bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimated Trends in the Prevalence of Heroin Addiction in Switzerland
Authors: Maag Verena
Published: September 2003

Data on the prevalence of heroin addiction have considerable relevance in the field of public health as a means of evaluating measures aimed at improving the lives of the individuals concerned. The number of heroin addicts in Switzerland was estimated by six different methods based on various data sources. This resulted in an overall estimate for the reference year 1997 ranging from a minimum of 24,000 to a maximum of 35,000 heroin addicts. In the 1990s, the trend in the prevalence of heroin addiction was characterised by a rapid rise up to 1993/94 followed by a gradual decline. The increasing medicalisation (focus on treatment rather than on punishment) of Switzerland’s heroin problem has therefore not translated into a clear downward trend in the estimated prevalence of heroin addiction; however, the data for the various sub-groups lend plausibility to the assumption that this population is more integrated, less conspicuous and receiving better medical care.
Alcohol as a Risk Factor for Global Burden of Disease
Authors: Rehm Jürgen , Room Robin , Monteiro Maristela , Gmel Gerhard , Graham Kathryn , Rehn Nina , Sempos Christopher T. , Jernigan David
Published: September 2003

Aim: To make quantitative estimates of the burden of disease attributable to alcohol in the year 2000 on a global basis. Design: Secondary data analysis. Measurements: Two dimensions of alcohol exposure were included: average volume of alcohol consumption and patterns of drinking. There were also two main outcome measures: mortality, i.e. the number of deaths, and disability-adjusted life years (DALYs), i.e. the number of years of life lost to premature mortality or to disability. All estimates were prepared separately by sex, age group and WHO region. Findings: Alcohol causes a considerable disease burden: 3.2% of the global deaths and 4.0% of the global DALYs in the year 2000 could be attributed to this exposure. There were marked differences by sex and region for both outcomes. In addition, there were differences by disease category and type of outcome; in particular, unintentional injuries contributed most to alcohol-attributable mortality burden while neuropsychiatric diseases contributed most to alcohol-attributable disease burden. Discussion/Conclusions: The underlying assumptions are discussed and reasons are given as to why the estimates should still be considered conservative despite the considerable burden attributable to alcohol globally.
Soma-Restricted Products of the Myelin Proteolipid Gene Are Expressed Primarily in Neurons in the Developing Mouse Nervous System
Authors: Jacobs Erin C. , Bongarzone Ernesto R. , Campagnoni Celia W. , Kampf Kathy , Campagnoni Anthony T.
Published: September 2003

The myelin proteolipid gene encodes two sets of proteins, the classic PLP and DM20 and the sr (soma-restricted)-PLP and sr-DM20. Unlike the classic proteolipids, the sr-products are expressed in both neurons and oligodendrocytes (OLs) and are not components of the myelin sheath. In OLs, the sr-isoforms are associated with endosomes and recycling vesicles indicating a possible nonmyelin function for these proteins. In this study, a purified antibody specific for the sr-products was used to examine the expression of these proteins during the development of the mouse brain. We found that while sr-PLP and sr-DM20 are expressed in OLs, the highest levels of immunoreactivity were found in neuronal populations. During early embryonic development (E13–E15), sr-proteolipids were detected in the dorsal root ganglion and motor neurons in the spinal cord. By E17, immunostaining for sr-PLP and sr-DM20 in the brain increased dramatically. The highest levels of immunoreactivity were found during the first and second weeks postnatal after which staining intensity declined to adult levels and the pattern of expression was more restricted. Robust staining persisted in many neuronal populations including nuclei in the hindbrain, Purkinje and granule neurons in the cerebellum, pyramidal cells in the cortex and mitral cells in the olfactory bulb. The spatial and temporal pattern of sr-PLP and sr-DM20 expression is very similar to that of the endosomal protein, syntaxin 13, consistent with the finding that the sr-PLPs may play a role in vesicular transport in neurons.
Tachykinin Expression and Localization in Developing Feline Neocortex
Authors: Fisher R.S. , Boylan M.K. , Xie Y.
Published: September 2003

Developmental patterns of expression and localization of tachykinins in feline neocortex were determined by qualitative immunohistochemical means. Three observations were obtained. (1) By midgestation, tachykinins were progressively accumulated in an infrequent (<1%) population of interneurons (sparse dendritic spines) settled mainly in superficial and deep sites. (2) Tachykinins were in a sparse axonal innervation showing horizontal elaboration in layers I and VI and vertical elaboration within the intervening layers (II–V) of true cortical plate. (3) Tachykinin innervation of the capillary beds arose in conjunction with tachykinin interneurons instead of extending from basal cerebral or meningeal vasculature. These patterns indicate that tachykinin local circuit neurons of feline neocortex are derived, at least in part, from early-generated neocortical preplate neurons that initiate tachykinin expression after they settle into the marginal zone of primitive neocortex. In addition to their roles in peptidergic modulation of synaptic connectivity in neocortex, this innervation may participate in trophic developmental interactions leading to the establishment of neocortical vasculature.
Neural Stem Cells in the Subventricular Zone Are a Source of Astrocytes and Oligodendrocytes, but Not Microglia
Authors: Levison Steven W. , Druckman Stuart K. , Young Greg M. , Basu Anirban
Published: September 2003

