bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in body mass index in a Finnish population between 1972 and 1982
Authors: JALKANEN L. , TUOMILEHTO J. , NISSINEN A. , PUSKA P.
Published: October 2011

Abstract Jalkanen L, Tuomilehto J, Nissinen A, Puska P (Department of Epidemiology, National Public Health Institute, Helsinki, and Department of Community Health, University of Kuopio, Kuopio, Finland). Changes in body mass index in a Finnish population between 1972 and 1982.

Population‐based data on changes in body mass index are scarce. We have examined about 9700 people aged 30–59 years in two provinces of East Finland in 1972, 1977 and 1982. The age adjusted mean value of body mass index (kg m−2) in 1972 was 26.0 ± 3.4 in men and 26.9 ± 4.7 in women, increasing with age. During the 10‐year follow‐up the mean body mass index increased in men to 26.5 ± 3.6 (P < 0.001). In women we found a decrease in mean body mass index to 26.4 ± 4.9 (P < 0.001). The increase trend in body mass with age remained in women, while in men the age trend increased from survey to survey. The proportion of obese men also increased while in younger women a decrease was observed. The results of this study show the association between changes in physical activity, education etc. and the observed changes in the body mass index.
Comparability of echocardiography and chest X‐ray following myocardial infarction
Authors: ALAM M. , ROSENHAMER G. , HÖGLUND C.
Published: October 2011

Abstract Alam M. Rosenhamer G. Höglund C (Division of Cardiology, Department of Medicine I. Karolinska Institute at Södersjukhuset (South Hospital), Stockholm. Sweden). Comparability of echocardiography and chest X‐ray following myocardial infarction.

In a group of 23 patients with first‐time myocardial infarction (MI) we compared the results of echocardiography and chest X‐ray as measured 1 week, 2 months, and 6 months following acute MI. Left ventricular end‐diastolic dimension (LVEDd) and left atrial (LA) dimension were measured from the echocardiogram, and the cardiac volume in ml/m2 body surface area (BSA) was calculated from the chest X‐ray. A progressive increase in LA dimension was noticed during the 6‐month period: a significant increase after 2 months (P < 0.001) with a further increase at 6 months compared with after 2 months (P < 0.001). The changes in LA dimension were more pronounced in anterior and Q‐wave infarction (P < 0.001) than in inferior and non‐Q‐wave infarction (P < 0.01). On the other hand, LVEDd showed a less conspicuous change: a moderate increase (P < 0.05) at 2 and 6 months, also with a more pronounced change in anterior wall and Q‐wave infarction (P < 0.01). There was no significant concurrent change in the calculated heart volume in ml/m2 BSA, as measured from the chest X‐ray. It is suggested that the observed changes in LA dimension reflect reduced left ventricular compliance after MI.
Addison's disease, malignant lymphoma and death from cerebral giant cell arteritis
Authors: LANDIN K. , BENGTSSON B.‐Å. , WILHELMSEN L.
Published: October 2011

Abstract Landin K, Bengtsson B‐Å, Wilhelmsen L (Department of Medicine II. Sahlgrenska Hospital and Department of Medicine, Östra Hospital, Gothenburg University, Gothenburg, Sweden). Addison's disease, malignant lymphoma and death from cerebral giant cell arteritis.

A 61‐year‐old woman with Addison's disease and malignant lymphoma for several years was admitted to hospital with a 2‐month history of fatigue and a 7 kg weight loss. The erythrocyte sedimentation rate was 92 mm h−1 and a temporal biopsy was performed as a part of the clinical investigation. She suddenly suffered a paresis of the right arm, sudden blindness and her blood pressure fell to 100/60 mmHg. Hydrocortisone was given intravenously followed by betamethasone, and an Addison crisis as well as a giant cell arteritis (GCA) was suspected. Activity in the malignant lymphoma was also a possibility. The patient did not improve and died 8 d later. The temporal biopsy indicated GCA. The autopsy showed a pronounced intimal inflammatory reaction of the intracerebral arteries and an infarction in the left posterior hemisphere. A possible link between GCA and other autoimmune diseases is discussed.
Diabetic ketoacidosis in Denmark: epidemiology, incidence rates, precipitating factors and mortality rates
Authors: SNORGAARD O. , ESKILDSEN P. C. , VADSTRUP S. , NERUP J.
Published: October 2011

Abstract Snorgaard O, Eskildsen PC, Vadstrup S, Nerup J (Steno Memorial Hospital, Gentofte, Denmark). Diabetic ketoacidosis in Denmark: epidemiology, incidence rates, precipitating factors and mortality rates.

The epidemiology of uncontrolled diabetes mellitus was studied in an 11.2% sample of the Danish population (574 696 inhabitants) during a 24‐month period. Some 175 admissions in ketoacidosis (heavy ketonuria and plasma bicarbonate below 21 mmol/l) were recorded. Based on prevalence rates from a socio‐economically and ethnically comparable Danish county, the annual incidence rate was calculated to be 0.045 per diabetic. The incidence rate of moderate and severe episodes (bicarbonate < 16 mmol/l) was 0.032 and of severe episodes only (bicarbonate < 10 mmol/l) 0.017 per diabetic. The major risk group was female teenagers. The total annual frequency of recurrence was 8.7%; 48% of the male episodes were ketoacidosis (DKA) associated with onset of diabetes, against 30% of the female episodes (P = 0.02). All Danish diabetics were at the time of the survey (1978–79) treated with conventional insulin treatment. Annual incidence rate in these established diabetics was 0.028, i.e. three to five times less than reported during treatment with continuous subcutaneous insulin infusion. Mortality of DKA was low, 3.4%, and dependent upon age and precipitating factor but not upon the degree of acidosis. The overall annual mortality rate was 1.5 per 100 diabetics.
Theophylline and salbutamol in combination in patients with obstructive pulmonary disease and concurrent heart disease: effect on cardiac arrhythmias
Authors: POUKKULA A. , KORHONEN U. R. , HUIKURI H. , LINNALUOTO M.
Published: October 2011

Abstract Poukkula A, Korhonen UR, Huikuri H, Linnaluoto M (Department of Internal Medicine, University Central Hospital, Oulu, Finland). Theophylline and salbutamol in combination in patients with obstructive pulmonary disease and concurrent heart disease: effect on cardiac arrhythmias.

