bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of big stanniocalcin variants in mammalian adipocytes and adrenocortical cells
Authors: Paciga Mark , Hirvi Edward R. , James Kathi , Wagner Graham F.
Published: March 2005

The hormone stanniocalcin (STC) is widely distributed, and in rodents the highest levels of expression are in the ovaries. In both cows and rodents, ovarian STC consists of three high-molecular-weight variants collectively known as big STC. In the ovary, big STC is made by theca cells and interstitial cells and is targeted to lipid storage droplets of nearby luteal cells to inhibit progesterone release. An endocrine pathway is operative during pregnancy and lactation. Whether or not big STC is made by tissues other than ovary has never been addressed. Therefore, the purpose of this study was to determine via a detailed characterization of adrenal glands and adipocytes whether big STC is present in other cells that store and release lipids. The results showed that STC was made in bovine and mouse adrenals, mainly in steroidogenic, adrenocortical cells. The majority of ligand and receptor were likewise confined to cortical zone cells. As in luteal cells, high levels of ligand and receptor were found in the adrenocortical cell lipid droplet fraction. However, adrenals made only the largest (135 kDa) of the three big STC variants. Nonetheless, adrenal STC had much greater receptor affinity than a mixture of the three big STC variants. Adipocytes contained all three big STC variants, and both ligand and receptor were heavily concentrated on the lipid droplets. Moreover, adipocyte lipid storage droplets had 50-fold more receptors than those in steroidogenic cells, indicating that big STC is heavily targeted to adipose cells. The findings collectively support the hypothesis that big STC is not unique to ovarian steroidogenic cells but is in fact common to cells with a role in lipid storage and release.
Assessment of Left Ventricular Torsional Deformation by Doppler Tissue Imaging
Authors: Notomi Yuichi , Setser Randolph M. , Shiota Takahiro , Martin-Miklovic Maureen G. , Weaver Joan A. , Popović Zoran B. , Yamada Hirotsugu , Greenberg Neil L. , White Richard D. , Thomas James D.
Published: March 2005

Background—

Left ventricular (LV) torsional deformation is a sensitive index for LV performance but difficult to measure. The present study tested the accuracy of a novel method that uses Doppler tissue imaging (DTI) for quantifying LV torsion in humans with tagged magnetic resonance imaging (MRI) as a reference.

Methods and Results—

Twenty patients underwent DTI and tagged MRI studies. Images of the LV were acquired at apical and basal short-axis levels to assess LV torsion. We calculated LV rotation by integrating the rotational velocity, determined from DTI velocities of the septal and lateral regions, and correcting for the LV radius over time. LV torsion was defined as the difference in LV rotation between the 2 levels. DTI rotational and torsional profiles throughout systole and diastole were compared with those by tagged MRI at isochronal points. Rotation and torsion by DTI were closely correlated with tagged MRI results during systole and early diastole (apical and basal rotation,
r
=0.87 and 0.90, respectively; for torsion, 0.84;
P
<0.0001, by repeated-measures regression models). Maximal torsion showed even better correlation (
r
=0.95,
P
<0.0001).

Conclusions—

The present study has shown that DTI can quantify LV torsional deformation over time. This novel method may facilitate noninvasive quantification of LV torsion in clinical and research settings.
Molecular Magnetic Resonance Imaging of Coronary Thrombosis and Pulmonary Emboli With a Novel Fibrin-Targeted Contrast Agent
Authors: Spuentrup Elmar , Buecker Arno , Katoh Marcus , Wiethoff Andrea J. , Parsons Edward C. , Botnar Rene M. , Weisskoff Robert M. , Graham Philip B. , Manning Warren J. , Günther Rolf W.
Published: March 2005

Background—

The differential diagnosis of acute chest pain is challenging, especially in patients with normal ECG findings, and may include coronary thrombosis or pulmonary emboli. The aim of this study was to investigate the novel fibrin-specific contrast agent EP-2104R for molecular targeted MR imaging of coronary thrombosis and pulmonary emboli.

Methods and Results—

Fresh clots were engineered ex vivo from human blood and delivered in the lungs and coronary arteries of 7 swine. Subsequent molecular MR imaging was performed with a navigator-gated free-breathing and cardiac-triggered 3D inversion-recovery black-blood gradient-echo sequence before and after systemic administration of 7.5 μmol/kg EP-2104R. Two swine served as the control group. MR images were analyzed by 2 investigators, and contrast-to-noise ratio and gadolinium concentration in the clots were assessed. Before contrast media application, no thrombi were visible. After contrast administration, all 32 pulmonary emboli, 3 emboli in the right heart, and 5 coronary thrombi were selectively visualized as white spots with a mean contrast-to-noise ratio of 32±19. The average gadolinium concentration from all 3 types of thrombi was 144±79 μmol/L.

