bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis of gastric cancer using decision tree classification of mass spectral data
Authors: Su Yahui , Shen Jing , Qian Honggang , Ma Huachong , Ji Jiafu , Ma Hong , Ma Longhua , Zhang Weihua , Meng Ling , Li Zhenfu , Wu Jian , Jin Genglin , Zhang Jianzhi , Shou Chengchao
Published: October 2006

Although gastric cancer is the second leading cause of cancer death worldwide, specific and sensitive biomarkers that can be used for its diagnosis are still unavailable. Attempting to improve on current approaches to the serological diagnosis of gastric cancer, we subjected serum samples from 245 individuals (including 127 gastric cancer patients, 100 age‐ and sex‐matched healthy individuals, nine benign gastric lesion patients and nine colorectal cancer patients) for analysis by surface‐enhanced laser desorption/ionization (SELDI) mass spectrometry. Peaks were detected with Ciphergen SELDI software version 3.1.1 and analyzed with Biomarker Patterns’ software 5.0. We developed a classifier for separating the gastric cancer groups from the healthy groups. Three protein masses with 1468, 3935 and 7560 m/z were selected as a potential ‘fingerprint’ for the detection of gastric cancer. It was able to distinguish the gastric cancer patients from the health volunteers with a sensitivity of 95.6% and a specificity of 92.0% in the training set. In the blinding set, it was capable of differentiating the gastric cancer samples from the others with a specificity of 88.0%, a sensitivity of 85.3%, and an accuracy of 86.4%. These values were all higher than those achieved in a parallel analysis by measuring serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19‐9 together. Therefore, the decision tree analysis of serum proteomic patterns has the potential to be used in gastric cancer diagnosis. (Cancer Sci 2007; 98: 37–43)
Clinical implications of nodal marginal zone B‐cell lymphoma among Japanese: study of 65 cases
Authors: Kojima Masaru , Inagaki Hiroshi , Motoori Tadashi , Itoh Hideaki , Shimizu Kazuhiko , Tamaki Yoshio , Murase Takuhei , Nakamura Shigeo
Published: October 2006

To clarify the clinical presentation and outcome of nodal marginal zone B‐cell lymphoma (NMZBL), 65 Japanese patients with this disease were studied and compared with the published literature from western countries. The clinical findings of our 65 cases were similar to those of their cases in some aspects: (1) 58% of the patients were >60 years old (median age, 64 years); (2) there was a slight female predominance; (3) 90% of the patients exhibited asymptomatic lymphadenopathy in the head and neck area; (4) only a minority of patients had B symptoms (6%) and poor performance status (8%); and (5) only 5% of patients were positive for M‐protein. However, the 65 patients in this series exhibited relatively longer 5‐year overall survival (85%) and failure‐free survival (60%) than the NMZBL series published in western literature, suggesting that NMZBL should be classified as indolent lymphoma. Moreover, based on the histological findings, we further classified four histological subtypes as follows: (1) splenic type (n = 7); (2) floral type (n = 9); (3) mucosa‐associated lymphoid tissue (MALT) type (n = 29); and (4) diffuse large B‐cell lymphoma (DLBCL) + MALT type (n = 20). DLBCL + MALT type exhibited significantly poorer 5‐year overall survival than the splenic variant. The recognition of DLBCL + MALT type appears important. No API2–MALT1 fusion transcript was detected in any of the 14 cases examined. (Cancer Sci 2007; 98: 44–49)
Multistep carcinogenesis of the colon in ApcMin/+ mouse
Authors: Yamada Yasuhiro , Mori Hideki
Published: October 2006

Colon cancer arises through different histological stages representing different genetic and epigenetic alterations. The ApcMin/+ mouse has a point mutation at the Apc gene, and it is considered to be a model for human familial adenomatous polyposis. Our previous studies have revealed the presence of a number of intramucosal microadenomas in the colons of ApcMin/+ mice, in which only a few macroscopic tumors were recognized. These observations suggest that there are two distinct stages for colon carcinogenesis in ApcMin/+ mouse, and the ApcMin/+ mouse is regarded as a good model to study multistage colon carcinogenesis. A number of genes that modify intestinal tumorigenesis have been identified using Apc mutant mice combined with other mutant mice. It has become apparent that epigenetic modification strongly affects intestinal tumorigenesis in ApcMin/+ mice. We herein describe the different stages of colon tumorigenesis and their modifiers, and discuss the possible application of Apc mutant mice in order to better understand the molecular mechanisms of multistage carcinogenesis in the large bowel of humans. (Cancer Sci 2007; 98: 6–10)
Phase II study of the irinotecan (CPT‐11), mitoxantrone and dexamethasone regimen in elderly patients with relapsed or refractory peripheral T‐cell lymphoma
Authors: Niitsu Nozomi , Kohori Mika , Higashihara Masaaki , Bessho Masami
Published: October 2006

