bluuebunny/crossref_metadata_2025 huggingface dataset:
Cystic phaeochromocytoma is a distinctive subgroup with special clinical, imaging and histological features that might mislead the diagnosis
Authors: Andreoni Cassio , Krebs Rodrigo K. , Bruna Paulo C. , Goldman Suzan M. , Kater Claudio E. , Alves Maria T.S. , Ortiz Valdemar
Published: September 2008

OBJECTIVE

To report and analyse cases of cyctic phaeochromocytoma at our institution and in previous publications, as adrenal cystic masses are usually associated with nonfunctional lesions, but they can be phaeochromocytoma.

PATIENTS AND METHODS

The prospective adrenalectomy database at our institution was reviewed to identify patients with phaeochromocytoma and cystic lesions. The clinical, radiological and histological features of cystic phaeochromocytoma were evaluated. Other previously published data were identified and compared with the present series.

RESULTS

In all, there were 107 adrenalectomies at our institution from November 2000 to March 2007; 31 of these patients had a confirmed diagnosis of phaeochromocytoma and six (19%) were cystic phaeochromocytomas. Three of the six cases were asymptomatic and had a negative biochemical evaluation (one male and five females, mean tumour size 6.6 cm); the imaging diagnosis was mainly based on computed tomography and magnetic resonance imaging, and the foremost feature was the enhancement of the tumour rim associated with a central cystic mass. Nine other previously published cases were reviewed.

CONCLUSIONS

From the present large series and previous anecdotally reported cases, patients with cystic phaeochromocytomas are more likely to be asymptomatic, to complain of chronic abdominal pain, and to have a negative biochemical evaluation, which might deter physicians from conducting a full evaluation for phaeochromocytoma and mislead the final diagnosis. As such, there could be an even higher prevalence of this entity that is yet to be determined.
High‐level expression of human immunodeficiency virus antigens from the tobacco and tomato plastid genomes
Authors: Zhou Fei , Badillo‐Corona Jesus A. , Karcher Daniel , Gonzalez‐Rabade Nuria , Piepenburg Katrin , Borchers A.‐M. Inka , Maloney Alan P. , Kavanagh Tony A. , Gray John C. , Bock Ralph
Published: September 2008

Transgene expression from the plant's plastid genome represents a promising strategy in molecular farming because of the plastid's potential to accumulate foreign proteins to high levels and the increased biosafety provided by the maternal mode of organelle inheritance. In this article, we explore the potential of transplastomic plants to produce human immunodeficiency virus (HIV) antigens as potential components of an acquired immunodeficiency syndrome (AIDS) vaccine. It is shown that the HIV antigens p24 (the major target of T‐cell‐mediated immune responses in HIV‐positive individuals) and Nef can be expressed to high levels in plastids of tobacco, a non‐food crop, and tomato, a food crop with an edible fruit. Optimized p24‐Nef fusion gene cassettes trigger antigen protein accumulation to up to approximately 40% of the plant's total protein, demonstrating the great potential of transgenic plastids to produce AIDS vaccine components at low cost and high yield.
Bouwsma on Wittgenstein's Philosophical Method
Authors: Cook John W.
Published: September 2008

It is argued that Wittgenstein was a greatly misunderstood philosopher, both as regards his own philosophical views and his ideas about philosophical method. O. K. Bouwsma's interpretation of Wittgenstein is used to illustrate the most common misunderstandings.
The Standard Metre in Paris
Authors: Avital Doron
Published: September 2008

In Philosophical Investigations, Wittgenstein argues that we can neither say of the standard One Metre in Paris that it is a single metred length, nor that it is not. Kripke's reply to the puzzle is well known: the sentence expressing the assertion that the standard One Metre is one metre in length (at time t0) is a true, a priori and contingent sentence. In this paper, I would like to show the nature of the intuition that runs behind Kripke's reply to the puzzle, and why, in the final analysis, it is not satisfactory, with respect to the point made by Wittgenstein. In addition, I will show that the case of the One Metre in Paris exemplifies the radical break Wittgenstein makes with traditional concepts of meaning. I then draw a general lesson that shows that the structure of concepts and functions (measures) in Wittgenstein is given by the idea of an arbitrary choice of “an object of comparison.” Concepts and functions (measures) are materialised and internalised in the form of objects that are arbitrarily sampled from a sample space of same logical‐type objects.
Assessment of self‐conscious emotions: A Swedish psychometric and structure evaluation of the Test of Self‐Conscious Affect (TOSCA)
Authors: STRÖMSTEN LOTTA M. J. , HENNINGSSON MIKAEL , HOLM ULLA , SUNDBOM ELISABET
Published: September 2008

The Test of Self‐Conscious Affect (TOSCA) is a well‐established scenario‐based questionnaire assessing self‐conscious emotions, such as shame and guilt, which have been shown to be differentially associated with a variety of functional, motivational, behavioral and health outcomes. The aim of this study was to evaluate the psychometric properties and internal structure of a Swedish version of TOSCA in a sample of 361 healthy adults. The psychometric properties and internal consistency of the Swedish version were at level with the original US TOSCA version for shame, guilt and detachment. The internal structure of the Swedish version was acceptable for shame, guilt and detachment but contained shortcomings in assessment of externalization.
Negative affect and 24‐hour ambulatory physiological recordings as predictors of spontaneous improvement of medically unexplained symptoms
Authors: HOUTVEEN JAN H. , VAN DOORNEN LORENZ J. P.
Published: September 2008