The developmental origin of microglia remains a controversial subject. While it is generally accepted that primitive fetal macrophages that migrate from the yolk sac to the brain become microglia, it also has been argued that there is a second source of microglia that are of neuroectodermal lineage. To determine whether progenitors in the dorsolateral subventricular zone (SVZDL) are capable of producing microglia as well as macroglia, we infected perinatal rat SVZDL cells with a mixture of two replication-deficient retroviruses, placed these progenitors in vitro and then varied the media formulations to promote microglial differentiation. Mixed macroglial clones were obtained, but no heterogeneous clones containing microglia were observed, regardless of the media components. Among the macroglial clones, we observed every possible combination of type 1 astrocyte and O-2A lineage cells. Some clones were homogeneous and contained cells belonging to a single macroglial lineage. Other clonal clusters were heterogeneous and were comprised of type 1 astrocytes and oligodendrocytes, type 1 and type 2 astrocytes, or type 2 astrocytes and oligodendrocytes. Of 130 clones examined, where we used triple immunofluorescence with antibodies that recognize microglia, 2 clonal clusters contained OX-42+ microglia that were retrovirally labeled, but all of the cells in those clones expressed the microglial marker and none expressed either GFAP or O4. In addition, we isolated neural stem cells from the perinatal SVZDL and assessed their capacity to generate macroglia and microglia. Confirming and extending our previous analyses, neural stem cells generated homogeneous and heterogeneous macroglial clones, but they did not generate microglia. We conclude that brain macroglia and microglia do not share a common precursor, even though the neural stem cells in the SVZDL cells can produce neurons, astrocytes and oligodendrocytes. Therefore, the microglia that reside in the SVZDL are immigrants from nonneural precursors.
Differential Regulation of Thalamic and Cortical Axonal Growth by Hepatocyte Growth Factor/Scatter Factor
Authors: Powell Elizabeth M. , Mühlfriedel Sven , Bolz Jürgen , Levitt Pat
Published: September 2003

The initial axonal projections between the cerebral cortex and thalamus are established during embryogenesis. Chemoattractants and repellents are thought to provide specific guidance cues for directional growth of these pathways. Hepatocyte growth factor/scatter factor (HGF/SF) serves as an attractant for developing motor neurons, and its distribution in embryonic pallidum, pallium and thalamus suggests a similar role in forebrain development. We examined the effectiveness of HGF/SF in regulating thalamic and cortical neuronal growth using in vitro assays. HGF/SF increased neurite outgrowth of thalamic, but not cortical neurons, grown in dissociated cultures or as explants. HGF/SF also exhibited a chemoattractant property for thalamic axons, promoting the extension of neurites towards an HGF/SF source. These experiments demonstrate HGF/SF has the capacity to selectively direct thalamocortical projections into an intermediate target, the pallidum, and eventually to their final cortical destination.
Minimizing Radiation Exposure from Patients Treated with Iodine-131 for Hyperthyroidism Using a Lead Collar: A Simple and Effective Approach
Authors: Loutfi Issa , Sakr Mohamed , Al-Shummari Awatef M.
Published: September 2003

Objective: To construct a lead collar useful for shielding the electromagnetic radiation from the thyroid of patients treated with radioiodine 131I for hyperthyroidism, thereby reducing the radiation emitted from these patients. Materials and Methods: A specially designed cervical lead collar was used to shield radiation exposure from ‘hot thyroids’ of 20 patients treated with iodine-131 for hyperthyroidism. The collar was made of lead strips stacked together around a plastic neck support fastened around the patient’s neck. Measurements of the radiation exposure rate were obtained at increasing distances from the patients (50, 100, 200 cm), with and without the lead collar, at various times after 131I treatment. Results: Radiation exposure measurements over 3 weeks showed relatively high exposure rates in the first week after treatment. The radiation exposure from the patients wearing the lead collar was half that found in the same patients not wearing the collar. Conclusion: The use of the lead collar significantly reduced the radiation exposure of patients’ surroundings. It was particularly useful in patients who could not abide strictly to the standard restrictive protocols after treatment with 131I.
Frequency of CYP21 Gene Mutations in Czech Patients with Steroid 21-Hydroxylase Deficiency and Statistical Comparison with Other Populations
Authors: Kotaška Karel , Průša Richard
Published: September 2003

Objective: To undertake mutational analysis in patients with different forms of steroid 21-hydroxylase deficiency. Subjects and Methods: CYP21 gene molecular analysis was performed in 76 Czech patients diagnosed with steroid 21-hydroxylase deficiency. Eight of the most common point mutations (intron 2 splice, P30L, 8bp deletion in exon 3, I172N, V281L, Q318X, R356W, and P453S) were analyzed using an amplification-created restriction site method, and 5 additional mutations (intron 7 splice, F307insT, cluster in exon 6, R484P, and R484X) were analyzed using dot-blot hybridization with 5′-biotin-labeled oligonucleotides. Deletions and conversions were screened using a sequence-specific oligonucleotide hybridization method. Comparison of common mutation frequencies in CYP21 reported for different regions, both within Europe and worldwide (North and South America, Asia, and North Africa), was undertaken and the significance of the differences was determined by statistical analysis (Fisher’s F test, Student’s t test, paired t test, and confidence intervals) using a value of p < 0.05. Results: The most frequent genetic defect found in this group of Czech patients was intron 2 splice mutation (46.7%). Comparison of mutation frequencies between Czech and other European populations showed that the Czech patients had a lower frequency of deletions/large gene conversions, R356W, and cluster mutations in exon 6, together with a higher frequency of intron 2 splice mutation, 8-bp deletion and F307insT compared with other populations. Conclusion: A high prevalence of P30L mutations, mostly associated with nonclassical forms of congenital adrenal hyperplasia, was found in Czech patients with classic simple virilizing forms of steroid 21-hydroxylase deficiency.
Early Changes in Thyroid-Stimulating Antibody Activity following Radioiodine Therapy
Authors: Syed Akheel A. , Evans Carol , Ludgate Marian , Lazarus John H.
Published: September 2003