We treated elderly patients with relapsed or refractory peripheral T‐cell lymphoma (PTCL) using a CMD (CPT‐11, mitoxantrone [MIT], dexamethasone [DEX]) regimen and studied its safety and efficacy. The subjects were 70–79‐year‐old patients with relapsed or refractory PTCL. CPT‐11 at 25 mg/m2 on days 1 and 2, MIT at 8 mg/m2 on day 3, and DEX at 40 mg/day on days 1–3 were administered once every 3 weeks, and this was performed for six cycles. Eleven (37%) of the 30 patients achieved complete remission and seven patients (23%) achieved partial remission. With a median follow‐up period of 32 months, the 3‐year survival rate was 28.2% and the 3‐year progression‐free survival rate was 17.5%. The main adverse drug reaction was hematological toxicity and there were no deaths related to the treatment. B‐type natriuretic peptide and troponin T levels did not increase after the treatment and none of the patients showed electrocardiogram or echocardiogram abnormalities. Our results indicate that the CMD regimen is safe in elderly patients and no cardiotoxicities developed as a result of this regimen. In addition, it was effective in patients who had previously been treated with doxorubicin and good treatment results were obtained in elderly patients with relapsed PTCL. (Cancer Sci 2007; 98: 109–112)
Recent advances in the treatment of peritoneal dissemination of gastrointestinal cancers by nucleoside antimetabolites
Authors: Yonemura Yutaka , Endo Yoshio , Obata Tohru , Sasaki Takuma
Published: October 2006

Peritoneal dissemination is the most common cause of metastasis from malignancies in the abdominal cavity. There are no standard treatments for peritoneal dissemination and the results are poor. The reasons for this are as follows: (1) no effective chemotherapeutic agents have been identified or developed; (2) surgical cytoreduction has little effect on survival improvement; and (3) the molecular mechanisms of peritoneal dissemination have not been clarified and no therapy against the target molecules has been developed. However, studies on the molecular mechanisms of peritoneal dissemination have elucidated some of the target molecules and the development of new multimodal therapies has also improved survival. Early postoperative intraperitoneal chemotherapy, hyperthermic intraperitoneal perfusion chemotherapy and neoadjuvant intraperitoneal‐systemic chemotherapy have been newly developed, and a novel surgical therapy named peritonectomy has been proposed to perform complete cytoreduction of peritoneal dissemination. At present, these approaches appear to be effective therapeutic modalities for peritoneal dissemination. However, TS‐1 and capecitabine have shown worthwhile results in recent clinical trials for patients with advanced gastric cancer. We recently found that newly developed antitumor cytosine nucleoside analogs show a survival advantage in peritoneal dissemination models using human cancer cells. These non‐fluoropyrimidine nucleosides may potentially help to improve the poor prognosis observed in patients with advanced cancers involving peritoneal dissemination. (Cancer Sci 2007; 98: 11–18)
Hepatic steatosis and insulin resistance are associated with serum imbalance of adiponectin/tumour necrosis factor‐α in chronic hepatitis C patients
Authors: DURANTE‐MANGONI E. , ZAMPINO R. , MARRONE A. , TRIPODI M.‐F. , RINALDI L. , RESTIVO L. , CIOFFI M. , RUGGIERO G. , ADINOLFI L. E.
Published: October 2006

Background

Steatosis and insulin resistance (IR) have a pathogenic role in chronic hepatitis C (HCV). Adipocytokines balance modulates hepatic lipid content and IR.

Aim

To evaluate serum adipocytokines and relationship with virological, histological and metabolic parameters in chronic HCV.

Methods

Adiponectin and tumour necrosis factor‐α (TNF‐α) levels, HCV genotypes, HCV‐RNA, IR (HOMA‐IR), body mass index and liver steatosis and fibrosis were assessed in 161 non‐diabetic chronic HCV patients.

Results

Chronic HCV patients with steatosis showed lower serum adiponectin levels and higher levels of TNF‐α, HOMA, alanine aminotransferase, γ‐glutamiltransferase and Histological Activity Index (HAI) and fibrosis scores. Low adiponectin levels were independently associated with grades of steatosis and HOMA‐IR. Higher tumour necrosis factor‐α levels were observed in patients with low adiponectin levels. The extension of steatosis was inversely correlated with adiponectin levels. A correlation between grade of steatosis with HOMA‐IR and fibrosis was observed. HCV genotype 3‐infected patients showed lower adiponectin levels than those with other genotypes. An independent predictor of low adiponectin levels in genotype 3 infection was the extension of steatosis. Liver fibrosis score was associated with steatosis, HAI and age.

Conclusions

Chronic HCV patients with steatosis showed a serum adiponectin/TNF‐α imbalance that is associated with IR. Reduced adiponectin levels may be involved in the pathogenesis of steatosis, which in turn accelerates progression of fibrosis in chronic HCV.
Diagnostic value of the proton pump inhibitor test for gastro‐oesophageal reflux disease in primary care
Authors: AANEN M. C. , WEUSTEN B. L. A. M. , NUMANS M. E. , DE WIT N. J. , BARON A. , SMOUT A. J. P. M.
Published: October 2006

Aim

To assess the diagnostic accuracy of the proton pump inhibitor test in a primary care population as well as its additional value over reflux history, using the symptom association probability outcome during 24‐h oesophageal pH recording as reference test for gastro‐oesophageal reflux disease.

Methods

Subjects with symptoms suggestive of gastro‐oesophageal reflux disease were recruited from primary care. After a 24‐h pH recording with calculation of the symptom association probability, subjects started using 40 mg esomeprazole once daily for 13 days. The proton pump inhibitor test was considered positive when the subjects reported adequate symptom suppression. Data are presented as means with 95% confidence intervals.