The predictive value for spontaneous improvement in individuals suffering from medically unexplained symptoms (MUS) was explored of (1) anxiety and depression obtained from questionnaires, (2) negative affective states obtained from experience‐sampling, and (3) ambulatory‐assessed real‐life physiological recordings. Sixty‐seven individuals with MUS and 61 healthy controls were included. Twenty‐four hour ambulatory recordings of cardiac autonomic activity, respiration, end‐tidal CO2 and saliva cortisol were combined with experience‐sampling of somatic complaints and mood. Complaints were assessed again after one year. Although a reduction in symptoms (25%) was found, this could not be predicted from initial anxiety and depression. Improvement was somewhat related to relatively low diary reports of fatigue, especially in the late‐afternoon and evening (3% variance explained). From the physiological measures only relatively high PetCO2 values in the morning predicted improvement (5% explained). It was concluded that spontaneous recovery from MUS is hard to predict from self‐reported distress and ambulatory physiological recordings.
The impact of poverty and immigrant background on children's school satisfaction: evidence from Norway
Authors: Grødem Anne Skevik
Published: September 2008

Children's school enjoyment and satisfaction with their teachers is crucial to their quality of life. Still, we have little knowledge about what shapes positive outcomes in this respect, and to what extent groups of children and youth differ from each other. This article compares immigrant children with Norwegian children from low‐income families and with a reference group of children from normal‐income families. The children were interviewed at age 10–12 years, and again at age 13–15 years; thus, we can follow changes over time. Immigrant children from income‐poor families express significantly higher school and teacher satisfaction than any other category of 10–12‐year‐olds. However, for the 13–15‐year‐olds, there are no systematic differences between group averages, but there are more signs of polarisation among low‐income immigrant children. Explanations for these patterns are sought in the literature on social capital in immigrant families.
Building assets from birth: a global comparison of Child Development Account policies
Authors: Loke Vernon , Sherraden Michael
Published: September 2008

Asset building is a growing theme in public policy, and building assets from birth in the form of Child Development Accounts is now occurring in several countries. This article provides an overview of the Child Development Account policies in Singapore, Canada, the UK and Korea, and the proposed policy in the USA. The key elements of inclusiveness, progressivity, coherence and integration, and development are explicated and discussed.
The welfare state, the individual and the need for care: older people's views
Authors: Gunnarsson Evy
Published: September 2008

The aim of this qualitative study was to study how older people experience aging and reflect on their need for care in the Swedish welfare context. Sixteen people were interviewed, aged between 77 and 92 years. Staying healthy and independent in their everyday lives were prized values for the informants. Some brushed aside thoughts of being in need of home help services in the future and others had a more reflecting attitude. The informants did not want to burden either society or their children. Through mass media and the experiences of their neighbours, they had gained a negative impression of eldercare. They were uncertain if there would be any helping hand of good quality in the future. On the other hand, informants who already had home help thought that it was helping them to maintain independence in everyday life and they were also satisfied with the help they received.
What Happens to New-Onset Headache Presented to Primary Care? A Case-Cohort Study Using Electronic Primary Care Records
Authors: Kernick D , Stapley S , Goadsby PJ , Hamilton W
Published: September 2008

In the UK, 4± of general practitioner consultations are for headache, yet the natural history of these presentations is unknown. The objective of this study was to describe the outcome of new headache presentations to the general practitioner. This was a prospective case-control study in adults over a period of 1 year using data from the General Practitioner Research Database, UK. Records of patients who presented with primary headache (migraine, tension-type headache, cluster headache) or undifferentiated headache (no further descriptor) were examined for the subsequent year for subarachnoid haemorrhage, primary brain tumour, benign space-occupying lesion, temporal arteritis, stroke and transient ischaemic attack. We identified 21 758 primary headaches and 63 921 undifferentiated headaches. The likelihood ratio was 29 (9.9, 92) for a subarachnoid haemorrhage after an undifferentiated headache and increased with age. The 1-year risk of a malignant brain tumour with new undifferentiated headache was 0.15±, rising to 0.28± above the age of 50 years. For primary headache the risk was 0.045±. The risk for a benign space-occupying lesion was 0.05± for an undifferentiated and 0.009± for a primary headache. The risk of temporal arteritis was the highest of the conditions studied, 0.66± in the undifferentiated and 0.18± in the primary headache group. Accepting the limitations of this approach, our data can inform management guidelines for new presentations of headache in primary care and confirm the need for follow-up, even if a primary headache diagnosis is made.
Antiepileptic Drugs on Calcium Currents Recorded from Cortical and PAG Neurons: Therapeutic Implications for Migraine
Authors: Martella G , Costa C , Pisani A , Cupini LM , Bernardi G , Calabresi P
Published: September 2008