Objective: The aim of this study was to determine whether or not the titre of thyroid-stimulating hormone receptor antibody with stimulating (TRAb-S) activity changes in patients with Graves’ disease (GD) or toxic multinodular goitres (TMNG) 3 months after treatment with sodium iodide (131I). Subjects and Methods: Serum specimens were obtained from 21 hyperthyroid patients (15 with GD and 6 with TMNG) at a median 0.5 months before and 3 months after 131I treatment using a standard ablative dose of 555 MBq. TRAb-S activity was measured in a sensitive and specific luminescent bioassay employing the lulu cell line and expressed as a stimulation index (SI; normal ≤1.5). Results: The mean TRAb-S in the GD patients was 2.72 SI (95% CI: 1.51–4.03) 0.5 months before administration of 131I and 3.98 SI (95% CI: 1.20–6.76) 3 months after administration of 131I. The difference was not statistically significant at p < 0.8. It was not elevated in the TMNG patients before (0.57 SI; 95% CI: 0.41– 0.73) and after (1.00 SI; 95% CI: 0.74–1.26) treatment either. Conclusions: Radioiodine therapy for GD or TMNG did not induce a significant change in TRAb-S activity at 3 months after treatment with 131I, probably due to effective antithyroid therapy or the timing of samples.
Acute Suppurative Necrotizing Pancholangitis
Authors: Nasr Magid M.A. , Asfar Sami , Nur Ali , Wafai Ibrahim
Published: September 2003

Objective: To present a case of ascending cholangitis with resulting necrosis of the biliary system with perforation. Clinical Presentation and Intervention: A 40-year-old male patient presented with upper abdominal pain, fever and jaundice assessed clinically and investigated by laboratory and radiological tests. Endoscopic retrograde cholangiogram and surgery were performed. However, because of extensive suppurative pancholangitis involving most of the intrahepatic radicles, sound surgical drainage could not be accomplished. Unfortunately, the patient died 2 days after surgery. Conclusion: In this case of severe cholangitis, endoscopic and surgical interventions were not successful and might have contributed to the worsening of the condition.
Targeting Genetically Modified Macrophages to the Glomerulus
Authors: Wilson H.M. , Kluth D.C.
Published: September 2003

Macrophages are key players in the development of the majority of renal diseases and are therefore ideal cellular vectors for site specifically targeting gene therapy to inflamed glomeruli. Macrophages can be genetically modified using viral vectors ex vivo then re-introduced into the body where they can home to the diseased site. This review summarises current experience in efficiently targeting modified macrophages to the inflamed glomerulus focussing on the factors controlling macrophage localisation, macrophage gene transfer methods, in vivo gene delivery and results of recent investigations using modified macrophage gene therapy for glomerular disease.
Right Ventricle to Pulmonary Artery Conduit Improves Outcome After Stage I Norwood for Hypoplastic Left Heart Syndrome
Authors: Pizarro Christian , Malec Edward , Maher Kevin O. , Januszewska Katarzyna , Gidding Samuel S. , Murdison Kenneth A. , Baffa Jeanne M. , Norwood William I.
Published: September 2003

Background—

Diastolic run off into the pulmonary circulation and labile coronary perfusion are thought to contribute to morbidity and mortality after the Norwood procedure (NP). We compared outcomes from the use of a RV to PA conduit (RV/PA) or a modified Blalock-Taussig shunt (BTS), physiologically distinct sources of pulmonary blood flow.

Methods and Results—

Review of 56 consecutive patients who underwent a Norwood procedure with a RV/PA (n=36) or a BTS (n=20) between 2000 and 2002. Median age was 4.5 days (range 1 to 40) and median weight was 3.1 kg (range 1.8 to 4.1). The RV/PA was constructed with a 5-mm conduit. Patients in the BTS group received a 4-mm shunt. Comparisons between RV/PA and BTS groups showed no difference for weight, gestational age, prenatal diagnosis, HLHS variant, associated diagnoses, ascending aortic size, ventricular function, AV valve function, and pulmonary venous obstruction. Operative survival was higher with RV/PA [33/36 (92%) versus 14/20 (70%);
P
=0.05]. Patients with RV/PA had less need for ventilatory manipulations to balance the Qp/Qs (1/36 v/s 8/20;
P
=0.001), delayed sternal closure (6/36 v/s 7/20;
P
=0.001), and extracorporeal support (5/36 v/s 7/20;
P
=0.036). RV/PA patients had more favorable postoperative hemodynamics: higher diastolic blood pressure without changes in systolic blood pressure at 1, 8, 24, 48 hours after the NP (46.3 v/s 39.5; 47.2 v/s 42.1; 46.1 v/s 37.1; and 47.1 v/s 40.2; all
P
=0.001).