Results

Successful 24‐h pH recording was accomplished in 84 of the 90 subjects, while the symptom association probability was calculable in 74. The symptom association probability was positive in 70% of the subjects. The sensitivity of the proton pump inhibitor test was 0.91 (CI 0.78–0.96) and the specificity was 0.26 (CI 0.10–0.49). The mean likelihood ratio was 1.2 (CI 0.9–1.6) with little variation over the 13 consecutive proton pump inhibitor test days. The likelihood ratios of gastro‐oesophageal reflux disease symptoms were comparable, ranging around 1.

Conclusions

In primary care patients with reflux symptoms gastro‐oesophageal reflux disease is highly prevalent. Under these conditions the additional value of short‐term treatment with a proton pump inhibitor for diagnosing gastro‐oesophageal reflux disease is limited.
Review article: medical therapy for fistulizing Crohn's disease
Authors: BRESSLER B. , SANDS B. E.
Published: October 2006

Background

Fistulae will develop in approximately one‐third of patients with Crohn's disease. With an expected spontaneous healing rate of only 10%, fistulizing Crohn's disease requires a comprehensive strategy with a medical and possible surgical approach.

Aim

To summarize the current literature evaluating various medical options for treating patients with fistulizing Crohn's disease.

Methods

A literature review was conducted using PubMed (search terms: Crohn's disease and fistula) and manual search of references among the identified studies and relevant review papers to identify papers that present data on medical treatment of fistulizing Crohn's disease.

Results

The first line of medical therapy remains antibiotics (metronidazole and ciprofloxacin). Mercaptopurine and azathioprine are medications that are effective in treating fistulizing Crohn's disease. The current gold standard of medical treatment to induce and maintain remission for fistulizing Crohn's disease is infliximab. Used as induction therapy, infliximab produced a 62% clinical response, and a complete closure rate of 46%. A maintenance therapy trial demonstrated at 54 weeks, 46% of patients receiving infliximab continued to respond to treatment, compared with 23% in the placebo group (P = 0.001).

Conclusion

Further research to find new therapies and to improve our existing medical treatment of fistulizing Crohn's disease is required.
Review article: altering the natural history of Crohn's disease – evidence for and against current therapies
Authors: VERMEIRE S. , VAN ASSCHE G. , RUTGEERTS P.
Published: October 2006

Background

The natural course of Crohn's disease is characterized by flare‐ups altered with periods of remission. The majority of Crohn's disease patients need surgery within 10 years of diagnosis. Major advances in treatment options over the past years have made our treatment goals more ambitious and modification of the natural course has become the ultimate endpoint.

Aim

To review the evidence of existing therapies for Crohn's disease for changing the natural history.

Methods

A Medline search was undertaken by using ‘natural history’, ‘Crohn's disease’, ‘therapy’ (corticosteroids, azathioprine, methotrexate, infliximab and enteral feeding), ‘surgery’, ‘hospitalizations’ and ‘mucosal healing’.

Results

Corticosteroids do not alter the disease course and maintenance therapy with corticosteroids should be avoided given their side effects. The immunomodulators azathioprine and methotrexate heal the mucosa but their onset of action is slow. Infliximab therapy introduces rapid mucosal healing and is associated with decreased hospitalizations and surgical interventions. Despite the fact that immunomodulators and infliximab are effective in maintaining clinical and endoscopic remission, there is little hard evidence at present that these therapies alter the natural history of the disease. The main reason being the fact that these therapies have so far been used only in refractory patients and that early initiation in the right patient is crucial in order to change the disease course.

Conclusion

Prospective studies should validate predictors of complicated disease and randomized studies in high‐risk groups should be performed to answer if early introduction of immunomodulators or biological therapies slows down disease progression and alters natural history.
Does Barrett's oesophagus develop over time in patients with chronic gastro‐oesophageal reflux disease?
Authors: STOLTEY J. , REEBA H. , ULLAH N. , SABHAIE P. , GERSON L.
Published: October 2006

Background

Barrett's oesophagus is present in 8–10% of patients with gastro‐oesophageal reflux disease (GERD).

Aim

We performed a cohort study to determine the incidence of Barrett's oesophagus in patients with chronic heartburn symptoms.

Methods

We identified patients, with GERD and/or Barrett's oesophagus between 1998 and 2004 by primary or secondary International Classification of Diseases (ICD‐9) codes of 530.81 and/or 530.2, who had two or more oesophagogastroduodenoscopies performed at least 6 months apart.

Results

We screened 11 040 patients (41 390 random data entries by ICD‐9 code) and enrolled 515 (4.6%) GERD patients and 169 (1.5%) Barrett's oesophagus patients. The mean (±s.d.) number of oesophagogastroduodenoscopies in the GERD cohort was 3.2 ± 1.8 (range: 2–15) over 3.4 ± 2.2 (range: 0.5–11) years. None of the 412 (80%) GERD patients with non‐erosive disease developed Barrett's oesophagus over a mean follow‐up time of 3.4 ± 2.2 years (95% CI: 0–0.9%). Five (1%) of the 103 GERD patients with erosive oesophagitis developed subsequent Barrett's oesophagus. Fifty‐seven per cent of the GERD patients were on PPI therapy at the time of index endoscopy. None of the 169 Barrett's oesophagus patients had normal index oesophagogastroduodenoscopies within a mean retrospective time period of 4.5 ± 2.8 years (95% CI: 0–2%). Using the ICD‐9 code of 530.2 as a predictor of the presence of Barrett's oesophagus, the sensitivity was 79% with a specificity of 88%.