Cortex and periaqueductal grey (PAG) play a major role in the pathophysiology of migraine. Some antiepileptic drugs (AEDs) influence the activity of these structures by modulating high-voltage-activated (HVA) Ca2+ channels and are effective in migraine prevention. The aim of the present study was to investigate the expression of total HVA Ca2+ channels in cortical and PAG neurons and to study the differential action of AEDs on these channels. Isolated neurons were visually identified based on morphological criteria. HVA currents were recorded by whole-cell patch-clamp technique. The distribution ratio of L-, N-, P-, Q- and R-type HVA Ca2+ channels was different between cortical and PAG neurons. In particular, we found that P- and Q-type HVA Ca2+ channels were more expressed in PAG neurons than in cortical cells, whereas L- and R-type HVA Ca2+ channels showed an opposite distribution. Interestingly, N-type HVA Ca2+ channels were equally distributed in these two neuronal populations. A differential sensitivity to AEDs of HVA Ca2+ channels located on cortical and PAG neurons was observed for topiramate (TPM), but not for lamotrigine (LTG) or levetiracetam (LEV). In fact, whereas both LTG and LEV were equally effective and potent in inhibiting HVA Ca2+ currents in the two neuronal populations, TPM showed a much higher potency and efficacy in blocking these currents in PAG neurons than in cortical pyramidal cells. TPM, in fact, inhibited N-, P- and L-type channels in PAG neurons, whereas in cortical neurons this AED modulated only P- and L-type channels. Unlike the other AEDs investigated, valproic acid did not affect HVA Ca2+ currents in cortical and PAG neurons. The negative modulation of specific subtypes of HVA Ca2+ channels by various AEDs can restore normal electrical activity in target brain areas such as cortex and PAG, providing interesting therapeutic approaches in migraine prevention.
The Link Between Pain Patient and Analgesic Medication is Greater in Migraine than in Rheumatic Disease Patients
Authors: Ferrari A , Leone S , Tacchi R , Ferri C , Gallesi D , Giuggioli D , Bertolini A
Published: September 2008

Our aim was to measure and compare the link between pain patients and the different kinds of analgesic medications they use by the Leeds Dependence Questionnaire (LDQ). This is a self-completion 10-item instrument to measure the severity of dependence upon a variety of substances. LDQ was administered to 200 episodic migraine patients (EM group), 77 chronic migraine patients (CM group) overusing acute medications, and 114 patients suffering from rheumatic disease (RD group), consecutively attending the Headache Centre or the Rheumatology Clinic of the University Hospital of Modena in the course of the first semester of 2007. The link with analgesics was greater in migraine patients than in patients with rheumatic disease, since the LDQ total score was significantly higher in the EM (6.65 ± 0.32, P < 0.005) and CM groups (9.61 ± 0.59, P < 0.0001) than in the RD group (5.17 ± 0.37) (Kruskal–Wallis and Mann–Whitney U-tests). Migraine patients were significantly more linked to triptans and to combined medications than to non-steroidal anti-inflammatory drugs. The strength of the link between migraine patients and the analgesic medications they take could represent a factor of vulnerability: overusing these medications could develop medication overuse headache.
A neurobiological model for the effects of early brainstem functioning on the development of behavior and emotion regulation in infants: implications for prenatal and perinatal risk
Authors: Geva Ronny , Feldman Ruth
Published: September 2008

Neurobiological models propose an evolutionary, vertical‐integrative perspective on emotion and behavior regulation, which postulates that regulatory functions are processed along three core brain systems: the brainstem, limbic, and cortical systems. To date, few developmental studies applied these models to research on prenatal and perinatal risk. We propose a conceptual model that incorporates three integrated levels of observations for the study of early risk: (a) brainstem‐related physiological regulation of cyclic processes and sensory integration, e.g., vagal regulation, circadian rhythms; (b) emotion and attention regulation capacities that draw on the integration of brainstem and limbic systems; and (c) higher‐level outcomes that draw on the intactness of brainstem and limbic networks, including socio‐emotional self‐regulation, inhibitory control, and cognitive processing. We discuss implications of the model for the development of regulatory capacities during the prenatal and early postnatal stages in infants born with specific perinatal risk. We underscore the importance of assessing sub‐cortical and brainstem systems and the longitudinal effects of transitory brainstem dysfunction on physiological homeostasis, motivation, arousal‐modulated attention, stress reactivity, and mother‐infant co‐regulation. The assessment of brainstem dysfunction can be conducted during hospitalization and may help detect infants at risk for the development of self‐regulatory deficits at the first weeks of life.
Ancient woodlands: modern threats
Authors: Rackham Oliver
Published: September 2008

Contents

Summary
571

I.
Introduction
572

II.
What is meant by threats?
573

III.
Destruction and fragmentation
573

IV.
Depletion
574

V.
Pollution and eutrophication
574

VI.
Fire and lack of fire
575

VII.
Excessive shade
575

VIII.
Excessive numbers of deer and other ungulates
576

IX.
Invasive species
577

X.
Infilling of savanna
578

XI.
Climate change
578

XII.
Globalization of plant diseases
580

XIII.
Interactions
581

XIV.
Importance of different threats
581

XV.
Conclusions
582

Acknowledgements
583

References
583
Investments in agricultural water management for poverty reduction in Africa: Case studies of Limpopo, Nile, and Volta river basins
Authors: Hanjra Munir A. , Gichuki Francis
Published: September 2008