Conclusions—

Molecular MR imaging with the fibrin-targeted contrast-agent EP-2104R allows selective visualization of acute coronary, cardiac, and pulmonary thrombi.
Persistent Sympathetic Activation During Chronic Antihypertensive Therapy
Authors: Fu Qi , Zhang Rong , Witkowski Sarah , Arbab-Zadeh Armin , Prasad Anand , Okazaki Kazunobu , Levine Benjamin D.
Published: March 2005

Previous studies have demonstrated that antihypertensive treatment resets baroreflex control of heart rate (HR) and increases cardiac vagal baroreflex sensitivity. However, it is uncertain whether baroreflex control of muscle sympathetic nerve activity (MSNA) also resets after treatment. We tested the hypothesis that chronic antihypertensive therapy alters baroreflex regulation of MSNA in patients with untreated moderate hypertension. Seven newly diagnosed patients with systolic blood pressure (BP) of 159±5 mm Hg (mean±SE) and diastolic BP of 103±4 mm Hg were studied before and after 1 to 2 weeks ' and 3 months (chronic) of antihypertensive treatment with losartan-hydrochlorothiazide (Hyzaar). MSNA and hemodynamics were measured supine, during a Valsalva maneuver (VM), and at 70° head-up tilt (HUT) for 10 minutes. Data were compared with those obtained in 7 age-matched healthy controls. We found that Hyzaar lowered mean BP acutely and chronically by 20±4 and 23±3 mm Hg (both
P
<0.01) but did not change HR. Supine MSNA increased by 43±11% and 34±11% after acute and chronic treatment (both
P
<0.01). However, MSNA responses to VM and HUT did not differ after treatment compared with before treatment, indicating unchanged reflex control. These data indicate that sympathetic neural activity was augmented substantially by antihypertensive treatment with Hyzaar, consistent with an ongoing baroreflex unloading, and did not return to baseline or “reset” after 3 months of therapy. We speculate that persistent and marked sympathetic activation by the baroreflex may be a potential mechanism for hypertension that is refractory to antihypertensive therapy and may provide a target mechanism for persistent morbidity despite adequate BP control.
Management of Hypertension in the Setting of Autonomic Failure
Authors: Shibao Cyndya , Gamboa Alfredo , Diedrich André , Biaggioni Italo
Published: March 2005

We discuss 2 cases presenting clinically with disabling orthostatic hypotension and severe supine hypertension. This is a common presentation of autonomic failure, and one that challenges conventional treatment. Clinical findings of isolated autonomic failure were the most prominent manifestation in case 1, whereas a movement disorder was the key finding in case 2. The differential diagnosis and treatment of orthostatic hypotension is discussed from a pathophysiological approach. Understanding of the underlying mechanisms of disorders of the autonomic nervous system is fundamental for an effective management of these patients and provides insight into more common disorders such as essential hypertension.
Elevated Pulse Pressure Is Associated With Low Renal Function in Elderly Patients With Isolated Systolic Hypertension
Authors: Verhave Jacobien C. , Fesler Pierre , du Cailar Guilhem , Ribstein Jean , Safar Michel E. , Mimran Albert
Published: March 2005

In the past decade, pulse pressure has emerged as a strong predictor of cardiovascular morbidity and mortality. During aging, elevation of pulse pressure is a consequence of stiffening of the arterial wall. The relationship between pulse pressure and the renal aging process was studied in a cohort of 212 patients with never-treated isolated systolic hypertension. Glomerular filtration rate and effective renal plasma flow were measured using constant infusion of technetium 99m (
99m
Tc)-DTPA and
131
I-ortho-iodohippurate, respectively, and timed urine collections. The relationship between pulse pressure and renal function was studied using a linear regression model in the total population and in 40 to 49, 50 to 59, and 60 years and older age categories. In the whole population, there was an inverse relationship between pulse pressure and glomerular filtration rate; however, this relation did not persist after adjustment for age. In fact, the inverse relationship between pulse pressure and glomerular filtration rate was only present in patients 60 years of age or older. This relationship in elderly patients remained after adjustment for age, gender, MAP, and cardiovascular risk factors (
P
=0.006). It is suggested that pulse pressure, a marker of arterial stiffening, may have a detrimental influence on the age-related decline in glomerular filtration rate, after 60 years of age in patients with never-treated isolated systolic hypertension.
PGC-1α Gly482Ser Polymorphism Associates With Hypertension Among Danish Whites
Authors: Andersen Gitte , Wegner Lise , Jensen Dorit Packert , Glümer Charlotte , Tarnow Lise , Drivsholm Thomas , Poulsen Pernille , Hansen Sara Kristine , Nielsen Eva-Maria Damsgaard , Ek Jakob , Mouritzen Peter , Vaag Allan , Parving Hans-Henrik , Borch-Johnsen Knut , Jørgensen Torben , Hansen Torben , Pedersen Oluf
Published: March 2005