Conclusion—

RV/PA simplifies postoperative management and improves hospital survival after NP for HLHS.
Off-Pump Coronary Artery Bypass (OPCAB) Surgery Reduces Risk-Stratified Morbidity and Mortality: A United Kingdom Multi-Center Comparative Analysis of Early Clinical Outcome
Authors: Al-Ruzzeh Sharif , Ambler Gareth , Asimakopoulos George , Omar Rumana Z. , Hasan Ragheb , Fabri Brian , El-Gamel Ahmed , DeSouza Anthony , Zamvar Vipin , Griffin Steven , Keenan Daniel , Trivedi Uday , Pullan Mark , Cale Alex , Cowen Michael , Taylor Kenneth , Amrani Mohamed
Published: September 2003

Objective—

Off-Pump Coronary Artery Bypass (OPCAB) surgery is gaining more popularity worldwide. The aim of this United Kingdom (UK) multi-center study was to assess the early clinical outcome of the OPCAB technique and perform a risk-stratified comparison with the conventional Coronary Artery Bypass Grafting (CABG) using the Cardio-Pulmonary Bypass (CPB) technique.

Methods—

Data were collected on 5,163 CPB patients from the database of the National Heart and Lung institute, Imperial College, University of London, and on 2,223 OPCAB patients from eight UK cardiac surgical centers, which run established OPCAB surgery programs. All patients had undergone primary isolated CABG for multi-vessel disease through a midline sternotomy approach, between January 1997 and April 2001. Postoperative morbidity and mortality were compared between the CPB and OPCAB patients after adjusting for case-mix. The mortality of the OPCAB patients was also compared, using risk stratification, to the mortality figures reported by the Society of Cardiothoracic Surgeons of Great Britain and Ireland (SCTS) based on 28,018 patients in the national database who were operated on between January 1996 and December 1999.

Results—

Morbidity and mortality were significantly lower in the OPCAB patients compared with the CPB patients and the UK national database of CABG patients, over the same period of time, after adjusting for case-mix.

Conclusion—

This study demonstrates that risk stratified morbidity and mortality are significantly lower in OPCAB patients than CPB patients and patients in the UK national database.
Global Impairment of Cardiac Autonomic Nervous Activity Late After the Fontan Operation
Authors: Davos Constantinos H. , Francis Darrel P. , Leenarts Marjolein F.E. , Yap Sing-Chien , Li Wei , Davlouros Periklis A. , Wensel Roland , Coats Andrew J.S. , Piepoli Massimo , Sreeram Narayanswami , Gatzoulis Michael A.
Published: September 2003

Background

Atrial tachyarrhythmia is a common cause of morbidity and mortality in patients with univentricular physiology undergoing the Fontan operation. We examined cardiac autonomic nervous activity, a predictor of arrhythmia and sudden death in other cardiovascular disease, in patients late after the Fontan operation, employing heart rate variability (HRV) and baroreflex sensitivity.

Methods and Results

We measured HRV and baroreflex sensitivity in 22 consecutive patients (8 male, age 26±9 years) who had undergone the Fontan operation 13±6 years previously, and 22 age- and sex-matched healthy controls. Fontan patients had significantly lower HRV (
P
<0.0001). Baroreflex sensitivity was measured by the α-index method (square root of ratio of RR interval spectral power to systolic blood pressure (SBP) spectral power, in the LF and the HF band) and was also significantly depressed in the Fontan group (
P
<0.0001 for both). Both low frequency (LF) and high frequency (HF) components of HRV were reduced in the Fontan patients (
P
<0.0001), but there was interindividual variation so that the LF/(LF+HF) ratio may be high, normal, or low, and decreased with increasing right atrial dimensions (
r
=−0.62,
P
=0.006). Patients with a history of sustained atrial arrhythmia had a stronger baroreflex than those without (
P
=0.005).

Conclusions

Autonomic nervous control of the heart is markedly deranged in patients late after the Fontan operation, with reduced HRV and baroreflex sensitivity. A relative suppression of the sympathetic–compared with the parasympathetic–system was observed in patients with marked right atrial dilation within the Fontan group. Furthermore, stronger baroreflexes were seen in Fontan patients in association with a higher incidence of sustained atrial tachyarrhythmia, implying that sinus node dysfunction is unlikely to be the dominant mechanism. Additional studies are clearly required to examine the prognostic importance of impaired BRS and HRV in these patients.
Stay!
Authors: Llewelyn John
Published: September 2003

Stay! That is to say, either stay with your decision or stay your hand. Demeure: either remain or delay. Morari or moriri: either life or death. The alternation is also a hyphenation, a connection-disconnection, as with that of Judaeo-Christianity and the ethicoreligious. How are these hyphenations construed in Kierkegaard's divergence from Kant and Hegel and in the responses of Derrida and Levinas to Johannes de silentio's story of what happened and did not happen on Mount Moriah? Perfect duties and imperfect duties fall under the responsibility of absolute duty. If the ethical is externally related to natural life, the life that is internal to the ethical is due to another externality, that of responsibility to the absolute other - or God, if you like. Another alternation. Another hyphenation? Or a dash? And would it be a dash that separates justice from love? And is love ever separate from self-love or from narcissisim? What sort of narcissism is exemplifed in Kierkegaard's search for salvation? Meanwhile Abraham waits, and with him or against him but without demur, so do Isaac (or is it Ishmael?), the ram, and a host of hostages, guests, and asylum-seekers, one by one.
Treatment of Locally Advanced Pancreatic Cancer in the Real World: Population-Based Practices and Effectiveness
Authors: Krzyzanowska Monika K. , Weeks Jane C. , Earle Craig C.
Published: September 2003

Purpose: To evaluate the use and effectiveness of cancer-directed therapy in elderly patients with locally advanced pancreatic cancer (LAPC).

