bluuebunny/crossref_metadata_2025 huggingface dataset:
Antiepileptic Drug Withdrawal after Successful Surgery for Intractable Temporal Lobe Epilepsy
Authors: Kim Young Dae , Heo Kyoung , Park Soo Chul , Huh Kyoon , Chang Jin Woo , Choi Joong Uhn , Chung Sang Sup , Lee Byung In
Published: January 2005

Summary:  Purpose: To investigate the prognosis related to antiepileptic drug (AED) discontinuation after successful surgery for intractable temporal lobe epilepsy.

Methods: The clinical courses after temporal lobectomies (TLs) were retrospectively analyzed in 88 consecutive patients. All the patients had TLs as the only surgical procedure, and they had been followed up for longer than 3 years. AED discontinuation was attempted if the patient had been seizure free without aura for ≥1 year during the follow‐up period.

Results: Sixty‐six (75%) patients achieved complete seizure freedom for ≥1 year; 28 patients were seizure free immediately after surgery (immediate success); and 38 patients became seizure free after some period of recurrent seizures (delayed success). AED discontinuation was attempted in 60 (91%) of 66 patients with a successful outcome. In 13 (22%) patients, seizure relapse developed during AED reduction (n = 60), and in seven (12%) patients after discontinuation of AEDs (n = 38). The seizure recurrence rate was not different between the immediate‐ and delayed‐success groups. Among 20 patients with seizure relapse related to AED tapering, nine (45%) of them regained seizure freedom after reinstitution of AED treatment, and AEDs were eventually discontinued in six of them. Seizures that recurred after complete AED discontinuation had a better prognosis than did the seizures that recurred during AED reduction (seizure freedom in 86% vs. 23%). At the final assessment, 54 (61%) patients had been seizure free ≥1 year; 37 without AEDs and 17 with AEDs. The successful discontinuation of AEDs was more frequent for patients with a younger age at the time of surgery and for those patients with shorter disease duration.

Conclusions: Our results suggest that seizure freedom without aura at ≥1 year is a reasonable indication for the attempt at AED discontinuation. The subsequent control of recurrent seizures was excellent, especially if seizures relapsed after the complete discontinuation of AEDs. Younger age at the time of surgery and a shorter disease duration seem to affect successful AED discontinuation for a long‐term period.
Estimating Prevalence, Incidence, and Disease‐related Mortality for Patients with Epilepsy in Managed Care Organizations
Authors: Holden E. Wayne , Thanh Nguyen Hoang , Grossman Elizabeth , Robinson Scott , Nelson Leila S. , Gunter Margaret J. , Von Worley Ann , Thurman David J.
Published: January 2005

Summary:  Purpose. The purpose of the present study was to apply computer algorithms to an administrative data set to identify the prevalence of epilepsy, incidence of epilepsy, and epilepsy‐related mortality of patients in a managed care organization (MCO).

Methods. The study population consisted of members enrolled in Lovelace Health Plan, a component of Lovelace Health Systems, a statewide MCO headquartered in Albuquerque, New Mexico. Patient records were obtained from July 1996 to June 2001. Four logistic regression models with high sensitivity and specificity were applied to 1‐, 3‐, and 5‐year time frames in which members were continuously enrolled in the MCO. Incidence was defined for patients who did not have an epilepsy‐associated code in the 18 months before the first diagnosis entry. Mortality estimates in the population also were assessed by using a matched control group and linkage to a statewide death registry.

Results: The data yielded estimated prevalence rates of 7–10 per 1,000, depending on age, sex, ethnicity, and time interval. Annualized incidence was 47 per 100,000 for members continuously enrolled for 3 years and 71 per 100,000 for members continuously enrolled for 5 years. Crude mortality rates were 2–2.5 times higher for epilepsy patients identified with the algorithms than for the matched controls. Conditional logistic regression indicated that the odds of death for epilepsy patients as compared with controls ranged from 1.24 to 2.06.

Conclusions. Accurate estimation of prevalence, incidence, and mortality rates for epilepsy is an essential component of disease management in MCOs. The algorithms in this project can be used to monitor trends in prevalence, incidence, and mortality to inform decisions critical to improving the health care needs and quality of life for patients with epilepsy.
Rapid Onset of Action of Levetiracetam in Refractory Epilepsy Patients
Authors: French Jacqueline , Arrigo Celestina
Published: January 2005

Summary:  Purpose: To investigate whether rapid achievement of levetiracetam (LEV) steady state is translated into an immediate measurable efficacy. The time to onset of action of LEV immediately after its initiation in adult patients with refractory partial seizures was analyzed.

Methods: Treatment effect was assessed in a pooled analysis (n = 883) from three randomized, double‐blind, placebo‐controlled add‐on trials.

Results: The increase in the proportion of seizure‐free patients over baseline was 15, 17, and 17% for the first, second, and third day, respectively, for the LEV 1,000‐mg group (all differences statistically significant; McNemar p value <0.001), whereas the increase was 7, 9, and 9% for the 333‐mg LEV group (differences not significant). No major changes were observed for the placebo group. For differences in proportion of seizure‐free patients between groups, the probability of being seizure free in the LEV groups was twofold higher than in the placebo group. For the 1,000‐mg LEV group, odds ratios were 2.3, 2.5, and 2.7 for the first, second, and third day of therapy, respectively; all differences versus placebo were statistically significant (logistic regression p values, all <0.001). The addition of LEV significantly increased the proportion of patients without a seizure as of the first day of therapy. Each of the first 3 days, seizure freedom was twice as likely to occur with LEV 1,000 mg than with placebo.

