that are also consistent over time, settings and countries.

Conclusion: Given that the drugs studied are one constant across all the studies, the antidepressants' underlying pharmacological differences in tolerability and other properties may provide an explanation for differences in prescribing patterns.
Compound heterozygosity of Hb DIran (β22 Glu→Gln) and β0‐thalassemia (619 bp‐deletion) in India
Authors: Agrawal Meenal G. , Bhanushali Aparna A. , Dedhia Pratiksha , Jeswani Kanchan D. , Dayanand Sucheta , Dasgupta Amar , Das Bibhu R.
Published: July 2007

The present report describes the hematologic and molecular study of the second case of Hb DIran associated with β0‐thalassemia (619 bp‐deletion) found in India and the first case in which the mutations have been identified at molecular level. The patient showed hypochromic, microcytic red cell picture with reduced red cell indices. The characterization of the hemoglobinopathy was made by electrophoretic and chromatographic techniques and confirmed by sequencing of the beta‐globin gene. Both the propositus and her father were found to be carriers of the gene for β0‐thalassemia owing to the 619 bp‐deletion mutation as seen by the polymerase chain reaction (PCR). Single base substitution GAA > CAA (indicative of Hb DIran) in the heterozygous form was seen in the propositus as well as the mother by sequencing.
Analysis of 6q deletion in Waldenstrom macroglobulinemia
Authors: Chang Hong , Qi Xiaoying , Xu Wei , Reader Jocelyn C , Ning Yi
Published: July 2007

The frequency and prognostic significance of chromosome 6q deletion were investigated in a cohort of patients with Waldenstrom macroglobulinemia (WM). By interphase cytoplasmic fluorescence in situ hybridization with probes for 6q21 and 6q25, we detected hemizygous 6q deletions in the clonal lymphoplasmacytic cells in 13 (38%) out of 34 patients. Patients with 6q deletions had a lower IgM paraprotein levels than non‐deleted patients (P = 0.04). There was no correlation between 6q deletion and other clinical features of WM. There was no significant difference in overall survival between 6q deleted and non‐6q deleted groups (P = 0.92). Our study confirms that 6q deletion is a frequent event, but it does not appear to be a prognostic marker for patients with WM.
Haemoglobin Hope in a northern Thai family: first identification of homozygous haemoglobin Hope associated with haemoglobin H disease
Authors: Sura Thanyachai , Busabaratana Manisa , Youngcharoen Supak , Wisedpanichkij Raewadee , Viprakasit Vip , Trachoo Objoon
Published: July 2007

Haemoglobin (Hb) Hope [β136(H14)Gly→Asp(GGT→GAT)] is one of the unstable haemoglobin variants of the β‐globin chain, which is demonstrated in people of various ethnic backgrounds. Here we report a Thai female patient with clinical thalassaemia intermedia since childhood. This patient had experienced neither blood transfusion nor hospitalisation. Hb Bart’s‐H and a large amount of Hb Hope were identified by high‐performance liquid chromatography (HPLC) assay and the diagnosis of homozygous Hb Hope was definitely achieved by direct sequencing of exon 3 of β‐globin gene. Furthermore, we could identify that her brother carried the mutation of homozygous Hb Hope without abnormal α globin chain involvement, and another family member had heterozygous Hb Hope in association with –α3.7 mutation, and both of them were clinically silent.
Low‐dose thalidomide plus low‐dose dexamethasone therapy in patients with refractory multiple myeloma
Authors: Murakami Hirokazu , Handa Hiroshi , Abe Masahiro , Iida Sinsuke , Ishii Akihiro , Ishikawa Takayuki , Ishida Tadao , Oota Masatsugu , Ozaki Shuji , Kosaka Masaaki , Sakai Akira , Sawamura Morio , Shimazaki Chihiro , Shimizu Kazuyuki , Takagi Toshiyuki , Hata Hiroyuki , Fukuhara Takashi , Fujii Hiroshi , Miyata Akira , Wakayama Toshio , Takatsuki Kiyoshi
Published: July 2007