PGC-1α is a coactivator of numerous transcription factors and is expressed in tissues with high energy demands and abundant in mitochondria. It is induced in the myocardium on fasting and physical exercise, and cardiac-specific overexpression stimulates mitochondrial biogenesis in mice. The common Gly482Ser polymorphism of PGC-1α has previously shown association with arterial hypertension among Austrian men. Thus, we aimed at investigating this relationship in the Danish white population. The Gly482Ser polymorphism was genotyped in a total of 2562 Danish white subjects using polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) and a GenoView locked nucleic acid assay (LNA), and the relationships of this variant with blood pressure levels and arterial hypertension were analyzed. Furthermore, we performed a combined analysis of the data from the present study in combination with previously published results. The Ser/Ser genotype was significantly associated with a reduced risk of hypertension and with lower systolic, diastolic, and mean arterial blood pressure levels, predominantly among women. Finally, in a combined analysis using data obtained in both sexes, the Ser/Ser genotype group had an estimated odds ratio of 0.70 (95% confidence interval, 0.56 to 0.86) for hypertension compared with Gly/X carriers (
P
=0.001). In conclusion, the Ser allele of PGC-1α Gly482Ser confers a significantly reduced risk of hypertension in whites. Further studies are needed to elucidate the differential role of this polymorphism in men and women.
Relation between Annular Modes and the Mean State: Southern Hemisphere Summer
Authors: Codron Francis
Published: March 2005

The annular modes emerge as the leading mode of extratropical month-to-month climate variability in both hemispheres. Here the influence of the background state on the structure and dynamics of the Southern Hemisphere annular mode (SAM) during the austral summer when the climatology is characterized by a single, well-defined, eddy-driven jet is studied. Subsets of the climatology are constructed for early and late summer, and for contrasting polarities of the ENSO cycle. The analysis is based both on observations and on perpetual-state GCM experiments. The main differences between the subsets involve variations of the latitude of the mean jet.

It is found that in all the cases, the SAM is characterized by latitudinal shifts of the jet about its mean position, reinforced by a positive momentum flux feedback from baroclinic waves. This result is consistent with previous studies of the dynamics of the zonally averaged circulation but is found here to hold over all longitudes and for different positions of the mean jet. The low frequency eddies exert a weaker negative feedback upon the mean flow, with a less zonally symmetric structure.

The strong differences in the amplitude of the SAM among the various climatologies seem to be determined by a combination of 1) the variance of the “random” forcing by transient eddies and 2) the strength of the positive feedback component of this forcing. The latter mechanism increases the variance at low frequencies only and lengthens the decorrelation time of zonal-mean zonal wind anomalies. It tends to become stronger when the mean jet moves equatorward.
An Empirical Parameterization of Subsurface Entrainment Temperature for Improved SST Anomaly Simulations in an Intermediate Ocean Model
Authors: Zhang Rong-Hua , Kleeman Richard , Zebiak Stephen E. , Keenlyside Noel , Raynaud Stephane
Published: March 2005

An empirical model for the temperature of subsurface water entrained into the ocean mixed layer (Te) is presented and evaluated to improve sea surface temperature anomaly (SSTA) simulations in an intermediate ocean model (IOM) of the tropical Pacific. An inverse modeling approach is adopted to estimate Te from an SSTA equation using observed SST and simulated upper-ocean currents. A relationship between Te and sea surface height (SSH) anomalies is then obtained by utilizing a singular value decomposition (SVD) of their covariance. This empirical scheme is able to better parameterize Te anomalies than other local schemes and quite realistically depicts interannual variability of Te, including a nonlocal phase lag relation of Te variations relative to SSH anomalies over the central equatorial Pacific. An improved Te parameterization naturally leads to better depiction of the subsurface effect on SST variability by the mean upwelling of subsurface temperature anomalies. As a result, SSTA simulations are significantly improved in the equatorial Pacific; a comparison with other schemes indicates that systematic errors of the simulated SSTAs are significantly small—apparently due to the optimized empirical Teparameterization. Cross validation and comparisons with other model simulations are made to illustrate the robustness and effectiveness of the scheme. In particular it is demonstrated that the empirical Te model constructed from one historical period can be successfully used to improve SSTA simulations in another.
Seasonal Cycle Shifts in Hydroclimatology over the Western United States
Authors: Regonda Satish Kumar , Rajagopalan Balaji , Clark Martyn , Pitlick John
Published: March 2005

Analyses of streamflow, snow mass temperature, and precipitation in snowmelt-dominated river basins in the western United States indicate an advance in the timing of peak spring season flows over the past 50 years. Warm temperature spells in spring have occurred much earlier in recent years, which explains in part the trend in the timing of the spring peak flow. In addition, a decrease in snow water equivalent and a general increase in winter precipitation are evident for many stations in the western United States. It appears that in recent decades more of the precipitation is coming as rain rather than snow. The trends are strongest at lower elevations and in the Pacific Northwest region, where winter temperatures are closer to the melting point; it appears that in this region in particular, modest shifts in temperature are capable of forcing large shifts in basin hydrologic response. It is speculated that these trends could be potentially a manifestation of the general global warming trend in recent decades and also due to enhanced ENSO activity. The observed trends in hydroclimatology over the western United States can have significant impacts on water resources planning and management.
The Impact of Corporate Culture, the Reward System, and Perceived Moral Intensity on Marketing Students' Ethical Decision Making
Authors: Nill Alexander , Schibrowsky John A.
Published: March 2005