Conclusion

The majority of patients with GERD do not appear to develop Barrett's oesophagus when it is not present on the index endoscopy.
Total spinal anaesthesia after an attempted brachial plexus block using the posterior approach
Authors: Grefkens J. M. , Bürger K.
Published: October 2006

A 66‐year‐old patient scheduled for elective shoulder surgery underwent a brachial plexus block using the posterior approach. Shortly after injection of the local anaesthetic, he rapidly became unresponsive and apnoeic. We identify the possible reasons for this occurrence and discuss the place of the posterior approach in brachial plexus anaesthesia.
Effect of propofol on seizure‐like phenomena and electroencephalographic activity in children with epilepsy vs children with learning difficulties
Authors: Meyer S. , Shamdeen M. G. , Kegel B. , Mencke T. , Gottschling S. , Gortner L. , Grundmann U.
Published: October 2006

There is an ongoing debate as to whether propofol exhibits pro‐ or anticonvulsant effects, and whether it should be used in patients with epilepsy. We prospectively assessed the occurrence of seizure‐like phenomena and the effects of intravenous propofol on the electroencephalogram (EEG) in 25 children with epilepsy (mean (SD) age: 101 (49) months) and 25 children with learning difficulties (mean (SD) age: 52 (40) months) undergoing elective sedation for MRI studies of the brain. No child demonstrated seizure‐like phenomena of epileptic origin during and after propofol sedation. Immediately after stopping propofol, characteristic EEG changes in the epilepsy group consisted of increased beta wave activity (23/25 children), and suppression of pre‐existing theta rhythms (11/16 children). In addition, 16 of 18 children with epilepsy and documented EEG seizure activity demonstrated suppression of spike‐wave patterns after propofol sedation. In all 25 children with learning difficulties an increase in beta wave activity was seen. Suppression of theta rhythms occurred in 11 of 12 children at the end of the MRI study. In no child of either group was a primary occurrence or an increase in spike‐wave patterns seen following propofol administration. The occurrence of beta wave activity (children with learning difficulties and epilepsy group) and suppression of spike‐wave patterns (epilepsy group) were transient, and disappeared after 4 h. This study demonstrates characteristic, time‐dependent EEG patterns induced by propofol in children with epilepsy and learning difficulties. Our data support the concept of propofol being a sedative‐hypnotic agent with anticonvulsant properties as shown by depression of spike‐wave patterns in children with epilepsy and by the absence of seizure‐like phenomena of epileptic origin.
Comparison of forced‐air warming and electric heating pad for maintenance of body temperature during total knee replacement
Authors: Ng V. , Lai A. , Ho V.
Published: October 2006

We conducted a randomised controlled trial to compare the efficacy of forced‐air warming (Bair Hugger™, Augustine Medical model 500/OR, Prairie, MN) with that of an electric heating pad (Operatherm 202, KanMed, Sweden) for maintenance of intra‐operative body temperature in 60 patients undergoing total knee replacement under combined spinal‐epidural anaesthesia. Intra‐operative tympanic and rectal temperatures and verbal analogue score for thermal comfort were recorded. There were no differences in any measurements between the two groups, with mean (SD) final rectal temperatures of 36.8 (0.4) °C with forced‐air warming and 36.9 (0.4) °C with the electric pad. The heating pad is as effective as forced‐air warming for maintenance of intra‐operative body temperature.
A randomised controlled trial of the effect of continuous electronic physiological monitoring on the adverse event rate in high risk medical and surgical patients
Authors: Watkinson P. J. , Barber V. S. , Price J. D. , Hann A. , Tarassenko L. , Young J. D.
Published: October 2006

We conducted a randomised controlled trial of mandated five‐channel physiological monitoring vs standard care, in acute medical and surgical wards in a single UK teaching hospital. In all, 402 high‐risk medical and surgical patients were studied. The primary outcome was the proportion of patients experiencing one or more major adverse events, including urgent staff calls, changes to higher care levels, cardiac arrests or death, in 96 h following randomisation. Secondary outcomes were the proportion of patients requiring acute treatment changes, and the 30‐day and hospital mortality. In the 96 h following randomisation, 113 (56%) patients in the monitored arm and 116 (58%) in the control arm (OR 0.94, 95% CI 0.63–1.40, p = 0.76) had a major event. An acute change in treatment was necessary in 107 (53%) monitored patients and 101 (50%) control patients (OR 0.55, 95% CI 0.87–1.29). Thirty‐four (17%) monitored patients and 35 (17%) control patients died within 30 days. Thirteen patients in the control group received full five‐channel monitoring at the request of the ward staff. We conclude that mandated electronic vital signs monitoring in high risk medical and surgical patients has no effect on adverse events or mortality.
An evaluation of protocolised weaning on the duration of mechanical ventilation*
Authors: Blackwood B. , Wilson‐Barnett J. , Patterson C. C. , Trinder T. J. , Lavery G. G.
Published: October 2006