Much of Sub‐Saharan Africa is burdened with water scarcity and poverty. Continentally, less than four percent of Africa's renewable water resources are withdrawn for agriculture and other uses. Investments in agricultural water management can contribute in several ways to achieving the Millennium Development Goals of eradicating extreme poverty and hunger and ensuring environmental sustainability. Increased yield and cropping area and shifts to higher valued crops could help boost the income of rural households, generate more employment, and lower consumer food prices. These investments can also stabilize output, income and employment, and have favourable impacts on education, nutrition and health, and social equity. Investments in agricultural water management can cut poverty by uplifting the entitlements and transforming the opportunity structure for the poor. The overall role of investments in agricultural water management in eradicating hunger and poverty is analyzed. This paper contributes to the present debate and efforts to identify strategies and interventions that can effectively contribute to poverty reduction in Africa. It provides an overview of population growth, malnutrition, income distribution and poverty for countries in three case study river basins — Limpopo, Nile, and Volta. With discussions on the contribution of agriculture to national income and employment generation, the paper explores the linkages among water resources investments, agricultural growth, employment, and poverty alleviation. It examines the potential for expansion in irrigation for vertical and horizontal growth in agricultural productivity, via gains in yield and cropping area to boost the agricultural output. Factors constraining such potential, in terms of scarcity and degradation of land and water resources, and poor governance and weak institutions, are also outlined. The paper argues that increased investments in land and water resources and related rural infrastructure are a key pathway to enhance agricultural productivity and to catalyze agricultural and economic growth for effective poverty alleviation.
Water management in the world of globalization
Authors: Orlóci István , Szesztay Károly
Published: September 2008

Water management is changing its paradigm. The millennia of economic indoctrination are to be replaced by the logic of ecology. The economic sector satisfying the demands for water and water‐related services guided until now by its own ideology and institutions, is gradually becoming an integral part of environmental protection and eco‐economy.

Within the great diversity of national water policies, efforts towards sustainability are a dominant common objective. Discussions of the World Water Fora and other initiatives indicate that ecologically oriented water management is the emerging new challenge for achieving this objective. Ecological orientation emphasizes the unified system of the world water balance processes as transmitters of various human impacts leading to economic externalities.

Water management is becoming a component of the processes of globalization primarily through its externalities requiring a comprehensive informational infrastructure as well as adequate institutional competence for their management. The paper analyzes fundamental features of the conceptual models incorporating such informational and institutional arrangements.

The outlook of water is inseparably tied to the world order of the future, and water management in the world of globalization can either promote a genuine worldwide collaboration or can become a source of dangerous international tensions and conflicts.
Re‐thinking water scarcity: Can science and technology solve the global water crisis?
Authors: Lopez‐Gunn Elena , Ramón Llamas Manuel
Published: September 2008

This paper provides examples from the last fifty years of scientific and technological innovations that provide relatively easy, quick and affordable means of addressing key water management issues. Scientific knowledge and technological innovation can help open up previously closed decision‐making systems. Four of these tools are discussed in this paper: a) the opportunities afforded by virtual water trade; b) the silent revolution for beneficial use of groundwater; c) salt water desalination; and finally, d) the use of remote sensing and geographic information systems (GIS). Together these advances are changing the options available to address water and food security that have been predominant for centuries in the minds of most water decision‐makers.
Dryland characteristics and its optimized eco‐productive paradigms for sustainable development in China
Authors: Yang Xiaohui , Ci Longjun , Zhang Xinshi
Published: September 2008

Dryland area occupies 37% of the national territory in China. Desertification and other disasters have limited dryland sustainable development. Here we overview the dryland characteristics and desertification status and introduce four regionally optimized eco‐productive paradigms for dryland sustainable development, i.e., the mountain‐oasis paradigm in arid desert; the small watershed‐based paradigm on the Loess Plateau; the integrated animal husbandry paradigm on the Inner Mongolia Steppe and the agro‐pastoral transitional region; and three circle paradigm on the Ordos Plateau. These paradigms are established on the basis of regional landscape patterns and their underlying material and energy flow rules, and different functional belts are determined and capitalized upon with the integrated consideration of regional biogeophysical processes, biogeochemical cycles and biogeosocial relations. These paradigms cannot cover all complex landscape types, but provide theoretical frameworks and practicable models for dryland sustainable development in China.
Inhibition of Calcitonin Gene‐Related Peptide Function: A Promising Strategy for Treating Migraine
Authors: Durham Paul L.
Published: September 2008

The neuropeptide calcitonin gene‐related peptide (CGRP) is implicated in the underlying pathology of migraine. Serum levels of CGRP, which are elevated during a migraine attack, have been reported to return to normal with alleviation of pain. In addition, CGRP administration has been shown to cause a migraine‐like headache in susceptible individuals. Importantly, CGRP receptors are found on many cell types within the trigeminovascular system that are thought to play important roles in controlling inflammatory and nociceptive processes. Based on these findings, it was proposed that blockage of CGRP receptor function and, hence, the physiological effects of CGRP would be effective in aborting a migraine attack. This review will summarize key preclinical data that support the therapeutic potential of using CGRP receptor antagonists or molecules that bind CGRP within the context of current neurovascular theories on migraine pathology.
Acute Migraine Medications and Evolution From Episodic to Chronic Migraine: A Longitudinal Population‐Based Study
Authors: Bigal Marcelo E. , Serrano Daniel , Buse Dawn , Scher Ann , Stewart Walter F. , Lipton Richard B.
Published: September 2008

Background.— Though symptomatic medication overuse is believed to play a major role in progression from episodic to chronic or transformed migraine (TM), population‐based longitudinal data on these agents are limited.

Objectives.— To assess the role of specific classes of acute medications in the development of TM in episodic migraine (EM) sufferers after adjusting for other risk factors for headache progression.