An experiment was conducted to study how marketing students' ethical decision making was influenced by their perceived moral intensity (PMI), corporate culture, and the reward system. The findings indicate that levels of awareness of the ethical consequences of a decision, the corporate culture, and the reward system all significantly affect ethical decision making. The results provide marketing educators with a framework for understanding the drivers of ethical decision making among marketing students. Given the results, some of the issues associated with teaching marketing ethics are highlighted.
Exploring the “Lone Wolf” Phenomenon in Student Teams
Authors: Barr Terri Feldman , Dixon Andrea L. , Gassenheimer Jule B.
Published: March 2005

The proliferation of projects using student teams has motivated researchers to examine factors that affect both team process and outcomes. This research introduces an individual difference variable found in the business environment that has not been examined in a classroom context. The lone wolf appears to play a role in how teams function and perform. Described by practitioners and academics, the lone wolf is identified by a preference to work alone, a dislike of group process and the ideas of others, and a proclivity to see others as less capable and effective. This study finds the lone wolf phenomenon among marketing students working in teams through self-ratings and the assessments of team members. Furthermore, the inclusion of lone wolves on teams is found to have a negative impact on student team performance. Implications of these findings and ideas for managing the team process when lone wolves are present are considered.
From “Disgraceful Carelessness” to “Intelligent Precaution”: Accidents and the Public Child in English Canada, 1900-1950
Authors: Gleason Mona
Published: March 2005

Highlighting how medical professionals in English Canada understood accidents in childhood, this article explores the emergence of the idea of a “public child” throughout the course of the twentieth century. It asks how shifts in attitudes toward public health, domesticity, race, and gender shaped ideas about children, their safety, and their protection. The medicalized construction of a public child helped foster a more recognizable sense of community responsibility for the wellbeing of particular children at the same time as it increased and deepened the surveillance of families and parents. Although the management of children has always been a task ascribed primarily to women, the early twentieth century witnessed a new interest in categorizing children, whether as infants, workers, or students, as public health and safety risks worthy of public attention.
“Modern” Daughters-In-Law in Colonial Taiwanese Families
Authors: Lin Chin-ju
Published: March 2005

What were the experiences of daughters-in-law in the patriarchal household? Did they ever resist? By analyzing the life stories of twenty-two “modern” women living in complex households of colonial Taiwan, this article suggests that experiences of daughters-in-law differed a great deal from each other, according to family structures, family life cycles, and life cycles of the individual. It also argues that most of the daughters-in-law did rebel. Whether their resistance could be successful, however, depended a great deal on the rising of modern discourses, employment opportunities outside the home, and the possessed economic resources of the daughter-in-law and her natal family.
Facilitating Higher Education Collaborative Efforts Between the United States and México
Authors: Arellano Eduardo Casillas , Martinez Mario C.
Published: March 2005

This study investigated the personal and organizational characteristics that facilitate collaborative efforts between U.S. and Mexican institutions of higher education (IHEs) along the U.S.-México border. The importance of collaborative efforts between IHEs will only intensify as the economic, social, cultural, and political forces that shape the relationship between the United States and México accelerates. The study also compared perceptions of U.S. participants regarding bilingualism and Mexican culture by ethnicity and proximity to the U.S.-México border.
Chicana Identity Construction: Pushing the Boundaries
Authors: Vera Helen , Santos Esmeralda de los
Published: March 2005

Identity concepts that Chicana feminists have described as central to their developmental experience are not reflected in the traditional views of identity, feminist accounts of women’s identity, or ethnic identity theory. Chicana feminist Gloria Anzaldúa initially postulated that in the straddling of two cultures, a hybrid or mestiza identity is created. Recent research efforts conducted by Chicanas identify attitudes and behaviors characteristic of mestizas, yielding new details and information on Chicana identity formation.
Mentoring and 1st-Year Latina/o College Students
Authors: Bordes Veronica , Arredondo Patricia
Published: March 2005

This study focuses on college students of Latina/o heritage—one of the fastest growing college student groups, but with a slowly increasing graduation rate. The purpose of this study was to investigate the relationship between university-based mentoring experiences and Latina/o students’ perceived comfort in the university environment.
Effects of prostaglandin E2 on the electrical properties of thermally classified neurons in the ventromedial preoptic area of the rat hypothalamus
Authors: Ranels Heather J , Griffin John D
Published: March 2005

Background

Physiological and morphological evidence suggests that activation of the ventromedial preoptic area of the hypothalamus (VMPO) is an essential component of an intravenous LPS-dependent fever. In response to the endogenous pyrogen prostaglandin E2 (PGE2), the majority of temperature insensitive neurons in the VMPO show an increase in firing rate, while warm sensitive neurons are inhibited. We have hypothesized that these PGE2 dependent effects on firing rate are due to changes in the inherent electrical properties of VMPO neurons, which are regulated by the activity of specific ionic currents.