Methods: We used the linked Surveillance, Epidemiology, and End Results Medicare database to perform a retrospective cohort study in 1,696 patients diagnosed with LAPC between 1991 and 1996. We calculated cancer-directed treatment use rates, then used logistic regression to identify patient and health system factors that were associated with receipt of treatment. Effectiveness of treatment was estimated using Cox proportional hazards models and propensity score methods.

Results: In our cohort, 44% of patients received some form of cancer-directed therapy (24% radiation with concurrent chemotherapy, 13% radiation alone, and 7% chemotherapy alone). Older age, lower socioeconomic status, presence of comorbid illness, no care in a teaching hospital, and residence in the western United States were associated with a lower likelihood of receiving treatment (P ≤ .05). Among those treated, younger age and certain geographic locations were the only predictors of receiving combined-modality therapy. The adjusted hazard ratio for death associated with any treatment in the Cox model was 0.53 (P < .0001). Effectiveness estimates obtained using propensity score methods were similar.

Conclusion: This analysis supports the effectiveness of cancer-directed treatment in elderly patients with LAPC, but use is low. Receipt of treatment is strongly correlated with non–disease-related factors, especially sociodemographic characteristics, indicating possible disparities in access to care.
Catheter Design Influences Recurrence of Catheter-Related Bloodstream Infection in Children With Cancer
Authors: Flynn Patricia M. , Willis Brian , Gaur Aditya H. , Shenep Jerry L.
Published: September 2003

Purpose: Multiple studies have demonstrated that catheter-related bloodstream infections (CRBI) can be successfully treated without catheter removal (in situ therapy), but there is insufficient information available to determine if catheter design can influence the eradication of bacteremia or recurrence.

Patients and Methods: Bacteremic episodes in patients at St Jude Children’s Research Hospital between January 1996 and May 2001 were identified and patient records were reviewed.

Results: A total of 172 unique episodes of CRBI were identified. In situ therapy resulted in successful eradication of bacteremia in 87% of the episodes. Bacteremia recurred in 10% of the episodes. Although catheter design (Hickman and Broviac versus totally implantable central venous catheter) did not influence short-term eradication of bacteremia, totally implantable central venous catheters were significantly associated with recurrence of bacteremia (odds ratio, 10; 95% confidence interval, 3.1 to 33.3). In a multivariable analysis, this association between catheter design and recurrence remained statistically significant after adjustment for other factors that influenced recurrence in this study (isolation of coagulase-negative staphylococci and inadequate duration of initial antibiotic therapy).

Conclusion: This study demonstrates that patients with CRBI with a totally implantable central venous catheter in place are more likely to develop recurrent bacteremia. Management strategies to prevent recurrence in this setting should be explored.
The available‐enthalpy cycle. I: Introduction and basic equations
Authors: Marquet Pascal
Published: September 2003

A diagnostic package is derived from the concept of specific available enthalpy, leading to the definition of a local and complete energy cycle. It is useful to understand the transformations of energy occurring at any particular pressure level or pressure layer of a limited‐area domain. The global version of this diagnostic tool is very similar to the cycle of Lorenz, but the local counterpart contains several additional terms, with zonal, eddy and static‐stability components close to definitions already given by Pearce. The new cycle takes into account the flow of energy components across the vertical and horizontal boundaries, with additional conversion terms involving potential energy, leading to accurate computations of dissipation and generation terms obtained as residuals. A new accurate temporal scheme is proposed in order to allow use of a large time interval in future numerical applications. Finally, comments are made on the arbitrary choice of two constant reference values for pressure and temperature. Copyright © 2003 Royal Meteorological Society
Primary hyperaldosteronism
Authors: Nadar Sunil , Lip Gregory YH , Beevers D Gareth
Published: September 2003

Primary hyperaldosteronism is an important cause of hypertension. Its true prevalence is still a matter of debate, since about 10% of hypertensives may have underlying hyperaldosteronism. Primary hyperaldosteronism is due to aldosterone-secreting tumours, bilateral adrenal hyperplasia or, rarely, adrenal carcinoma or genetic causes.

There is considerable debate over the optimal screening methods for detecting hyperaldosteronism. The patients who benefit the most from screening are young hypertensives, those with resistant hypertension and patients with serum potassium of less than 3.5 mmol/L, especially in the presence of a high sodium. Various tests are available for screening patients with hypertension for hyperaldosteronism. Serum potassium is an unreliable marker for hyperaldosteronism, although a low value in a patient not taking diuretics should make one suspect the diagnosis. The use of serum potassium as a screening test would miss about a third of cases. Determination of the ratio of plasma aldosterone concentration to plasma renin activity is widely accepted as the test of choice for screening. Tests such as diurnal variations in aldosterone concentration and response to angiotensin II help to demonstrate the autonomy of the aldosterone secretion.