Conclusions: Evidence of a rapid onset of action of LEV 1,000 mg was demonstrated through a significant increase in the proportion of seizure‐free patients as of the first day of therapy.
Computerized Tremor Analysis of Valproate‐induced Tremor: A Comparative Study of Controlled‐release versus Conventional Valproate
Authors: Rinnerthaler Martina , Luef Gerhard , Mueller Joerg , Seppi Klaus , Wissel Joerg , Trinka Eugen , Bauer Gerhard , Poewe Werner
Published: January 2005

Summary:  Purpose: Valproate (VPA) induces postural tremor in 6–45% of patients. The characteristics of VPA‐induced tremor have not yet been quantitatively assessed, and it is not known whether tremor prevalence or severity is affected by VPA formulation (controlled‐release CR‐VPA vs. conventional VPA). The aim of this study was quantitatively to assess tremor in epilepsy patients receiving VPA and to compare the effects of two VPA formulations (CR‐VPA vs. VPA) on tremor severity.

Methods: In a prospective study, 18 consecutive patients with newly diagnosed focal or generalized epilepsy were assigned to receive alternately either VPA (n = 10) or CR‐VPA (n = 8) monotherapy. Computerized tremor analysis was performed at baseline 1 day before initiating VPA treatment and repeated after a seizure‐free period of ≥8 weeks, during which VPA doses had remained stable. Rest and postural tremor were recorded by accelerometry, and surface electromyograms (EMGs) were recorded from the wrist flexors and extensors.

Results: At baseline, the two groups had similar postural tremor amplitudes. At follow‐up, the CR‐VPA group had remained at the same level, whereas VPA subjects exhibited a significant increase in tremor amplitudes (p < 0.05) despite comparable VPA doses and comparable plasma VPA concentrations at the time of tremor testing.

Conclusions: This is the first study to assess quantitatively VPA‐induced tremor by standardized tremor analysis. These results suggest that CR‐VPA may cause less tremorigenic activity as compared with standard VPA. The mechanisms underlying this difference are unclear but may include greater peak–trough variation with VPA than with CR‐VPA.
Recruitment of Families for Genetic Studies of Epilepsy
Authors: Ottman Ruth , Berenson Karina , Barker‐Cummings Christie
Published: January 2005

Summary:  Purpose: Study of families containing multiple affected individuals is essential for genetic research on the epilepsies, yet practically nothing has been published about methods for identification and recruitment of families or expected participation rates. Here we describe the strategy used for data collection in a genetic linkage study, to provide guidelines for efficient design of new studies.

Methods: Potentially eligible families were ascertained from private physicians, clinics, and self‐referrals. Participation rates were examined at each step of the recruitment process, according to ascertainment source, initial contact method, gender, and ethnicity.

Results: Among 320 potentially eligible families identified, only 68 (21%) were successfully enrolled. Contact was established with an index subject in 83% of families, and a screen for eligibility was completed in 88% of these. However, only 54% of screened families were confirmed to be eligible, and of these, only 54% were enrolled. In eligible families, 79% of index subjects agreed to participate; the low family enrollment rates resulted largely from refusals by other family members whose participation was needed for linkage analysis. At each step in the recruitment process, the participation rate was higher in self‐referred than in other families.

Conclusions: Recruitment of families for genetic studies is labor‐intensive; many potentially eligible families may have to be screened for each family enrolled. Recruitment is easier with self‐referred families than with those identified through other methods. The introduction of standardized methods for identification of eligible families from clinical settings can improve efficiency.
Reducing Infant Mortality Rates Using the Perinatal Periods of Risk Model
Authors: Burns Paulette G.
Published: January 2005

Abstract  Despite decreases in the last 50 years, infant mortality rates in the United States remain higher than in other industrialized countries. Using overall infant mortality rates to determine the effectiveness of interventions does not help communities focus on particular underlying factors contributing to static, and sometimes increasing, community rates. This study was designed to determine and rank contributing factors to fetal‐infant mortality in a specific community using the Perinatal Periods of Risk (PPOR) model. The PPOR model was used to map fetal‐infant mortality for 1995 to 1998 in the Tulsa, Oklahoma, Healthy Start Program as compared to traditional calculation methods. The overall fetal‐infant mortality rate using the PPOR model was 12.7 compared to 7.11 calculated using the traditional method. The maternal health cell rate was 5.4, maternal care cell rate was 2.9, newborn care cell was 1.9 compared to a 4.1 neonatal death rate calculated using the traditional method, and the infant health cell was 2.4 compared to a 2.9 postneonatal rate calculated using the traditional method. Because the highest infant mortality was in the maternal health cell, intervention strategies were designed to promote the health of women prior to and between pregnancies. The PPOR model was helpful in targeting interventions to reduce fetal‐infant mortality based on the prioritization of contributing factors.
Deaf Community Analysis for Health Education Priorities
Authors: Jones Elaine G. , Renger Ralph , Firestone Rob
Published: January 2005