We report the results of a non‐randomized phase II study of low‐dose thalidomide plus low‐dose dexamethasone therapy in 66 patients with refractory multiple myeloma. The overall response rate (near complete, partial and minimal response) was 63.6%, and progression‐free and overall survival periods were 6.2 and 25.4 months. In adverse events, the incidence of peripheral neuropathy and deep vein thrombosis was lower than the data reported in USA and Europe. On the other hand, leukopenia was observed in 41% of patients, including 11% of those with Grade 3. Leukopenia was closely related to pretreatment pancytopenia, especially thrombocytopenia. The incidence of adverse events related to dexamethasone was low. In conclusion, low‐dose thalidomide plus low‐dose dexamethasone therapy was as effective as high‐dose thalidomide plus high‐dose dexamethasone therapy in patients with refractory multiple myeloma. Leukopenia is one of the most serious adverse events in Japanese patients, especially in patients with pretreatment pancytopenia.
Vancomycin‐resistant Enterococcus faecium infection in patients with hematologic malignancy: patients with acute myeloid leukemia are at high‐risk
Authors: Worth Leon J. , Thursky Karin A. , Seymour John F. , Slavin Monica A.
Published: July 2007

Background:  Vancomycin‐resistant enterococci (VRE) are significant nosocomial pathogens in patients with hematologic malignancy. Identification of risk factors for infection is necessary for targeted prevention and surveillance.

Objectives and methods:  An outbreak of VRE infection occurred at a tertiary cancer hospital between 1 August 2003 and 30 June 2005. Infection control measures recommended by the Society for Healthcare Epidemiology of America were used throughout the outbreak period. A matched case–control study was performed to identify risk factors for VRE infection.

Results:  Fourteen VRE infections (13 episodes of bacteremia, one urinary tract infection) occurred a median of 10.5 d following hospital admission. All were due to Enterococcus faecium vanB. Univariate analysis identified the following variables to be significantly associated with VRE infection: presence of neutropenia, neutropenia ≥7 d, underlying diagnosis of acute myeloid leukemia (AML), and receipt of vancomycin, metronidazole or carbapenem antibiotic therapy in the 30 d prior to infection. On multivariate analysis, an underlying diagnosis of AML [odds ratio (OR), 15.00; P = 0.017] and vancomycin therapy during the previous 30 d (OR, 17.96; P = 0.036) were retained as independent risk factors for infection.

Conclusions:  Risk stratification for development of VRE infection is possible for patients with hematologic malignancy. Patients with AML represent a high‐risk population, and targeted prevention strategies must include improved antibiotic stewardship, particularly judicious use of vancomycin therapy.
Perioperative management of MYH9 hereditary macrothrombocytopenia (Fechtner syndrome)
Authors: Selleng Kathleen , Lubenow Lena E. , Greinacher Andreas , Warkentin Theodore E.
Published: July 2007

Objective:  Hereditary thrombocytopenias characterized by mutations in the gene for non‐muscle myosin heavy chain IIA (NMMHC‐IIA) are known as MYH9‐related hereditary macrothrombocytopenia, and include the May–Hegglin anomaly, Sebastian platelet syndrome, Fechtner syndrome, and Epstein syndrome. Despite the presence of thrombocytopenia, these patients often have only mild or non‐bleeding phenotypes. A major risk for these patients can be inappropriate treatment with long‐term corticosteroids or splenectomy for misdiagnosed chronic autoimmune thrombocytopenia, as well as inadequate peri‐ and postoperative management.

Methods:  Using the case of a 44‐yr‐old male with Fechtner syndrome (macrothrombocytopenia, leukocyte inclusions, sensorineural deafness, glomerulonephritis) who underwent neurosurgery for an intracerebral arteriovenous malformation, we describe current methods to diagnose hereditary MYH9‐related macrothombocytopenia by analysis of the blood smear, immunofluorescence staining of the NMMHC‐IIA in leucocytes, and by MYH9‐gene sequencing.

Results:  Clusters of NMMHC‐IIA in granulocytes and a R1165C mutation in the MYH9‐gene in two macrothrombocytopenic family members confirmed the diagnosis of a MYH9‐related disease. The patient had no bleeding diathesis by history or physical examination. Thus no perioperative prohemostatic pharmacologic therapies or transfusions were given, with only minimal bleeding observed. Postoperative antithrombotic thromboprophylaxis was not given because of anticipated enhanced risk for bleeding. However, the patient developed symptomatic pulmonary embolism on postoperative day 6, which was successfully managed with 8 months of anticoagulation.