Once the diagnosis of hyperaldosteronism is made, further tests such as magnetic resonance imaging or computed tomographic scanning and adrenal vein sampling should be undertaken to determine the aetiology of the hyperaldosteronism. Depending on the findings and the lateralization of the lesion, either surgery or medical therapy may be advised for the patient. Spironolactone would be the drug of choice for medical treatment. Laparoscopic adrenalectomy has become a widely employed method of surgically removing adrenal tumours.

Hyperaldosteronism represents one of the few treatable causes of hypertension and a systematic approach is therefore needed to ensure that the few patients with an aldosterone-secreting adrenal adenoma are identified. It is important to identify these patients so that only those patients with proven adenomas are referred for adrenalectomy.
Poor specificity and recovery of urinary free cortisol as determined by the Bayer ADVIA Centaur extraction method
Authors: Gray G , Shakerdi L , Wallace AM
Published: September 2003

Background: Immunoassay methods for urinary free cortisol (UFC) lack specificity, and many procedures have not been fully evaluated for routine use. In the current study we evaluated the Bayer ADVIA Centaur extraction UFC immunoassay and compared results to those obtained by a specific gas chromatography-mass spectrometry (GC-MS) method.

Results: The Bayer ADVIA Centaur cortisol assay lacked specificity. Cortisone, a steroid present in urine at concentrations similar to those of cortisol, demonstrated a cross-reactivity of 44%. In addition, the choice of matrix used to resuspend steroids after solvent extraction from urine affected recovery. Recovery was improved if the recommended urine reconstruction buffer was replaced by steroid-free serum.

Conclusion: Irrespective of the sample matrix used, the Centaur method overestimates UFC, giving results up to twice those obtained by a specific GC-MS method.
Mediator mentors: Improving school climate, nurturing student disposition
Authors: Lane‐Garon Pamela S. , Richardson Tim
Published: September 2003

Mediator Mentors, a collaborative research and service project, was begun by California State University‐Fresno faculty and the staff of an
elementary school (K–8) in the Central San Joaquin Valley. The purpose of the research was to assess conflict resolution program effects
on students (N = 300) and school climate. Cross‐age mentoring is an important component of this collaborative project.
University students preparing for roles in helping professions served as mentors to elementary students. Impacts on student cognitive and affective
perspective taking were assessed and student perceptions of school safety were explored.
Optimal noise removal using an adaptive Wiener filter based on a locally stationary Gaussian mixture distribution model for images
Authors: Yamane Nobumoto , Morikawa Yoshitaka , Kawakami Youichi , Takahashi Hidekazu
Published: September 2003

This paper proposes an adaptive Wiener filter (AWF) based on the Gaussian mixture distribution model (GMM) as a realization of an optimum restoration filter. The proposed method is a kind of simple adaptive WF that classifies image blocks according to their local statistical properties and selects a matched WF from a class of a priori deduced WFs. In this method, the optimum filter is realized based on the fact that the minimum mean square error filter is reduced to a WF when the image and noise signals are both Gaussian. In addition, the probability distribution function of the signals in each class can be transformed to Gaussian by using the GMM as a statistical model for the image. In order to improve the accuracy of variance estimation and to reduce the computational complexity in deducing the WFs, a universal mixture model obtained from various kinds of training images is used as the underlying mixture model. In this paper, in restoring images corrupted with white noise, the method of estimating the covariance matrices in locally stationary processes and the method of designing the mixture model are studied, and the adaptive WF is designed. Finally, simulation results show the efficiency of the proposed method compared with conventional methods. © 2003 Wiley Periodicals, Inc. Electron Comm Jpn Pt 3, 87(1): 49–60, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ecjc.10082
Erratum: State feedback control of timed hybrid Petri nets
Authors: Tanaka Atsushi , Ushio Toshimitsu , Kodama Shinzo
Published: September 2003

A system in which discrete variables and continuous variables are mixed is called a hybrid system. Many models have been proposed for the description of hybrid systems. A model graphically describing the causality relationship between the variables is the hybrid Petri net (HPN). A model in which the concept of time is introduced into the HPN is the timed HPN (THPN). In this paper, with regard to the THPN with an external input place (THPNIP), state feedback control is discussed in the case where the control specifications are given by a predicate on the reachable set. In THPNIP, in general there is no guarantee that the maximum permissive feedback, which is the maximum element in the set of the state feedback satisfying the control specification, will exist. Hence, the necessary and sufficient conditions are presented for the existence of the maximum permissive feedback. © 2003 Wiley Periodicals, Inc. Electron Comm Jpn Pt 3, 87(1): 83–89, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ecjc.10011
Effects of column axial force – bending moment interaction on inelastic seismic response of steel frames
Authors: Como Marina , De Stefano Mario , Ramasco Roberto
Published: September 2003

It is well known that axial force – bending moment interaction (N–M interaction) affects to a large extent the cyclic inelastic behaviour of structural elements, especially columns in framed structures, with reduction in bending capacity and loss of available ductility. A few studies have also shown that significant inelastic axial shortening affects the response of column elements subjected to medium–high levels of axial loads and cyclic bending.