Using a before and after study design, we compared protocolised weaning from mechanical ventilation with usual non‐protocolised practice in intensive care. Outcomes (duration of mechanical ventilation, duration of intubation, intensive care stay) and complications (re‐intubations, tracheostomy, mortality) were compared between baseline (Phase I) and following implementation of protocolised weaning (Phase II). Over the same period, we collected data in a second (reference) unit to monitor practice changes over time. In the intervention unit, outcomes were longer in Phase II compared with Phase I (all p < 0.005). When adjusted for admission APACHE II score and diagnostic category, only intensive care stay remained significantly longer (p = 0.002). There were significantly more tracheostomies in Phase II (p = 0.004). The reference unit demonstrated no statistically significant differences in study outcomes or complications between Phases. Protocolised weaning did not reduce the duration of mechanical ventilation and was not associated with an increased rate of re‐intubation or intensive care unit mortality.
A comparison of nerve stimulator guided paravertebral block and ilio‐inguinal nerve block for analgesia after inguinal herniorrhaphy in children
Authors: Naja Z. M. , Raf M. , El Rajab M. , Daoud N. , Ziade F. M. , Al Tannir M. A. , Lönnqvist P. A.
Published: October 2006

The aim of this study was to compare the efficacy of nerve stimulator guided paravertebral block with ilio‐inguinal nerve block in children undergoing inguinal herniorrhaphy. Eighty children were randomly allocated to receive either paravertebral block or ilio‐inguinal nerve block. Each block was evaluated in terms of intra‐operative haemodynamic stability, postoperative pain scores at rest, on movement and during activity, requirement for supplemental analgesia and parental satisfaction. Haemodynamic stability was maintained significantly better during sac traction in the paravertebral block group (p < 0.005). Pain scores and analgesic consumption were significantly lower in the paravertebral block group during the postoperative follow‐up period (p < 0.05). Parental satisfaction (93%vs 69%) and surgeon satisfaction (93%vs 64%) were significantly higher in the paravertebral block group (p < 0.05). Paravertebral blockade improved and prolonged postoperative analgesia, and was associated with greater parental and surgeon satisfaction when compared to ilio‐inguinal nerve block.
Vinorelbine‐based salvage chemotherapy for therapy‐refractory aggressive leukaemias
Authors: Uckun Fatih M. , Morar Sanda , Qazi Sanjive
Published: October 2006

This study examined the ability of the semi‐synthetic vinca alkaloid, Vinorelbine/Navelbine, to cause apoptotic death in freshly obtained primary leukaemia cells from 53 patients with haematological malignancies, including 22 patients with acute lymphoblastic leukaemia (ALL), 24 patients with chronic lymphocytic leukaemia (CLL), three patients with chronic myeloid leukaemia in blast crisis (CML‐BC) and four patients with acute myeloid leukaemia (AML). Vinorelbine caused apoptosis in primary leukaemia cells from 42 (79%) of these leukaemia patients. Objective responses, including complete remission (CR) and CR with incomplete haematological recovery, were achieved in 12 of 17 (71%) patients with aggressive and therapy‐refractory leukaemias, including five of nine patients with relapsed ALL, three of three patients with CML‐BC and four of five patients with rapidly progressive CLL, who were treated with a vinorelbine‐based salvage chemotherapy regimen. Drug sensitivity profiling of multidrug‐resistant primary cancer cells using apoptosis assays revealed a significant association between Vinorelbine sensitivity in vitro and the likelihood of an objective clinical response to Vinorelbine‐based chemotherapy. Vinorelbine‐sensitivity testing of primary leukaemia cells might help tailor Vinorelbine‐based salvage regimens to those patients who are most likely to respond.
Surface electrical stimulation of the quadriceps femoris in patients affected by haemophilia A
Authors: QUEROL F. , GALLACH J. E. , TOCA‐HERRERA J. L. , GOMIS M. , GONZALEZ L‐M.
Published: October 2006

Summary.  Eighteen sessions of surface electrical stimulation was applied to the quadriceps femoris of the left leg of ten male subjects affected by severe haemophilia A, while ten healthy subjects constituted the control group. The isometric strength, the electromyographic activity and the diameter of the rectus femoris were measured in both legs before and after a six‐week treatment period. After the treatment, the people affected by haemophilia showed a gain in strength by 13.8% in the stimulated leg and by 17.1% in the non‐stimulated one. No changes were detected in the electromyographic activity. On the contrary, the diameter of the rectus femoris of the stimulated leg increased in 24.34%, while no significant change was found in the nonelectrically stimulated leg. These results show for the first time that the application of electrical stimulation in haemophilic patients contributes to the gain and development of strength and trophism. The results also show that the surface electrical stimulation does not represent a threat to the patients' health, and that can be used for therapeutic purposes.
Effects of heat‐processing regime, pH, water activity and their interactions on the behaviour of Listeria monocytogenes in ground pork. Modelling the boundary of the growth/no‐growth areas as a function of pH, water activity and temperature
Authors: Zuliani Véronique , Lebert Isabelle , Garry Pascal , Vendeuvre Jean‐Luc , Augustin Jean‐Christophe , Lebert André
Published: October 2006