Methods.— As a part of the American Migraine Prevalence and Prevention study (AMPP), we initially surveyed a population sample of 120,000 individuals to identify a sample of migraineurs to be followed annually over 5 years. Using logistic and linear regression, we modeled the probability of transition from EM in 2005 to TM in 2006 in relation to medication use status at baseline. Adjustments were made for gender, headache frequency and severity, and prevention medication use.

Results.— Of 8219 individuals with EM in 2005, 209 (2.5%) had developed TM by 2006. Baseline headache frequency was a risk factor for TM. Using acetaminophen user as the reference group, individuals who used medications containing barbiturates (OR = 2.06, 95%CI = 1.3‐3.1) or opiates (OR = 1.98, 95%CI = 1.4‐2.2) were at increased risk of TM. A dose–response relationship was found for use of barbiturates. Use of triptans (OR = 1.25, 95%CI = 0.9‐1.7) at baseline was not associated with prospective risk of TM. Overall, NSAIDs (OR = 0.85, 95%CI = 0.63‐1.17) were not associated with TM. Indeed, NSAIDs were protective against transition to TM at low to moderate monthly headache days, but were associated with increased risk of transition to TM at high levels of monthly headache days.

Conclusion.— EM sufferers develop TM at the rate of 2.5% per year. Any use of barbiturates and opiates was associated with increased risk of TM after adjusting for covariates, while triptans were not. NSAIDs were protective or inducers depending on the headache frequency.
“The Tree Is the Enemy Soldier”: A Sociolegal Making of War Landscapes in the Occupied West Bank
Authors: Braverman Irus
Published: September 2008

War landscapes have a particular sociology; they are also formed through distinct legal technologies. By examining the genealogy of trees as totemic displacements in the occupied West Bank I demonstrate how the Israeli/Palestinian war is deflected onto the landscape and how this deflection erodes the boundary between law and war. Dealing with issues of colonization, nationalization, and the way that these implicate landscape as a “natural alibi,” the article examines the intricate making of politics into nature. Further, it explores the ironic nesting of colonial processes from Ottoman, to British, to Zionist, and finally to the new Jewish settler society that seeks to unsettle the old colonial landscapes of this place. Utilizing a detailed interpretation of a range of interviews and participatory observations, the article unpacks the mutually constitutive relationship between law, technologies of seeing, and landscape, illustrating how this relationship is played out by various actors in the occupied West Bank.
Judging Bias: Juror Confidence and Judicial Rulings on Challenges for Cause
Authors: Rose Mary R. , Diamond Shari Seidman
Published: September 2008

The judge in a jury trial is charged with excusing prospective jurors who will not be impartial. To assess impartiality, prospective jurors are typically asked whether they can be fair. Using an experimental paradigm, we found that small changes in jurors' self-reported confidence in their ability to be fair affected judges' decisions about bias but did not affect the judgments of either attorneys or jurors. We suggest why a judge's role and unique relationship with jurors is likely to foster a decision strategy based on reported juror confidence, and we discuss the implications of our analysis for current legal debates over jury selection practices. Unexpected patterns in our results also highlight the ways in which perceptions of impartiality are affected, in part, by the social characteristics of the observer.
“What Rights?” The Construction of Political Claims to American Health Care Entitlements
Authors: Levitsky Sandra R.
Published: September 2008

Despite a growing health care crisis, Americans remain reluctant to treat “health security” as a right or entitlement of citizenship. This article examines the effects of unmet health care needs on the beliefs that individuals hold about family, market, and state responsibility for health security. Drawing on a study of individuals caring for family members with chronic diseases, I find that when imagining solutions to unmet long-term care needs, individuals evaluate a range of alternative social arrangements, but they select the model that is most consistent with previously existing beliefs about family, market, and state responsibility for care provision. This process of discursive assimilation, of integrating new needs for public provision with more familiar ways of thinking about social welfare, produces claims for entitlements that challenge existing social arrangements but do so within a welfare state framework that conceives of only a minimal role for the state in safeguarding social welfare.
How Law Rules: Torture, Terror, and the Normative Judgments of Iraqi Judges
Authors: Hagan John , Ferrales Gabrielle , Jasso Guillermina
Published: September 2008

We present a factorial survey experiment conducted with Iraqi judges during the early military occupation of Iraq. Because U.S. soldiers are immune from prosecution in Iraqi courts, there is no opportunity for these judges to express their views regarding highly publicized torture cases. As legally informed representatives of an occupied nation, however, Iraqi judges arguably have a strong claim to a normative voice on this sensitive subject. We are able to give voice to these judges in this study by using a quasi-experimental method. This method diminishes social desirability bias in judges' responses and allows us to consider a broad range and combination of factors influencing their normative judgments. We examine why and how the U.S. effort to introduce democracy with an indeterminate rule of law produced unintended and inconsistent results in the normative judgments of Iraqi judges. A critical legal perspective anticipates the influences of indeterminacy, power, and fear in our research. More specifically, we anticipated lenient treatment for guards convicted of torture, especially in trouble cases of Coalition soldiers torturing al Qaeda prisoners. However, the results—which include cross-level, judge-case interaction effects—were more varied than theoretically expected. The Iraqi judges responded in disparate and polarized ways. Some judges imposed more severe sentences on Coalition guards convicted of torturing al Qaeda suspects, while others imposed more lenient sentences on the same combination of guards and suspects. The cross-level interactions indicate that the judges who severely sentenced Coalition guards likely feared the contribution of torture tactics to increasing violence in Iraq. The judges who were less fearful of violence were more lenient and accommodating of torture by Coalition forces. The implication is that the less fearful judges were freed by an indeterminate law to advance Coalition goals through lenient punishment of torture. Our analysis suggests that the introduction of democracy and the rule of law in Iraq is a negative case in the international diffusion of American institutions. The results indicate the need for further development of a nuanced critical legal perspective.
CA 125 Tumoral Marker Plasma Levels Relate to Systolic and Diastolic Ventricular Function and to the Clinical Status of Patients with Chronic Heart Failure
Authors: Vizzardi Enrico , Nodari Savina , D'Aloia Antonio , Chiari Ermanna , Faggiano Pompilio , Metra Marco , Dei Cas Livio
Published: September 2008