Abstract Deaf persons' access to health‐related information is limited by barriers to spoken or written language: they cannot overhear information; they have limited access to television, radio, and other channels for public information; and the average reading level of Deaf adults is at a 3rdto 4thgrade level. However, literature searches revealed no published reports of community analysis focusing specifically on health education priorities for Deaf communities. A seven‐step community analysis was conducted to learn the health education priorities in Arizona Deaf communities and to inform development of culturally relevant health education interventions in Deaf communities. The word “Deaf rdquo; is capitalized to reflect the cultural perspective of the Deaf community. A 14‐member Deaf Health Committee collected data using multimethods that included review of state census data, review of national health priorities, key informant interviews, discussions with key community groups, a mail survey (n = 20), and semistructured interviews conducted in sign language with 111 Deaf adults. The community diagnosis with highest priority for health education was vulnerability to cardiovascular disease (CVD). Following completion of the community analysis, a heart‐health education intervention (The Deaf Heart Health Intervention) was developed using a train‐the‐trainer, community health worker model. If this model proves to be effective in addressing vulnerability to CVD, then a similar protocol could be employed to address other health concerns identified in the Deaf community analysis.
Incidence and Risk Factors for Developing Fear of Falling in Older Adults
Authors: Lach Helen W.
Published: January 2005

Abstract  Fear of falling is a potential cause of excess disability and an emerging public health problem. This study explores fear of falling in a longitudinal study of falls to determine incidence, prevalence, and risk factors for developing fear of falling. Prospective cohort study with annual follow‐up for 2 years, conducted in a large urban metropolitan area, included 890 community‐dwelling older adults—approximately equal numbers in four age groups over the age of 65. Demographic data, falls, injuries, balance, fear of falling, cognition, health, and functional status were collected through annual interviews. The prevalence of fear of falling increased over 2 years from 23 to 43%; the incidence averaged 22.5% in the 2 follow‐up years. Having two or more falls, feeling unsteady, and reporting fair or poor health status were independent risk factors for developing fear of falling. The incidence and prevalence of fear of falling is significant among community‐dwelling older adults and has the potential to impact function and quality of life. Public health nurses should consider fear of falling in practice, in developing screening and health programs for older adults, and as an important avenue for further research.
“The Expectation Gap”: A Look at the Sybil Palmer Bellos Lecture by Ruth B. Freeman, 1970
Authors: Abrams Sarah E.
Published: January 2005

Abstract  Ruth B. Freeman was an outstanding public health nurse leader of her time. Born in 1906, Freeman earned a doctorate and became an educator at Johns Hopkins University School of Hygiene and Public Health and a prolific author in the field of public health nursing. She spoke elegantly and forthrightly about the issues of public health, placing nursing on a par with other professions working toward the improvement of health on a global level. A year before her retirement, she was invited to give the Sybil Palmer Bellos lecture, an annual event that continues today at the Yale University School of Nursing. Selected excerpts from this lecture are reprinted in this analysis of Freeman's address. The entirety of the address was printed in Public Health Nursing, Volume 1, Issue 1, in 1984.
Corrections to Morris and Mound (2004) ‘Molecular relationships between populations of South African citrus thrips (Scirtothrips aurantii Faure) in South Africa and Queensland, Australia’
Authors: Palmer W A
Published: January 2005

Abstract  Contrary to the statements by Morris and Mound (2004), Scirtothrips aurantii were first found outside the quarantine facility on mother‐of‐million plants (Bryophyllum spp.) sourced from the western suburbs of Brisbane and in January 2003 the distribution of the thrips in south‐eastern Queensland was from at least 20 km south‐east and 70 km west of the detection site. Some records in South Africa of thrips from mother‐of‐million plants may not refer to this species.
Preclinical studies on NSC290205 aza‐steroid alkylator activity in combination with adriamycin against lymphoid leukaemia
Authors: Trafalis Dimitrios T. P. , Tsavdaridis Dimitrios , Camoutsis Charalambos , Karayiani Venetia , Mourelatos Dionysios , Chrysogelou Eleni , Dalezis Panayotis , Athanassiou Athanasios , Pangalis Gerassimos A. , Papageorgiou Athanasios
Published: January 2005

NSC290205 (A) is an hybrid synthetic antineoplastic ester that is a combination of a d‐lactam derivative of androsterone and an alkylating derivative of N,N‐bis(2‐chloroethyl)aniline. We tested NSC290205 for synergistic antileukaemic activity with adriamycin (ADR), (i) in vitro against the human lymphoid leukaemia cell lines: CCRF‐CEM, MOLT‐4, and RPMI‐8226, (ii) in vivo against P388 lymphocytic and L1210 lymphoid murine leukaemias (at incipient and advanced phase). Our results indicated significant cytostatic and cytotoxic synergy of NSC290205 and ADR in vitro. We further examined these results in vivo by replacing cyclophosphamide in the standard CHOP (cyclophosphamide, hydroxydaunomycin, Oncovin, prednisone) regimen with NSC290205 (AHOP) and comparing the efficiency of these two regimens in vivo. Although treatment of P388 and L1210 with cyclophosphamide or NSC290205 alone yielded equivalent results, AHOP produced a clear benefit for survival compared with CHOP against advanced leukaemias, confirming the in vitro observations [higher percentage increase in median lifespan of treated animals over the untreated (control): 188% and 239% in L1210, 308% and 353% in P388, P < 0·01, for CHOP and AHOP respectively]. AHOP also proved to be more genotoxic and cytostatic than CHOP, inducing higher sister chromatid exchange levels and cell division delays on P388 cells in vivo. NSC290205 showed superior antineoplastic potential against lymphoid leukaemia and significant synergy with ADR, producing an excellent therapeutic outcome.
MDR1 and MRP1 gene expression are independent predictors for treatment outcome in adult acute myeloid leukaemia
Authors: Schaich Markus , Soucek Silke , Thiede Christian , Ehninger Gerhard , Illmer Thomas ,   the SHG AML96 study group
Published: January 2005