We compared the frequency and severity of cardiac arrhythmias during combined oral theophylline and inhaled salbutamol vs. salbutamol therapy alone in 18 patients with moderate to severe chronic obstructive pulmonary disease who had concurrent cardiac disease. Seventeen patients showed at least one supraventricular premature complex (SVPC) on the 24‐h ECG recording when receiving salbutamol alone: eight patients had isolated SVPCs, less than 10/h; five patients had ≥ 10 SVPCs/h; eight patients showed runs of supraventricular tachycardia or paroxysmal atrial fibrillation. Seventeen patients also had at least one ventricular premature complex: seven patients had < 10 isolated PVCs/h, five patients ≥ 10 PVCs/h; eight patients had paired or multifocal PVCs and one patient a run of ventricular tachycardia. The addition of oral theophylline at an average dose of 600 mg in the evening (blood concentrations showed a mean maximum of 13.4 ± 4.0 (SD) and minimum of 5.5 ± 2.9 mg/1) had no influence on the frequency or severity of either ventricular or supraventricular arrhythmias. Thus, cardiac arrhythmias are very common in patients with chronic obstructive pulmonary disease and concomitant heart disease, but oral theophylline added to a regimen of salbutamol does not seem to affect the occurrence or severity of arrhythmias.
Abnormal structure and increased stiffness of the femoral arterial wall in young patients with sustained essential hypertension
Authors: EISKJÆR H. , CHRISTENSEN T. , PEDERSEN E. B.
Published: October 2011

Abstract Eiskjær H, Christensen T, Pedersen EB (Department of Medicine C and Department of Radiology R, Aarhus Kommunehospital and Aarhus University, Aarhus, Denmark). Abnormal structure and increased stiffness of the femoral arterial wall in young patients with sustained essential hypertension.

Thickness, elastic modulus, and stiffness of the common femoral arterial wall were estimated in 11 patients with essential hypertension and in 11 age‐matched normotensive control subjects by use of an in vivo, non‐invasive, ultrasound time‐motion display technique (M‐mode). Hypertensive patients had significantly higher levels than normotensive subjects with regard to arterial wall thickness (0.23 cm vs. 0.18 cm, medians: P < 0.01). elastic modulus (10.6 × 107 Pa vs. 6.18 × 107 Pa, medians; P < 0.05) and arterial wall stiffness (3.80 × 107 Pa vs. 2.07 ± 107 Pa, medians: P < 0.01). It is concluded that structural changes in the wall of the large arteries contribute to the increase in arterial wall stiffness in young patients with sustained essential hypertension.
Effects of isometric exercise and heart rate on left ventricular filling pattern assessed by pulsed Doppler echocardiography
Authors: AIRAKSINEN K. E. J. , IKÄHEIMO M. J. , HUIKURI H. V. , KOISTINEN M. J. , LINNALUOTO M. , TAKKUNEN J. T.
Published: October 2011

Abstract Airaksinen KEJ, Ikäheimo MJ, Huikuri HV, Koistinen MJ, Linnaluoto M, Takkunen JT (Cardiovascular Division, Department of Medicine, Oulu University Central Hospital, Oulu, Finland). Effects of isometric exercise and heart rate on left ventricular filling pattern assessed by pulsed Doppler echocardiography.

Left ventricular filling pattern was assessed by pulsed Doppler echocardiography at rest and during handgrip exercise in 33 healthy middle‐aged subjects. The peak mitral flow‐velocities during the early rapid filling phase (E) and during late (atrial) filling (A) were measured and the ratio of these peak flow‐velocities (E:A ratio) was calculated. The E:A ratio was inversely related to age (r = −0.50), heart rate (r = −0.47) and septal thickness (r = −0.36) at rest. Exercise caused a significant (P < 0.001) decrease in E:A ratio as a result of an increase in the peak A velocity. No significant change in the peak E velocity was observed during exercise. The exercise E:A ratio was related to heart rate (r = −0.53), but not to resting E:A ratio or age, since the decrease in E:A ratio tended to be less in the older subjects. Our study shows that isometric exercise augments the relative contribution of atrial contraction to left ventricular filling and this increase may ‘mask’ minor changes in resting transmitral flow pattern associated with, e.g. ageing. Secondly, in addition to age, heart rate must be taken into account when studying populations with different heart‐rate levels or interventions associated with simultaneous heart rate changes.
High serum erythropoietin levels are normalized during treatment of congestive heart failure with enalapril
Authors: FYHRQUIST F. , KARPPINEN K. , HONKANEN T. , SAIJONMAA O. , ROSENLÖF K.
Published: October 2011

Abstract Fyhrquist F, Karppinen K, Honkanen T, Saijonmaa O, Rosenlöf K (Department of Internal Medicine, Päijät‐Häme Central Hospital, Lahti and Minerva Institute for Medical Research, Helsinki, Finland). High serum erythropoietin levels are normalized during treatment of congestive heart failure with enalapril.