Plasma levels of the tumoral carbohydrate 125 antigen marker (CA 125) have been found elevated in patients with heart failure. We measured the plasma levels of CA 125 and other tumoral markers in a group of patients with chronic heart failure and we found a correlation between the serum levels with some left ventricular parameters calculated with transthoracic echocardiography (ETT). We studied 200 patients, 159 males and 41 females, suffering from idiopathic or ischemic cardiomyopathy, 126 of them in NYHA class II, 39 in class III, and 35 in NYHA class IV. CA 125 levels were correlated with Doppler mitral flow E‐wave, E/A ratio, deceleration time (DT), isovolumetric relaxation time (IVRT), and myocardial performance index (MPI) (r = 0.38, 0.35, –0.46, –0.48, and 0.35, respectively, all with P < 0.05). Multiple regression analysis found the following parameters to be independently correlated to CA 125: long‐ and short‐axis diameter, MPI, IVRT, and E/A. Plasma CA 125 levels were raised in patients with chronic heart failure and were related to clinical condition and to diastolic and systolic function parameters of the left ventricle. CA 125 could be used as an additional, noninvasive, easily determinable, and low‐cost marker of the clinical condition of patients affected by heart failure.
Diagnostic Accuracy of Doppler Echocardiography for Determining Left Ventricular Diastolic Pressure Elevation: Prospective Comparison to Chest Radiography, Serum B‐Type Natriuretic Peptide, and Chest Auscultation
Authors: Spevack Daniel M. , Bowers James , Banerjee Anita , Talreja Ashok , Altman Erik J. , Friedman Mark A. , Bloom Michelle , Malhotra Divya , Goldberg Ythan , Patel Kavita , Spindola‐Franco Hugo
Published: September 2008

Background: Doppler echocardiography (DE), chest radiography (CXR), serum B‐type natriuretic peptide (BNP) measurement and physical examination are all commonly employed to estimate left ventricular diastolic pressure (LVDP) in clinical care. There are no published studies directly comparing the diagnostic accuracy of these tests. Methods and Results: DE, BNP, CXR, and physical examination were performed on 56 consecutive patients immediately following clinically indicated cardiac catheterization with measurement of LVDP. LVDP measured preceding atrial contraction at end‐expiration was elevated (>16 mmHg) in 19 subjects. Diagnostic accuracies were 79%, 70%, 61% for DE, BNP, and CXR, respectively. None of the study subjects had evidence of raised LVDP by chest auscultation. Conclusions: The diagnostic accuracy of DE compares favorably to other noninvasive markers for prediction of invasively determined LVDP.
Evaluation of the Left Ventricular Diastolic Function Using Three‐Dimensional Echocardiography
Authors: Tashiro Hideki , Aoki Takiko , Sadamatsu Kenji , Ooe Kensuke , Yamawaki Tohru , Sagara Shuichirou
Published: September 2008

The aim of this study was to evaluate the left ventricular (LV) diastolic function parameter calculated using three‐dimensional (3D) echocardiography. Method: Using 3D echocardiography and an analysis software program, the left ventricular volume through the cardiac cycle was measured automatically. We therefore calculated 25%, 50%, and 75% of the subtraction end‐systolic volume (ESV) from the end‐diastolic volume (EDV). The period that the left ventricular volume reached those volumes was calculated from the ESV. Those periods divided all diastolic periods and those calculated values were named D1/4, D1/2, and D3/4, respectively. The peak‐filling rate and 1/3 filling fraction (FF) were calculated. E/A, mitral annulus velocities (E′), E/E′, ejection fraction (EF), and left ventricular end‐diastolic pressure (LVEDP) were also measured. Results: E/A significantly correlated with D3/4. E/E′significantly correlated with the D1/4, D1/2, and 1/3 filling fraction. E′had a significantly negative correlation with the D1/4, D1/2, D3/4, and 1/3 FF. DT significantly correlated with D1/4, D1/2, D3/4, 1/3 FF, and the mean filling rate and it had a significant negative correlation with the 1/3 filling fraction. EF showed a significant positive correlation with the peak filling ratio. LVEDP demonstrated a significant correlation with D1/4 and D1/2. Conclusion: This study suggests that the LV diastolic indexes as determined by 3D echocardiography provide useful information in the clinical assessment of the diastolic LV function.
The Correlation of Left Atrial Volume Index to the Level of N‐Terminal Pro‐BNP in Heart Failure with a Preserved Ejection Fraction
Authors: Kim Hyungseop , Jun Dong‐Whan , Cho Yun‐Kyeong , Nam Chang‐Wook , Han Seong‐Wook , Hur Seung‐Ho , Kim Yoon‐Nyun , Kim Kwon‐Bae
Published: September 2008