The influence of four heat‐processing regimes and a storage phase on the behaviour of Listeria monocytogenes in ground pork was studied. The effects of pH and water activity (aw) were also tested. During the heat process phase, aw, the heat‐processing regime and its interactions with pH or aw, had a significant effect on the behaviour of L. monocytogenes. During the storage phase, all parameters tested and their interactions had significant effects. Nevertheless, the area in which the growth of L. monocytogenes was observed at the end of the experiment was not influenced by the heat‐processing regime tested. On the contrary, pH, aw and their interactions had significant effects on Listeria behaviour. The boundary of the growth area delimited by environmental conditions where growth was higher than 1.0 Log CFU g−1 from those where growth was lower than this limit was correctly predicted by Augustin's model.
Developing an advanced nurse practitioner service in emergency care: attitudes of nurses and doctors
Authors: Griffin Miriam , Melby Vidar
Published: October 2006

Aim.  This paper reports a study to determine the attitudes of nurses, doctors and general medical practitioners towards the development of an advanced nurse practitioner service within an emergency department.

Background.  The role of advanced nurse practitioner in emergency care has emerged in a number of countries, and has brought with it confusion about titles, role boundaries, clinical accountability and educational requirements. Initially, the role resulted from a need for healthcare professionals to provide a service to the increased numbers of patients presenting to hospital with less urgent problems. Since then, the service has evolved to one where nurse practitioners provide high‐quality and cost‐effective care to persons who seek help for non‐urgent, urgent or emergent conditions in a variety of emergency care settings. However, little research could be identified on the attitudes of relevant nursing and medical staff towards the development of this role.

Methods.  A questionnaire survey was carried out, and a 29‐item Likert rating scale was developed to measure attitudes. Along with some demographic variables, two open‐ended questions were added to allow respondents to elaborate on what they perceived as benefits and difficulties associated with an advanced nurse practitioner service. All general practitioners, emergency nurses and emergency doctors in one health board in the Republic of Ireland were targeted, and 25 emergency nurses, 13 emergency doctors and 69 general practitioners were approached to take part. Data were collected in February 2004.

Findings.  An overall response rate of 74·8% was achieved. All respondents were positive towards the development of an advanced nurse practitioner service, with general practitioners being less positive. The principal differences appeared between general practitioners and hospital emergency care staff.

Conclusion.  There is a need for a multidisciplinary approach to the planning of advanced nurse practitioner services. To achieve multiprofessional acceptance, an accredited and standardized education programme is required, and this must address existing role boundaries.
What makes a good midwife? An integrative review of methodologically‐diverse research
Authors: Nicholls Lynn , Webb Christine
Published: October 2006

Aim. This paper reports an integrative review aimed at answering the question: ‘What makes a good midwife?’

Background. A research‐based definition of a good midwife which can be used as an operational definition in research and as a basis for curriculum development could not be found. Research in nursing has identified that patients and nurses may give different responses when asked about the most important aspects of nurses’ contribution to care. It is also possible that views of how to define a good midwife might differ.

Methods. A four‐stage systematic review process was used, consisting of protocol development, carrying out the search, appraisal/analysis of the papers retrieved, and synthesis of the information. The initial search covered the period from 1993 and used the keywords ‘midwi*’, ‘nurse‐midwi*’ and ‘good’. This was later extended to include the terms ‘exemplary’, ‘excellent’ and ‘superb’ as synonyms of ‘good’, and ‘bad’ as its antonym. The integrative review was descriptive and focussed on extracting from the papers the findings that contributed to answering the research question.

Findings. Thirty‐three research‐based papers were included in the review, and these had used a range of approaches and methods. Eight key concepts were derived from the data: attributes of a midwife, education, research, what a midwife does, care organization, other professionals, partners and an international perspective.

Conclusion. Having good communication skills made the greatest contribution to being ‘a good midwife’, while being compassionate, kind, supportive (affective domain), knowledgeable (cognitive domain) and skilful (psychomotor domain) also made major contributions. Being involved in education and research were necessary requirements, and midwives’ abilities to treat women as individuals, adopt a caring approach, and ‘be there’ for women were essential. A good midwife can compensate for poor management systems, but women should be able to choose who provides their care, and partners should be involved in this care.
A test of the vicariance hypothesis of western North American freshwater biogeography
Authors: Liu Hsiu‐Ping , Hershler Robert
Published: October 2006

Aim The biogeography of western North American freshwater molluscs has traditionally been attributed to vicariance associated with late Tertiary rearrangement of landscape based on distributional evidence and the putatively limited dispersal ability of these organisms. We examined the phylogeography of a widely ranging western springsnail (Pyrgulopsis wongiHershler, 1989) to test this hypothesis and evaluate the relative importance of vicariance and dispersal in structuring the distribution of this species.

Location Southwestern Great Basin (California and Nevada), United States of America.

Method Two mitochondrial genes (COI, NDI) were sequenced for 28 populations ofP. wongispanning its entire geographic range, which consists of 10 topographically closed drainage basins. We also sequenced eight closely related congeners, as well as the type species of the closely related eastern North American genusFloridobiaHershler & Thompson, 2002, which was used as the outgroup. Phylogenies based on the combined data set were obtained using several methods, and networks for each gene were generated as an additional means of examining relationships among haplotypes. Partitioning of haplotype variation was studied usingamova, migration between populations was estimated using a coalescent‐based method (mdiv), and divergence times were inferred using a locally calibrated molecular clock andmdiv.