Eighteen patients with dilated cardiomyopathy (three female, mean age 57 years), were treated for 48 weeks with enalapril added to digoxin and diuretic therapy for congestive heart failure of New York Heart Association (NYHA) functional class II (three patients), III (eight patients) and IV (seven patients), respectively. Serum levels of erythropoietin (EPO) were raised at the start (37 ± 12.8 pmol 1−1; mean ± SD) and were normalized during enalapril treatment (17.5 ± 9.9 pmol 1−1 at 48 weeks; P < 0.001). Serum EPO correlated at the start with NYHA functional class (r = 0.68; P < 0.05). Normalization of elevated serum EPO concentrations during treatment with enalapril paralleled clinical and haemodynamic improvement, and probably reflected relief from renal hypoxia.
Femoral neuropathy secondary to anticoagulation
Authors: OLESEN L. L.
Published: October 2011

Abstract Olesen LL (Department of Medicine C, Aalborg Sygehus, Aalborg, Denmark). Femoral neuropathy secondary to anticoagulation.

On the basis of a case history, the causes, symptoms, investigations, diagnosis and treatment of femoral neuropathy complicating anticoagulation are reviewed.
Simvastatin and cholestyramine in the long‐term treatment of hypercholesterolaemia
Authors: YTRE‐ARNE K. , NORDØY A.
Published: October 2011

Abstract Ytre‐Arne K, Nordøy A (Department of Medicine, Regionsykehuset i Tromsø, Tromsø, Norway). Simvastatin and cholestyramine in the treatment of hypercholesterolaemia.

After 6 weeks on a lipid‐lowering diet, 20 outpatients with type II hyperlipoproteinaemia (18 type IIa) were randomized to treatment with cholestyramine 12 g b.i.d. (5 patients) or simvastatin (a new HMG‐CoA reductase inhibitor) 40 mg q.p.m. (15 patients) for 12 weeks. From week 13 to week 20 nine patients in the simvastatin group and all patients in the cholestyramine group were treated with the combination of the two drugs. From week 21 to week 52 all patients were on monotherapy with simvastatin. Simvastatin treatment reduced low‐density lipoprotein (LDL) cholesterol by 40% after 12 weeks, compared with 33 % in the cholestyramine group. This difference was not significant. The total reductions of LDL‐cholesterol on combination therapy were respectively 60% and 56% in each group. After 52 weeks LDL‐cholesterol was still reduced by 36% (P< 0.001) on monotherapy with simvastatin. Simvastatin also reduced triglycerides (TG) by 17% (P < 0.05) and high‐density lipoprotein (HDL) cholesterol was increased by 19% (P<0.01). No serious side effects were observed, and the new HMG‐CoA reductase inhibitors may offer a new approach to the treatment of hypercholesterolaemia.
Nutritional iron requirements and food iron absorption
Authors: BOTHWELL T. H. , BAYNES R. D. , MACFARLANE B. J. , MACPHAIL A. P.
Published: October 2011

Abstract Bothwell TH, Baynes RD, MacFarlane BJ, MacPhail AP (MRC Iron and Red Cell Metabolism Research Unit, Department of Medicine, University of the Witwatersrand Medical School, Parktown, Johannesburg, South Africa). Nutritional iron requirements and food iron absorption.

To prevent nutritional iron deficiency, sufficient iron must be absorbed from the diet to meet the normal physiological requirements. Daily iron losses in males are about 1 mg (14 μg kg−1), while the average additional requirements incurred in women include menstruation (0.6 mg), pregnancy (2.7 mg) and lactation (less than 0.3 mg). Requirements during pregnancy are not evenly distributed and increase to between 5–6 mg in the last trimester of pregnancy, which is more than can be absorbed from even an optimal diet. While the amounts absorbed are affected by the iron content of the diet, the composition of the latter is even more relevant. About one‐quarter of the iron in haem proteins is absorbed regardless of the other components in the diet, while non‐haem iron absorption is subject to the interplay of promoting and inhibiting substances in the diet. Thus diets rich in enhancers of non‐haem iron absorption, chiefly meat and/or ascorbic acid, have high iron bioavailability (about 3 mg d−1) while diets in which inhibitors, such as polyphenols and phytates, predominate are poor sources of iron (less than 1 mg d−1). Examination of the relative proportions of promoters and inhibitors of iron absorption in individual foodstuffs and the measured iron absorption from them may be useful in predicting the overall iron bioavailability from mixed diets.
An overview of iron metabolism at a molecular level
Authors: WORWOOD M.
Published: October 2011

Abstract Worwood M (Department of Haematology. University of Wales College of Medicine, Heath Park. Cardiff CF4 4XN, UK). An overview of iron metabolism at a molecular level.

Over the last 10 years there has been steady progress in our understanding of the structure of the iron‐binding proteins transferrin and ferritin, and the transferrin receptor. In the last few years there have been very rapid developments in understanding of the genetics of these proteins and the regulation of synthesis. This review includes a description of gene localization and structure, the regulation of protein synthesis and the structure of proteins of the transferrin family, the transferrin receptor and the iron storage protein ferritin.
Deficiency of the core proteins of dermatan sulphate proteoglycans in a variant form of Ehlers‐Danlos syndrome
Authors: FUSHIMI H. , KAMEYAMA M. , SHINKAI H.
Published: October 2011

Abstract Fushimi H, Kameyama M, Shinkai H (Department of Medicine, Sumitomo Hospital, Osaka and Department of Dermatology, Medical College of Oita, Oita, Japan). Deficiency of the core proteins of dermatan sulphate proteoglycans in a variant form of Ehlers‐Danlos syndrome.