Background: Patients with heart failure with a preserved ejection fraction (HFPEF) have high N‐terminal pro‐B‐type natriuretic peptide (NT‐pro‐BNP) level and a high ratio of early transmitral inflow to diastolic velocity of the mitral annulus (E/E′) derived from tissue Doppler imaging (TDI). Because left atrial volume indexed to body surface area (LAVI) is believed to reflect chronic diastolic dysfunction, we assessed the ability of LAVI and E/E′ ratio to predict NT‐pro‐BNP level in patients with HFPEF. Methods: One hundred forty‐eight patients with HFPEF (ejection fraction ≥ 50%, NT‐pro‐BNP ≥ 100 pg/ml) underwent conventional echocardiography including LAVI and E/E′ ratio, which were compared with NT‐pro‐BNP level. Results: In the overall patient population, modest correlations were found between NT‐pro‐BNP level and peak systolic TDI (S′) (P = 0.009), LAVI (P = 0.009), and E/E′ ratio (P = 0.017). However, in patients with E/E′ ratio ≥13, LAVI was the most important predictor of NT‐pro‐BNP level (P < 0.001), whereas in those with E/E′ ratio <13 it was S′ (P < 0.001) in multivariate analysis. Conclusion: In patients with HFPEF evidenced by high NT‐pro‐BNP level, LAVI correlates with NT‐pro‐BNP level in the setting of elevated E/E′ ratio. However, in the setting of low E/E′ ratio, LAVI does not seem to be associated with NT‐pro‐BNP level.
Association of Coronary Sinus Diameter with Pulmonary Hypertension
Authors: Gunes Yilmaz , Guntekin Unal , Tuncer Mustafa , Kaya Yuksel , Akyol Aytac
Published: September 2008

Background: Impaired venous drainage secondary to increased right atrial pressure (RAP) may result in coronary sinus (CS) dilatation. Methods: Two hundred fifteen patients referred for transthoracic echocardiography were included in the study. CS diameters were measured from apical four‐chamber view with the transducer being slightly tilted posteriorly to the level of the dorsum of the heart. Pulmonary artery systolic pressure (PASP) is estimated by measurement of tricuspid regurgitation velocity (v) and estimate RAP based on size and collapsibility of inferior vena cava (VCI) with the formula PASP: 4v2+RAP. Patients with PASP >35 mmHg were considered to have pulmonary hypertension (PH). Results: CS diameter was measured in 80.3% of the patients with normal PASP (8.1 ± 2.4 mm) and 93.1% of the patients having PH (12.3 ± 2.5 mm). PASP was significantly correlated with CS diameter (r = 0.647, P < 0.001), RA volume index (r = 0.631, P < 0.001), RV volume index (r = 0.475, P < 0.001), VCI diameter (r = 0.365, P < 0.001), and left ventricular ejection fraction (LVEF) (r =–0.270, P < 0.001). CS diameter was also correlated significantly with estimated RAP (r = 0.557, P < 0.001), RA volume index (r = 0.520, P < 0.001), RV volume index (r = 0.386, P < 0.001), LVEF (r =–0.327, P < 0.001), and VCI diameter (r = 0.313, P < 0.001). Multivariate analyses, testing for independent predictive information of CS size, VCI diameter, RA and RV volume indexes, and estimated RAP for the presence of PH revealed that estimated RAP (beta = 0.465, P < 0.001) and CS size (beta = 0.402, P = 0.003) were the significant predictors. Conclusions: Coronary sinus is dilated in patients with pulmonary hypertension. Coronary sinus diameter significantly correlates with PASP, RAP, right heart chamber volumes, LVEF, and VCI diameter.
Use of the Monoplane Intracardiac Imaging Probe in High‐Risk Infants during Congenital Heart Surgery
Authors: Drinker Lisa R. , Camitta Michael G.W. , Herlong James Rene , Miller Stephen , Lodge Andrew J. , Jaggers James , Barker Piers C. A.
Published: September 2008

Imaging options are limited in high‐risk infants with small or abnormal oropharyngeal anatomy during congenital heart surgery. Methods: All cases in which the monoplane intracardiac echo probe was used for transesophageal intraoperative imaging over a 15‐month period at a single institution were reviewed. Results: Eleven patients underwent intraoperative imaging using the intracardiac probe. Patient weight ranged from 1.96 kg to 4 kg. Adequate images of the anatomy relevant to the surgical repair were obtained in all cases. No adverse events related to probe use occurred. Conclusion: Transesophageal echocardiography using the monoplane intracardiac echo probe provides safe and effective imaging in patients who are not candidates for standard transesophageal echocardiography.
Erroneous Diagnosis of Significant Obstruction by Doppler in a Patient with Discrete Subaortic Membrane: Correct Diagnosis by 3D‐Transthoracic Echocardiography
Authors: Bandarupalli Naveen , Faulkner Michael , Nanda Navin C. , Pothineni Koteswara R.
Published: September 2008