Results

To characterize the electrical properties of VMPO neurons, whole-cell recordings were made in tissue slices from male Sprague-Dawley rats. Our results indicate that PGE2 dependent firing rate responses were not the result of changes in resting membrane potential, action potential amplitude and duration, or local synaptic input. However, PGE2 reduced the input resistance of all VMPO neurons, while increasing the excitability of temperature insensitive neurons and decreasing the excitability of warm sensitive neurons. In addition, the majority of temperature insensitive neurons responded to PGE2 with an increase in the rate of rise of the depolarizing prepotential that precedes each action potential. This response to PGE2 was reversed for warm sensitive neurons, in which the prepotential rate of rise decreased.

Conclusion

We would therefore suggest that PGE2 is having an effect on the ionic currents that regulate firing rate by controlling how fast membrane potential rises to threshold during the prepotential phase of the action potential.
Abdominal surgical site infections: incidence and risk factors at an Iranian teaching hospital
Authors: Razavi Seyd Mansour , Ibrahimpoor Mohammad , Sabouri Kashani Ahmad , Jafarian Ali
Published: March 2005

Background

Abdominal surgical site infections are among the most common complications of inpatient admissions and have serious consequences for outcomes and costs. Different risk factors may be involved, including age, sex, nutrition and immunity, prophylactic antibiotics, operation type and duration, type of shaving, and secondary infections. This study aimed to determine the risk factors affecting abdominal surgical site infections and their incidence at Imam Khomeini, a major referral teaching hospital in Iran.

Methods

Patients (n = 802) who had undergone abdominal surgery were studied and the relationships among variables were analyzed by Student's t and Chi-square tests. The subjects were followed for 30 days and by a 20-item questionnaire. Data were collected through pre- and post-operative examinations and telephone follow-ups.

Results

Of the 802 patients, 139 suffered from SSI (17.4%). In 40.8% of the cases, the wound was dirty infected. The average age for the patients was 46.7 years. The operations were elective in 75.7% of the cases and 24.7% were urgent. The average duration of the operation was 2.24 hours, the average duration of pre-operative hospital stay 4.31 days and the average length of (pre- and post-operation) hospital stay 11.2 days. Three quarters of the cases were shaved 12 hours before the operation. The increased operation time, increased bed stay, electivity of the operation, septicity of the wound, type of incision, the administration of prophylactic antibiotic, type of operation, background disease, and the increased time lapse between shaving and operation all significantly associated with SSI with a p-value less than 0.001.

Conclusion

In view of the high rate of SSI reported here (17.4% compared with the 14% quoted in literature), this study suggests that by reducing the average operation time to less than 2 hours, the average preoperative stay to 4 days and the overall stay to less than 11 days, and approximating the timing of shaving to the operation and substituting cefazolin for cefaluthin when prophylactic antibiotic is to be administered, the SSI may be reduced to a more acceptable level.
Measurement of fractionated plasma metanephrines for exclusion of pheochromocytoma: Can specificity be improved by adjustment for age?
Authors: Sawka Anna M , Thabane Lehana , Gafni Amiram , Levine Mitchell , Young William F
Published: March 2005

Background

Biochemical testing for pheochromocytoma by measurement of fractionated plasma metanephrines is limited by false positive rates of up to 18% in people without known genetic predisposition to the disease. The plasma normetanephrine fraction is responsible for most false positives and plasma normetanephrine increases with age. The objective of this study was to determine if we could improve the specificity of fractionated plasma measurements, by statistically adjusting for age.

Methods

An age-adjusted metanephrine score was derived using logistic regression from 343 subjects (including 33 people with pheochromocytoma) who underwent fractionated plasma metanephrine measurements as part of investigations for suspected pheochromocytoma at Mayo Clinic Rochester (derivation set). The performance of the age-adjusted score was validated in a dataset of 158 subjects (including patients 23 with pheochromocytoma) that underwent measurements of fractionated plasma metanephrines at Mayo Clinic the following year (validation dataset). None of the participants in the validation dataset had known genetic predisposition to pheochromocytoma.

Results

The sensitivity of the age-adjusted metanephrine score was the same as that of traditional interpretation of fractionated plasma metanephrine measurements, yielding a sensitivity of 100% (23/23, 95% confidence interval [CI] 85.7%, 100%). However, the false positive rate with traditional interpretation of fractionated plasma metanephrine measurements was 16.3% (22/135, 95% CI, 11.0%, 23.4%) and that of the age-adjusted score was significantly lower at 3.0% (4/135, 95% CI, 1.2%, 7.4%) (p < 0.001 using McNemar's test).

Conclusion

An adjustment for age in the interpretation of results of fractionated plasma metanephrines may significantly decrease false positives when using this test to exclude sporadic pheochromocytoma. Such improvements in false positive rate may result in savings of expenditures related to confirmatory imaging.
Ethical challenges in surgery as narrated by practicing surgeons
Authors: Torjuul Kirsti , Nordam Ann , Sørlie Venke
Published: March 2005

Background

The aim of this study was to explore the ethical challenges in surgery from the surgeons' point of view and their experience of being in ethically difficult situations.

Methods

Five male and five female surgeons at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in such situations. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation.