A variant form of Ehlers‐Danlos syndrome with single adrenocorticotrophic hormone (ACTH) deficiency and mild diabetes mellitus was studied by immunohistochemical and biochemical analyses of the connective tissue. The patient exhibited features characteristic of the Ehlers‐Danlos syndrome, such as fragility, hyperextensibility, and bruisability of the skin and large veins were readily seen, but no hypermobility of any joint was detectable. Biochemical studies of the connective tissue confirmed that the apparent synthesis of collagens was within normal limits, but the deposition of the major proteoglycan in the skin of this patient was markedly reduced, mainly because the synthesis of core protein of dermatan sulphate proteoglycan was defective.
Chronic infectious mononucleosis; a case report
Authors: TALSTAD I. , SCOTT H. , JENUM P. , LINDE A.
Published: October 2011

Abstract Talstad I, Scott H, Jenum P, Linde A (Medical Department. Haukeland Hospital, University of Bergen, Laboratory for Immunohistochemistry and Immunopathology (LIIPAT). Institute of Pathology. Rikshopitalet. Oslo, National Institute of Public Health, Oslo, Norway, and the National Bacteriological Laboratory, Stockholm, Sweden). Chronic infectious mononucleosis; a case report.

A 39‐year‐old woman had an adenitis colli followed by anaemia, splenomegaly, atypical lymphoid cells in blood with increased B‐lymphocytes, reduced T‐suppressor/cytotoxic cells, increased polyclonal IgM, high titres of EB VCA IgG, EB EA IgD&R ± and EBNA IgG —. The disease progressed slowly for 2 years, splenectomy was followed by clinical improvement; spleen morphology was compatible with a benign disease of viral origin.
Functional and molecular evidence of myelin‐ and neuroprotection by thyroid hormone administration in experimental allergic encephalomyelitis
Authors: Dell'Acqua M. L. , Lorenzini L. , D'Intino G. , Sivilia S. , Pasqualetti P. , Panetta V. , Paradisi M. , Filippi M. M. , Baiguera C. , Pizzi M. , Giardino L. , Rossini P. M. , Calzà L.
Published: October 2011

M. L. Dell'Acqua, L. Lorenzini, G. D'Intino, S. Sivilia, P. Pasqualetti, V. Panetta, M. Paradisi, M. M. Filippi, C. Baiguera, M. Pizzi, L. Giardino, P. M. Rossini and L. Calzà (2012) Neuropathology and Applied Neurobiology38, 454–470

Functional and molecular evidence of myelin‐ and neuroprotection by thyroid hormone administration in experimental allergic encephalomyelitis

Aims: Recent data in mouse and rat demyelination models indicate that administration of thyroid hormone (TH) has a positive effect on the demyelination/remyelination balance. As axonal pathology has been recognized as an early neuropathological event in multiple sclerosis, and remyelination is considered a pre‐eminent neuroprotective strategy, in this study we investigated whether TH administration improves nerve impulse propagation and protects axons. Methods: We followed up the somatosensory evoked potentials (SEPs) in triiodothyronine (T3)‐treated and untreated experimental allergic encephalomyelitis (EAE) Dark‐Agouti female rats during the electrical stimulation of the tail nerve. T3 treatment started on the 10th day post immunization (DPI) and a pulse administration was continued until the end of the study (33 DPI). SEPs were recorded at baseline (8 DPI) and the day after each hormone/ vehicle administration. Results: T3 treatment was associated with better outcome of clinical and neurophysiological parameters. SEPs latencies of the two groups behaved differently, being briefer and closer to control values (=faster impulse propagation) in T3‐treated animals. The effect was evident on 24 DPI. In the same groups of animals, we also investigated axonal proteins, showing that T3 administration normalizes neurofilament immunoreactivity in the fasciculus gracilis and tau hyperphosphorylation in the lumbar spinal cord of EAE animals. No sign of plasma hyperthyroidism was found; moreover, the dysregulation of TH nuclear receptor expression observed in the spinal cord of EAE animals was corrected by T3 treatment. Conclusions: T3 supplementation results in myelin sheath protection, nerve conduction preservation and axon protection in this animal model of multiple sclerosis.
Immunodiagnostic Value of Combined Detection of Autoantibodies to Tumor‐associated Antigens as Biomarkers in Pancreatic Cancer
Authors: Li J. , Wang L. J. , Ying X. , Han S. X. , Bai E. , Zhang Y. , Zhu Q.
Published: October 2011