We report an adult with a discrete subaortic membrane in whom two‐dimensional transthoracic Doppler echocardiography demonstrated peak and mean gradients of 64 and 33 mmHg, respectively in the left ventricular outflow tract (LVOT) and a calculated orifice area by continuity equation of 1.14 cm2 consistent with significant obstruction. However, by direct en face visualization of the LVOT at the level of the membrane by live/real time three‐dimensional transthoracic echocardiography (3D TTE), a larger orifice measuring 2.29 cm2 was seen and was indicative of no significant obstruction. This finding was confirmed at cardiac catheterization, which showed insignificant obstruction.
The Impacts of Transcatheter Occlusion for Congenital Atrial Septal Defect on Atrial Volume, Function, and Synchronicity in Children: A Three‐Dimensional Echocardiography Study
Authors: Ma Xiao‐Jing , Huang Guo‐Ying , Liu Fang , Wu Lin , Sheng Feng , Tao Zi‐Yu
Published: September 2008

Objective: To evaluate the impacts of transcatheter closure for atrial septal defect (ASD) on the atria. Methods: Thirty‐four patients with ASD undergoing transcatheter occlusion were recruited in the study, and 34 patients undergoing surgical operation and 34 healthy children were age‐matched as controls. A real time three‐dimensional (RT3DE) echocardiography was used to measure the volume, function, and synchronicity of the atria. Results: There was no difference in the atrial volume and function between the transcatheter occlusion group and healthy control group (P > 0.05). However, the parameters reflecting the atrial asynchrony were larger in the transcatheter occlusion group (P < 0.05). Compared to the surgical repair group, the transcatheter occlusion group had smaller maximum volume of the left atrium (21.0 ± 5.2 ml/m2 vs 24.3 ± 5.8 ml/m2, P = 0.01), smaller total emptying volume of the left atrium (12.7 ± 4.3 ml/m2 vs 15.1 ± 3.8 ml/m2, P = 0.014), smaller total emptying volume of the right atrium (13.5 ± 5.2 ml/m2 vs 16.1 ± 4.7 ml/m2, P = 0.029), and larger atrial systolic asynchrony indices. Conclusions: An atrial asynchrony is observed in patients with transcatheter closure of ASD, although little negative impacts on the atrial volume and function are demonstrated, which deserves more attention during follow‐up of this specific population.
Effects of Continuous Positive Airway Pressure Therapy on Right Ventricular Function Assessment by Tissue Doppler Imaging in Patients with Obstructive Sleep Apnea Syndrome
Authors: Bayram Nihal Akar , Ciftci Bulent , Bayram Hüseyin , Keles Telat , Durmaz Tahir , Akcay Murat , Yeter Ekrem , Bozkurt Engin
Published: September 2008

Objectives: The effects of continuous positive airway pressure (CPAP) therapy on right ventricular (RV) function in patients with obstructive sleep apnea syndrome (OSAS) has not been previously studied by tissue Doppler imaging (TDI). The aim of this study was to assess RV function using TDI in patients with OSAS before and after CPAP therapy. Methods: Twenty‐eight patients with newly diagnosed OSAS in the absence of any confounding factors and 18 controls were included in this study. The peak systolic velocity (S′m), early (E′m) and late (A′m) diastolic myocardial peak velocities at tricuspid lateral annulus, isovolumic acceleration (IVA), myocardial precontraction time (PCT′m), myocardial contraction time (CT′m), and myocardial relaxation time (RT′m) were measured. All echocardiographic parameters were calculated 6 months after CPAP therapy. Results: The RV diastolic parameters such as E′m velocity and E′m‐to‐A′m ratio were significantly lower, RT′m was significantly prolonged, A′m velocity was similar in patients with OSAS compared to controls; and the RV systolic parameters such as IVA and CT′m were significantly lower and S′m was similar in patients with OSAS compared to controls. At the end of the treatment, 20 of 28 patients were compliant with CPAP therapy. E′m velocity, E′m‐to‐A′m ratio, IVA, and CT′m increased, PCT′m, PCT′m‐to‐CT′m ratio, and RT′m decreased significantly after therapy, whereas S′m velocity and A′m velocity did not change after CPAP treatment in the compliant patients. Conclusion: OSAS is associated with RV systolic and diastolic dysfunction, and 6 months of CPAP therapy improves the RV systolic and diastolic dysfunction.
Subaortic Stenosis Missed by Invasive Hemodynamic Assessment
Authors: Hage Fadi G. , Zoghbi Gilbert J. , Aqel Raed A. , Nanda Navin C.
Published: September 2008

We present a case of 61‐year‐old man that was evaluated for possible aortic stenosis but did not show a left ventricular outflow gradient on invasive assessment in the catheterization laboratory. Transthoracic echocardiography showed subaortic stenosis secondary to a discrete membranous structure in the left ventricular outflow tract. This is the first case in the literature of a patient with discrete subaortic stenosis missed by invasive hemodynamic assessment.
Mediastinal Plasmacytoma Detected by Echocardiography and Biopsied with EUS‐FNA
Authors: Mallo Rebecca , Gottlieb Klaus , Waggoner Douglas , Wittenkeller Jay
Published: September 2008

Mediastinal ultrasound is currently being performed by a variety of different practioners but all need to be familiar with major pathology outside their narrow fields. We are reporting the first case where echocardiography led to the discovery of a mediastinal mass which upon endoscopic‐ultrasound guided fine needle aspiration biopsy (EUS‐FNA) was found to be a plasmacytoma. The differential diagnosis of mediastinal masses is briefly reviewed.