Results

No differences in ethical reasoning between male and female surgeons were found. They reasoned in both action and relational ethical perspectives. Surgeons focused on their relationships with patients and colleagues and their moral self in descriptions of the ethical challenges in their work. Dialogue and personal involvement were important in their relationships with patients. The surgeons emphasized the importance of open dialogue, professional recognition, and an inclusive and accepting environment between colleagues.

Conclusion

The surgeons are personally challenged by the existential realities of human life in their relationships with patients. They realized that ethical challenges are an inherent part of performing surgery and of life itself, and say that they have to learn to "live with" these challenges in a way that is confirmed both socially and by their inner moral self. This means accepting their personal and professional limitations, being uncertain, being fallible, and being humble. Living with the ethical challenges of surgery seems to contribute to the surgeons' confidence and vulnerability in their professional identity.
Negative density-distribution relationship in butterflies
Authors: Päivinen Jussi , Grapputo Alessandro , Kaitala Veijo , Komonen Atte , Kotiaho Janne S , Saarinen Kimmo , Wahlberg Niklas
Published: March 2005

Background

Because "laws of nature" do not exist in ecology, much of the foundations of community ecology rely on broad statistical generalisations. One of the strongest generalisations is the positive relationship between density and distribution within a given taxonomic assemblage; that is, locally abundant species are more widespread than locally sparse species. Several mechanisms have been proposed to create this positive relationship, and the testing of these mechanisms is attracting increasing attention.

Results

We report a strong, but counterintuitive, negative relationship between density and distribution in the butterfly fauna of Finland. With an exceptionally comprehensive data set (data includes all 95 resident species in Finland and over 1.5 million individuals), we have been able to submit several of the mechanisms to powerful direct empirical testing. Without exception, we failed to find evidence for the proposed mechanisms creating a positive density-distribution relationship. On the contrary, we found that many of the mechanisms are equally able to generate a negative relationship.

Conclusion

We suggest that one important determinant of density-distribution relationships is the geographical location of the study: on the edge of a distribution range, suitable habitat patches are likely to be more isolated than in the core of the range. In such a situation, only the largest and best quality patches are likely to be occupied, and these by definition can support a relatively dense population leading to a negative density-distribution relationship. Finally, we conclude that generalizations about the positive density-distribution relationship should be made more cautiously.
Reduction of motion artifact in pulse oximetry by smoothed pseudo Wigner-Ville distribution
Authors: Yan Yong-sheng , Poon Carmen CY , Zhang Yuan-ting
Published: March 2005

Background

The pulse oximeter, a medical device capable of measuring blood oxygen saturation (SpO2), has been shown to be a valuable device for monitoring patients in critical conditions. In order to incorporate the technique into a wearable device which can be used in ambulatory settings, the influence of motion artifacts on the estimated SpO2 must be reduced. This study investigates the use of the smoothed psuedo Wigner-Ville distribution (SPWVD) for the reduction of motion artifacts affecting pulse oximetry.

Methods

The SPWVD approach is compared with two techniques currently used in this field, i.e. the weighted moving average (WMA) and the fast Fourier transform (FFT) approaches. SpO2 and pulse rate were estimated from a photoplethysmographic (PPG) signal recorded when subject is in a resting position as well as in the act of performing four types of motions: horizontal and vertical movements of the hand, and bending and pressing motions of the finger. For each condition, 24 sets of PPG signals collected from 6 subjects, each of 30 seconds, were studied with reference to the PPG signal recorded simultaneously from the subject's other hand, which was stationary at all times.

Results and Discussion

The SPWVD approach shows significant improvement (p < 0.05), as compared to traditional approaches, when subjects bend their finger or press their finger against the sensor. In addition, the SPWVD approach also reduces the mean absolute pulse rate error significantly (p < 0.05) from 16.4 bpm and 11.2 bpm for the WMA and FFT approaches, respectively, to 5.62 bpm.

Conclusion

The results suggested that the SPWVD approach could potentially be used to reduce motion artifact on wearable pulse oximeters.
Dendritic cells are defective in breast cancer patients: a potential role for polyamine in this immunodeficiency
Authors: Gervais Alban , Levêque Jean , Bouet-Toussaint Françoise , Burtin Florence , Lesimple Thierry , Sulpice Laurent , Patard Jean-Jacques , Genetet Noelle , Catros-Quemener Véronique
Published: March 2005

Introduction

Dendritic cells (DCs) are antigen-presenting cells that are currently employed in cancer clinical trials. However, it is not clear whether their ability to induce tumour-specific immune responses when they are isolated from cancer patients is reduced relative to their ability in vivo. We determined the phenotype and functional activity of DCs from cancer patients and investigated the effect of putrescine, a polyamine molecule that is released in large amounts by cancer cells and has been implicated in metastatic invasion, on DCs.

Methods

The IL-4/GM-CSF (granulocyte–macrophage colony-stimulating factor) procedure for culturing blood monocyte-derived DCs was applied to cells from healthy donors and patients (17 with breast, 7 with colorectal and 10 with renal cell carcinoma). The same peroxide-treated tumour cells (M74 cell line) were used for DC pulsing. We investigated the effects of stimulation of autologous lymphocytes by DCs pulsed with treated tumour cells (DC-Tu), and cytolytic activity of T cells was determined in the same target cells.