Previous studies demonstrated that cancer sera contain antibodies, which react with a unique group of autologous cellular antigens called tumour‐associated antigens (TAAs). This study determines whether a panel of TAAs would enhance antibody detection and be a useful approach in pancreatic cancer (PC) detection and diagnosis. The panel of TAAs was composed of six TAAs including p53, p16, p62, survivin, Koc and IMP1 full‐length recombinant proteins. Enzyme‐linked immunosorbent assay (ELISA) was used to detect antibodies against these six TAAs in 23 sera from patients with PC and also 23 sera from normal individuals. Antibody frequency to any individual TAA in PC was variable and ranged from 14.7% to 30.4%. With the successive addition of TAAs to a final total of six antigens, there was a stepwise increase in positive antibody reactions reaching a sensitivity of 60.9% and a specificity of 87.0% in PC. Positive and negative likelihood ratio were 4.685 and 0.449, respectively. Positive and negative predictive values were, respectively, 82.4% and 69.0%. Agreement rate and Kappa value were 73.9% and 0.478, respectively. The data from this study support our previous hypothesis that using a panel of appropriately selected TAAs can enhance autoantibody detection in immunodiagnosis of PC. In 15 PC sera with carbohydrate antigen 19‐9 (CA19‐9) negative, 6 (40%) were found to have anti‐TAA (anti‐tumour associated antigens) antibodies. When CA19‐9 and anti‐TAAs were used together as markers in PC detection, the diagnostic sensitivity could be raised from 60.9% to 69.6%. Anti‐TAA and CA19‐9 were independent markers, and the simultaneous use of these two markers could raise the sensitivity of PC detection.
Impact of colonoscopic screening in male and female Lynch syndrome carriers with an MSH2 mutation
Authors: Stuckless S , Green JS , Morgenstern M , Kennedy C , Green RC , Woods MO , Fitzgerald W , Cox J , Parfrey PS
Published: October 2011

Stuckless S, Green JS, Morgenstern M, Kennedy C, Green RC, Woods MO, Fitzgerald W, Cox J, Parfrey PS. Impact of colonoscopic screening in male and female Lynch syndrome carriers with an MSH2 Mutation.

The lifetime risk of developing colorectal cancer (CRC) in Lynch syndrome (LS) carriers is very high. To determine the impact of colonoscopic screening in 54 male and 98 female MSH2 mutation carriers, outcomes were compared with 94 males and 76 females who were not screened. CRC incidence and survival in the screened group were compared to that expected, derived from the non‐screened group. To correct for survivor bias, controls were matched for age at entry into screening and also for gender. In males, median age to CRC was 58 years, whereas expected was 47 years (p = 0.000), and median survival was 66 years vs 62 years (p = 0.034). In screened females, median age to CRC was 79 years compared to 57 years in the non‐screened group (p = 0.000), and median survival was 80 years compared with expected of 63 years (p = 0.001). Twenty percent of males and 7% of females developed an interval CRC within 2 years of previous colonoscopy. Although colonoscopic screening was associated with decreased CRC risk and better survival, CRCs continued to occur. CRC development may be further reduced by decreasing the screening interval to 1 year and improving quality of colonoscopy.
Identification of a new HLA‐A*02 allele, HLA‐A*02:305 N, which differs from the HLA‐A*02:01:01 allele by a single nucleotide deletion in exon 4
Authors: Weschler B. , Bert S. , Hanau D. , Parissiadis A. , Tourne S.
Published: October 2011

The HLA‐A*02:305N new allele lacks a nucleotide in exon 4 compared to HLA‐A*02:01:01 allele.
Transcranial Doppler microembolic signals and serum marker evidence of brain injury during transcatheter aortic valve implantation
Authors: REINSFELT B. , WESTERLIND A. , IOANES D. , ZETTERBERG H. , FREDÉN‐LINDQVIST J. , RICKSTEN S.‐E.
Published: October 2011

Background

Recent studies have shown that transcatheter aortic valve implantation (TAVI) is associated with new foci of restricted diffusion on cerebral magnetic resonance imaging suggestive of cerebral microembolism. The aim of the present investigation was to quantify the cerebral embolic load and to evaluate during which phase of the TAVI procedure microembolism occurs. We also evaluated the association between the cerebral embolic load and post‐procedural release of S100B, a serological marker of cerebral injury.

Methods

In 21 patients, we described the extent and intra‐procedural distribution of microemboli during the TAVI procedure using the transcranial Doppler technique. S100B, a marker of astroglial injury, was measured for 24 h after the procedure, and the area under the curve (AUC24h) relating S100B to time was calculated.

Results

During the TAVI procedure, a mean of 282 ± 169 emboli was detected, 37% occurred during manipulation of the aortic arch/root/valve by guide wires and catheters, 22% occurred immediately after balloon dilatation of the native valve and 41% occurred during frame expansion of the valve prosthesis. S100B increased in all patients with a peak at 1 h after the procedure and returned to baseline after 4 h. There was a positive correlation between the total amount of cerebral microemboli and the AUC24h for S100B (r = 0.68, P < 0.001). None of the patients developed neurological impairment.

Conclusion

TAVI is associated with a substantial amount of cerebral microemboli. The microembolic load correlates to the degree of post‐procedural release of a marker of cerebral injury.
A standardized protocol for the perioperative management of myasthenia gravis patients. Experience with 110 patients
Authors: GRITTI P. , SGARZI M. , CARRARA B. , LANTERNA L. A. , NOVELLINO L. , SPINELLI L. , KHOTCHOLAVA M. , POLI G. , LORINI F. L. , SONZOGNI V.
Published: October 2011

Background

Video‐assisted thoracoscopic extended thymectomy (VATET) is well established in the treatment of myasthenia gravis; however, patient selection remains controversial. Perioperative management protocol is lacking, and concerns regarding post‐operative myasthenic crisis still remain. We performed a retrospective observational study evaluating the impact of the introduction of a protocol in the perioperative management of patients with myasthenia gravis who underwent VATET.

Methods

The perioperative management protocol was developed by a team of neurologists and anesthesiologists who reviewed the literature and their previous experience on myasthenia gravis patients. Respiratory, clinical, and neurological patient features were included in the protocol evaluation. A retrospective review of patients who underwent VATET before and after introduction to the protocol was finally performed.