Results Pyrgulopsis wongiis subdivided into narrowly localized and widely distributed lineages that diverged in the Pleistocene, well after the inception of the contemporary regional landscape. While large ΦSTvalues and the localized geographic distributions of most haplotypes imply absence or negligible contemporary dispersal of this spring‐dwelling snail, the pattern of phylogeographic structuring, presence of a few widespread haplotypes, and results of themdivanalyses suggest geologically recent dispersal across drainage divides.

Main conclusions Phylogeography ofP. wongiconflicts with the traditional vicariance model as it is not structured by the contemporary landscape and is instead indicative of geologically recent dispersal. In the absence of evidence that dispersal of this species occurred through surface water connections during the relevant (Quaternary) time frame, we conjecture that spread may have instead been mediated by transport on waterfowl or via upland stream capture. The non‐concordance between phylogeography and landscape reported in this and other recent studies ofPyrgulopsissuggests that members of this diverse and imperiled genus should not be managed using ana priori, ‘watershed as conservation unit’ approach.
Patient participation in clinical decision‐making in nursing: a comparative study of nurses’ and patients’ perceptions
Authors: Florin Jan , Ehrenberg Anna , Ehnfors Margareta
Published: October 2006

Aims and objectives.  The aim of this study was to compare the degree of concordance between patients and Registered Nurses’ perceptions of the patients’ preferences for participation in clinical decision‐making in nursing care. A further aim was to compare patients’ experienced participation with their preferred participatory role.

Background.  Patient participation in clinical decision‐making is valuable and has an effect on quality of care. However, there is limited knowledge about patient preferences for participation and how nurses perceive their patients’ preferences.

Methods.  A comparative design was adopted with a convenient sample of 80 nurse–patient dyads. A modified version of the Control Preference Scale was used in conjunction with a questionnaire developed to elicit the experienced participation of the patient.

Results.  A majority of the Registered Nurses perceived that their patients preferred a higher degree of participation in decision‐making than did the patients. Differences in patient preferences were found in relation to age and social status but not to gender. Patients often experienced having a different role than what was initially preferred, e.g. a more passive role concerning needs related to communication, breathing and pain and a more active role related to activity and emotions/roles.

Conclusions.  Registered Nurses are not always aware of their patients’ perspective and tend to overestimate patients’ willingness to assume an active role. Registered Nurses do not successfully involve patients in clinical decision‐making in nursing care according to their own perceptions and not even to the patients’ more moderate preferences of participation.

Relevance to clinical practice.  A thorough assessment of the individual's preferences for participation in decision‐making seems to be the most appropriate approach to ascertain patient's involvement to the preferred level of participation. The categorization of patients as preferring a passive role, collaborative role or active role is seen as valuable information for Registered Nurses to tailor nursing care.
Predictors of care‐giver stress in families of preschool‐aged children with developmental disabilities
Authors: Plant K. M. , Sanders M. R.
Published: October 2006

Background  This study examined the predictors, mediators and moderators of parent stress in families of preschool‐aged children with developmental disability.

Method  One hundred and five mothers of preschool‐aged children with developmental disability completed assessment measures addressing the key variables.

Results  Analyses demonstrated that the difficulty parents experienced in completing specific care‐ giving tasks, behaviour problems during these care‐giving tasks, and level of child disability, respectively, were significant predictors of level of parent stress. In addition, parents’ cognitive appraisal of care‐giving responsibilities had a mediating effect on the relationship between the child’s level of disability and parent stress. Mothers’ level of social support had a moderating effect on the relationship between key independent variables and level of parent stress.

Conclusions  Difficulty of care‐giving tasks, difficult child behaviour during care‐giving tasks, and level of child disability are the primary factors which contribute to parent stress. Implications of these findings for future research and clinical practice are outlined.
Refugial isolation and secondary contact in the dyeing poison frog Dendrobates tinctorius
Authors: NOONAN BRICE P. , GAUCHER PHILIPPE
Published: October 2006

Recent palaeoclimactic research suggests that fluctuating environmental conditions throughout the Pleistocene of Amazonia occurred with previously unrecognized frequency. This has resulted in a theoretical shift from glacially influenced fluctuations to those driven by precessional rhythms. This theoretical revolution has a profound impact on expectations of biotic diversity within biogeographical regions that have long been based on the idea of large‐scale landscape fragmentation associated with increased aridity and glacial cycles. Generally speaking, this shifts phylogeographical expectations from that of (i) large areas of sympatry of closely related (but not sister) species whose origins lie in separate refugia, and current distributions are the results of cyclic connectivity of those two refugia (refuge hypothesis), to that of (ii) fine scale genetic structure, often associated with elevation, and divergence well below expected speciation levels [disturbance–vicariance (DV) hypothesis]. To date there have been few tests of the expectations of the DV hypothesis based on empirical studies of Neotropical floral and faunal communities. Herein we examine phylogeographical structure of Dendrobates tinctorius, an amphibian species endemic to the uplands of the eastern Guiana Shield, based on sampling of 114 individuals from 24 localities. Phylogenetic, nested clade, and dispersal–vicariance (DIVA) analyses of cytochrome b sequence data reveal the presence of two mitochondrial lineages that are associated with previously identified western and eastern uplands of this area. The geographical distribution of mitochondrial haplotypes and the results of DIVA and coalescent analyses suggest that there has been extensive secondary contact between these lineages indicating a complex history of connectivity between these western and eastern highlands, supporting the predictions of the DV hypothesis.
What should we weigh to estimate heterozygosity, alleles or loci?
Authors: APARICIO J. M. , ORTEGO J. , CORDERO P. J.
Published: October 2006