Results

Certain differences were observed between donors and breast cancer patients. The yield of DCs was dramatically weaker, and expression of MHC class II was lower and the percentage of HLA-DR-Lin- cells higher in patients. Whatever combination of maturating agents was used, expression of markers of mature DCs was significantly lower in patients. Also, DCs from patients exhibited reduced ability to stimulate cytotoxic T lymphocytes. After DC-Tu stimulation, specific cytolytic activity was enhanced by up to 40% when DCs were from donors but only up to 10% when they were from patients. IFN-γ production was repeatedly found to be enhanced in donors but not in patients. By adding putrescine to DCs from donors, it was possible to enhance the HLA-DR-Lin- cell percentage and to reduce the final cytolytic activity of lymphocytes after DC-Tu stimulation, mimicking defective DC function. These putrescine-induced deficiencies were reversed by treating DCs with all-trans retinoic acid.

Conclusion

These data are consistent with blockade of antigen-presenting cells at an early stage of differentiation in patients with breast cancer. Putrescine released in the microenvironmement of DCs could be involved in this blockade. Use of all-trans retinoic acid treatment to reverse this blockade and favour ex vivo expansion of antigen-specific T lymphocytes is of real interest.
Management of clozapine-resistant schizophrenia
Authors: Kerwin Rob W. , Bolonna Anusha
Published: March 2005

The incidence of treatment resistance in schizophrenia (failure to respond to antipsychotic therapy) is about 20%. Factors that may contribute to it include non-adherence (non-compliance) to treatment, comorbid conditions and medication side-effects. The National Institute for Clinical Excellence recommends that clozapine be used for schizophrenia resistant to another atypical antipsychotic. Here we focus on patients who are also resistant to clozapine given in adequate dosage for sufficient duration. Switching from clozapine to a previously untried atypical (e.g. olanzapine, risperidone, quetiapine) might be of benefit in partial treatment resistance. In more difficult cases, augmentation of clozapine with benzamides (sulpiride, amisulpride) and anti-epileptics (lamotrigine) shows some success. In extreme treatment resistance, a strategy is recommended that combines the proven best drug for the particular patient and psychosocial treatments.
History is bunk†: Invited commentary on… re-evaluating confidentiality
Authors: Adshead Gwen
Published: March 2005

Draper & Rogers (2005, this issue) discuss the publication of case studies in psychiatry. They raise an issue in relation to consent that I would like to pursue in more detail: namely, what is it that we are asking patients to consent to when we ask them to participate in research?
College guidelines on electroconvulsive therapy: an update for prescribers
Authors: Scott Allan I. F.
Published: March 2005

This article is intended to update prescribers of electroconvulsive therapy (ECT) on the key points of the revised edition of the Royal College of Psychiatrist's ECT Handbook (due to be published in 2005). The two most important tenets that influenced the revision were that evidence from systematic reviews and appraisals was balanced with expert judgement based on clinical experience, and that both prescribers and practitioners should strive to reduce further the cognitive adverse effects of treatment. The article concentrates on revised guidance regarding the indications for ECT, important elements of the process of informed consent, and the prescription of treatment, i.e. choice of electrode placement and the frequency and total number of treatments.
Randomised controlled trials relevant to aggressive and violent people, 1955–2000: a survey
Authors: Cure Sharon , Chua Wan Lian , Duggan Lorna , Adams Clive
Published: March 2005

Background

Randomised trials remain the gold standard for evaluating health interventions. This applies to the criminal justice system as well as to health.

Aims

To identify and survey randomised trials relevant to forensic mental health services.

Method

We searched 29 electronic bibliographic databases and acquired randomised trials involving sex offenders, arsonists or people clearly and actively aggressive, or abusive of children or spouse. Two researchers reliably extracted data.

Results

Of 409 studies found, we were able to acquire 300 for further inspection. They all involved particularly violent people (totaln=28 669), mostly adult men; the mean study size was 197 (median 52, mode 60, range 1–1200). In these 300 randomised trials over 700 interventions were evaluated and short-term outcomes were recorded on 345 different scales.

Conclusions

Wider collaboration, rationalising treatments and simplifying outcomes could further strengthen the tradition of trialling in forensic psychiatry. Systematic reviews of these studies are overdue.
Personality and comorbidity of common psychiatric disorders
Authors: Khan Amir A. , Jacobson Kristen C. , Gardner Charles O. , Prescott Carol A. , Kendler Kenneth S.
Published: March 2005

Background

We know little about the degree to which comorbidity, so commonly seen among psychiatric disorders, arises from variation in normal personality.

Aims

To study the degree to which variation in normal personality accounts for the comorbidity of eight common psychiatric and substance use disorders.

Method

Internalising disorders (major depression, generalised anxiety and panic disorders, phobias), externalising disorders (alcohol and drug dependence, anti-social personality and conduct disorders) and personality dimensions of neuroticism, extraversion and novelty seeking were assessed in 7588 participants from a population-based twin registry. The proportion of comorbidity explained by each personality dimension was calculated using structural equation modelling.