Multi drug resistance (MDR) is a major obstacle for cancer therapy. The three major candidates accounting for the development of MDR in acute myeloid leukaemia (AML) are multi drug resistance gene (MDR1), multi drug resistance‐related protein gene (MRP1) and lung resistance protein gene (LRP). So far, the differential impact of resistance gene expression on treatment outcome in AML is not clear. Therefore, we examined MDR1, MRP1 and LRP gene expression at diagnosis in 331 adult AML patients in the context of other known prognostic factors, such as age, disease status, cytogenetics and FMS‐like tyrosine kinase 3 (FLT3)‐internal tandem duplication mutational status. Median observation time was longer than 5 years [64·1 months (40·0–87·6)]. MDR1 expression proved to be an independent prognostic factor for outcome of induction therapy (P < 0·001) and overall survival (P = 0·02), whereas MRP1 expression was an independent predictor for disease‐free survival (P = 0·01) in the multivariate analysis. This prognostic impact of both resistance genes was also found in patients with intermediate risk cytogenetics. LRP expression, however, had no impact on treatment outcome in AML. Our study shows that resistance gene expression should be considered together with age, cytogenetics and FLT3 mutational status for risk‐adapted treatment strategies in AML in the future.
Development of a human acute myeloid leukaemia screening panel and consequent identification of novel gene mutation in FLT3 and CCND3
Authors: Smith Matthew L. , Arch Rachael , Smith Lan‐Lan , Bainton Nigel , Neat Michael , Taylor Claire , Bonnet Dominique , Cavenagh Jamie D. , Andrew Lister T. , Fitzgibbon Jude
Published: January 2005

A study was undertaken to develop an acute myeloid leukaemia (AML) screening panel to uncover novel recurring gene mutations. Analysis was performed on six genes known to be mutated in AML (RUNX1, FLT3, KIT, CEBPA, PTPN11 and NRAS) and an additional two candidate genes (CCND3 and FES) in a panel of 175 primary human AML samples that included all French–American–British types except M3, and all cytogenetic risk groups. One hundred and fifteen mutations were identified in 97 (55%) patients comprising 81 patients (46%) with one mutation, 14 patients (8%) with two mutations and two patients (1%) with three mutations. Fifty‐five of 88 (63%) patients with normal karyotype AML had at least one mutation. Correlation was observed between KIT mutation and ‘favourable risk’ cytogenetics (P < 0·001), CEBPA mutation and ‘intermediate risk’ cytogenetics (P = 0·045), and PTPN11 mutation and ‘poor risk’ disease (P < 0·001). The frequency of individual gene mutation was in accordance with previously published studies. Three novel mutations of FLT3 were detected (Y589D, D839G, Y842H) that would have been overlooked by conventional gel electrophoresis. A 51‐bp deletion was detected in CCND3 in a patient with normal karyotype AML. This validated panel now provides an important tool to evaluate other candidate genes in the genesis of myeloid malignancy.
Anti‐tumour response despite loss of donor chimaerism in patients treated with non‐myeloablative conditioning and allogeneic stem cell transplantation
Authors: Dey Bimalangshu R. , McAfee Steven , Colby Christine , Cieply Kathy , Caron Martin , Saidman Susan , Preffer Frederic , Shaffer Juanita , Tarbell Nancy , Sackstein Robert , Sachs David , Sykes Megan , Spitzer Thomas R.
Published: January 2005

Based on a murine model, we conducted a series of trials of m‐myeloablative human leucocyte antigen (HLA)‐matched or mismatched related donor stem cell transplantation (SCT) with the intention of inducing mixed chimaerism (MC), then administering prophylactic donor lymphocyte infusions (DLIs), for the treatment of advanced haematologic malignancies. Preparative therapy consisted of cyclophosphamide, equine anti‐thymocyte globulin (ATG) or MEDI‐507 (an anti‐CD2 monoclonal antibody) for in‐vivo T‐cell depletion, thymic irradiation on day −1 and cyclosporine alone for graft‐versus‐host disease (GVHD) prophylaxis. DLIs were given as early as 5 weeks post‐SCT in patients with MC without evidence of GVHD. Twenty‐two patients ultimately lost their graft (<1% donor cells) that could no be rescued by DLIs. Nine of 22 (41%) patients who lost donor chimaerism achieved an objective response, including three patients who showed evidence of disease regression following DLI, despite continued absence of macrochimaerism. Six patients were alive at 2·5–5·5 years following SCT, including four in continuous complete remission. In summary, it is possible to achieve sustained remission in patients with chemorefractory malignancies following non‐myeloablative allogeneic SCT, even in the absence of sustained donor macrochimaerism; DLI may contribute to an ongoing anti‐tumour effect in these patients. Immunological mechanisms that correlated with rejection of the graft may have a role in anti‐tumour responses via a cell or cytokine‐mediated pathway.
Prognostic impact of low‐shear whole blood viscosity in hypertensive men
Authors: Ciuffetti G. , Schillaci G. , Lombardini R. , Pirro M. , Vaudo G. , Mannarino E.
Published: January 2005

Background The role of blood viscosity as a marker for discriminating cardiovascular risk in essential hypertension remains uncertain. The aim of this study was to assess whether whole blood viscosity (WBV) could be useful in assessing cardiovascular risk in men with a first diagnosis of hypertension.