This paper is primarily aimed at evaluating the effects of column N–M interaction on the inelastic seismic response of steel frames. By considering the contemporaneous action of vertical loads, due to gravity, and of horizontal seismic excitation, it is shown that the progressive axial shortening of adjacent columns may differ substantially, thus inducing significant relative settlements at the ends of the connecting beams and, then, remarkable amplifications in beam plastic rotations. An evaluation of additional beam plastic rotations induced by column N–M interaction is carried out for real structures by investigating the inelastic response of steel frames designed according to European standards under horizontal and vertical earthquake excitations. Copyright © 2003 John Wiley & Sons, Ltd.
Assessment of seismic performance of extended pile‐shafts
Authors: Chai Y. H. , Song S. T.
Published: September 2003

The seismic performance of extended pile‐shafts subjected to the current level of displacement ductility demand is assessed for different soil conditions. Local curvature ductility demand is compared with the curvature ductility capacity provided by the current level of confining steel. Parameters in the assessment of extended pile‐shafts include the undrained shear strength of cohesive soils, relative density of cohesionless soils, aboveground height, longitudinal reinforcement ratio, axial force level and pile diameter. Results indicate that the curvature ductility demand in the pile decreases with increased soil stiffness but increases with increased aboveground height. The curvature ductility demand however is not sensitive to the longitudinal reinforcement ratio or axial force level, and is independent of the pile diameter. Results further indicate that the curvature ductility capacity available from the current level of confining steel may not be adequate for tall extended pile‐shafts, especially for piles with large longitudinal reinforcement ratio and embedded in soft or loose soils. Limits on the maximum longitudinal reinforcement ratio are suggested in the paper. Copyright © 2003 John Wiley & Sons, Ltd.
Holocene colluvial soils and geoarchaeology in the unglaciated Appalachian Plateau: Two examples from West Virginia, USA
Authors: Cremeens D.L. , MacDonald D.H. , Lothrop J.C.
Published: September 2003

Buried and sometimes stratified prehistoric sites occur in upland landscapes of the Unglaciated Appalachian Plateau province, although archaeologists have traditionally believed that such settings contain only near surface cultural deposits. The age of colluvial slopes and the characteristics of associated soils vary considerably from north to south within the province, and with the size and order of the valley. We have identified numerous prehistoric sites in low‐order valleys in central and southern West Virginia, where the dominant valley fill is a variant of colluvium and alluvium (co‐alluvium) that is poorly to moderately sorted and usually stratified. Weakly developed buried soils containing archaeological materials often develop in these strata, and provide evidence of relatively short periods of landscape stability. The archaeological potential of colluvial settings is determined by both the attractiveness of a locale for settlement and by the prospects for preservation of the archaeological remains. In some cases, prehistoric components have been partially disturbed by co‐alluvial reworking and redeposition, but, in other cases, the archaeological remains are preserved in a relatively undisturbed context. © 2003 Wiley Periodicals, Inc.
Docosahexaenoic acid membrane content and mRNA expression of acyl‐CoA oxidase and of peroxisome proliferator‐activated receptor‐δ are modulated in Y79 retinoblastoma cells differently by low and high doses of α‐linolenic acid
Authors: Langelier Bénédicte , Furet Jean‐Pierre , Perruchot Marie‐Hélène , Alessandri Jean‐Marc
Published: September 2003

The mRNA expression levels of acyl‐CoA oxidase (AOX), a key enzyme in very‐long‐chain fatty acid peroxisomal oxidation, and of peroxisome proliferator‐activated receptor‐δ (PPAR‐δ), a nuclear receptor possibly involved in the gene regulation of brain lipid metabolism, were determined in human Y79 retinoblastoma cells by using real‐time quantitative polymerase chain reaction. Cells were dosed with α‐linolenic acid (18:3n‐3), the essential metabolic precursor of the n‐3 polyunsaturated fatty acid series that normally gives rise through terminal peroxisomal oxidation to the synthesis of membrane docosahexaenoic acid (22:6n‐3, or DHA). The AOX and PPAR‐δ relative expression levels increased 2.3 and 3.4 times, respectively, upon dosing of cells with 7 μM 18:3n‐3, whereas AOX cDNA abundance decreased by 50% upon dosing with 70 μM 18:3n‐3. Concurrently, the DHA content increased by 23% in the membrane ethanolamine‐phosphoglycerides from cells dosed with 7 μM 18:3n‐3, whereas it decreased by 38% upon dosing with 70 μM 18:3n‐3. The DHA's upstream precursors (20:5n‐3 and 22:5n‐3) both accumulated in cells dosed with 7 or 70 μM 18:3n‐3. The 18:3n‐3‐induced changes in membrane phospholipid fatty acid composition support the hypothesis that the terminal peroxisomal step of n‐3 conversion is rate limiting in the Y79 line. The concurrent 7 μM 18:3n‐3‐induced increase of mRNAs encoding for AOX and for PPAR‐δ suggests that 18:3n‐3 (or its metabolites) at low concentration could trigger its proper conversion to DHA, possibly through activation of PPAR‐δ‐mediated transcription of AOX. Decreased membrane DHA content and mRNA expression level of AOX in 70‐μM 18:3n‐3‐dosed cells corroborated the relationship between AOX expression and DHA synthesis and suggested that simultaneous down‐regulating events occurred at high concentrations of 18:3n‐3. © 2003 Wiley‐Liss, Inc.
Role for M5 muscarinic acetylcholine receptors in cocaine addiction
Authors: Fink‐Jensen Anders , Fedorova Irina , Wörtwein Gitta , Woldbye David P. D. , Rasmussen Thøger , Thomsen Morgane , Bolwig Tom G. , Knitowski Karen M. , McKinzie David L. , Yamada Masahisa , Wess Jürgen , Basile Anthony
Published: September 2003