Results

Neuroticism accounted for the highest proportion of comorbidity within internalising disorders (20–45%) and between internalising and externalising disorders (19–88%). Variation in neuroticism and novelty seeking each accounted for a modest proportion (10–12% and 7–14%, respectively) of the comorbidity within externalising disorders. Extraversion contributed negligibly

Conclusions

High neuroticism appears to be a broad vulnerability factor for comorbid psychiatric disorders. Novelty seeking is modestly important for comorbid externalising disorders.
Neural correlates of syntax production in schizophrenia
Authors: Kircher Tilo T. J. , Oh Tomasina M. , Brammer Michael J. , McGuire Philip K.
Published: March 2005

Background

The production of grammatically complex sentences is impaired in schizophrenia. It has been suggested that impaired syntax processing reflects a risk for the disorder.

Aims

To examine the neural correlates of syntax production in people with schizophrenia using functional magnetic resonance imaging (fMRI).

Method

Six patients with schizophrenia and six healthy volunteers spoke about seven Rorschach inkblots for 3 min each while correlates of brain activation were measured with fMRI. Participants produced varying amounts of syntactically simple and complex sentences during each 3 min run. The number of simple and complex sentences was correlated separately with the BOLD contrast.

Results

In the comparison between the control group and the patient group, the number of complex sentences produced was correlated with activation in the posterior portion of the right middle temporal (Brodmann area 21) and left superior frontal (BA 10) gyri in the control group but not in the patients.

Conclusions

The absence of activation in the right posterior temporal and left superior frontal cortex in patients with schizophrenia might contribute to the articulation of grammatically more simple speech in people with this disorder.
Repeated self-poisoning: increasing severity of self-harm as a predictor of subsequent suicide
Authors: Carter Greg , Reith David M. , Whyte Ian M. , McPherson Michelle
Published: March 2005

Background

Prediction of suicide risk is difficult in clinical practice.

Aims

To identify changes in clinical presentation predictive of suicide in patients treated for repeated episodes of self-poisoning.

Method

A nested case–control study used the Hunter Area Toxicology Service database to identify exposure variables and the National Death Index to identify suicide. Cases were patients who had hospital treatment on more than one occasion between 15 January 1987 and 31 December 2000.

Results

There were 31 cases, for which 93 controls were selected. Study variables associated with an increased risk of subsequent suicide were an increase in the number of drugs ingested (odds ratio 2.59, 95% CI 1.48–4.51), an increase in the dose ingested (OR1.33, 95% CI 1.01–1.76), an increase in coma score (OR 1.71, 95% CI 1.11–2.66), a decrease in Glasgow Coma Score (OR 1.21, 95% CI 1.03–1.43) and an increase in drug or alcohol misuse (OR 2.33, 95% CI 1.06–5.10).

Conclusions

Patients who have escalating severity of self-poisoning episodes are at high risk of completed suicide.
Suicide by hanging: multicentre study based on coroners' records in England
Authors: Bennewith Olive , Gunnell David , Kapur Navneet , Turnbull Pauline , Simkin Sue , Sutton Lesley , Hawton Keith
Published: March 2005

We studied 162 cases of hanging by suicide occurring in 24 coroners' jurisdictions in England within a 6-month period in 2001. Prison and psychiatric ward suicides accounted for only 6% of these. The most frequently used ligatures (ropes, belts and cable) and ligature points (beams, girders, lofts and trees) are commonly available in community settings, limiting opportunities for prevention. In only half the cases (52%) were victims fully suspended with both feet off the ground. Four per cent had also taken an overdose.
Unusual devastating self-injurious behaviour in a patient with a severe learning disability: treatment with citalopram
Authors: Martin Peter , Guth Christoph
Published: March 2005

Physicians caring for people with severe learning disabilities are frequently faced with the problem of self-injurious behaviour, which often takes a chronic course. Among neurotransmitter systems the serotonergic system in particular is thought to be involved in the initiation and maintenance of self-injurious behaviour, and pharmacological treatment with serotonin enhancers or serotonin reuptake inhibitors has been shown to reduce impulsive aggressive behaviour.
Psychiatry and the pharmaceutical industry: who pays the piper?
Authors: Moncrieff Joanna , Hopker Steve , Thomas Philip
Published: March 2005

There is increasing concern about the relationship between medicine and the pharmaceutical industry. In July the BMJ devoted a themed issue to this, and critical discussions have featured in other leading medical journals recently. The industry has grown in profitability and influence over the past 20 years, and is now second only to armaments in the US economy (Public Citizen, 2002). Its influence is enhanced through its control of research, and it employs sophisticated and wide-reaching marketing strategies. This level of influence is concerning because the private investment necessary to enable drug development demands ever more vigorous struggles to maintain and expand market presence. In other words, commercial rather than clinical or scientific demands are becoming the dominant driving force for ‘innovation’. This leads to the popularity of developing cheaper ‘me too’ options, and the promotion of new ‘disease concepts' to allow the re-badging of old products to expand markets without major development costs.