Design A total of 331 middle‐aged men with newly diagnosed essential hypertension (age at entry 40–64 years, average blood pressure 151/95 mmHg) underwent low‐shear‐rate (0·94 s−1) and high‐shear‐rate (94·5 s−1) WBV determination and were then followed for a mean of 4·8 ± 3 years (range 0–12 years).

Results Cardiovascular event rates in the bottom, middle and top tertiles of the distribution of low‐shear WBV were 1·10, 2·13 and 4·43 per 100 patient‐years, respectively (log‐rank test,P < 0·001). After taking into account several established cardiovascular risk factors in a Cox survival analysis, a raised low‐shear WBV conferred an increased risk for cardiovascular events (top vs. bottom tertile hazard ratio = 3·42, 95% confidence interval = 1·4–8·4,P = 0·006; middle vs. bottom tertile hazard ratio = 2·25, 95% confidence interval = 0·9–5·6,P = 0·09). The independent association between high‐shear‐rate WBV and cardiovascular events bordered statistical significance (P = 0·07). Inclusion in the survival model of low‐shear‐rate resulted in a significantly greater χ2improvement (P < 0·05) than inclusion of high‐shear‐rate WBV.

Conclusions In hypertensive men, an increased WBV at low shear rate is a predictor of cardiovascular events independently from the effect of several traditional risk factors. Low‐shear WBV is a better discriminator of cardiovascular risk than high‐shear WBV.
High levels of C‐reactive protein with low total cholesterol concentrations additively predict all‐cause mortality in patients with coronary artery disease
Authors: Jánoskuti L. , Förhécz Z. , Hosszúfalusi N. , Kleiber M. , Walentin S. , Bálint O. , Duba J. , Rugonfalvi‐Kiss S. , Romics L. , Karádi I. , Füst G. , Prohászka Z.
Published: January 2005

Background This study aimed to investigate independent and additive predictive effects of raised C‐reactive protein (CRP) levels and decreased total cholesterol levels on mortality in patients with chronic coronary artery disease (CAD). Low total cholesterol (TC) levels are associated with worsened survival in chronic and acute diseases. Elevated CRP level is an important predictor of vascular events and mortality in patients with CAD. Potential inhibition of immune activation by circulating lipoproteins could be a link between cholesterol and inflammatory markers.

Materials and methods A group of 387 patients (median age 59 years) with CAD and with or without severe heart failure (HF) were followed for a median of 5·06 years. Serum total cholesterol and CRP concentrations were measured at enrollment.

Results The relationship between lipoproteins, CRP and survival was explored. High CRP concentrations were in significant association with severity of HF and predicted worsened survival in patients with CAD (hazard ratio 5·214, 95% CI 1·762–15·427). The association between CRP levels and mortality was independent of potential confounding factors such as age, body‐mass index, severity of HF, smoking habits, hypertension and TC levels. The prediction of mortality by low TC levels was significant (hazard ratio 2·932, 95% CI 1·021–8·422). Furthermore, patients with increased CRP and decreased TC (additive predictive effect) phenotype had 11·714‐times higher risk (95% CI 2·619–52·385) of being nonsurvivors than patients with low CRP/high TC.

Conclusions High CRP levels and low TC concentrations are independent and additive predictors of mortality in patients with CAD. Our data indicate that joint analysis of circulating lipoproteins and inflammatory biomarkers may improve prediction of survival in patients with CAD.
Improved early risk stratification and diagnosis of myocardial infarction, using a novel troponin I assay concept
Authors: Ilva T. , Eriksson S. , Lund J. , Porela P. , Mustonen H. , Pettersson K. , Pulkki K. , Voipio‐Pulkki L.‐M.
Published: January 2005

Background  We evaluated the clinical performance of a novel cardiac troponin I (cTnI) assay specifically designed to improve the very early risk stratification in acute coronary syndromes.

Subjects and methods  Serum and plasma samples (taken 0, 6–12 h and 24 h after admission) from 531 patients with suspected acute coronary syndrome were studied using a novel investigational cTnI assay, reference cTnI assay and myoglobin. The lowest cTnI concentration giving a total assay imprecision of 10% was used as the positive myocardial infarction (MI) cut‐off value.

Results  At the time of admission, the investigational assay was positive in 27·9% of the patients, the reference cTnI assay was positive in only 17·5% (P < 0·001) and myoglobin in 24·1% (P = 0·067). Receiver operating characteristic (ROC) curve analysis for the detection of myocardial injury on admission gave area‐under‐curve (AUC) values of 0·937, 0·775 and 0·762, respectively (P < 0·001). Of those MI patients who presented within 3 h of symptom onset, 50·0% were identified by the investigational assay at the time of presentation, compared with 44·2% by myoglobin (P = 0·791) but only 11·5% by the reference assay (P < 0·001).

Conclusions  The novel cTnI assay considerably improves the performance of cTnI as an early rule‐in biomarker for MI.
Influence of irrigant needle depth in removing bioluminescent bacteria inoculated into instrumented root canals using real‐time imaging in vitro
Authors: Sedgley C. M. , Nagel A. C. , Hall D. , Applegate B.
Published: January 2005

Aim  To test the hypothesis that the mechanical efficacy of irrigation in reducing bacteria in the root canal is dependent on depth of placement of the irrigation needle.