Results

The medical records of 66 patients (pre‐protocol group) and 44 patients (protocol group) were available for the study. In the pre‐protocol group, 17 patients (26%) were admitted to intensive care unit (ICU) during the post‐operative period, while three patients (6.8%) of the protocol group met the criteria for ICU post‐operative admission. This resulted in a reduction of 73.5% of patients admitted to ICU (P = 0.023) and in an 80% (P = 0.002) reduction of the use neuromuscular blocking agents. Two post‐operative myasthenic crises preceded by bulbar symptoms (1.8%) were identified in the pre‐protocol group patients.

Conclusions

Although the application of our protocol results in a substantial reduction in the recovery of patients in the ICU and in hospital costs, there was no substantial difference in mortality and morbidity between patients admitted to the surgical ward or to ICU.
Integrated model for providing tactical emergency medicine support (TEMS): analysis of 120 tactical situations
Authors: VAINIONPÄÄ T. , PERÄJOKI K. , HILTUNEN T. , PORTHAN K. , TASKINEN A. , BOYD J. , KUISMA M.
Published: October 2011

Background

Various models for organising tactical emergency medicine support (TEMS) in law enforcement operations exist. In Helsinki, TEMS is organised as an integral part of emergency medical service (EMS) and applied in hostage, siege, bomb threat and crowd control situations and in other tactical situations after police request. Our aim was to analyse TEMS operations, patient profile, and the level of on‐site care provided.

Methods

We conducted a retrospective cohort study of TEMS operations in Helsinki from 2004 to 2009. Data were retrieved from EMS, hospital and dispatching centre files and from TEMS reports.

Results

One hundred twenty TEMS operations were analysed. Median time from dispatching to arrival on scene was 10 min [Interquartile Range (IQR) 7–14]. Median duration of operations was 41 min (IQR 19–63). Standby was the only activity in 72 operations, four patients were dead on arrival, 16 requests were called off en route and patient examination or care was needed in 28 operations. Twenty‐eight patients (records retrieved) were alive on arrival and were classified as trauma (n = 12) or medical (n = 16). Of traumas, two sustained a gunshot wound, one sustained a penetrating abdominal wound, three sustained medium severity injuries and nine sustained minor injuries. There was neither on‐scene nor in‐hospital mortality among patients who were alive on arrival. The level of on‐site care performed was basic life support in all cases.

Conclusions

The results showed that TEMS integrated to daily EMS services including safe zone working only was a feasible, rapid and efficient way to provide medical support to law enforcement operations.
Evaluation of sublingual microcirculatory blood flow in the critically ill
Authors: SALLISALMI M. , OKSALA N. , PETTILÄ V. , TENHUNEN J.
Published: October 2011

Background

The microcirculation regulates the supply of oxygen and nutrients to tissues. The sublingual region is frequently used as a window to microcirculation in critically ill patients. Numerous studies have reported impaired sublingual microcirculatory flow. We hypothesized that the quality of sidestream dark field imaging (SDF) recordings could be systematically analyzed to justify the monitoring of sublingual microcirculation in interventional studies or in clinical practice.

Methods

The sublingual microcirculation in critically ill patients with septic shock, open heart surgery, or alcoholic pancreatitis, and healthy subjects was recorded with a hand held SDF device by one trained investigator in observational setting. A total of 82 video recording sessions were performed and 240 video clips eligible for quality assessment were identified. Quality assessment was performed offline by two investigators independently and blinded for the origin of the video file.

Results

Of the 240 clips, pressure artifact was detected in 86 (36%), major blood in 5 (2.1%), major saliva in 21 (8.8%) and extreme brightness causing loss of visible capillaries in 16 (6.7%) clips. The dominating vessel architecture was multiple size vessels in 228 (95%) and repeating capillary loop motif in 12 (5.0%). The mean (± SD) relative size reduction during stabilization was −6.9% (± 4.7%). Excellent technical quality was detected in 74 of 240 (30.8%) recordings.

Conclusions

Our findings highlight the need of a comprehensive training period and reporting of data quality before findings with SDF imaging can be accepted as surrogate end points in interventional studies or as guidance in clinical practice.
Collective Vigilance in the Greater Kudu: Towards a Better Understanding of Synchronization Patterns
Authors: Pays Olivier , Sirot Etienne , Fritz Hervé
Published: October 2011

Collective detection of predators is one of the main advantages of living in groups in prey species. However, the mechanisms linking individual and collective vigilance remain largely unknown. Here, we investigated individual and collective vigilance in a natural population of greater kudu (Tragelaphus strepsiceros), a gregarious ruminant living under high predation risk. Controlling for environmental, individual and group factors, we show that the proportion of time during which at least one individual was vigilant increased with group size, whereas individual investment in vigilance decreased. We also show that individuals tended to synchronize both vigilance and feeding activities. More generally, and whatever the considered group size, we demonstrate how the independent scanning assumption underestimated both the proportion of time during which no individual was vigilant and the proportion of time during which all individuals were simultaneously vigilant, but overestimated the proportion of time during which one vigilant individual only was present. Our results thus contrast with the point of view that the alternative to independent vigilance is coordinated vigilance and plead for a better description of the processes whereby reciprocal influences between individuals shape collective patterns of vigilance.
Reduction in overweight and obesity from a 3‐year community‐based intervention in Australia: the ‘It's Your Move!’ project
Authors: Millar L. , Kremer P. , de Silva‐Sanigorski A. , McCabe M. P. , Mavoa H. , Moodie M. , Utter J. , Bell C. , Malakellis M. , Mathews L. , Roberts G. , Robertson N. , Swinburn B. A.
Published: October 2011