The interest to study the effects of inbreeding in natural populations has increased in the last years. Several microsatellite‐derived metrics have recently been developed to infer inbreeding from multilocus heterozygosity data without requiring detailed pedigrees that are difficult to obtain in open populations. Internal relatedness (IR) is currently the most widespread used index and its main attribute is that allele frequency is incorporated into the measure. However,IRunderestimates heterozygosity of individuals carrying rare alleles. For example, descendants of immigrants paired with natives (normally more outbred) bearing novel or rare alleles would be considered more homozygous than descendants of native parents. Thus, the analogy between homozygosity and inbreeding that generally is carried out would have no logic in those cases. We propose an alternative index, homozygosity by loci (HL) that avoids such problems by weighing the contribution of each locus to the homozygosity index depending on their allelic variability. Under a wide range of simulated scenarios, we found that our index (HL) correlated better than bothIRand uncorrected homozygosity (HO), measured as proportion of homozygous loci) with genome‐wide homozygosity and inbreeding coefficients in open populations. In these populations, which are likely to prevail in nature, the use ofHLinstead ofIRreduced considerably the sample sizes required to achieve a given statistical power. This is likely to have important consequences on the ability to detect heterozygosity fitness correlations assuming the relationship between genome‐wide heterozygosity and fitness traits.
Prevalence of IgG Antibody Against Measles, Mumps and Rubella in Bangladeshi Children: A Pilot Study to Evaluate the Need for Integrated Vaccination Strategy
Authors: Sultana R. , Rahman M. M. , Hassan Z. , Hassan M. S.
Published: October 2006

The present study was carried out to determine the seroprevalence of IgG antibodies in Bangladeshi children against measles (irrespective of vaccination status), mumps and rubella (MMR) to assess strategic need of combined vaccination for these diseases. A total of 456 children of 1 month to 15 years, were studied. Serum IgG antibodies against MMR were measured by enzyme‐linked immunosorbent assay (ELISA). By 3 months, protective IgG antibody level (>40 AU for measles and mumps and >15 IU/ml for rubella) for the diseases found to be between 50% and 80% among the studied children. Protective measles antibody (IgG) was not detected in all the children of 3–9 months and significant number of children between 9 months and 5 years were unprotected (87–65%; P < 0.001). Moreover, children of 3–15 months had no protective antibody level against mumps and significant number of children between 15 months and 5 years were unprotected (92–71%; P < 0.001). Between 5 and 15 years of age, significant number of children became protective (63–85%, P < 0.001). Although, a majority of children between 3 months and 5 years had shown to have no protective antibody against rubella (89–71%; P < 0.01–0.001) between >10 and 15 years 71% children had protective level of antibodies (P < 0.001). No significant difference was observed in antibody prevalence regarding socioeconomic classes, nutritional status and parental education. The data showed that: (i) a significant number of children remain unprotected against MMR in childhood and (ii) an extensive nationwide survey is required to suggest an integrated vaccination strategy in order to implement appropriate control measures of the three infectious diseases.
Sphingosine 1‐Phosphate Interferes on the Differentiation of Human Monocytes into Competent Dendritic Cells
Authors: Martino A. , Volpe E. , Auricchio G. , Izzi V. , Poccia F. , Mariani F. , Colizzi V. , Baldini P. M.
Published: October 2006

Sphingosine 1‐phosphate (S1P) is a lipidic messenger known to exert several physiological functions within the cell. We tested here whether the stimulation of human monocytes with different doses of S1P might interfere with their differentiation into competent dendritic cells (DC). Monocytes cultured with granulocyte macrophage colony stimulating factor, interleukin‐4 (IL‐4) and S1P differentiated into a DC population lacking CD1a molecules on the surface and acquired some aspects of mature DC (mDC), though in the absence of maturation stimuli. When stimulated with lipopolisaccharide (LPS), CD1a− DC produce high amounts of tumour necrosis factor‐α and IL‐10, but not IL‐12. Accordingly, these CD1a− DC were not capable of stimulating allogenic T lymphocytes so well as CD1a+ DC generated from untreated monocytes and maturated with LPS. S1P monocyte‐derived DC lost their polarizing capacity abrogating the production of γ‐interferon/IL‐4 by co‐cultured naïve CD4+CD45RA+ T cells. Our findings suggest a mechanism through which S1P can favour the development of immune‐related pathological states.
Polymyositis – An unusual presentation of cGvHD in children
Authors: Klein R. , Franck P. , Ehl S. , Schmitt‐Graeff A. , Duffner U. , Niemeyer C. M.
Published: October 2006

Abstract:  Polymyositis is a rare manifestation of cGvHD in adult patients following allogeneic BMT. Here, we report on a 2.1‐yr‐old girl who presented with a facial swelling and rapidly developing respiratory failure eight months after BMT for severe combined immunodeficiency. Possible infectious agents and autoimmune origin other than cGvHD were excluded. The girl responded promptly to steroid therapy and remains well without other signs of cGvHD four months later.