Methodology  The root canals of 30 permanent cuspids were instrumented to apical size 60 using a crown‐down technique. A suspension of the bioluminescent reporter strain Pseudomonas fluorescens 5RL was inoculated into each canal of sterilized teeth. Emission of bioluminescence (photons s−1) from each tooth was quantified on four sequential occasions using luminometry and bioluminescence imaging: (i) background, (ii) after inoculation, (iii) after irrigating the inoculated teeth with 3 mL of a nonantimicrobial irrigant delivered either 1 mm (group 1, n = 15) or 5 mm (group 2, n = 15) from working length (WL) using a 28G safety‐ended irrigating needle, (iv) after an additional 3 mL irrigation (total 6 mL). Intragroup and intergroup comparisons were made using Wilcoxon matched pairs and Mann–Whitney tests, respectively.

Results  In group 1, there was a mean log10 decrease in bacteria of 0.68 ± 0.26 after 3 mL of irrigant compared with 1.19 ± 0.48 after 6 mL (P < 0.001); in group 2 the mean log10 decrease was 0.58 ± 0.28 after 3 mL of irrigant compared with 0.69 ± 0.35 after 6 mL (P < 0.02) (Wilcoxon matched pairs). Using 3 mL of irrigant, needle depth did not have a significant effect on reduction of intracanal bacteria (P = 0.407), but the effect became significant when 6 mL of irrigant was used (P < 0.002) (Mann–Whitney tests).

Conclusions  The mechanical efficacy of 6 mL of irrigant in reducing intracanal bacteria was significantly greater when delivered 1 mm compared with 5 mm from WL.
Effect of ProRoot® MTA mixed with chlorhexidine on apoptosis and cell cycle of fibroblasts and macrophages in vitro*
Authors: Hernandez E. P. , Botero T. M. , Mantellini M. G. , McDonald N. J. , Nör J. E.
Published: January 2005

Aim  To compare the percentage of apoptotic cells and the cell cycle profile of fibroblasts and macrophages exposed to either ProRoot® mineral trioxide aggregate (MTA) mixed with chlorhexidine (CHX), or exposed to ProRoot® MTA mixed with sterile water.

Methodology  Mouse gingival fibroblasts or mouse macrophages were seeded in six‐well plates and allowed to attach overnight. Freshly mixed or set (allowed to dry for 24 h) specimens of tooth‐coloured (white) ProRoot® MTA were prepared with 0.12% CHX gluconate (MTA/CHX) or with sterile water (MTA/H2O). The cells were exposed for 24 h to the MTA specimens, which were placed over permeable membrane inserts to avoid direct contact with the cells. Untreated cells served as controls. Propidium iodide staining followed by flow cytometry was used to evaluate the effects of ProRoot® MTA on cell apoptosis and cell cycle. Statistical analyses were performed by one‐way anova followed by post‐hoc tests with the use of the SigmaStat 2.0 software, and significance was determined at P ≤ 0.05.

Results  MTA specimens containing CHX induced apoptosis of macrophages and fibroblasts (P < 0.05). In contrast, no change in the proportion of apoptotic cells was observed when sterile water was used to prepare the specimens (P > 0.05). Cell cycle analysis showed that exposure to MTA/CHX decreased the percentage of fibroblasts and macrophages in S phase (DNA synthesis) as compared with exposure to MTA/H2O (P < 0.05).

Conclusion  This in vitro study demonstrated that the substitution of CHX for sterile water in MTA increases its cytotoxicity. This suggests that the potentially beneficial antimicrobial effect of CHX may be accompanied by an increase in the cytotoxicity of the resulting MTA‐based material.
Reproductive decisions by couples undergoing artificial insemination with donor sperm for severe male infertility: implications for medical counselling
Authors: VERNAEVE V. , FESTRÉ V. , BAETENS P. , DEVROEY P. , VAN STEIRTEGHEM A. , TOURNAYE H.
Published: January 2005

Since 1992, ICSI has been introduced as a successful treatment for male infertility, including azoospermia. The present study is aimed at evaluating the practice of insemination with donor sperm (AID) in infertile couples who may benefit from the new developments that ICSI has brought in the last decade. AID was performed in 440 heterosexual couples. Twelve couples were lost for follow‐up (3%). In 128 (29.9%) and 229 (53.5%) of the couples the husband was either oligozoospermic (OAT) or azoospermic. In 60 couples (14.0%) the man had a transmissible genetic trait. In 11 couples (2.6%) there were other indications for performing AID. In the OAT group 36 couples never had ICSI treatment (28.1%) because they had already an AID child born before the introduction of ICSI (n = 16), the burden of ICSI treatment was too high (n = 9) or they considered that ICSI success rate was too low (n = 7). Ninety‐two couples tried ICSI treatment before opting for AID (71.9%), mainly because ICSI failed (n = 43). In 229 couples the husband had azoospermia (53.5%). In 112 couples (49%) no sperm or too few testicular sperm were found at testicular biopsy (TESE) and 15 couples (6.5%) had more than three failed ICSI‐TESE attempts. Eighty‐one azoospermic men refused TESE (35.4%) because of an anticipated low success rate (n = 28) or the burden of this approach (n = 23). Although a majority of patients could opt for ICSI, our results show that AID is still an option for many couples for whom these techniques were either not feasible or not successful. A substantial proportion of patients (33%) did not even opt for these advanced fertility treatments.
Monoclonal antibody c262 counteracts the stimulatory effect of progesterone on sperm–oocyte fusion
Authors: PANDOLFI C. , MACEROLA B. , ZUGARO A. , SANTUCCI R. , FRANCAVILLA S. , FRANCAVILLA F.
Published: January 2005