‘It's Your Move!’ was a 3‐year intervention study implemented in secondary schools in Australia as part of the Pacific Obesity Prevention In Communities Project. This paper reports the outcome results of anthropometric indices and relevant obesity‐related behaviours. The interventions focused on building the capacity of families, schools and communities to promote healthy eating and physical activity. Baseline response rates and follow‐up rates were 53% and 69% respectively for the intervention group (n = 5 schools) and 47% and 66% respectively for the comparison group (n = 7 schools). Statistically significant relative reductions in the intervention versus comparison group were observed: weight (−0.74 kg, P < 0.04), and standardized body mass index (−0.07, P < 0.03), and non‐significant reductions in prevalence of overweight and obesity (0.75 odds ratio, P = 0.12) and body mass index (−0.22, P = 0.06). Obesity‐related behavioural variables showed mixed results with no pattern of positive intervention outcomes. In conclusion, this is the first study to show that long‐term, community‐based interventions using a capacity‐building approach can prevent unhealthy weight gain in adolescents. Obesity prevention efforts in this important transitional stage of life can be successful and these findings need to be translated to scale for a national effort to reverse the epidemic in children and adolescents.
The role of policy in improving diets: experiences from the Pacific Obesity Prevention in Communities food policy project
Authors: Thow A. M. , Snowdon W. , Schultz J. T. , Leeder S. , Vivili P. , Swinburn B. A.
Published: October 2011

There is global interest in using multisectoral policy approaches to improve diets, and reduce obesity and non‐communicable disease. However, there has been ad hoc implementation, which in some sectors such as the economic sector has been very limited, because of the lack of quality evidence on potential costs and impacts, and the inherent challenges associated with cross‐sectoral policy development and implementation. The Pacific Obesity Prevention in Communities food policy project aimed to inform relevant policy development and implementation in Pacific Island countries. The project developed an innovative participatory approach to identifying and assessing potential policy options in terms of their effectiveness and feasibility. It also used policy analysis methodology to assess three policy initiatives to reduce fatty meat availability and four soft drink taxes in the region, in order to identify strategies for supporting effective policy implementation.
Reducing unhealthy weight gain in Fijian adolescents: results of the Healthy Youth Healthy Communities study
Authors: Kremer P. , Waqa G. , Vanualailai N. , Schultz J. T. , Roberts G. , Moodie M. , Mavoa H. , Malakellis M. , McCabe M. P. , Swinburn B. A.
Published: October 2011

Obesity is a significant problem among adolescents in Pacific populations. This paper reports on the outcomes of a 3‐year obesity prevention study, Healthy Youth Healthy Communities, which was part of the Pacific Obesity Prevention in Communities project, undertaken with Fijian adolescents. The intervention was developed with schools and comprised social marketing, nutrition and physical activity initiatives and capacity building designed to reduce unhealthy weight, and the individual exposure period was just over 2‐year duration. The evaluation incorporated a quasi‐experimental, longitudinal design in seven intervention secondary schools near Suva (n = 874) and a matched sample of 11 comparison secondary schools from western Viti Levu (n = 2,062). There were significant differences between groups at baseline; the intervention group was shorter, weighed less, had a higher proportion of underweight and lower proportion of overweight, and better quality of life (Pediatric Quality of Life Inventory only). At follow‐up, the intervention group had lower percentage body fat (−1.17) but also a lower increase in quality of life (Assessment of Quality of Life instrument: −0.02; Pediatric Quality of Life Inventory: −1.94) than the comparison group. There were no other differences in anthropometry, and behaviours' changes showed a mixed pattern. In conclusion, this school‐based health promotion programme lowered percentage body fat but did not reduce unhealthy weight gain or influence most obesity‐promoting behaviours among Fijian adolescents. Despite growing evidence supporting the efficacy of community‐based approaches to reduce obesity among children of European descent, findings from this study failed to demonstrate the efficacy of a community capacity‐building approach among an adolescent sample drawn from a different sociocultural, economic and geographical context. Additional ‘top–down’ or other innovative approaches may be needed to reduce adolescent obesity in the Pacific.
Socio‐cultural agents and their impact on body image and body change strategies among adolescents in Fiji, Tonga, Tongans in New Zealand and Australia
Authors: McCabe M. P. , Mavoa H. , Ricciardelli L. A. , Schultz J. T. , Waqa G. , Fotu K. F.
Published: October 2011

This paper reports on the findings of studies that were conducted as part of the Pacific Obesity Prevention in Communities project. The studies evaluated the types of messages that adolescents received in relation to body image, physical activity and eating. The participants were male and female adolescents from Fiji (two cultural groups), Tonga, New Zealand (Tongans) and Australia (European Australians). Three studies were conducted: interviews with 48 adolescents (24 male, 24 female) from each cultural group, questionnaires with 600 adolescents (300 male, 300 female) from each cultural group and the perceptual distortion study with 100 adolescents (50 male, 50 female) from the two cultural groups in Fiji and European Australians. The results demonstrate that parents, peers, the media, as well as religious influences impact on the type of body valued by adolescents in each of the cultural groups, as well as their levels of body satisfaction. These influences also shape the type and volume of food consumed, and the type and frequency of physical activity. The results of these studies highlight the major role played by the broader societal values in shaping the nature of the messages that adolescents receive in relation to their body size, eating and physical activity.
The Determinants and Some Consequences of Unemployed Workers' Wage Demands
Authors: Eriksson Stefan , Lagerström Jonas
Published: October 2011