Muscarinic cholinergic receptors of the M5 subtype are expressed by dopamine‐containing neurons of the ventral tegmentum. These M5 receptors modulate the activity of midbrain dopaminergic neurons, which play an important role in mediating reinforcing properties of abused psychostimulants like cocaine. The potential role of M5 receptors in the reinforcing effects of cocaine was investigated using M5 receptor‐deficient mice in a model of acute cocaine self‐administration. The M5‐deficient mice self‐administered cocaine at a significantly lower rate than wild‐type controls. In the conditioned place preference procedure, a classic test for evaluating the rewarding properties of drugs, M5‐deficient mice spent significantly less time in the cocaine‐paired compartment than control mice. Moreover, the severity of the cocaine withdrawal syndrome (withdrawal‐associated anxiety measured in the elevated plus‐maze) was significantly attenuated in mice lacking the M5 receptor. These results demonstrate that M5 receptors play an important role in mediating both cocaine‐associated reinforcement and withdrawal. © 2003 Wiley‐Liss, Inc.
Dopaminergic D2 receptor activation modulates FGF‐2 gene expression in rat prefrontal cortex and hippocampus
Authors: Fumagalli Fabio , Bedogni Francesco , Maragnoli Maria Elisabetta , Gennarelli Massimo , Perez Jorge , Racagni Giorgio , Riva Marco Andrea
Published: September 2003

We have investigated the role of dopaminergic receptors in modulation of basic fibroblast growth factor (FGF‐2) expression in rat prefrontal cortex and hippocampus, two brain regions important for cognition. We found that FGF‐2 expression is upregulated by quinpirole, a D2 agonist, in prefrontal cortex and to a lesser extent in hippocampus. This modulation was specific for dopamine D2 receptors because no effect was observed when the dopamine D1 and D3 agonists, SKF38393 and 7‐OH‐DPAT, respectively, were administered. Our findings show that activation of dopaminergic D2 receptors modulates FGF‐2 expression in rat prefrontal cortex and hippocampus. Our data highlight the complex modulation of FGF‐2 expression in limbic areas pointing to this trophic molecule as a putative target of drugs used against acute and chronic neurodegenerative diseases such as Parkinson's disease. © 2003 Wiley‐Liss, Inc.
Growth, development and tourism in a small economy: evidence from Aruba
Authors: Sr Manuel Vanegas , Croes Robertico R.
Published: September 2003

This study will focus on tourism economic growth and its development impacts on a microstate and will explore their implications for tourism analysis and planning. The evidence presented in this article reveals that tourism in Aruba can generate desirable and widely distributed impacts. The tourist performance also has been remarkable and consistent. The results also suggest that the export‐led growth strategy has affected the whole of the economy in a positive way. The principal conclusion is that institutional intervention can only become a positive force within a context of rapid integration with the global market. Copyright © 2003 John Wiley & Sons, Ltd.
Ensuring fairness among ECN and non‐ECN TCP over the Internet
Authors: Zabir Salahuddin Muhammad Salim , Ashir Ahmed , Kitagata Gen , Suganuma Takuo , Shiratori Norio
Published: September 2003

Explicit Congestion Notification (ECN) has been proved to provide a fast indication of incipient congestion and thus better the performance of a TCP/IP network. In this work, we carry out investigations on gateway or router performance in providing fairnesss when both FIM ECN‐capable and non‐ECN‐capable connections are employed. We propose a new packet‐dropping scheme called Fair In‐time Dropping (FID) which drops packets from a connection upon detecting an incipient indication of congestion depending on its share of gateway or router buffer occupancy. We also show that a combination of FIM and FID offers the best fairness compared with a combination of FIM along with other dropping schemes. Copyright © 2003 John Wiley & Sons, Ltd.
IPv6‐GSM: An IPv6‐based solution for GSM number portability
Authors: Chao Han‐Chieh , Tsuei T. G. , Ying Chih‐Hung
Published: September 2003

This paper proposes an algorithm called IPv6‐GSM. In IPv6‐GSM, users own GSM Local Number Portability (LNP) capability and can communicate with VoIP terminals efficiently. Therefore, with the ample address space and embedded neat mobility mechanism than its ancestor, IPv6‐GSM is demonstrated as an acceptable method for constructing future all‐IP networks. Copyright © 2003 John Wiley & Sons, Ltd.
Numerical implementation of the symmetric Galerkin boundary element method in 2D elastodynamics
Authors: Yuan Weifeng , Zhao Zhiye , Lie Seng Tjhen , Yu Guoyou
Published: September 2003

The symmetric Galerkin boundary element method (SGBEM) employs both the displacement integral equation and the traction integral equation which lead to a symmetric system of equations. A two‐dimensional SGBEM is implemented in this paper, with emphasis on the special treatments of singular integrals. The integrals in the time domain are carried out by an analytical method. In order to evaluate the strong singular double integrals and the hypersingular double integrals in the space domain which are associated with the fundamental solutions Gpu and Gpp, artificial body forces are introduced which can be used to indirectly derive the singular terms. Thus, those singular integrals which behave like 1/r and 1/r2 are all avoided in the proposed SGEBM implementation. An artificial body force scheme is proposed to evaluate the body force term effectively. Two numerical examples are presented to assess the accuracy of the numerical implementation, and show similar accuracy when compared with the FEM and the analytical solutions. Copyright © 2003 John Wiley & Sons, Ltd.