Some evidence suggests that the non‐genomic effects exerted by progesterone (P) on human spermatozoa are mediated by membrane receptor(s) displaying the C‐terminal domain, but not the N‐terminal domain of the genomic P receptor (PR). This study aimed at determining whether the monoclonal antibody (mAb) c‐262, directed against the C‐terminal domain of the genomic PR, counteracts the stimulatory effect of P on the human sperm ability to fuse with oocytes. Sperm/oocyte fusion was evaluated by means of the hamster egg penetration test. The brief exposure of capacitated spermatozoa to P produced a stimulatory effect on sperm/oocyte fusion. mAb c262 counteracted this stimulatory effect in a dose‐dependent manner. No counteraction was observed when capacitated spermatozoa were pre‐exposed to PGR‐312, a mAb directed against the N‐terminal domain of the genomic PR. These results reinforce the hypothesis that the non‐genomic effects exerted by P on human spermatozoa are mediated by membrane receptor(s) displaying the C‐terminal domain, but not the N‐terminal domain of the genomic PR.
Changes in osmolality during liquefaction of human semen
Authors: COOPER TREVOR G. , BARFIELD JENNIFER P. , YEUNG CHING‐H.
Published: January 2005

The osmolality of 18 liquefying human semen samples from 15 volunteers was measured by vapour pressure osmometry to be low (294 mmol/kg, range 269–311). For each sample the osmolality increased during liquefaction to reach a mean of 312 mmol/kg (280–331) by 30 min at 37 °C. These results are at variance with the widely held view that semen osmolality is greater than that of serum, which results from its first being examined after liquefaction in vitro. Thus when sperm are routinely examined after liquefaction they have been subjected to osmotic stresses that are not experienced by spermatozoa entering the female tract at coitus.
Circannual rhythm in the incidence of cryptorchidism in Finland
Authors: KALEVA MARKO , VIRTANEN HELENA E. , HAAVISTO ANNE‐MAARIT , MAIN KATHARINA M. , REUNANEN MIKKO , SKAKKEBÆK NIELS E. , TOPPARI JORMA
Published: January 2005

Conflicting data on circannual variation in birth rates of urogenital malformations have been reported previously. To assess risk factors of cryptorchidism we studied the seasonal variation of cryptorchidism in Finland. We performed a prospective cryptorchidism study in Turku, Finland, from 1997 to 2001 to evaluate the incidence of cryptorchidism. Clinical examinations were performed at birth and at 3 months. Of 9511 liveborn boys (1471 preterm boys) 216 (53 preterm boys) were cryptorchid at birth and 106 (19 preterm boys) at 3 months. The incidence of cryptorchidism was significantly higher in spring (February–April) (3.0%) than in summer (May–July) (1.7%) (OR 1.79; 95% CI: 1.23–2.63). This seasonal difference was observed both among preterm and term boys. We conclude that a circannual fluctuation in the incidence of cryptorchidism exists, which indicates an influence by environmental factors. The underlying reason for cyclicity affects similarly both preterm and term boys.
Children's accounts of their preoperative information needs
Authors: Smith Lucy , Callery Peter
Published: January 2005

Aims and objectives.  To explore the information needs of children aged 7–11 years relating to planned admission for surgery. To identify the knowledge of a group of children prior to admission and their own identified information needs.

Background.  There is widespread agreement that children should be given information prior to surgery but continuing debate about the most appropriate form and content of preadmission preparation. There is little research evidence about children's concerns, fears and misconceptions about hospitals and surgery. Previous investigations have examined the views of parents/carers and health care professionals rather than the direct reports of children themselves. This study was designed to explore whether children could identify their own information needs prior to admission for elective surgery.

Design.  Qualitative.

Method.  Nine children aged 7–11 years were interviewed using the write and draw technique to ascertain their preadmission information needs. Data collection occurred several weeks prior to the child's first admission to hospital for planned surgery.

Results.  Children reported that they had not received direct information from the hospital or from health professionals. They obtained information from a variety of sources including leaflets for parents, television and the experiences of relatives and friends. Some children knew very little about hospitals and their own planned operation. Children identified 61 questions about their forthcoming admissions, including questions about: getting information; procedures; anaesthesia; timing; hospital environment; family support; feelings/pain; their condition; and concerns.

Conclusions.  Children aged 7–11 years can identify their own information needs and so contribute to the development of preadmission education.

Relevance to clinical practice.  Patients attending a children's hospital can have little information provided prior to admission. Information about hospital should be presented directly to children in the most accessible and flexible form.
Children's Emotional Manifestation Scale: development and testing
Authors: Li Ho Cheung William , Lopez Violeta
Published: January 2005

Aims and objectives.  The objectives of this study were to develop an objective and operationalized behavioural observation scale that can be used to document children's emotional responses during stressful medical procedures, and to test the psychometric properties of this newly developed scale.

Background.  The availability of a valid and reliable instrument that accurately documents the manifestation of children's emotions prior to undergoing surgery or during stressful medical procedures is crucial before any intervention can be appropriately planned and evaluated. There is a lack of such an instrument with effective psychometric properties in the literature.

Design.  A cross‐sectional study was employed. A convenience sample of 82 children admitted for day surgery was recruited in this study.

Method.  Based on systematic literature search, a number of observable emotional behaviours with different levels or intensities were identified. A panel of nurse experts was set up to review this finding and develop the scale. Intra‐class correlation was used to estimate the inter‐rater reliability coefficient. Internal consistency reliability was assessed by determining the Cronbach's alpha. Content validity was established by six nurse experts’ ratings. The validity of the scale was also confirmed by convergent validity.