This paper studies the determinants and consequences in the early stages of the hiring process of unemployed workers' wage demands using direct data on workers' wage requests. We show that most unemployed workers want a wage close to their previous wage, and thus much more than they get in unemployment benefits. However, some groups, such as women, tend to demand lower wages. Moreover, we find that workers with high wage demands are contacted by firms less often than otherwise similar workers with lower wage demands. Thus, our results suggest that too high wage demands may contribute to high unemployment.
Rationalism and Necessitarianism
Authors: Lin Martin
Published: October 2011

Metaphysical rationalism, the doctrine which affirms the Principle of Sufficient Reason (the PSR), is out of favor today. The best argument against it is that it appears to lead to necessitarianism, the claim that all truths are necessarily true. Whatever the intuitive appeal of the PSR, the intuitive appeal of the claim that things could have been otherwise is greater. This problem did not go unnoticed by the great metaphysical rationalists Spinoza and Leibniz. Spinoza’s response was to embrace necessitarianism. Leibniz’s response was to argue that, despite appearances, rationalism does not lead to necessitarianism. This paper examines the debate between these two rationalists and concludes that Leibniz has persuasive grounds for his opinion. This has significant implications both for the plausibility of the PSR and for our understanding of modality.
Non‐wage benefits, costs of turnover and labour attachment
Authors: Juurikkala Tuuli , Lazareva Olga
Published: October 2011

Like firms in established market economies, many Russian firms provide non‐wage benefits to their workers, such as housing, medical care or day care. This article explains the provision of benefits as a strategic choice for firms in the presence of labour and service market imperfections. Analysing unique survey data for 404 industrial establishments from 40 Russian regions, the authors provide strong evidence that non‐wage benefits are used by firms to attach workers and thereby reduce the costs of labour turnover in the face of tight labour markets. It is also shown that this attachment strategy works due to imperfections in the regional markets for social services.
The Russian–Ukrainian earnings divide1
Authors: Constant Amelie F. , Kahanec Martin , Zimmermann Klaus F.
Published: October 2011

Ethnic differences are often considered to be powerful sources of diverse economic behaviour. In this article, we investigate to what extent ethnicity affects Ukrainian labour market outcomes. Using microdata from the Ukrainian Longitudinal Monitoring Survey and the Oaxaca–Blinder decomposition of earnings, we find a persistent and increasing labour market divide between ethnic Russians and Ukrainians throughout Ukraine’s transition era. We establish that language, rather than nationality, is the key factor behind this ethnic premium favouring Russians. Our findings further document that this premium is larger amongst males than females.
Capital Income Taxation, Economic Growth and Heterogeneity in the Motivation to Give
Authors: Kunze Lars
Published: October 2011

This study provides a comprehensive analysis of the relationship between capital income taxation and economic growth within an overlapping generations model when individuals may bequeath wealth. The altruistic concern is modeled as a synthesis of joy-of-giving and family altruism so that individuals may derive utility from the amount of bequest itself and by providing children with a disposable income later on in life. Using this framework, it is shown that, in contrast to the existing literature, increasing the capital income tax rate may well enhance growth under operative bequests.
Regional Integration and Economic Convergence in the Post‐Soviet Space: Experience of the Decade of Growth
Authors: LIBMAN ALEXANDER , VINOKUROV EVGENY
Published: October 2011

This article examines the dynamics of regional integration and economic convergence in the post‐Soviet world during the period 1999–2008, both considered as a whole and on the level of individual country groups. While the trade integration experienced a negative trend, at the same time one can observe an unprecedented expansion of labour migration – thus suggesting that integration of factor flows can outperform integration of markets for goods and services, at least in this specific case. Clustering processes of the post‐Soviet states for economic convergence and for economic integration seem to be unaffected by each other.
Rice DUR3 mediates high‐affinity urea transport and plays an effective role in improvement of urea acquisition and utilization when expressed in Arabidopsis
Authors: Wang Wei‐Hong , Köhler Barbara , Cao Feng‐Qiu , Liu Guo‐Wei , Gong Yuan‐Yong , Sheng Song , Song Qi‐Chao , Cheng Xiao‐Yuan , Garnett Trevor , Okamoto Mamoru , Qin Rui , Mueller‐Roeber Bernd , Tester Mark , Liu Lai‐Hua
Published: October 2011

Despite the great agricultural and ecological importance of efficient use of urea‐containing nitrogen fertilizers by crops, molecular and physiological identities of urea transport in higher plants have been investigated only in Arabidopsis.

We performed short‐time urea‐influx assays which have identified a low‐affinity and high‐affinity (Km of 7.55 μM) transport system for urea‐uptake by rice roots (Oryza sativa).

A high‐affinity urea transporter OsDUR3 from rice was functionally characterized here for the first time among crops. OsDUR3 encodes an integral membrane‐protein with 721 amino acid residues and 15 predicted transmembrane domains. Heterologous expression demonstrated that OsDUR3 restored yeast dur3‐mutant growth on urea and facilitated urea import with a Km of c. 10 μM in Xenopus oocytes.

Quantitative reverse‐transcription polymerase chain reaction (qPCR) analysis revealed upregulation of OsDUR3 in rice roots under nitrogen‐deficiency and urea‐resupply after nitrogen‐starvation. Importantly, overexpression of OsDUR3 complemented the Arabidopsis atdur3‐1 mutant, improving growth on low urea and increasing root urea‐uptake markedly. Together with its plasma membrane localization detected by green fluorescent protein (GFP)‐tagging and with findings that disruption of OsDUR3 by T‐DNA reduces rice growth on urea and urea uptake, we suggest that OsDUR3 is an active urea transporter that plays a significant role in effective urea acquisition and utilisation in rice.