Conclusion:  MYH9‐related hereditary macrothrombocytopenia does not necessarily protect against postoperative venous thromboembolism, and affected patients who do not evince bleeding diathesis should be considered for routine postoperative pharmacologic thromboprophylaxis.
Interferon‐γ +874A/T and interleukin‐4 intron3 VNTR gene polymorphisms in Chinese patients with idiopathic thrombocytopenic purpura
Authors: Chen Xiaoli , Xu Jianhui , Chen Zhenping , Zhou Zeping , Feng Xiaoming , Zhou Yuling , Ren Qian , Yang Renchi , Han Zhong Chao
Published: July 2007

Objectives:  The polarization of Th1/Th2 towards Th1 contributes to the pathogenesis of idiopathic thrombocytopenic purpura (ITP). Cytokines may play crucial roles in the pathogenesis of ITP. The purpose of this study was to investigate whether the interferon (IFN)‐γ +874(A/T) and interleukin‐4 (IL‐4) variable number of tandem repeats (VNTR) in intron3 polymorphisms may be responsible in part for genetic susceptibility to ITP.

Methods:  Genotyping of IFN‐γ +874A/T and IL‐4 intron3 VNTR was performed in 196 patients with ITP and 128 healthy individuals by polymerase chain reaction sequence‐specific primers and direct PCR respectively.

Results:  There was no association between IFN‐γ +874A/T and IL‐4 intron3 VNTR polymorphism and ITP risk when all patients, as a group, were analyzed. When the patients were subdivided into two groups: childhood ITP and adult ITP, no statistical differences were found in the genotype and allele frequencies of IFN‐γ +874A/T and IL‐4 intron3 VNTR between the two groups and the controls. Similar results were observed between acute childhood ITP, chronic childhood ITP, acute adult ITP or chronic adult ITP and the controls.

Conclusion:  These polymorphisms were distributed similarly between the patients with ITP and the controls, demonstrating that these two candidate gene polymorphisms are not attributed to ITP susceptibility.
Study of skin–fabric interactions of relevance to decubitus: friction and contact‐pressure measurements
Authors: Gerhardt L.‐C. , Mattle N. , Schrade G. U. , Spencer N. D. , Derler S.
Published: July 2007

Background/purpose: Prolonged pressure as well as friction and shear forces at the skin–textile interface are decisive physical parameters in the development of decubitus. The present article describes the contact phenomena at the skin–textile interface and the development of a purpose‐built textile friction analyser (TFA) for the tribological assessment of skin–fabric interactions, in connection with decubitus prevention.

Methods: Interface pressure distributions were recorded in the pelvic and femoral regions between supine persons and a foam mattress. Fabrics made of various natural and synthetic yarns were investigated using the TFA. A vertical load of 7.7 kPa was applied to the swatches, simulating high interface pressures at the skin–fabric interface and clinical conditions of bedridden persons. Fabrics were rubbed in reciprocating motions against a validated skin‐simulating material to determine static as well as dynamic friction coefficients (COFs).

Results: Maximum contact pressures ranged from 5.2 to 7.7 kPa (39–58 mmHg) and exceeded the capillary closure pressure (32 mmHg) in all investigated bedding positions. For both COFs, a factor of 2.5 was found between the samples with the lowest and highest values. Our results were in a similar range to COFs found in measurements on human skin in vivo. The results showed that our test method can detect differences of 0.01 in friction coefficients.

Conclusion: TFA measurements allow the objective and reliable study of the tribology of the skin–textile biointerface and will be used to develop medical textiles with improved performance and greater efficacy for decubitus prevention.
Interfacial kinetics effects on transdermal drug delivery: a computer modeling
Authors: Xing Malcolm M. Q. , Pan Ning , Zhong Wen , Hui Xiaoyin , Maibach Howard I.
Published: July 2007

Background/purpose: Percutaneous permeation is a frequently used approach in drug delivery, but the detailed physics process in the patch – stratum corneum (SC) – viable epidermis system remains unclear: the influence of the interphases in the multilayered structure has been little studied.

Methods: This paper applied the finite‐element method to develop a contact algorithm with an interphase element to account for the interphase barrier on drug diffusion and chemical absorption during a transdermal drug delivery process. A more realistic multilayer structure, including the patch, SC and viable epidermis, are incorporated into the algorithm. Both interphases between the patch and SC, and between SC and viable epidermis are considered.

Results: Our study confirms that the interphase transfer coefficients have a direct connection with drug concentration and flux distribution along the diffusion paths. The simulation results suggested a potential for the optimal control of drug diffusion. The partition coefficients and other interphase barrier factors can be incorporated into the model.

Conclusions: The algorithm can deal with complicated geometrical conditions, which is difficult using classical analytical approaches. Furthermore, calibrated against experiments, the model may predict more realistically the drug delivery process and drug distribution profiles so as to assist in the patch and even drug design.