Results.  The results showed that there was adequate inter‐rater reliability, high internal consistency reliability, good content validity and excellent convergent validity.

Conclusions.  This study has addressed a gap in the literature by developing an objective tool to document children's emotional responses during stressful medical procedure, which are under‐researched in the literature.

Relevance to clinical practice.  The Children's Emotional Manifestation Scale was developed to provide a simple, objective and consistent method for nurses to document children's emotional behaviour during stressful medical procedures. Clinical nurses can also use this scale to evaluate preoperative interventions directed towards minimizing anxiety and bolstering coping mechanisms in children undergoing surgery.
Dementia: involving patients in storytelling – a caring intervention. A pilot study
Authors: Holm Ann‐Kristin , Lepp Margret , Ringsberg Karin C
Published: January 2005

Aims and objectives.  The aim of this study was to explore the potential therapeutic role of storytelling in patients with dementia and, if so, to formulate pedagogic implications for the field of nursing with the focus on dementia care.

Background.  The present study is part of a larger project, Drama‐Ger (Lepp et al. 2003: Journal of Clinical Nursing 12, 873–881), consisting of a cultural drama programme designed for patients with dementia and their caregivers. The programme consisted of two groups (A and B). Group A focused on dance, rhythm and songs, group B focused on storytelling and conversations. The present pilot study deals with group B.

Design.  The study was an intervention study.

Methods.  Six strategically selected patients, five women and one man, with intermediate and severe dementia, and their three female paid caregivers participated in the programme. They met on six occasions for 1.5 hours once a week for two months. The leader of the group, a Registered Nurse, who was also trained as a symbol pedagogue/teacher, told stories that were related to Erikson's development theory. She continuously kept a reflective diary which was qualitatively analysed.

Results.  This pilot study clearly indicates that storytelling invited the patients to take part in associative conversations. The storytelling appeared to help them to remember and make associations with situations they had previously experienced in their lives. Erikson's stages of development could be traced in the conversations. The patients interacted with each other, their caregivers and the leader.

Conclusions.  A drama programme using storytelling appears to stimulate patients with dementia to communicate and interact with other people. Ten implications four statements about storytelling as a pedagogic tool and six statements to facilitate a pedagogic approach have been drawn from this study.

Relevance to clinical practice.  The implications can be used as a guide when using storytelling for caring intervention with the focus on dementia care.
Sex and Region‐Specific Regulation of Oestrogen Receptor β in the Rat Hypothalamus
Authors: Orikasa C. , Sakuma Y.
Published: January 2005

Sexual dimorphism in the expression of oestrogen receptor (ER)β mRNA and protein was characterized in the rostral forebrain of the rat and its dependence on the neonatal endocrine environment was revealed. We present novel data demonstrating, in gonadectomized adult rats, that the amount of oestrogen caused a significant reduction in the number of ERβ messages and protein in the ventromedial nucleus in both sexes, but no such effects were detected in the preoptic area or the amygdala. In gonadectomized females, more so than in males, the ventromedial nucleus of the adult rat contained a significantly larger number of ERβ‐positive neurones both in terms of ERβ mRNA and protein. In the juvenile rat on day 14, sex difference in ERβ expression was already observed in the ventromedial nucleus. Treatment of neonatal females with oestrogen from days 1–10 or neonatal orchidectomy of males reversed the sex difference in the ventromedial nucleus when observed on day 14, showing that the neonatal presence of oestrogen had caused irreversible masculinization of this structure. Our results suggest that sex‐specific expression of ERβ is patterned by perinatal hormone exposure: down‐regulation of ERβ caused by oestrogen in a region‐specific manner.
Fos Expression is Selectively and Differentially Regulated By Endogenous Glucocorticoids in the Paraventricular Nucleus of the Hypothalamus and the Dentate Gyrus
Authors: Fevurly R. D. , Spencer R. L.
Published: January 2005

We examined the extent to which basal levels of corticosterone, which vary in a circadian fashion, influence the pattern of Fos protein expression in the paraventricular nucleus of the hypothalamus (PVN), the hippocampal formation and three different functional cortical areas. Basal and poststress (1 h of restraint) Fos expression, as determined by immunohistochemistry, was examined in male rats with either no previous surgical manipulation or in rats 5 days after: (i) sham adrenalectomy; (ii) adrenalectomy with no corticosterone replacement; or (iii) adrenalectomy with corticosterone (25 µg/ml) in the drinking water replacement. In adrenal‐intact rats, restraint produced similar patterns of Fos expression in the PVN, cortical areas and hippocampus (CA1–CA3), with peak levels of expression attained 60–90 min after restraint onset. Surprisingly, in the dentate gyrus, there was a dissociation between the two blades in the pattern of Fos expression after restraint. In the inner blade (suprapyramidal), there was a delayed induction that occurred between 60 and 90 min after restraint onset and, in the outer blade (infrapyramidal), there was a steady decline in Fos expression after restraint. Adrenalectomy had an effect on Fos expression only in the PVN and dentate gyrus, and the nature of the effect was quite different for both brain regions. In the PVN, adrenalectomy had no effect on Fos expression in unstressed rats, but resulted in an enhanced number of Fos positive cells after restraint. In the dentate gyrus, adrenalectomy resulted in an overall reduction of Fos positive cells in both blades, and this reduction was present in unstressed and stressed rats. Corticosterone replacement normalized the adrenalectomy effect on Fos expression in both brain regions. Thus, Fos expression in the rat brain displays specific patterns of dependency on the permissive effects of glucorticoids, and this dependency varies between brain regions.